Open Donor

A hair transplant relies greatly on the capacity of the donor area to supply enough hair to cover the surface area of hair loss; the more times the donor is entered or harvested the quality of the area will be impaired

Donor management is vital to a successful hair transplant; older techniques such as punch grafting would leave large cylindrical scarring across the donor area and greatly reduce the amount of hair and density that can be safely harvested and leave obviously visible scarring

Planning is critical, both from the donor and recipient, to prioritise on what supply is available to what the demand is in the recipient area; as the number of follicular units available is a finite resource they need to be distributed in optimum approach

When dealing with a depleted donor it is important to prioritise how the hair that can be harvested can then be used in the recipient area; very often a depleted donor also means a less than successful recipient hair result and this will require planning to get the most from the donor to give a cosmetically pleasing result in the recipient

Known as an “open donor”, the area has been depleted of hair, either due to excessive scarring by previous operations or the donor hair quality not being adequate to be used, either miniaturised or simply a low density, possibly signs of DUPA

In cases where the donor is open with punch scarring, and assuming the skin laxity still allows it can be possible to excise the scarring using the FUT technique, or strip method; this allows for the strip to be taken and then sutured leaving a single line, opposed to multiple punch scarring

A depleted donor can also occur prior to any hair transplant being performed; if the area has a high % of miniaturised hair, or a low density or hair count. If the case a hair transplant is very possibly not the answer, short or long term it is unlikely a successful result can be achieved

Research is important, having the donor area checked and examined, especially with repair hair transplant surgery so a master plan can be made and both the candidate and doctor understand the goals, priorities and limitations


A Balancing Act

Before undergoing surgical hair restoration the donor resources need to be measured, hair density, average number of hairs per FU, skin laxity and general hair characteristics, hair to skin colour contrast, curl of the hair for example

These aspects will determine how good a hair transplant candidate an individual is, a good estimation how many grafts are available from the first procedure to future interventions, and how much coverage can be achieved

A balanced coverage does not necessarily mean total restoration with even density throughout, it simply means that from the hair line to the crown the placement does not leave a larger hair less surface area than treated

To achieve enough density on a higher Norwood scale candidate can require 7-9000 grafts from the hair line to the crown, a number that not every individual can achieve so it is important the hair transplant is planned

It is important to achieve a certain density of hair to create a shadow so the light is blocked from reflecting off the scalp; this is the basic principle that makes a hair transplant work and look natural

The hair line is generally the first area to be restored; the hair line frames the face and can have a great impact on how you look, but then behind is the frontal third, mid-section and then the crown or vertex

A hair line placed too high will reduce the potential surface area that needs to be treated but can appear unnaturally high, especially as the hair line will be perfect with no signs of thinning hair, that a receding hair line would have

A too low hair line can create two issues; as we age the hair line pattern does not match our age and changes in facial features; and if placed too low will fix the point of restoration permanently potentially making the recipient surface area too large to treat effectively

The better the characteristics the greater options are available, hair line placement and design can be more aggressive if desired and still maintain a balanced coverage even if hair loss advances to a high Norwood stage

If the hair characteristics are average or slightly below treating minor hair line hair loss may not be appropriate and it would be prudent to wait until a more obvious pattern of hair loss is evident; this will allow for a long term plan to be made to ensure a balanced coverage

As the hair resources are finite a master plan must be made from the first surgery to ensure in worst case scenario a balanced coverage can be achieved and the donor can sustain hair restoration

Along with graft placement, hair angles and orientation, and using natural follicular units an important aspect to a hair transplant looking natural is achieving a balanced coverage from the hair line to the crown.

Evaluating Hair Transplant Suitability

An individual will need to set out their goals for hair restoration then seek professional advice whether the goals can be suitably met. Certain criteria will be examined to ascertain if a satisfactory result can be achieved

A hair transplant should not be thought of as a cure for hair loss or suitable for everyone; if the hair characteristics are poor it is better not to start surgical hair restoration as results can be poor and lead to distress

If the hair in the donor area is low density, mainly small hair groupings, and miniaturised this will limit the quality of the hair and the numbers available over time; it may be possible to repair minor hair loss, a hair line, but as hair loss progresses the donor area will not be able to keep up with the demand for hair

Even with average donor characteristics if the area of hair loss advances aggressively, restoration, certainly total restoration may not be possible; especially if the pattern of hair loss drops down the sides and back, exposing the lateral humps and the crown dropping into the potential safe zone for harvesting hair

A hair transplant is a surgical procedure, relatively minor and relies on the hair and skin characteristics of the individual to determine whether a cosmetically suitable and balanced result can be achieved

Because we have to rely on the quality of the hair properties we have around the sides and back of the head results will vary from person to person and some will make better candidates than others, with some individuals not being a candidate at all

Some clinics will have strict protocols on who they consider to be a good hair transplant candidate; age is always high on the list of protocols, using medications can play a role, existing hair loss pattern and potential hair loss pattern. This does not belittle the feeling of someone who is younger and losing hair, in fact, although may be not initially appreciated, if the advice is to not undergo surgical hair restoration it is simply made with the best interests of the individual in mind

It must be impressed upon and understood that a hair transplant is not a miracle cure; as great as results can be on the right candidate, if all the parameters and risks are ignored then not only will the result not meet the goals but can result in the individual needing repair surgery which is not a position anyone wishes to find themselves in

4553 FUT Hair Transplant Result

FU’s               Hairs

1.         524                  524
2.      2284                  4568
3.      1434                   4302
4.       311                    1244

Total    4553              10,638     2,33/FU

Before Hair Transplant 1

Before Hair Transplant 2Before and Grown Out 4553 FUT. Hattingen Hair, Switzerland 1Graft Placement. 4553 FUT. Hattingen Hair, Switzerlandbefore and grown out frontalBefore and Grown Out 4553 FUT. Hattingen Hair, Switzerland 2    Grown Out 4553 FUT. Hattingen Hair, Switzerland Hair Line Reconstruction. Hattingen Hair, Switzerland

Large Hair Transplants Sessions


The FUT or Strip Surgery technique can remove a large number of grafts efficiently; allowing treating high Norwood Scale hair loss suffers in a one day procedure with sometimes total coverage on the right candidate

FUE generally takes longer as each follicular unit has to be punched individually, high numbers can be achieved but it takes multiple procedures and requires generally a higher starting donor density to achieve the same as FUT

The largest hair transplant procedures can be performed in a single procedure or over multiple procedures. FUT on the right candidate can exceed 7000 grafts in a single day procedure, obviously if required

Preparation Of Follicular Units Under Magnification

Preparation Of Follicular Units Under Magnification

The number of grafts required is largely determined by the surface area that needs to be treated; a high hair loss pattern from the hair line to the crown can require in excess of 8000 grafts

A second FUT procedure can be performed at a later date to increase the density in the areas the first procedure could not complete. Over 2 procedures FUT could complete full restoration on many candidates, and leave more in the donor if hair loss continues to progress

The clinic must have a dedicated, efficient and well trained team to be able to perform large sessions, care taken over all aspects, patient well-being, and care for the grafts, and graft survival being of great importance

It is important that each member of the technical team work together efficiently, from the harvesting of the grafts, cleaning the grafts under magnification and the placement of the grafts over the head

At any time the grafts can be damaged if not handled correctly, also the skin can be overly impaired if the harvesting and slit making is too aggressive due to the high numbers; therefore it is vital that whatever number is achieved it is within the safe limits the donor can achieve

With a Master Plan the best technique can be assessed and agreed with the candidate to achieve their goals be it with FUT or the FUE hair transplant technique


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How Good Is My Donor Hair Supply?

Ultimately a good or bad hair transplant candidate can be determined by the quality of hair around the back and sides of the head, known as the donor area; the hair is genetically strong and does not suffer the same symptoms of male pattern baldness

The donor supply area will vary dependent on the eventual pattern of hair loss across the top of the scalp; the wider the pattern of hair loss will reduce the size of the safe donor zone as hair loss progresses down the sides and back of the head

A Good Donor Hair Supply Allows For Restoration From Hair Line To Crown In One Procedure

A Good Donor Hair Supply Allows For Restoration From Hair Line To Crown In One Procedure

Measuring the quality of the donor supply can be listed into aspects, size or surface area, skin laxity, hair characteristics, hair or follicular unit density and the percentage of miniaturisation within the donor area

Hair shaft diameter; miniaturisation is the progressive thinning of the hair shaft, becoming finer and weaker than the surrounding good quality hair. Miniaturised hair should not be transplanted because it will impair the result and potentially will not regrow due to the trauma of the procedure

If the % of miniaturised hair in the donor is high it will reduce the chances of being a hair transplant candidate

Follicular unit hair density; FU´s are naturally growing groups of hairs, normally 1 to 4 hairs with the highest density generally around the back of the scalp. Donor hair density will determine how much can be removed safely

An average density is around 75 FUcm², the density will later dependent on ethnicity and hair characteristics. Too low a density makes treating progressive hair loss impossible and over harvesting the donor will impair the look and possibly increase visible scarring

Hair characteristics covers aspects such as hair calibre, hair curl, variant in skin to hair colour; if the characteristics are poor even with a high FU density can produce poor hair transplant results

Skin laxity affects the FUT hair transplant technique generally more than the FUE technique; FUT relies on removing a hair bearing strip and the width of the strip is largely determined by the skin laxity. Safe donor management needs to be employed to not make the strip too wide and increase the potential of poor healing

Laxity can affect FUE also but in a different way; if the skin physiology is very lax it can impair the punching of the follicular units, the skin can break away and damage the grafts, making them useless to transplant

The size or surface area of the donor supply; this again varies between the technique of choice. FUT harvesting is localised to a thin strip generally well within the safe donor zone but still the position has to be safely calculated, especially with very advanced hair loss, or individuals with retrograde alopecia

The length and width of the strip will be calculated dependent on the number of grafts required, can range from around 10 to 30 cms in length and 1 to 2 cm in width; better laxity attributes allows for 6000 plus grafts to be harvested on a good candidate

Correctly Assessing The FUE Donor Safe Zone

Correctly Assessing The FUE Donor Safe Zone

FUE relies on removing follicular units individually and over a wide non-specific area, caution needs to be taken not to venture out of the safe zone when extracting. On lower hair loss stages it can be impossible to predict the size of the safe zone and a conservative approach is advised when measuring the safe area

To measure the safe zone is easier on higher hair loss stages as there is a clear demarcation line between the donor zone and the recipient area; an average size safe zone can be around 28cm wide by 6cm in height; not taking the area directly from the start of where the hair begins, such as directly above the ears or the nape of the neck, but keeping around 1-2cm in case of future hair loss or miniaturisation

Using all these aspects will help determine how much hair can be safely harvested, what density will be required when placed and the coverage that can be achieved over the surface area. Correct donor management of the supply of hair can restore even advanced hair loss; utilising the correct harvesting technique will maximise the graft numbers in one or over multiple sessions


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How To Continue Successful Surgical Hair Restoration?

The initial decision to undergo surgical hair restoration obviously focusses on the immediate problem, the hair loss pattern an individual suffers from at the time of the initial hair transplant session

As hair loss, in particular male pattern baldness is progressive the decision when to start restoration and the plan or design is crucial to the long term happiness of the candidate; as the ultimate pattern of hair loss can be hard to predict

The donor hair resource is a finite entity and after every hair transplant session, be it by FUE or FUT hair transplant techniques will alter and less and less hair or follicular units can be removed over time

Two FUT Hair Transplant Procedures. 7305 Grafts And Total Restoration Of A NW6 Hair Loss Sufferer

Two FUT Hair Transplant Procedures. 7305 Grafts And Total Restoration Of A NW6 Hair Loss Sufferer

A plan must be made from the outset how future hair loss will affect the result and how a successful, balanced and natural coverage can be achieved; individuals have different goals from a hair transplant, not all individuals are looking for the appearance of a full head of hair, but all individuals are looking for a natural result

An average donor density is around 75 follicular units per cm squared; the density of FU´s will differ around the sides to the back of the head with the highest concentration of hair being around the back, or the occipital area

If the starting donor hair density or general hair and scalp characteristics are substantially below average then surgical hair restoration is probably not the option an individual should take; although a weak donor can treat relatively minor hair loss it will not be able to sustain more aggressive hair loss patterns

As a hair transplant is not viable to reverse, leaving signs of a surgical procedure, planning with the future in mind and the individual being aware of the limitations a hair transplant has can go a long way to long term successful hair restoration

Considerations to be taken into account besides the donor area qualities are: age of the candidate, hair loss patterns on both sides of the family, the goals of the individual and hair line placement

7305 Grafts 2 FUT Surgery Sessions Donor Healing

7305 Grafts 2 FUT Surgery Sessions Donor Healing

On higher Norwood scale hair loss sufferers it can be easier to predict future hair loss, and at the same time achieve total coverage from hair line to crown in one procedure on the right candidate, reaching 6000 plus grafts with the FUT technique

Even if hair loss continues it is likely a much smaller procedure would be required in the future to sustain a natural pattern of hair growth. Minor hair loss will require repeatedly entering the donor area to repair smaller areas of hair loss

Constant entering of the donor impairs the skin healing over time, can increase miniaturisation of the hair, change the skin laxity and donor density; very likely reducing the potential number of grafts that can be safely removed

A hair transplant success can be measured on many levels, patient happiness being paramount, but also how the donor area is managed to ensure the minimum number of grafts are used but the maximum natural coverage is achieved

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