Donor Strip Width Second Surgery

[Cant decide]

My understanding is that in general, an average maximum possible donor strip width on a virgin scalp is around 1.25-1.75 cm for a person with good laxity. What would the MAXIMUM possible average donor strip width be for this same person in their second surgery? I realize that donor strip widths are not uniform accross the entire strip but I am referring to the average width along the entire strip. My guess is that it would be about 1 cm - 1.3 cm in the second surgery.

[nativeremdies]

I have average density , and excellent laxity

 

1st HT 3400

2nd HT 1800

 

I feel I could have gotten 2000 (possibly more) on the 2nd HT, had the doctor follow the same length as the first HT.

[Jotronic]

CD,

 

With sufficient scalp laxity exercises there is no reason why the second pass cannot be the same width but keep in mind the tissue removed will have fewer grafts as some of the tissue will have the scar from the first pass within it. My general rule of thumb, if you go to the same doctor and he's efficient with his strips, is that the 2nd pass will have about 30% to 40% fewer grafts than the first pass. This is assuming each pass is going for as much hair as possible.

[tacolinowest]

and what about a 3rd surgery ?

[Cant decide]

Thanks Joe. That was very helpful. So in my case, in the first pass, a strip of 44.15 sq sm was taken out yielding 5229 grafts (equaling a donor density of about 118 grafts per sq cm). However, the strip taken did not go the full ear to ear and the doc did say that if he did not get enough, he could harvest the remaining piece on the side but ended up not haing to. So basically, that piece is still "Virgin scalp". I feel my laxity is still very good. So if another 44 sq cm is taken in round 2 and the scar is say 0.2 mm (mine is very thin), then that would be 44.15 sq cm*118 g/sq cm = 5229-(44.15 sq cm*0.2 mm) = 4187. Plus, I suppose that the approx. 3 cm piece that was not harvested in the first procedure could be added to that as well and assuming that density is 90 g cm sq (Since the sides are less dense than the back in most patients) and a strip width of 1.3 cm, thats another 351. This would make the total about 4538 grafts harvested.

 

You stated 30-40% less as a general rule of thunb so where are my VERY rough calculations off?

[nativeremdies]

Great info, thanks Jotronic

[Dr. Michael Beehner]

My opinion in almost cases is that the second strip should be 1mm narrower than the first strip. I take a second strip exactly above the first one. In most cases the first strip's scar is almost undetectable, usually 1mm or less in width. The flat part of the occipital part of the scalp in back can be cut wider than the rest. Once you come to the curve around the back of the head and into the area behind the ears, it is important to narrow the width of the striip taken, as this is the trouble spot for widening of the scar.

I typically take a 1.3 or 1.4 cm wide strip in that flat occipital portion of the scalp for a distance of around 10.5cm. I then narrow the strip's width down to 1.1 cm wide as I begin the turn and keep it at that width the rest of the way laterally.

If it is necessary to do a third procedure, I leave a small "pillar" of intact scalp at both corners, so that I am essentially taking three separate strips - one in the back and one on each side. Leaving this small intact "pillar" anchors the scalp together and prevents the classical widening that often happens with third-time strips in that area.

For females, where oftentimes the occipital region is the only area with hair worth harvesting, I will push the limits in order to get enough hair to make the procedure worthwhile for the patient and I will push as high as 2 cm wide if I think there is enough laxity. With undermining, it is possible to easily close such a wound, as long as it isn't taken too far laterally and around the corner at that width.

Mike Beehner, M.D.

[Cant decide]

Thanks for taking the time to respond Dr. Beehner.

[Jotronic]

Thanks Joe. That was very helpful. So in my case, in the first pass, a strip of 44.15 sq sm was taken out yielding 5229 grafts (equaling a donor density of about 118 grafts per sq cm). However, the strip taken did not go the full ear to ear and the doc did say that if he did not get enough, he could harvest the remaining piece on the side but ended up not haing to. So basically, that piece is still "Virgin scalp". I feel my laxity is still very good. So if another 44 sq cm is taken in round 2 and the scar is say 0.2 mm (mine is very thin), then that would be 44.15 sq cm*118 g/sq cm = 5229-(44.15 sq cm*0.2 mm) = 4187. Plus, I suppose that the approx. 3 cm piece that was not harvested in the first procedure could be added to that as well and assuming that density is 90 g cm sq (Since the sides are less dense than the back in most patients) and a strip width of 1.3 cm, thats another 351. This would make the total about 4538 grafts harvested.

 

You stated 30-40% less as a general rule of thunb so where are my VERY rough calculations off?

 

Honestly, your calculations are off because they are calculations:) What I mean is, your math may be right but it is mixed with assumptions and incomplete data therefore making any calculation moot. If you take my general numbers of 30% to 40% then you'll probably get in the range of 3200 to 3600 grafts. This a rough guideline and does not take into account any assumptions of laxity or taking a longer strip. Calculations help us to feel more secure about the unknown but I find they are rarely accurate and can lead to disappointment if and when they are higher than what manifests in reality.

[Cant decide]

Thanks Joe. I am shooting for 3500 so I "Should" be able to get there in round 2