All about Donor Site (in FUT method)
Table of contents
There are many of us who are eager to know whether or not hair will grow back naturally at the donor site after undergoing hair restoration surgical procedure. Well, to be precise and upfront, the answer would be ‘NO’. Since all of hair follicles and the surrounding cells are fully removed from below the scalp’s surface, natural hair re-growth in the donor site is not possible. Hair re-growth will certainly occur in the regions of the donor site where the hair follicles were not completely removed.
However, since the hair graft surgeon will harvest follicles from a region in the scalp with the plentiful of hair accumulation, the impact will be hardly noticeable. The remaining neighboring hair that surrounds the donor area is more than sufficient to cover up the spots where the excisions were made.
Additionally, hair is assumed to grow back from either side of the incision, and under various conditions, even through the incision after the scar has completely healed. This is one of the crucial reasons why hair transplant surgeons try to keep the donor scar as contracted as possible.
Reducing the scar from the donor incision is one of the most significant aspects of a successful hair restoration surgery. An evident donor scar grants an individual to keep their hair comparatively short after the hair transplantation (if one wishes to do so) and rise up the number of hair that can be planted (removed) in upcoming sequential hair transplant procedures
There are several surgical methodologies that have been developed to minimize donor scarring when making use of a strip excision during FUT hair Transplant procedure. This involves the use of buried sutures, tumescent anesthesia, absorbable sutures, staples trichophytic closures and undermining. The technique of FUE hair restoration surgery, where follicular units are displaced straightaway from the scalp without having to apply linear incision, is covered in another section.
Strip incisions are extensively used because they allow the hair transplant physician to adequately and systematically perform large hair transplant procedures, minimize damage to hair follicles, while at the same time. The reason this has become feasible is because the strip of donor tissue that is eliminated from the scalp is placed under a streak of stereo-microscopes, where the individual follicular units can be easily dissected from the tissue under downright visualization.
There are 4 main facets to having the donor incision heal in a fine line; this includes:
- Use of appropriate donor strip dimensions
- Locating the incision in the correct place
- Withdrawing the strip without causing any sort of damage to the tissue
- Closing of the donor area with unbeatably exquisite surgical techniques
Position of the Donor Incision
As a word of valuable information, the perfect placement of the donor incision is suggested to be in the mid-part of the permanent zone which is located in the sides and back of the head. This part of the scalp lies in a band that begins above the occipital protuberance (the bump sensed in the centre part of the back of the scalp) and stretches to either side in a compassionate, upward inclined curve that proceeds to the contour of the scalp. If hair is planted below this area, there is a higher risk of scarring from the wound expanding, since the incision will be just too nearby to the muscles of the neck. If the incision is marked above this region, the hair may not be long-lasting and may shed out as the baldness progresses.
Size of the Donor Strip
Although the size (length) of the donor incision is principally determined by the number of follicular unit grafts needed for the hair transplant, the width (height) of the donor incision solely depends upon the patient’s scalp laxity. This is an inherent characteristic of the patient’s scalp that must be cautiously measured by the hair transplant physician at the time of first assessment. With a fair scalp laxity, a wider strip may be planted from the donor area without the danger of scarring, although patients with very flexible scalps may be at greater risk of a wide scar. If the scalp has too much laxness or tightness, using a normal size strip may be nearly impossible.
If the diameter of the strip is too tapered or slim, the incision will required to be uselessly heightened in order to gain substantial amount of donor hair. If the width of the strip is too wide, the risk of getting an enlarged scar will be increased notably. As per the expert clinical professionals judgment, obtained over years of experience, is necessitated for the surgeon to constantly set a relevant length and width of the donor strip and fulfill the agenda of obtaining the minimum possible scar.
Majority of the transplant patients possess 90-100 follicular units per square cm in their donor area. Therefore, in a hair restoration of 2,000 follicular unit grafts, a donor strip that is 1cm broad would require to be a little bit over 20 cm long to yield the adequate number of grafts.
Scalp Laxity Exercises
In Follicular Unit Transplantation (FUT), the hair transplant expert will acquire donor hair from a long, thin strip removed from the sides or back of the scalp. This surgical process can most comfortably be fulfilled when the scalp is relatively loose as it allows the doctor to harvest more grafts. You can aid to make your hair restore experience a worthwhile by working out with scalp exercises for about few weeks or months before the surgery. Scalp exercises can greatly help to elevate the scalp laxity which may enable more grafts to be harvested in one single session. Even candidates with good scalp laxity can reap benefits from scalp exercises.
Follow the steps one-by-one below to loosen the tightened scalp for scalp laxity:
Scalp Laxity Exercise 1
- Swiftly cling on both your hands (thumbs pointing towards each other and fingers pointing upwards) and place on the back of your head
- Place your hands marginally above the boney ridge that glides horizontally at the back of your scalp
- Pull both your hands in the forward direction i.e. towards your forehead while at the same time energetically moving your scalp up and down perpendicularly
- Assert enough pressure against your head so that only the scalp moves, but your hand remains intact in the same position to avoid slipping over your hair
- Practice this scalp workout regularly for 5minutes each in the morning and in the evening
Scalp Laxity Exercise 2
- Rest both your hands tightly at the side of your scalp
- Move your head up and down until and unless the scalp movement will allow without hitting your hands on your head
- Perform the exercise daily for 5 minutes in the morning and evening till obtaining desirable results
To stretch the whole of donor area, use 3 different types of positions for the thumbs and palm:
- Position 1 – palms in back of head with both thumbs overlapping
- Position 2 – palms on sides of scalp with thumbs touching each other at the back
- Position 3 – Both palms and thumbs on the sides of the scalp
Continue these exercises until a day before your hair transplant.
Removing the Donor Strip
An extensive upgrading in the removal of the donor strip is the use of tumescent anesthesia. Tumesce plainly refers to enlarge by inserting fluid into the tissues. In this technical procedure, very dilute absorptions of anesthetic fluid are inserted into the fat layer of the donor area of the scalp. This caters to numerous purposes, like, the one is to reduce bleeding by the pressure exerted by the fluid on capillaries (the small blood vessels), second is to tighten the skin so that the incision can be comfortably controlled and third, to extend the distance in between the follicles and the deeper tissues of the scalp. This enables the hair transplant expert to keep the incision superficial so that the larger blood vessels and nerves in the scalp are not wounded and so that the fascia is not cut up. The fascia is a thin surface of fibrous tissue that stays just beneath the fat layer which provides immense support to the scalp. If the fascia layer is cut, the risk of having an elongated scar evidently increases.
Undermining is an impeccable technique of detaching the upper layers of the scalp from the lower sections in the region around the injured edges & can be effective if there is extravagant tension on the injured edges during closure.
The technique is periodically required
- when the scalp is firm
- when a patient previously have had undergone many hair transplant procedures
- When the donor strip is too wide
Undermining, at times, can mount up the risk of bleeding, trauma and nerve injury to the scalp and may also lead to poor healing. Although the technique is quite helpful in some circumstances, it is usually recommended to avoid the usage of undermining wholly by cautiously planning the donor incision.
The biggest benefit of using staples is that, of all the donor closures, staples are known to preserve the most hair. And there are 2 major reasons behind staple’s hair sustainability factor.
- The first is that the stainless steel staples are stagnant (motionless). This simply means that, contrary to sutures, the body tissues do not respond to them and thus staples negligible inflammation (that has the capability to destroy hair follicles).
- The second noteworthy benefit of staples is that they are simple interrupted stitch, unlike sutures which are performed in a long running loop stitch. A running loop stitch has a propensity to strangle hair follicles, specifically if there is any complaint of swelling after the surgery. The use of interrupted staples fends off this conceivable damage to grafts.
The potential advantage of sutures has been that the hair transplant doctor had the most control in closing together the injured edges. For the longest period of time it was perceived that the better control of the wound edges rendered by sutures superseded its drawbacks. However, with the newly invented stapling method and revising the time for which the staples are left in the scalp, outstanding wound edge approximation (closing together) is obtained. Hence, the main advantage of sutures has largely been banished by introduction of new technique of staples.
Sutures are usually been considered more pleasant after the surgery than staples and are even more comfortable for patients as they are not required to be removed. However, since staples serves superior conservation of donor hair, this is best regarded choice for most surgical hair transplant procedures. This closure of choice is also meant for patients who simply prefer sutures or will benefit from them.
Remember that there will be a little trace of scar in the donor area even with the hair cut comparatively short.
Monocryl is a synthetic absorbable suture with too low tissue responsiveness. This new suture for hair transplantation is soaked up by hydrolysis (diffused by the water in tissues instead by an inflammatory reaction) so that there is very less harm caused to the hair follicles. After presenting the application of Monocryl sutures to hair transplantation in the year 2001, restoration surgeons continued to use Monocryl suture for a number of years. The potential benefit of this closure is patient’s well-being and comfort, the ease of not having to be removed and exercising complete control over the wound edges (which is observed to result in effective healing).Although, in spite of these advantages, most of the expert surgeons all across prefer to use staples in the majority of cases because of the competency of stapled closures to optimally conserve the patient’s donor hair supply.
Trichophytic “Tricho” Closure
In Trichophytic closure, the transplant surgeon sculpts the open flaps of scalp in a manner that enables one flap to overlap the other. In this closure process, physician makes the first incision parallel to the hair follicles and then cut away 1 to 3-mm of tissue of either the lower or the upper wound edge (or both), so that the top of the hair follicles at that wound edge are eliminated. Once the flaps are closed, both the sides are clasped together for about 15 days with surgical staples while the scalp constructs itself and the two sides bind to each other. When the staples are removed, you are left with a merely noticeable scar that appears like a thin white line when you see it.
At the time of performing the “tricho” closure, the snipped wound edge is drawn towards the opposite edge so that the bottom parts of the trimmed hairs are directed towards the incision (rather than parallel to each other). The objective is that these hairs will ultimately grow through the incision and therefore minimize the visibility of the scar.
The “tricho” closure technique conceals the edge of one flap, instantly decreasing the visibility of the forming scar. The angle of the incision refers that the existing hair follicles from one side will grow from the other side, generating an even stronger bond and eliminating fear of exposing a surgical scar, even with a short hair cut.
Trichophytic closures usually need the wound edges to be sutured, even though it is possible to obtain advantage with a trichophytic closure when staples are put to use.
This topic currently emits light on the combination of a trichophytic closure with staples. The prospective benefit of this kind of trichophytic closure is that staples allow the maximum preservation of donor hair.
In the type of upper ledge trychophyic closure, the hair of the upper wound edge points down and emerges into the scar.
In the type of lower ledge trychophytic closure, the hair in the lower wound edge grows from the running over upper edge.
In addition, trichophytic closure can also be used to repair scars left by previous surgeries.