donor scar placement: how high can you go?

[Megatron]

I'm talking about a ~30cm strip which I believe is needed for 3,000+ grafts. I remember reading that the best place to extract from is right above the bumps of the neck bone, but below the bump of the crown in the back of someone's head. But, my question is how far upward should you go towards the ears?

 

I'm asking because I've seen varying placements of the donor strip from many top docs. Some go very high above the ears which is ideal to conceal the scar. But, how could one be sure that these hairs aren't susceptible to DHT? And what if the hair receeeds to expose the scar. What then?

 

Going lower and reaching around just above the ears is certainly a bitch to hide, but it seems like the safer bet.

 

Your thoughts?

[Bill - Seemiller]

Megatron,

 

The answer to this isn't so cut and dry, but I'll do my best to try to answer this.

 

Many leading hair transplant surgeons will extend into the upper areas well above the ears since in many cases, the densest and most viable hair resides there. It's also typically easier to conceal and hide the scar in these areas. Moreover, additional risks of scar stretching exist when hair is excised too closely to the ears. To stay within the universal safe zone, physicians who extend into the upper levels won't want to extend too closely to the temples since this area may be at risk for further loss depending on the patient. Some physicians will risk extending into these areas (with patient consent) if they feel the risks are minimal of loss to these areas and to harvest more grafts.

 

Depending on the patient's characteristics, some physicians may decide harvest the strip in the lower levels a little closer to the ears if they feel the best hair for transplanting resides there. While some additional risks of stretching exists and concealing the scar may be more difficult in some cases, I've seen beautiful scars in areas closer to the ears easily concealed by existing hair.

 

Evaluating a patient's individual characteristics will be vital for the physician in determining the best places to harvest the strip for surgical hair restoration. That said, I'd recommend discussing all aspects of the surgery with your physician, including his game plan for harvesting the strip. That way, the benefits and risks of all approaches are discussed and the decision making process is collaborative.

 

All the Best,

 

Bill

[Megatron]

Thanks Bill for your very informative and thorough response, as usual.

 

When I had my HT done a few days ago I didn't think twice because my donor strip matched the charts I saw that display where the "donor area" is versus where the "sides" are versus the "lateral humps" versus the "recession" etc...

 

But, the day after my HT (mainly because I've got all this time on my hands right now! LOL) I noticed several people's donor strip go much, much higher than mine.

 

I hear what you're saying about each patient being different. But, isn't it common sense to assume that it's riskier the higher you go? Or perhpas some doctors have so much experience that they can be relatively sure that it's safe to go higher for certain patients? If so, I would love to hear them explain how they judge this!

 

I'm not being facetious here. I truly don't know the answer, but I think it's an important question.

[Dr. Ricardo Mejia]

As Bill mentioned, alot depends on the clinical exam of the patient. I do not like to go to low or close to the ear because tof the risk of visibility if you have thinning in this area. As a general rule, some state approx two finger breadths. You can go higher if a patient has better donor area and you do not feel they are at significan t risk of recession. Age plays a major role as well. In the end, it depends on the clinical circumstance. In some cases, there is more tissue laxity as you go higher which allows you to get a wider strip and more grafts.

[Dr. William Lindsey]

Dr. Mejia gave an excellent response.

 

About a month ago we saw a patient from another clinic who probably had injury to the facial nerve from a hair transplant. The doctor had gone all the way to the front edge of the side burns on the lateral strip and had injured the nerve which raises the eyebrows.

 

That is an extremely rare occurance from hair procedures and extending the strip that far anteriorly is something that I haven't seen before. Its also something I don't want to see again.

 

Dr. Lindsey McLean VA