Donor Site Safe Zone

Professor Unger studied 328 men aged 65 years or older and determined the safe donor area (safe zone).
When you are 80 years old, 80% of the chance that  your safe zone at occipital area is only 7 to 8 cm wide, at lateral and posterior area only 5 cm wide.
If grafts harvested are not in the “safe zone” then hair at that area are not permanent hair. When the surrounding hair loss or even get thinner, thousand of scars will appear and extremely difficult to cover up. 

FUT surgery-donor site with suturing

Photos taken immediately after donor removal and suturing




Immediately after FUT surgery, no sign of surgery visible from donor site.

Live Patient Session of ISHRS Annual Meeting

There are always live patient sessions in the ISHRS ( International Society of Hair Restoration Surgery) annual meeting . About 20 to 30 live patients will show their hair transplant surgery results to the meeting attendants. Of course, these are the best results from doctors who presented them.

Started from 2006 San Diego meeting, I personally asked every patient if they take Finasteride to find out the relationship between surgery result and Finasteride.

The survery below shows the percentage of live patients on Finasteride:

2006 San Diego meeting- 100%
2007 Las Vegas meeting-100%
2008 Montreal meeting- 100%
2009 Amsterdam meeting- about 70%, In Europe the trend is different, but the surgery result was not as impressive as in the States.
2010 Boston meeting- only two patients didn’t take Finasteride. But both told me that after received hundreds of advices from attendant doctors, they would like to try it.
2011 Anchorage meeting- only 3 to 4 patients presented and the main target moved towards how to cover donor scar.

Conclusion from the survey:
To have the best surgery result, taking Finasteride is necessary.

Intruder

After microscopy dissection was introduced, the chance for hair transaction during the surgery was mainly during donor harvesting.
To reduce it, the instrument changed from a multiple blade knife to a single knife. Instead of cutting blindly, the Haber Spreader and Tykocinski intruder were invented.
So far the intruder seems the safest and has minimum transecting rate( less then 1%).
The method is to score the outline about 2mm in depth, then make multiple insertions of the intruder into the incision line going to a depth slightly below the hair bulbs. Then, using two skin hooks to separate the incision gently. This way there is almost no transection and you don’t have to worry about damaging nerves and vessels.
Tykocinski intruder is easy to use and a great break through for donor harvesting.

Short donor hair

Even with short hair, we can cover the donor site, but it is still visible to the naked eye. This is 3 days post op. We prefer the donor hair to be at least 3/4 inch in length. The donor site availability is limited when the hair is too short, because we prefer the hair to be long enough to cover the suture site.

Hair Can Grow Through Donor Scar

Since Dr. Mario Marzola presented Trichophytic closure in the 2005 July/Aug ISHRS Forum, (Dr. Patrick Frechet also presented a variation of the technique), the appearance of donor scars have been improved significantly. Now hair can grow through the scar.

This photo shows the scar on the donor site (shaved for purpose of picture taking). You can see that there are hairs growing on the red scar area.

If you keep the hair long, the scar is nearly invisible. (Click on photos to see enlarged images)

It is one of the most important discoveries in hair transplant history.

Previously, the hair transplant patient may have wanted to use the same donor area on the second surgery to remove the scar from the prior surgery. However, if we use the same donor area (where the scar is), we harvest 20-30 percent less donor hair. The density in that area was already reduced in the first surgery.

Now with Trichophytic closure, since the scar is not ugly, there is no point in using the same donor area anymore. If one needs a second surgery, we can use a new donor area.