Question on donor over-harvesting

[GoliGoliGoli]

Hi all, quick Q on donor over harvesting. Is the problem with over harvesting simply that it leaves the donor area looking splotchy and patchy?

Asked differently, if you don't care much about how your donor area looks as long as long as your hairline and crown area look good is it a problem to have your donor area over harvested a little bit? Or are their other concerns with over-harvesting other than aesthetics

 

Thanks

 

Edited June 20, 2022 by GoliGoliGoli

[BaldDude]

4 minutes ago, GoliGoliGoli said:

Hi all, quick Q on donor over harvesting. Is the problem with over harvesting simply that it leaves the donor area looking splotchy and patchy?

Asked differently, if you don't care much about how your donor area looks as long as long as your hairline and crown area look good is it a problem to have your donor area over harvested a little bit?

 

Thanks

 

Do a google search for images of it, there's some pretty awful results of it.  And yes it does look worse than natural balding.

Edited June 20, 2022 by BaldBobby

[GoliGoliGoli]

Ok you're right that looks like absolute crap. 

I wonder if a bit of "light" over harvesting would not be so bad though if the trade off meant full coverage in other areas

[Ajamilo]

If you deplest your donor homogenous is better than some places. But you have to do it with a good doctor who understand this. Dr. Mwamba is really good at donor management and also Dr. Pitella. Mwamba did it excellent with my donor so now i can grow it out without looking weird. 

Edited June 20, 2022 by Ajamilo

[MAIZE1694]

5 hours ago, GoliGoliGoli said:

Ok you're right that looks like absolute crap. 

I wonder if a bit of "light" over harvesting would not be so bad though if the trade off meant full coverage in other areas

Depends on how long you like to keep your hair and your skin/hair contrast.

This is my biggest fear as well and has held back my procedure. I have dark hair, fair skin and decent donor but it's not exactly a thicket.

You can always try and plead with your surgeon to spread out the extraction pattern.

Edited June 21, 2022 by MAIZE1694
typo

[Rahal Hair Transplant]

Goli,

yes, overharvesting the donor area has to do with the way the donor area looks and appears after the procedure and when it heals. Most people don’t want the hair on the sides and back of their scalp to appear patchy or unnatural. Taking too much hair will cause this to happen. Technically, if you aren’t concerned about the way you’re done or area looks, more hair contact would be taken to use for the top. But I don’t know how many surgeons I really do this because it’s not really ethical.

Consider this. Right now, you might not be concerned about the way the donor area looks because you are more concerned about the thinning on top of your scalp. But let’s say a surgeon does what you want and takes more done her hair to make the sitting area much thicker. Once you’re content and happy with that, you might begin to regret the way you’re done or area looks.  But once it’s done, it can’t be undone.

Not only that, but doing this will make the surgeon look bad even if it was really your request to do so. People will wonder why a doctor would purposely thin out the donor area even to provide you with more hair on top of the scalp. Plus, without explaining every time you share your results, it will make the surgeon look bad.  Ultimately, the best surgeon to maximize the amount available donor her hair providing you with the best results while also keeping your donor area intact and looking natural.

I hope this helps 

Rahal Hair Transplant 

[Raphael84]

In regard to over harvesting, obviously it is the amount of grafts that are extracted that creates the main issue. But the problems created, do not stop there.

In most cases, it is due the very large graft numbers being taken in single procedure, which is more than the donor can safely provide. In other cases, graft numbers can be more conservative, but when focus is only in the richer occipital rear donor for example and therefore surface area of donor utilised is much smaller, then if not optimally managed, the obvious moth eaten appearance can still occur.

In the punching and extraction process and as follicles are essentially cut from the surrounding tissue, the scalp experiences a level of trauma. The more extraction sites in any cm2 of donor, the more blood vessels below the scalp are disrupted and the more extreme the "trauma".

Due to the "over-disruption" of these blood vessels which are responsible for healing and providing "nutrients" to the follicles that are untouched, healing in these areas can be sub optimal meaning not only have too many grafts been taken from a particular area, but the follicles left in tact also experience decline in terms of potential miniaturisation and thinning of the structure of the hair due to such disruption.

Below I share two videos with Dr. Bisanga explaining these concerns further. The second video due to some blood being visible means it is only available on the YouTube platform, but it is well worth the watch.

 

 

[Eugenix Hair Sciences]

 

 

 

[GoliGoliGoli]

23 hours ago, Raphael84 said:

In regard to over harvesting, obviously it is the amount of grafts that are extracted that creates the main issue. But the problems created, do not stop there.

In most cases, it is due the very large graft numbers being taken in single procedure, which is more than the donor can safely provide. In other cases, graft numbers can be more conservative, but when focus is only in the richer occipital rear donor for example and therefore surface area of donor utilised is much smaller, then if not optimally managed, the obvious moth eaten appearance can still occur.

In the punching and extraction process and as follicles are essentially cut from the surrounding tissue, the scalp experiences a level of trauma. The more extraction sites in any cm2 of donor, the more blood vessels below the scalp are disrupted and the more extreme the "trauma".

Due to the "over-disruption" of these blood vessels which are responsible for healing and providing "nutrients" to the follicles that are untouched, healing in these areas can be sub optimal meaning not only have too many grafts been taken from a particular area, but the follicles left in tact also experience decline in terms of potential miniaturisation and thinning of the structure of the hair due to such disruption.

Below I share two videos with Dr. Bisanga explaining these concerns further. The second video due to some blood being visible means it is only available on the YouTube platform, but it is well worth the watch.

 

 

Thank you for the very detailed answer. I am currently scheduled to get 4000 grafts with a reputable Dr in November. This will be to cover my hairline and scalp. Do you think 4000 over two day session is risky for these reasons you explained? I know 4000 is the maximum most reputable Dr's will do, but is 4000 even pushing it? Asking @Eugenix Hair Science@Eugenix Hair Sciencesas well, thanks!

[Eugenix Hair Sciences]

15 hours ago, GoliGoliGoli said:

Thank you for the very detailed answer. I am currently scheduled to get 4000 grafts with a reputable Dr in November. This will be to cover my hairline and scalp. Do you think 4000 over two day session is risky for these reasons you explained? I know 4000 is the maximum most reputable Dr's will do, but is 4000 even pushing it? Asking @Eugenix Hair Science@Eugenix Hair Sciencesas well, thanks!

It depends from case to case whether the said amount can be extracted. If your donor area is good then definitely it can be extracted.

[Raphael84]

16 hours ago, GoliGoliGoli said:

Thank you for the very detailed answer. I am currently scheduled to get 4000 grafts with a reputable Dr in November. This will be to cover my hairline and scalp. Do you think 4000 over two day session is risky for these reasons you explained? I know 4000 is the maximum most reputable Dr's will do, but is 4000 even pushing it? Asking @Eugenix Hair Science@Eugenix Hair Sciencesas well, thanks!

It really depends on many factors specific to the patient and therefore why a unique surgery approach for each patient is essential.
Donor density is obviously an influential factor. Patients with significantly above average density may be able to achieve higher graft counts providing their donor is healthy.
Density however is not the only consideration.
FUE takes from surface area and therefore patients who may have a dipping or drop in the lower crown or potential retrograde alopecia with thinning from the nape of the neck moving upwards and possibly weakness above and around the ears, may mean that despite a natively higher density, weaker areas limit the surface area viable for FUE extraction.

4000 is pushing the average donor. We would personally prefer to see the patient in person for consultation before recommending or considering a 4000 graft surgery and much more commonly a patient may safely reach 3500 grafts for example. 

If the donor is pushed too much, then due to the overall negative effect that this can have on untouched grafts as detailed in my above post, this would mean that less grafts would be available in subsequent procedures due to a decline in general health of the donor and that is never the preference.

If you have no concerns with dipping in the crown or retrograde alopecia and density is high, then 4000 grafts can be achieved, but again this is not every patient.

The following case is a good example of higher graft counts being suitable.

You can see the patients rear donor has great height. No signs of decline in the lower crown or anywhere within the rear occipital, and you can see the strength and density moving toward the nape which is not so common.

This patient had an average density of 82.5 follicles per cm2 (70 - 75 is an average patient) so he was above average and his donor allowed a "safe" zone of 8cm in height and 32 in length, providing a surface area of 256cm2.
Another patient may only be able to consider a surface area of donor of 180cm2 for example, and therefore density is not the only consideration.
 

 

[GoliGoliGoli]

3 hours ago, Raphael84 said:

It really depends on many factors specific to the patient and therefore why a unique surgery approach for each patient is essential.
Donor density is obviously an influential factor. Patients with significantly above average density may be able to achieve higher graft counts providing their donor is healthy.
Density however is not the only consideration.
FUE takes from surface area and therefore patients who may have a dipping or drop in the lower crown or potential retrograde alopecia with thinning from the nape of the neck moving upwards and possibly weakness above and around the ears, may mean that despite a natively higher density, weaker areas limit the surface area viable for FUE extraction.

4000 is pushing the average donor. We would personally prefer to see the patient in person for consultation before recommending or considering a 4000 graft surgery and much more commonly a patient may safely reach 3500 grafts for example. 

If the donor is pushed too much, then due to the overall negative effect that this can have on untouched grafts as detailed in my above post, this would mean that less grafts would be available in subsequent procedures due to a decline in general health of the donor and that is never the preference.

If you have no concerns with dipping in the crown or retrograde alopecia and density is high, then 4000 grafts can be achieved, but again this is not every patient.

The following case is a good example of higher graft counts being suitable.

You can see the patients rear donor has great height. No signs of decline in the lower crown or anywhere within the rear occipital, and you can see the strength and density moving toward the nape which is not so common.

This patient had an average density of 82.5 follicles per cm2 (70 - 75 is an average patient) so he was above average and his donor allowed a "safe" zone of 8cm in height and 32 in length, providing a surface area of 256cm2.
Another patient may only be able to consider a surface area of donor of 180cm2 for example, and therefore density is not the only consideration.
 

 

So I guess one concern I had with doing 4000 grafts is that it would potentially risk the newly implanted grafts due to swelling/inflammation. Is that not a concern? Reading the above two posts it sounds like the concern is more with regards to the donor area than the implant zone?

[mafpe]

4 hours ago, Raphael84 said:

It really depends on many factors specific to the patient and therefore why a unique surgery approach for each patient is essential.
Donor density is obviously an influential factor. Patients with significantly above average density may be able to achieve higher graft counts providing their donor is healthy.
Density however is not the only consideration.
FUE takes from surface area and therefore patients who may have a dipping or drop in the lower crown or potential retrograde alopecia with thinning from the nape of the neck moving upwards and possibly weakness above and around the ears, may mean that despite a natively higher density, weaker areas limit the surface area viable for FUE extraction.

4000 is pushing the average donor. We would personally prefer to see the patient in person for consultation before recommending or considering a 4000 graft surgery and much more commonly a patient may safely reach 3500 grafts for example. 

If the donor is pushed too much, then due to the overall negative effect that this can have on untouched grafts as detailed in my above post, this would mean that less grafts would be available in subsequent procedures due to a decline in general health of the donor and that is never the preference.

If you have no concerns with dipping in the crown or retrograde alopecia and density is high, then 4000 grafts can be achieved, but again this is not every patient.

The following case is a good example of higher graft counts being suitable.

You can see the patients rear donor has great height. No signs of decline in the lower crown or anywhere within the rear occipital, and you can see the strength and density moving toward the nape which is not so common.

This patient had an average density of 82.5 follicles per cm2 (70 - 75 is an average patient) so he was above average and his donor allowed a "safe" zone of 8cm in height and 32 in length, providing a surface area of 256cm2.
Another patient may only be able to consider a surface area of donor of 180cm2 for example, and therefore density is not the only consideration.
 

 

does this mean usually after 3500 grafts, on average person the donor area would start to look "thinned"?

i had thought that we're okay until around 5000/6000 grafts since that seems to be like the limit on most people graft count with high NW

[Raphael84]

42 minutes ago, GoliGoliGoli said:

So I guess one concern I had with doing 4000 grafts is that it would potentially risk the newly implanted grafts due to swelling/inflammation. Is that not a concern? Reading the above two posts it sounds like the concern is more with regards to the donor area than the implant zone?

The original question was in regard to the donor area and over harvesting.

In terms of the recipient, the higher the placing density in each cm2, the more competition for blood.

The most important factor here is the performing doctor, their ethics, their donor management, their approach in terms of design and density etc

In the right patient and candidate, 4000 grafts is completely viable. Can the average patient safely reach such numbers? At consultation most patients are more commonly within the 3000 - 3500 range for their own best interests and to allow larger overall graft availability in subsequent surgeries.

26 minutes ago, mafpe said:

does this mean usually after 3500 grafts, on average person the donor area would start to look "thinned"?

i had thought that we're okay until around 5000/6000 grafts since that seems to be like the limit on most people graft count with high NW

The reason to limit harvesting appropriately within each patient is to avoid the donor looking thinner.

As detailed, below your scalp in your donor area you have small blood vessels that will play a crucial part in donor area healing post surgery. it is important not to make too many extraction sites within any cm2 in one single surgery that would put too much in terms of demand on these blood vessels and could therefore compromise healing.

Capping surgery to an appropriate graft number that your donor can safely handle, will encourage optimal healing and would then allow further harvesting of more grafts from your donor area in a subsequent surgery. In the average patient this would then allow harvesting of higher graft numbers such as the 6000 graft example that you have cited and if optimally managed in terms of extraction pattern, then such numbers can be attained without signs of over harvesting in the donor.

This is one element that is often overlooked. Many patients choose to "roll the dice" in terms of their chosen clinic, with the mentality of, if I can achieve my objectives at one half or one third of the cost, then I will take the chance/risk, and if things do not go to plan, then I can consider repair surgery.

The concern with such an approach is a damaged donor can never be "repaired". Sure you can place some beard or body hair into the area at high cost and with no guarantee of growth to break up the contrast of scalp and hair, but once a donor is negatively impacted, you will never be able to harvest the same graft numbers that a well managed donor could provide.
This is without even considering the complications within the recipient.

With poor quality surgery, even if growth is acceptable and the patient is satisfied in terms of their result, oftentimes donor management is non optimal meaning if there is a further requirement for surgery in the future due to progressive loss for example, then limitations are in place that may not have been necessary, had the donor been better managed.

Any surgery no matter how small or large, should always have long term as priority. This is both in terms of appropriate hairline design as we age, and depending on each patients unique status, planning appropriately for potential future reliance on the donor.