Hair transplant surgery takes hair and follicles from a hair-bearing area of scalp and places them into a scalp area where hair has been lost. The donor site is the scalp area from which hair and follicles are removed. The recipient site is the scalp area where the donor hair is transplanted. The donor hair transplanted to the recipient site will then continue to grow and provide coverage where hair that was lost.
The removal of hair and follicles from the donor site is called harvesting. Harvesting is a multi-step procedure that begins with planning and ends with delivery of healthy hair and follicles that are ready for transplantation. No hair is removed from the donor site until planning has been completed for the entire hair transplant procedure.
Planning for Harvesting at the Donor Site
Donor sites are most commonly the scalp areas at the back of the head, the nape of the neck and above the ears. These areas are usually unaffected by hair loss due to pattern baldness. See About hair loss for a description and illustrations of pattern baldness.
However, patterns of baldness vary from person to person, as do characteristics such as hair color, hair texture, hair curl and wave, and hair density. The characteristics of hair at different donor sites are important in determining how much hair will be needed from each donor site for transplantation—for example, how much fine hair from above the ears for use in creating a natural hairline and how much heavier-caliber hair from the back of the head for replacing hair lost in the center of the scalp. All of these characteristics are taken into account by the physician hair restoration specialist in planning the hair restoration procedure from beginning to end.
Another very critical consideration in planning for harvest from donor sites is the likelihood that a patient’s hair loss will be progressive over a period of years. This is an especially important consideration for younger men whose hair loss may continue for many years after the first area of hair loss is transplanted. The likelihood of progressive hair loss suggests a need to reserve some hair at donor sites for use in future transplantations. The possibility of future hair loss is often indicated by (1) the rapidity with which hair has been lost, and (2) a family history of progressive hair loss. The likelihood of progressive hair loss, and the need for future transplantation, should be discussed by the patient and physician hair restoration specialist as a part overall planning for hair transplantation.
When a substantial portion of the scalp is involved in hair transplantation, donor-site harvesting and recipient-site transplantation may be carried out over a period of time in two, three or more sessions several weeks or months apart.
Techniques of Donor-Site Harvesting
Several techniques of donor-site harvesting are available today. With a variety of harvesting techniques available, it is easier to select one that is appropriate to the unique needs of the individual patient.
Strip harvesting is the most common technique for removing hair and follicles from a donor site. A single-, double-, or triple-bladed scalpel is used to remove strips of hair-bearing tissue from the donor site. Each incision is planned carefully to assure that the follicles are removed intact. Later, the physician hair restoration specialist or a surgical assistant dissects the follicles out of the strip in the form in which they are to be transplanted—for example, single follicles for single-hair transplantation, groups of two to four follicles for micro- or minigrafting, or in larger groups as needed for covering large areas of scalp.
Strip-harvesting incisions are closed with sutures or staples; healing usually proceeds without complications.
A variation on strip harvesting is elliptical harvesting, where donor hair is removed with an elongated oval incision rather than a strip.
Round Graft Harvesting
Round graft harvesting is a relatively uncommon harvesting technique today. It was a more commonly used technique before newer methods were developed that stress the use of smaller grafts.
Follicular Unit Transplantation
A newer technique of donor-site harvesting and transplantation is follicular unit transplantation (FUT). Follicular units (FUs) are small groupings of hair follicles that are the natural “units” in which hair grows in the scalp. FUT harvests and transplants follicles using these naturally occurring FUs. The FUT technique when used by a skilled and experienced physician hair restoration specialist allows the creation of maximally natural and frequently undetectable transplants.
See Follicular Unit Transplantation & Extraction for additional discussion.