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Ultra Dense Packing

By Dr Raghu Reddy

Ultra dense packing has been a controversial subject among the medical fraternity for various reasons. On the positive side, ultra dense packing can help achieve natural density in one session, limiting morbidity and saving a lot of money and time for the client.

On the negative side, there are concerns with donor depletion, limiting availability for future sessions and also the practical aspects of the procedure can be very challenging. Besides this, there is the misconception about poor uptake with ultra dense packing.

There are some issues that are addressed with the development of the 3G FUE Restoration technique. We have known for years that more hair per graft (chunky grafts) yields better density than placing a lot of fine grafts. Let’s compare this concept to a garden: If you have a similar sized garden, you can either try to populate it with a lot of twigs, risking poor uptake or use a few twigs and plenty of trees to achieve respectable coverage.

A close inspection of the donor area reveals that there are a mixture of grafts of different sizes, namely two’s, three’s and four and five hair grafts. This mix makes the donor area look very dense and also very natural. Now if we apply a similar concept to the recipient area, there is no reason why this cannot be achieved.

However, there are a few technical issues associated with the recipient area that makes ultra dense packing a bit challenging. Firstly bald skin is exposed to sunlight and there are always issues with chronic sun exposure that makes the skin a bit harder than hair bearing skin. Secondly, bleeding is more of an issue with the recipient area causing the flushing away of grafts.

Overcoming practical issues in dense packing

To counter the difficulties, what we tend to do is to phase the procedure over a couple of sweeps. A closer inspection of the recipient area reveals the pores and hair bearing skin. There is convincing evidence to support the fact that the stem cells go dormant rather than die. From experience, we have realised there is a zone of least resistant both around the graft and hair bearing skin. We capitalize on this concept by using instrumentation that precisely fit the size of the grafts, both during extraction and placement. This makes us achieve grafts with no transaction and also graft of different sizes. We can utilise a similar concept while placing, by making incision in the area of least resistant. Incisions are made to fit the size of the graft that also adds specific angles. Ultra dense packing can be achieved in one single session.

Addressing the practical issues

We use two methods of placement:

  1. being the Choi implanters
  2. forceps for the chunkier grafts

Another trick we employ is doing the placement over three sweeps. During the first sweep we tend to place the chunky grafts at random intervals and let the skin heal while we extract more. This ensures that the grafts don’t stay out the body longer. This in turn allows the grafts to bed into the fine incisions. Now the same process is repeated during the second sweep. For the third sweep we use a Choi implanter to place mostly two-hair grafts. This in turn prevents dessication and also you achieve an advantage mechanically that there is no popping of graft and minimal bleeding. Lastly, the use of Acell prevents neogenisis (new blood vessel formation). This in turn makes sure there are better uptake of grafts.

Using this technique, ultra dense packing can be achieved in one session without causing a lot of (eyelid) swelling. However, caution should be exercised in patient selection in order to prevent donor depletion in patient with unstable hair loss.

Norwood 4 hairless pattern – 2619 grafts in a single session
Frontal view of ultra dense packing

What our customers say

"A very big thank you. I am finding it hard to believe the hairline I have this morning! You and your team did a fabulous job, and a man of my age really shouldn’t be so excited.... It was also illuminating to see how well your teamed worked together, they certainly appear to be a happy, cohesive and very professional, they all treated one another with such respect. Equally importantly, they made me feel that my needs were paramount. Well done on creating that spirit. I very much look forward to seeing you again soon. By the way, it was an unexpected pleasure to see and speak with Kriste again. Please give her my best wishes. Thank you again"

Graham in UK

Just thought I would give a breif summary of my recent FUE with Dr Raghu Reddy and his excellent team at the Private Clinic, London. Over the course of two days I had ~2000 grafts implanted by Dr Reddy's 3G FUE technique. I chose Dr Reddy based on his comparative amazing yields and results with relatively few grafts compared to the commonly discussed other 'top FUE surgeons". First off his team are all pro's and have been working together for years to refine this minimally invasive FUE technique. They were personably, relaxed, funny, and above all caring, profession, and meticulous. I always read that people get experience pain, discomfort, and swelling during and post op. I have to say that with Dr Reddy's technique I have experienced zero pain or swelling both during and post op. The operation finished yesterday and I feel absolutely normal. Not a spot of swelling or even a head ache. It's obvious after doing research on the FUE procedures conducted by the regarded 'best FUE doctors', that Dr Reddy's 3G FUE stands out as being both innovative and geared towards optimal results. He uses specialized techniques to create an extremely non invasive yet high yielding technique, which I am sure he would be more than willing to discuss with anyone interested. In regards to my case, I apparently had really strong, healthy, and "big" grafts (so lots with 3 and 4 hairs). We chose a hairline hat reflects my age (31) and the fact that I have never had sharp temple points. Plus I was strongly advised against having points worked on as many cases are seen where transplanting to this region looks very odd in years to come where further recession occurs. Plus I have a big head so had lots of baldy to cover I am very happy with my results thus far and I am predicted to have a great result due to graft condition and density. One thing worth mentioning is that is became obvious that Dr Reddy's skills are not only recognized by international patients (there was talk of people coming in from all over the world during my visit), but also he is held in high esteem by the other 'best' FUE surgeons discussed on this site, and from what I gathered some of these surgeons .

Hairloss Patient in UK
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