Donor area on long term

[Sam23]

Hi

 

I notice that most of old guys have weak donor area, so that makes me think that the donor area will be thin also over time and it is not a safe zone as they call it. So if the normal guy will have a weak donor area when he become older.

 

What will be the case of the ones who have HT then? Anybody think about it?

[Melvin- Admin]

Sam, unfortunately the donor area does thin overtime, and yes most of us who get hair transplants at a young age will continue to bald, there are things you can do to slow it down like propecia and minoxidil, however these medications will not stop hair loss. That's why I personally chose FUE, because I don't want to be old and have a huge scar in the back of my head become visible. Lifetime grafts are a bunch of bologne, now not every man will have a thin donor area, we are all different guys with very little hairloss will probably have a dense donor area, but those of us Norwood 5 and higher will more than likely have a thin donor area this is why I don't advocate FUT for guys with severe balding.

[Sam23]

That s why i choose fue also, and i hope it works, to be honest i 'm still skeptical about the whole thing and i will be like this until i shave i need to see how the receipient and donor area will look like and i m not so optimistic so much, i saw some videos snd i seems should be ok but still the hairline will always be there and you cannot rid of of it even if you shave, so if you become bald it will appear odd i think

[Melvin- Admin]

The hairline will only look odd if you don't address the rest of the scalp, most cases you'll have to do additional surgeries to address the mid scalp or even the crown, but for high norwoods the chance of you having a descent was of hair for the rest of your life is not really the case, let's say you have 6,000 grafts lifetime, that's not a lot for a large surface area, coverage will be thin.

[Dr Blake Bloxham]

Hey Sam,

 

Here's something I wrote about the donor region, and more specifically the "safe donor area" versus other regions around it, a while back. There may be some helpful information in it:

 

The "safe donor area" (SDA) is actually a very controversial area -- no pun intended -- in the hair transplant surgery field. Let me provide a little context and explain how I believe doctors make surgical decisions with regard to the donor area and educate their patients about the permanency of their donor follicles:

 

The SDA was first essentially discovered by Dr Orentreich when he first described the theory behind 'donor dominance' and revolutionized hair transplant surgery in the 1950s. At this point in time, he didn't really define a 'safe donor region,' but he did note that follicles from this region were 'permanent' and seemingly unaffected by the androgenic alopecia (AGA) process when transplanted to the front of the scalp.

 

This is really what kicked off the 'plug' phase of hair transplant surgery. Initially, plug procedures were small. And these extractions were pretty safe with respect to safe donor. As time went on, however, they become larger and the idea of defining a safe donor became a more important reality -- in my opinion.

 

Before this could really become too big of an issue, however, strip harvesting (FUT) really took hold and defining the SDA wasn't that big of a deal. This is because there should really be a truly 'safe' harvest zone on nearly all patients. Even those with some retrograde nature to their hair loss or the 3% who, very unfortunately, will hit the dreaded NW VII at a reasonable age should still have at least a narrow strip of truly permanent follicles in the heart of the harvesting area. This is essentially where strips were taken, and everything was seemingly okay.

 

However, the follicular unit extraction (FUE) procedure began returning to prominence in the mid 90s onward and suddenly the SDA became a very important issue. It may not seem like it, but this is where it really became a 'hot topic' in the HT world. Most of what is published in hair restoration is released in the 'Forum International' journal through the ISHRS. There is a lot of good information in these journals, but it sometimes doesn't reach the online patient population. If you read these journals throughout this time period however, you'd find that there were actually A LOT of people looking into the SDA dilemma. One of whom was Dr Unger. He did a study in the late 90s or early 2000s (my dates could be slightly off here) to determine which regions of the scalp truly expressed DHT-resistant follicles and could be safely utilized for harvest. As expected, the region was the area utilized more frequently in strip procedures. So this put the issue to bed, right?

 

Well, no. You see, many FUE practitioners had begun to push the limits of donor harvesting and started experimenting with regions outside of the zone re-defined by Unger. This led to a whole new classification of: 'Safe Donor Area (SDA),' 'pretty SDA,' and 'not SDA.' I don't recall the exact terminology off the top of my head, but it was somewhere along these lines and you get the general picture. Obviously, this stirred up more controversy. However, this is basically where we are today: with strip harvesting and small non-strip harvesting procedures, you can pretty much stay within the true SDA (as defined by the studies). In larger non-strip (IE FUE) harvesting procedures, however, you'll likely start to creep into the 'pretty SDA' regions.

 

Now, what's important to realize is that harvesting in the pretty SDA regions isn't inherently wrong. BUT, this statement only holds true if the HT surgeon does a very thoroughly scalp examination, determines the safety of the pretty SDA region (which, I'll admit, is a bit of a scary task), and informs the patient of precisely where they are harvesting from and the potential fate of these follicles.

 

In this sense, some less DHT-resistant follicles may be transplanted. Is this right or wrong? I think it's tough to say. Like I said above, it really comes down to professional judgement and full disclosure.

 

What's more, all of above pertains to individuals with AGA. Other types of alopecia make this a very, very different discussion.

 

I think this is an important conversation to have with your HT doc. Especially if you have reason to believe you may experience thinning in the 'pretty SDA' areas I described above OR if you're planning a large non-strip harvest session. Hopefully this will help a few guys out.

 

And, BeHappy, I hope this didn't sound like I'm trying to skirt around any of the issues you mentioned. Obviously this is something to consider and thoroughly understand before 'taking the plunge!'

[Melvin- Admin]

Dr. Bloxham id say nearly half of Norwood 6 men I see have retrograde alopecia, their sides remain high that keeps them a Norwood 6. In addition, hair density in all people decreases with age, if you compare a man with AGA when he was 30 his donor density will not be the same when he's 70, how much the donor area will thin is really unknown, I think most low Norwood guys are pretty safe but for those Norwood 5 and above there's a good chance the donor area will thin significantly. This is what I see day to day, for example Danny Devito he's been a Norwood 6 since the 80's but now his donor area looks significantly thinner, if he would've gotten an FUT when he was younger, I'd venture to say his scar would be visible in most situations. It may be bad for your business but it's something men with severe hairloss need to consider.