Totally confused: above or below the occipital knot?

[follicle]

I am now totally confused as to where the donor hair should be taken from. My scar is below the occipital knot, others are above. It seems logical (to me at least) that the donor should be taken from below the occipital knot because that is the only hair that remains as you approach NW 6-7. I recall FUTzyHead saying his doctor said you should never take from below the knot and his scar is above. I've also seen it said that it should never be taken from above the occipital knot. Dr. Bernstein said in an answer to a different question that it is a general rule but everyone is different so it is not absolute.

 

So my question to the doctors is just what factors must be considered when determining the proper location to take the donor from? If you take from above the knot and the patient continues to bald, that scar will be exposed to the world in a few short years. If you only take from below the knot, it seems there would be less total donor available.

[follicle]

I am now totally confused as to where the donor hair should be taken from. My scar is below the occipital knot, others are above. It seems logical (to me at least) that the donor should be taken from below the occipital knot because that is the only hair that remains as you approach NW 6-7. I recall FUTzyHead saying his doctor said you should never take from below the knot and his scar is above. I've also seen it said that it should never be taken from above the occipital knot. Dr. Bernstein said in an answer to a different question that it is a general rule but everyone is different so it is not absolute.

 

So my question to the doctors is just what factors must be considered when determining the proper location to take the donor from? If you take from above the knot and the patient continues to bald, that scar will be exposed to the world in a few short years. If you only take from below the knot, it seems there would be less total donor available.

[Dr. Michael Beehner]

Dear "follicle,"

You asked about whether the donor hair should be harvested on the occipital protrusion at the back of the head, or below or above it. When I evaluate the donor hair in the rear (and on the sides), I take into consideration a number of factors: First of all, how old is the patient? Obviously a lot can change over the years in a younger patient - both at the bottom and the top of that fringe of hair I see before me in back. If the patient is in his 40's or 50's, then the pattern before us is much more stable and predictable for the rest of that man's lifetime. Second, a hair transplant surgeon notes the presence of any "retrograde alopecia," which is thinning of hair from the nape of the neck up. This is fairly common in many men,perhaps in as many as half of all the men we transplant. So obviously you don't want to take hair from an area low enough that it may someday thin - in which case the hair harvested from that area will likewise thin in its new home on top of the head. And the worst thing of all is to harvest the donor strip from high in the rear occipital hair, just beneath the edge of the strong fringe of hair - as progressive enlargement of the "crown" area is almost a universal given in any balding man's future.

My own approach is to place one of my fingers at the bottom of the "strong" hair present just above the neck and another one at the top of the occipital fringe hair where it is also strong. I then place a third finger one-third of the way up from my bottom point to the top point, and THAT is where I cut my strip - not too low, and definitely not too high. With this method I feel confident that the hair I am using will be hair that the patient will keep on the top of his head for the rest of his life.

By the way, using this method, around 8 out of 10 times that point ends up being the exact location of the occipital protuberance. The other 20% of the time, it is either slightly above or slightly below it. It will be above it when there is significant thinning of the man's hair at the nape of the neck.

Mike Beehner, M.D.