Strip harvesting’s rationale is to harvest all the donor hair is the area selected. If we choose hair from the safest donor area, then we can be more confident that the transplant surgery results will last. This makes it a proficient harvest of the safest area.
Now consider FUE’s (follicular unit extraction) harvesting rationale, where the technique only uses partial removal of hair from the donor area. Only 25-35% of the available hairs are harvested, as over-harvesting leads to a variation in the density of the donor area compared to the rest of the hair. In extensively balding areas this becomes a concern but is unlikely to be a problem in small cases.
How do we deal with this potential issue? In my opinion, considerably bald, young patients should be urged to sustain long-term medication to limit future possible hair loss.
I do not believe that choice of strip harvesting or FUE changes any contra-indications to transplantation, but it may impact relative contra-indications to surgery.
Consider a young man, developing extensive balding, who also has thinning from the nape of the neck. The restriction of existing donor area will reduce the number of ‘safe’ donor grafts that could be extracted by FUE Hair Transplant whereas; a greater number of grafts could be taken from the safe donor area by strip harvesting (FUT). In this instance, more grafts could be achieved by strip harvesting than FUE.
The simple solution at this point is to use a spray on concealer. I would suggest spraying it directly onto your scalp while your hair is wet and then combing out the strands to maintain the highlights. You could try something like Dermatch but that seems to be so hard to use on the back of one’s scalp as opposed to spray.
Maybe you just have some shock loss. But you did say you had limited donor so it is quite possible that you have already harvested 30+ % of the donor region which means you should have at least 30% less hair back there. Of course if the sides were not harvested the contrast can be noticeable. A possible solution is to harvest the sides and have thin hair all around.
It’s probably better to over harvest the sides as it gives a more natural appearance of going from thin to thicker towards the back. The bottom line and all patients should be aware of this is that the hair has to come from somewhere so it becomes a tradeoff of having less hair in the donor regions and more up on top. How far a patient decides to push that is up to them but it really becomes a personal choice.
Every extraction leaves a scar, no matter what punch size is used. Obviously the smaller the punch, the smaller the scar; However there is more than just the punch size.
If one were to use a 0.4 or 0.5 mm punch it is impossible to harvest 2-3-4 haired grafts. Patients are paying for hair transplantation, not to leave most hairs in the donor area.
In our opinion a 0.7-0.8 mm punch seems to be in the range of the best tradeoff between punch size and getting most grafts out. Another factor to consider is skin/hair contrast in combination with donor density. For example the following patient will have more white dots visible: fair skin + dark brown/black hair + high density donor compared to fair skin + light colour hair + low density donor. Last but not least the total amount of grafts harvested is also a key factor and the size of the donor area that was used.
We know there are patients that can shave to grade zero after 3000 grafts and see nothing, and there are patients that need to have 5 mm hair length in order to cover up the white dots.
Figure 1. A high power magnification of the scalp at the back a scalp, from the “preferred donor” site. The scalp is made up of special embryologic groups of hairs shafts that share the same bulb or root and these “families” are called Follicular Units. Extracting these embryologic groups, is called Follicular Unit Extraction or FUE Hair Transplant.
Figure 2. The preferred donor site, or fringe is the hair with normal 5 alpha re-educates activity and can be transferred to the balding top of the scalp and survive and grow normally.
A strip graft involves using a scalpel to cut out and remove a large piece of scalp that extends from ear to ear from the back of your head in the donor fringe. This piece of scalp is approximately one centimetre wide by 10 to 12 centimetres long. Once the scalp is cut away, the donor site is then pulled together and stapled. The strip graft hunk of scalp is then prepared by hair technicians under a microscope by cutting out individual hairs and groups of hairs into non anatomic, non-follicular unit orientation.
There are no miracles in hair transplants, everything has its limitations.