Hair Transplant Surgery and The "Illusion of Density"

hair transplant density illusion

The great Houdini once said "what the eyes see and the ears hear, the mind believes" this holds true for surgical hair restoration. Today, hair restoration surgery is advertised everywhere on TV, radio, podcasts and social media. The images that are shown to prospective patients are enticing, men and women that were completely bald with seemingly full heads of hair. 

However, some of these clinics use shameful marketing and advertising practices to lure in potential patients. In this article, we will be discussing what can be realistically achieved through surgery and the "illusion of density", as it pertains to hair transplantation.

Hair Transplant Surgery Limitations

Unfortunately, surgical hair restoration has physical limitations that every potential patient should be aware of prior to undergoing surgery. The first issue that is rarely discussed is the progression of genetic hair loss. Hair transplant surgery does not prevent, slow or stop hair loss. 

In fact, it does not create new hair, it simply relocates existing hair to a new location. Many individuals believe that surgical hair restoration will be the answer to all of their follicular woes and worries. Sadly, this is not true. Patients must understand that hereditary hair loss is a progressive condition that spreads and worsens over time if left untreated.

In addition, surgical hair restoration is dependent on various factors to be successful. First, the hair transplant must be carried out by a skilled, talented and experienced hair transplant surgeon. Secondly, the surgeon's team must be expertly trained and be equally experienced in order to execute the procedure with precision and efficiency. Thirdly, the results are dependent on the patient's donor supply, hair characteristics, head shape, size and hair loss pattern.

But Density is Not Quantifiable, Why is it an "illusion"?

Well, density is quantifiable. In fact, most individuals are born with approximately 100,000 hairs on their head. This translates to roughly 50,000 follicular units give or take. An individual with a Norwood 6 pattern of baldness will lose about half of their hair which would mean the balding area would require 25,000 grafts to restore. Luckily, we can restore the "appearance" of a full head of hair with about 6,000 grafts, which is about a 1/4th of the lost hair. 

The reason why this can be done is because of the "illusion of density". The human eye cannot easily detect a change in density until more than 50% of the hair has been lost. Most individuals have around 80-120 follicular units per square centimeter (cm2) prior to experiencing hair loss. Therefore, the appearance of a full head of hair can be done with 45-60 follicular units per cm2.

You may be scratching your head thinking "I hate math, what the heck does this mean"? This basically means that a hair transplant can restore a head of hair that appears to be full. However, the appearance of fullness depends on several factors. The first factor is the length of the hair, if an individual wears their hair very short, the difference in density will be visible to the human eye. When the hair is too short the layering effect is significantly diminished. 

The second factor is the individual's hair characteristics; meaning the hair shaft diameter, texture, and curl. Individuals with thick, curly coarse hair will appear to have more hair than someone with straight and fine hair. Does one individual have more hair than the other? No, in fact, the person with fine straight hair could actually have more hair follicles on their head, but the person with thicker hair will appear to have more hair.


Today, hair transplant surgery is natural and virtually undetectable, but that doesn't mean that it is a hair loss cure or a perfect procedure. Anyone considering surgery should have realistic expectations. Sadly, the hair we once sported as children can never be regained whether it's through medicine, surgery or a combination of both. 

Until there is a cure, we must rely on hair loss prevention medications such as Rogaine (minoxidil) and Propecia (finasteride) and hair transplantation. Even the best hair transplant results have their weaknesses in certain situations that prospective patients must be cognizant of prior to undergoing surgery. 

Like the saying goes "if it's too good to be true, then it probably is" some hair transplant clinics/surgeons will promise the moon and the stars to get a patient in their chair. Ethical high-quality hair restoration physicians are few and far in between.