Where exactly is the safe donor and how far does it extend ? Some scars puzzle me

[Lotsofhair]

Dear fellow patients and doctors,

 

I do not understand where exactly the donor area is eg. where the area that contains permanent hairs is located.

 

Now please don't say at the back of the head, because that I got.

 

Ok, here's a picture which is supposed to show where the safe area is (from Unger textbook, which may or not be outdated, I do not know) :

 

 

In other words : between and above/up until the ears. But from this picture the sides seem to be excluded and hence do not constitute a safe area.

 

Now, what puzzles me is the many amounts of (real life) pictures of patients with scars that extent up to the temple points and go very high up : the following picture not being close to the most extreme cases of very long scars I've seen...

 

So in other words : do the hairs on the sides also qualify as permanent ? As permanent as those in the back ?

 

 

Thank you very much for clarifying what exactly constitutes the safe donor area and where the permanent hairs on the head are located.

 

Actually wait, I found exactly the patient I had in mind when writing this, as I would wish for exactly the same scar (he is a Hasson and Wong patient, so maybe Jotronic could help me) but I'm not sure whether those hairs high up on the sides are permanent or not... In any case, I admire this patient's case. Still I'm looking for confirmation or clarification on the topic.

 

Edited December 20, 2012 by Lotsofhair

[Blake Bloxham]

Normally, it's the area near the occipital notch in the occipital region of the scalp (I traditionally learned that the occipital notch served as the lowest border of the safe zone, and that the universal donor region extended several centimeters above this. However, I've been told by surgeons that this isn't necessarily the case, and the occipital ridge can actually serve, in some cases, as a midpoint for the universal safe zone) and the subsequential regions of the temporal (and somewhat parietal) scalp (if you're looking for more scientific terms).

 

To look at it an easier way, envision the balding pattern of a NW VII patient; the area of hair that still remains generally signifies the safe donor extraction site. Obviously this whole region won't be used, but the general principle of a DHT resistant donor extraction site holds true.

[Lotsofhair]

Thank you Blake! Very helpful. Here's a picture to help "envision" :

 

 

 

Thus the Hasson and Wong scar is exemplary of an excellent scar I believe... while I'm afraid I cannot say exactly the same for the other patient. The lower part of the sides are bound to get weaker (in the hypothesis of a NW7) and I don't think a scar should ever reach them... but should go higher up (again see HnW patient).

[gillenator]

Here's the botton lime to answer your question as specifically as possible to a somewhat subjective question. I say subjective because of the differences between patients in where DHT deposits in the scalp.

 

For the most part, and was already addressed, it is the occipital (back) and parietal (sides) where hair is mostly DHT resistant. Yet any individual headed for the more advanced classes of hairloss can lose hair outside of the proposed "safe zone" as noted in the diagram you provided us.

 

I am always amazed that more HT doctors do not first check for miniturization throughout the donor zone inclusive of the "outer perimeters" of the proposed safe zones. Some simply evaluate the donor areas with the naked eye in the consultation or on the day of surgery and then define exactly where the strip will be harvested, and also how long and wide it needs to be to "accomodate the number of grafts scheduled for the procedure". Once the actual donor density per cm2 is evaluated and determined, whether it is a virgin scalp or a subsequent procedure, the length and width of the proposed strip can then be equated.

 

But what I am leading to is that any part of the scalp considered for harvest, strip or FUE, should not show evidence or very little evidence of miniturization IMHO. Why? Because those areas that may look like terminal hair to the naked eye, meaning DHT resistant, may indeed be subject to DHT after evaluationg that hair under a high power scope.

 

And since MPB is progressive, it's more the younger patient who in their 20s and even 30s, may not show much surface (naked eye) evidence of the miniturization that is clearly impeding the outer perimeters of the proposed safe zone. Again, this can vary patient-to-patient more than we realize.

 

So what is the implication? Some of the donor strips that appear to be taken higher in the safe zone, may indeed be donor hair that is DHT receptive and can be lost sometime in the future even years after the procedure.

 

It is not a perfect science but like I stated earlier, MPB is indeed progressive and what appears to be the same safe zone in various diagrams and charts, I believe every proposed HT patient should be micrsopically evaluated for minitrization and then continue to be evaluated again as the years go by and they consider a susequent procedure(s).

 

Every now and then we see an example of a young man getting a significant strip or FUE procedure and yet somewhere in his initial thread/story he states that his family history (father, uncle, grandfather, etc) have advanced classes of hairloss. The young man is typically in his mid to late 20s and even thirties and his strip was harvested from the upper perimeters of what we think is still the safe zone. I always wonder if that individual might lose some or even most of that donor hair because it could be outside of the proposed safe zone.

 

BTW, I am not referring to any of the patient examples that was put up in this thread, but rather speaking in general terms of examples that I still see from some patients to this present day.

 

Some of the younger patients that have lots of existing hair because they are still young, should be encouraged to pull down their larger more aggressive goals if they indeed have advanced classes of hairloss that is readily evident in their respective family histories. And these individuals especially should insist on having their scalps microscopically evaluated for miniturization on a continual basis as they age, and especially prior to any susequent procedure whether strip or FUE.

 

IMHO, this is the safest most scientfic approach that is in the best interest of every proposed HT patient especially the younger guys who can tend to have the more aggressive goals.

[gillenator]

I forgot to add that IMHO, the donor zones on the sides of the scalp (parietal) is best harvested by FUE because the scarring is typically more minimal (no strip scar), and more importantly, each and every FU can be "cherry-picked" through the parietal zones where scalp laxity may not be ideal for strip harvest.

 

The FUE surgeon is also able to cherry-pick those FUs that have the best degree of caliber and show no evidence of minituriztion.

 

Those select areas of donor can also thin by density as one ages and the strip scar can be more noticable as the patient gets older. This is why I prefer only FUE for harvesting in the parietal zones.

[sharan9895]

Just check out the Guy in Pic.. He's a fully blown NW7.. and has lost hair even on sides...:confused::confused:

 

[sharan9895]

Just check out the Guy in Pic.. He's a fully blown NW7.. and has lost hair even on sides...:confused::confused:

 

[Al - Moderator]

My hair loss on the sides of my head has extended past the point of the scar in the Hasson and Wong picture posted. You can see what I mean if you look at my profile picts.

[gillenator]

The man previewed in the last photo is without question a Norwood 7 and obviously not a candidate for HT surgery. And it's true that the entire scalp can thin out for men who reach their retirement years.

[sharan9895]

The man previewed in the last photo is without question a Norwood 7 and obviously not a candidate for HT surgery. And it's true that the entire scalp can thin out for men who reach their retirement years.

 

which implies that there are no options for a norwood 7.... Hair systems looks so unnatural on such guys..

 

Live it BALDD....... :rolleyes:

[TommyLucchese]

How do you know if you'll ever reach that advanced NW7 position without waiting?

 

Why say to someone to wait to see your balding pattern if you end waiting 15 years before you've lost everything? Then the meds and transplants wont work for you. Is it not better to take the meds and chase it with HTs?

 

Ah, this f-n gene. Hate it. Why me? Why us