How big a Strip?

[Mountinvan]

Recently read a thread where Janna said the Shapiros do not like to exceed 2cm in width? I take it different docs are comfortable with varying widths. I also assume the wider the strip the more aggressive the procedure and more likilihood of going beyond the safe zone. Am I right? What is a condervative width? Does it depend on the patient? How about length?

[RodG]

Hi,

 

My understanding that the width also depends on scalp laxity. I also thought a hair transplant clinic has tools that measure scalp laxity to ensure that the strip isn't too wide. Are you after maximum grafts from one procedure?

 

Regards

 

Rod

[RCWest]

Healthy, non balding scalp contains anywhere from 80 to 120 follicular units per square centimeter. If you wanted say 2000 grafts, depending on laxity, they could take a 1 cm wide by 20 cm long strip or a 2 cm by 10 cm long strip, if you average 100 fu per square cm. The narrower the strip the less chance of a tight closure and scar stretching.

 

I've seen cases where they could only get 1500 fu max because of a tight scalp and low density, and just recently Jotronic posted the case where they got well over 9000 fu in one session because of exceptional density and laxity.

 

If you want to get an idea of what the strip looks like, look up any of Dr. Lindsey's cases in the "Results Posted By Leading Hair Restoration Clinics" section of this forum. He always shows the donor strip.

[Dr. William Lindsey]

With rare exception my strips are always about 1.75 cm wide...about the width of a stick of gum. The variable is the length...ear to ear or shorter if we need less hair. That usually results in me getting a pretty decent scar.

 

But there are plenty of times where I'll say to the patient right after the strip is out: "Wow, you really have a stretchy scalp...we could have taken a bigger strip". And there are times when I'll say " that is pretty dog gone tight, I'm glad we didn't go any wider".

 

Now, the trouble is predicting that, and its a bit like predicting the stock market. Meaning I don't know anyone who is always right. So I err on the side of caution.

 

For those guys who need alot of hair and then say..."well go ahead and take another strip" I respond that we'll likely transect a bunch of hair with a second cut, and a little more excision may result in a bunch more tension on the incision line. Plus I don't like to change a plan once we agree on it.

 

There are very reputable Docs who take wider strips than me and do just fine. I just do what works pretty consistently for me.

 

Remember, perfection is the enemy of good. The halls of medicine are full of bad outcomes that came from trying to do just "a little more".

 

Dr. Lindsey McLean VA

[RCWest]

Dr. Lindsey, how do you cut a strip without transecting a bunch of hair? Is there a technique to doing it or do you just cut carefully as you can around the follicles?

[Dr. William Lindsey]

Well you do hit some follicles. Anyone who says different is full of it. Its like building a road through a forest. You are going to have to take out some trees....BUT, with care, you can try to hit fewer trees/hairs and build only a single lane road--ie a fine cut. And we wouldn't come back and make a second "un planned for" cut adjacent to the edge of our strip we just excised, in order to get more hair. That starts to be like those old multi-bladed knives that were common, and used by me, in the 90s. Better to take one good strip, then have a good cutter, use magnifyers, and cube it and try not to hit any roots in doing so. Preserve them all, that is what I say. A person can steal more money, but hair is a finite resource for most patients.

 

Dr. Lindsey