As the Greek philosopher, Plato said, “Beauty is in the eyes of the beholder.” The same can be said of density. What one person considers dense, another person may view as less than adequate or sparse. The same number of follicular unit grafts or hairs placed over the same recipient area can appear totally different. The appearance of density is not only dependent on the number of grafts, but also on the color, quality, and texture of the hair.
The color of the hair is important in contrast to the color of the scalp. The more contrast, the more hair is required to achieve optical density. Dark hair on a Caucasian scalp is going to appear thinner or sparser than lighter color hair such as blonde, gray, or white. The same is true of lighter color hair on an African-American or darker pigmented scalp.
The quality of the hair is also important for determining density. Hair that is curly or wavy appears to achieve more optical density since it camouflages the skin to a greater extent than straight hair. In the 1970s men would perm their thinning hair to reduce the visual contrast between hair and scalp.
The texture of the hair is one of the most important factors influencing the number of grafts required for a specified area of the scalp. Hair shafts can either be very fine, fine, medium, medium-coarse, or coarse. The difference is in the width of the hair; the wider or thicker the hair, the more optical surface density will be visualized.
With the advent of a custom blade cutting device by Hasson & Wong, dense packing has become a reality. Since each individual has a unique texture width, we can customize a recipient site blade to perfectly match the width of the follicular unit graft. In the past, recipient sites were made with pre-cut manufactured blades which were “one size fits all.” With custom-cut blades, we can place the grafts closer together to attain more density per square centimeter. These custom-made blades have allowed hair transplant surgeons to dense pack fine hair without compromising blood supply. We can transplant 50-60 follicular unit grafts per square centimeter in the hairline and approximately 40 follicular units per square centimeter over the frontal, midscalp, and vertex.