Hair Transplant Surgery - Step by Step - Donor
Area
What
is the Donor Area?
It is the area that will donate the hairs
to be transplanted to the bald recipient area
(RA). As the hairs do not have the genetic
code for balding, the hair from the Donor
Area (DA) will never fall out.
The donor area is a limited resource, in other
words, with each surgery, this area becomes
smaller.
| Important:
The donor area gets smaller as the years
go by and the balding areas get bigger. |
    
| Therefore, we should be extremely cautious
when scheduling surgery, because in a
young patient in early stages of hair
loss, the circumstances in that moment
do not reflect reality. Hair loss will
continue and as it does the donor area
will get smaller and the bald area larger.
The patient runs the risk of removing
an area of hair that will fall out in
the future when baldness progresses. As
this is the case, the transplanted hair
will also fall out, and worse still, the
scarred area will appear in the crown
region. |
Analysis
of the Donor Area
As every result is based on quality of the
donor area, we must perform this analysis
with precision taking into consideration the
following criteria:
1 – Hair
Volume
This is related to hair type. The finer, straighter
and lighter the hair is, the less volume we
will obtain in the results.
2 – Hair
Density
This is the most important factor to be analyzed
in the donor area. The density varies from
patient to patient depending on:
a) Percent of Follicular
Units – As we have seen, hair
does not grow from the scalp one by one, but
rather in groups of 1, 2, and 3 hairs, called
follicular units.
The patient that has a higher percentage of
3-hair follicular units will have a better
result in terms of fullness, and the patient
who has a greater percentage of 1- and 2-hair
follicular units (and therefore a smaller
percentage of 3-hair FUs) will have a “less
full” result.
To illustrate: imagine a forest in which 80%
of the trees have 3 branches and the other
20% are trees that have 1 or 2 branches. In
a second forest the opposite is true, that
is 20% of the trees have 3 branches and 80%
of the trees have 1 or 2 branches. If you
were to fly over both forests, which forest
would you see more green and therefore less
earth below? Obviously in the forest that
has a greater percentage of trees with 3 branches.
The same is true of the hair on your scalp.
 |
Donor
Area with high density |
Donor
Area with low density |
b)
Distance between FUs – The closer
the FUs are to one another, the greater the
density, in other words, the closer the hairs
are to one another, the greater the density.
To give you an idea, the number of follicular
units per square centimeter can vary from
50 to 100, depending on each patient and each
scalp area.
So,
analyze the following situations:
Patient A has 100 FUs per cm2, that is 50
3-hair FUs, 30 2-hair FUs and 20 1-hair FUs.
The total is (50*3) + (30*2) + (20*1) = 150
+ 60 + 20 = 230 hairs.
Patient B has 70 FUs per cm2, (as the distance
between FUs is greater than patient A). Of
these 70 FUs, 20 are 3-hair FUs, 20 2-hair
FUs and 30 1-hair FUs. The total is (20*3)
+ (20*2) + (30*1) = 130 hairs.
Do you see the difference? Patient B has 100
hairs less in an area the same size. This
patient, therefore, will not have the same
result as Patient A in terms of fullness and
coverage.
See the examples below of three different
patients with low, medium and high density
donor areas.
|
|
Low
density |
Medium
density |
High
density |
* Note
the density difference between a patient with
low density and fine hair versus another one
with high density and thick hair.
3
– Elasticity
The greater the skin elasticity in the donor
region, the wider the region to be removed
from the donor area may be, and, consequently,
the greater the number of follicles obtained.
We use a device that gives us the exact maximum
size that may be removed. If an area wider
than the maximum were to be removed, there
could be tension upon closing the incision,
and consequently a widening of the scar, and
noticeably hairless.
Measuring elasticity
|
Medium |
Low |
Marking
the donor area
This is a very important part of planning
surgery. When marking is done correctly, it
permits us to maximize the donor area, as
well as position the resulting scar as best
possible, to permit an additional surgical
session. For the first surgery, the marking
should be done as low as possible, respecting
a minimum distance from the nape of the neck
so that the scar is not obvious or does not
widen.
We have
opted for a much longer (from ear to ear)
and thinner area, rather than shorter and
wider, to remove from the donor area. This
area generally measures 32 to 37 cm in length
and from 1 to 1.5 cm in width (depending on
elasticity).
In this
manner, not only do we maximize the donor
area, but we also reduce the tension on closing
the incision. The result is an imperceptible
scar, in addition to maintaining the elasticity
for possible future sessions.
The hair should never be cut beyond the limits
of the region that will be removed to avoid
inconsistencies in hair length in these areas
after surgery. In some cases we transplant
long hairs. (click here to
learn more)
If future
surgery is necessary to increase volume, we
use the same scar as the lower line for a
new donor area. In other words, independent
of the number of surgeries, there should only
be one scar. For this reason marking the donor
area should be correct the first time around.
| * It is important
to remember that with each surgical session,
the donor area will become smaller, and,
that being the case, it is a limited (finite)
resource. |
Removing
the Donor Area
In this step a specially designed pillow is
used to provide the patient with the most
comfort possible.
Removing
the strip from the scalp (DA) that will donate
the hairs should always be done with a surgical
scalpel or blade and NEVER with punches, machines
or “pens”. Removing the donor
area should be done with great caution so
as not to damage the bulbs.
It should be deep enough to reach the follicular
root but also as superficial as possible to
not cause damage to the structures deeper
within the skin.
* Donor area that has been removed
and after making a transversal cut (sliver)
Donor
area removals with punches, needles, hand
engines, and other tools are absolutely prohibited
because they harm the donor area and cause
significant loss to the number of hair roots
in addition to aesthetic damage.
·
Compare Area 1, which is virgin, with Area
2, which was removed with a punch (hand engine,
biopsy punches, etc.) and
· Observe that Area 1 has much more
density. Area 2 is comparable to a forest
full of clearings.
· See what the appearance looks like
should the patient decide to wear his hair
short (photo on the right)
Closing
the incision in the donor area
After removing the donor area, we close the
edges and approximate the hairs again. This
way we totally camouflage the resulting scar,
making it already imperceptible at the end
of surgery. We prefer to use biodegradable
surgical suture. It is more comfortable for
the patient as stitches will not need to be
removed in the post-operative period.
The appearance after surgery, even with wet
hair, should be normal and will not have a
section that is noticeably hairless.
|
Before
removal |
End
of surgery |
Scar
The scar in the donor area generally is thin
and imperceptible already at the end of surgery,
because we bring the hairs together again,
not allowing for areas with hair missing.
As soon as the suture in the donor area is
finished, the scar is already unnoticeable
as it is camouflaged by the hair.
* After
surgery, close-up of the suture.
In other
words, do not worry about the aesthetic aspect
of the scar, as it will not be noticed.
The transplanted area will be more evident
than the scar in the donor area.
We usually suture with biodegradable surgical
thread, which make unnecessary to have the
stitches removed as they will fall out spontaneously
in 10 to 20 days.
In the first three months, the scar is a bit
red and still experiencing some alterations
in sensitivity (itching, numbness, etc...)
After the fourth month, it begins to lighten,
acquiring normal skin color between 6 months
and 1 year after surgery. During this period
the changes in sensitivity also end. One year
after surgery the scar is not perceived, even
with short hair. Only a thin line can be seen
if you lift the hair up or if hair is cut
very short (1 cm or less).
 |
In
some cases only a fine line can be seen
upon raising the hair or if the hair
has been cut very short (1cm or less). |
Trychophytic
Suture
This involves removing only the skin (leaving
the bulbs) of one of the edges of the suture,
before closing. In this manner the hairs will
grow through the scar, hence camouflaging
it and making it imperceptible even with short
hair.
 |
scar
with regular suture |
scar
with trychophytic suture |
If a
future surgical session to increase volume
is necessary, we will always remove from the
donor area at the same scar line, with the
exception of cases with alterations in elasticity,
which forces us to create a new scar.
| IMPORTANT: Remember
that the donor area is a limited (finite)
source and there is no possibility (as
many may imagine) for regeneration. Therefore
in each surgical session, the donor area
becomes smaller. |
The
Scarring Process
Every scar experiences a process of evolving
and maturing: from just after surgery to about
10 to 15 days later, the scar should be thin,
fair, and nearly unnoticeable. After this
period, the scar becomes increasingly red.
This redness reaches its maximum 3 months
after surgery and then begins to subside.
During this period, some changes in sensitivity
generally occur (itching, slight pain, etc.).
After three months the scar begins to lighten
in color, taking up to two years to lighten
entirely (this time varies depending on the
type of scarring process of each person).
Note: The scarring process varies from patient
to patient. As this is true, in some cases,
even when experienced surgeons utilize the
most modern technology, the scar could widen,
remain red or even form a keloid (very rare
in the scalp). When these cases occur, scars
may be revised six months after surgery, pulling
together the edges and improving the physical
appearance of the scar.
These incidences may be treated or improved,
however the final aspect of the scar is unique
to the individual, varying from patient to
patient. The advantage to Hair Transplant
Surgery is that the scar can always be easily
hidden under the hair, even short hair.
|
