Safe donor area?

[Patrick_Joyce]

I have some questions about the safe donor area. @Zoomster had mentioned a couple of things that made me start wondering.

1) What/where exactly are the boundaries of the "safe donor area?" It seems so many transplant surgeon's have different ideas of where the boundaries are (ie, some are more narrow, some go further into the temples, etc).

2) Many prominent surgeons like Feller, Shapiro and Rassman claim that FUE has a lower yield than FUT and cannot harvest as many grafts from the donor; they often site that for most people, a healthy donor can give a max of 5,000-6,000 grafts (in total, not at all once) before it becomes depleted. When you look at surgeons like those at Eugenix and Pittella however, they routinely obtain at or well above 6,000 FUE grafts on their client's. Even clients like @Bandit90 and @Zoomster that had compromised donors to begin with, those surgeons were still able to harvest at or well above 6,000 grafts while still having more left to spare in the donor. How are they doing that? Are they going outside of the safe donor area?

3) Some state that the safe donor area might be different for for each person and that the it might be larger for some than it is for others because for example they aren't a Norwood 7 pattern and therefore their crown or lateral humps doesn't dip as low; they determine this through close assessment and mapping for miniaturization. Well how do they know that an area that currently isn't miniaturized won't start to miniaturize in the future? Or that a Norwood 6 who perceivably has a larger donor area won't start to progress to a Norwood 7? If graft are taken from that expanded zone, they can be lost in the future, no?

[A_4_Archan]

@Patrick_Joyce

There are no different ideas about a safe donor and everything is crystal clear to doctors but some doctors do tend to move out of it to match up the required number of grafts....

Ofcourse donor area will vary from patient to patient....some people can get more grafts and some people gets lesser and this depends on head size and shape and number of grafts available in the safe zone

Some people can get more hairs(not grafts) comparatively if he/she has more number of multiple hair grafts available at the donor site...so this all depends on such factors/scenarios

Imo FUT do have an upper hand when it comes to lifetime availability of total number of grafts from the donor but this advantage does have some shortcomings too...

Hairloss can't be predicted and thats why safe zone is perfectly determined...though it isn't that grafts taken out of the safe zone are 100% resistant to DHT but they are less prone to DHT and it can get thin/miniaturized with time(very long) but less likely to fall off in near future...

Edited August 6, 2023 by A_4_Archan

[Patrick_Joyce]

24 minutes ago, A_4_Archan said:

@Patrick_Joyce

There are no different ideas about a safe donor and everything is crystal clear to doctors but some doctors do tend to move out of it to match up the required number of grafts....

Ofcourse donor area will vary from patient to patient....some people can get more grafts and some people gets lesser and this depends on head size and shape and number of grafts available in the safe zone

Some people can get more hairs(not grafts) comparatively if he/she has more number of multiple hair grafts available at the donor site...so this all depends on such factors/scenarios

Imo FUT do have an upper hand when it comes to lifetime availability of total number of grafts from the donor but this advantage does have some shortcomings too...

Hairloss can't be predicted and thats why safe zone is perfectly determined...though it isn't that grafts taken out of the safe zone are 100% resistant to DHT but they are less prone to DHT and it can get thin/miniaturized with time(very long) but less likely to fall off in near future...

@A_4_Archan Yes, because some pictures I've seen of post op with some doctors, the area seemed well outside of what other doctors consider the safe donor zone.

And when I speak of the number of grafts obtained, I'm not referring to the quality of the donor itself and their hair density etc, I'm referring again to the size of the area where grafts were extracted from. For instance, I've seen some doctors go and extract grafts from higher up into the lateral humps and right up into the fringe of where the hairloss in their crown is because their hairloss pattern is a 6 and there is no miniaturization beyond those boundaries. But how do they know those lateral humps won't start to miniaturize in the future and progress to a Norwood 7?

[A_4_Archan]

@Patrick_Joycethose cases which you are seeing are clear example of taking out grafts from not so safe or unsafe zone and there are no two opinions regarding this ..

[Patrick_Joyce]

30 minutes ago, A_4_Archan said:

@Patrick_Joycethose cases which you are seeing are clear example of taking out grafts from not so safe or unsafe zone and there are no two opinions regarding this ..

@A_4_Archan why would surgeons do that if those grafts will end up falling out?

So major FUE procedures like Bandit90 and Zoomster, I'm not sure if you saw their stories and pictures of the donor after surgery but were a lot of their grafts taken from outside the safe zone?

[GoliGoliGoli]

It isn't at all uncommon on here to see grafts taken from areas that are already thinning, or that will likely thin in the future. 

Here's the point: Never just blindly trust your surgeon/clinic. A lot of people think that "doing research" on a HT is just finding a Dr who has good reviews from people who were in a similar situation that you're in and then pulling the trigger. But it's a lot more than that. If you're serious about getting a HT then YOU need to become an expert on how to plan a HT. Even if your Dr is ethical, only you can ensure that you construct a lifelong plan that fits your needs. 

You're asking the right questions though. 

[Patrick_Joyce]

5 minutes ago, GoliGoliGoli said:

It isn't at all uncommon on here to see grafts taken from areas that are already thinning, or that will likely thin in the future. 

Here's the point: Never just blindly trust your surgeon/clinic. A lot of people think that "doing research" on a HT is just finding a Dr who has good reviews from people who were in a similar situation that you're in and then pulling the trigger. But it's a lot more than that. If you're serious about getting a HT then YOU need to become an expert on how to plan a HT. Even if your Dr is ethical, only you can ensure that you construct a lifelong plan that fits your needs. 

You're asking the right questions though. 

@GoliGoliGoli So the Dr's at Eugenix and Pittella go outside of the safe zone?

[GoliGoliGoli]

It depends what you mean by safe zone. If you're talking about the thin strip from the mid ear to the top of the ear, then yes of course they do. You can confirm that for yourself simply by looking at any high/medium norwood's post op pictures. 

[GoliGoliGoli]

What you're probably asking about though is something that is more accurately called the "Patients Predicted Safe Zone". And of course this varies patient to patient. But yes even by that definition there are certainly plenty of cases where Dr's harvested grafts in areas that seem to quite obviously be prone to future thinning. 
 

[A_4_Archan]

5 hours ago, Patrick_Joyce said:

why would surgeons do that if those grafts will end up falling out?

Only they can answer this...

Sometimes the grafts available in safe zone are not enough to fill up the area to be transplanted so they have to go out of the safe zone ..now whether they do this keeping the patient in loop or not can only be answered by the particular patient....i guess i have seen Melvin stating that they took some grafts from outside the so called safe zone and they was no option as his safe zone was already exhausted and he was in loop and willing to take a calculated risk...but as he is on medication those hairs can be preserved....

[Bandit90]

 

17 hours ago, Patrick_Joyce said:

I have some questions about the safe donor area. @Zoomster had mentioned a couple of things that made me start wondering.

1) What/where exactly are the boundaries of the "safe donor area?" It seems so many transplant surgeon's have different ideas of where the boundaries are (ie, some are more narrow, some go further into the temples, etc).

2) Many prominent surgeons like Feller, Shapiro and Rassman claim that FUE has a lower yield than FUT and cannot harvest as many grafts from the donor; they often site that for most people, a healthy donor can give a max of 5,000-6,000 grafts (in total, not at all once) before it becomes depleted. When you look at surgeons like those at Eugenix and Pittella however, they routinely obtain at or well above 6,000 FUE grafts on their client's. Even clients like @Bandit90 and @Zoomster that had compromised donors to begin with, those surgeons were still able to harvest at or well above 6,000 grafts while still having more left to spare in the donor. How are they doing that? Are they going outside of the safe donor area?

3) Some state that the safe donor area might be different for for each person and that the it might be larger for some than it is for others because for example they aren't a Norwood 7 pattern and therefore their crown or lateral humps doesn't dip as low; they determine this through close assessment and mapping for miniaturization. Well how do they know that an area that currently isn't miniaturized won't start to miniaturize in the future? Or that a Norwood 6 who perceivably has a larger donor area won't start to progress to a Norwood 7? If graft are taken from that expanded zone, they can be lost in the future, no?

It's very hard to determine what is a safe zone. In my situation, though a Norwood 7,  I could take the view there would be no further progression of hair loss as my final  pattern is firmly established. But because I went bald so young there is a chance (albeit small) that my sides could dip as I got older. Now If I were to take the totally risk-adverse approach and only extract grafts from the 'guaranteed' safe zone, I would probably only have enough grafts for a hairline (and would be pointless even contemplating hair restoration). So to allow me to utilise my full donor area, I take out an insurance policy in the form of Finasteride, to protect the area outside of the 'guaranteed' safe zone from the small chance it could be susceptible to further hairloss. Now should there by any sign of hair loss progression own the line (as we know fin only slows down hair loss) there is a an acceptance from me I would have to jump on Dutasteride. 

 

[Patrick_Joyce]

7 hours ago, Bandit90 said:

 

It's very hard to determine what is a safe zone. In my situation, though a Norwood 7,  I could take the view there would be no further progression of hair loss as my final  pattern is firmly established. But because I went bald so young there is a chance (albeit small) that my sides could dip as I got older. Now If I were to take the totally risk-adverse approach and only extract grafts from the 'guaranteed' safe zone, I would probably only have enough grafts for a hairline (and would be pointless even contemplating hair restoration). So to allow me to utilise my full donor area, I take out an insurance policy in the form of Finasteride, to protect the area outside of the 'guaranteed' safe zone from the small chance it could be susceptible to further hairloss. Now should there by any sign of hair loss progression own the line (as we know fin only slows down hair loss) there is a an acceptance from me I would have to jump on Dutasteride. 

 

Interesting, this is the first I knew of doctors doing this. Even with beard grafts involved, in the risk-averse situation, they would have only been able to do a hairline?

[Patrick_Joyce]

22 hours ago, GoliGoliGoli said:

It depends what you mean by safe zone. If you're talking about the thin strip from the mid ear to the top of the ear, then yes of course they do. You can confirm that for yourself simply by looking at any high/medium norwood's post op pictures. 

Well I meant through FUE not FUT.

[GoliGoliGoli]

3 minutes ago, Patrick_Joyce said:

Well I meant through FUE not FUT.

Does not matter. 

[Patrick_Joyce]

31 minutes ago, GoliGoliGoli said:

Does not matter. 

Oh when you said strip I thought you were referring to FUT, I apologize. 

But yes within that strip of scalp considered "safe donor" the average person has about 6,000 grafts they can get right?

[GoliGoliGoli]

13 minutes ago, Patrick_Joyce said:

Oh when you said strip I thought you were referring to FUT, I apologize. 

But yes within that strip of scalp considered "safe donor" the average person has about 6,000 grafts they can get right?

I'm honestly not sure, probably varies patient to patient.

Even googling "safe donor area" and looking at the images you'll see different heights of what is suppoedly the safe donor area. So it really depends. 

[Patrick_Joyce]

1 hour ago, GoliGoliGoli said:

I'm honestly not sure, probably varies patient to patient.

Even googling "safe donor area" and looking at the images you'll see different heights of what is suppoedly the safe donor area. So it really depends. 

I noticed that as well when I googled. I even came across how doctor Umar came up with something called the FUE shave test to determine if someone will develop retrograde alopecia; if not then he can  expand the donor area to include the name of the neck.

[GoliGoliGoli]

Whats the test? Post link please

[Patrick_Joyce]

22 hours ago, GoliGoliGoli said:

Whats the test? Post link please

@GoliGoliGoli here it is:

https://dru.com/dr-us-shave-test-identifies-nape-hair-candidates-for-more-natural-looking-hairline-transplant-outcomes-in-los-angeles/?amp

[GoliGoliGoli]

Ok ya, basically just shaving the retrograde area and looking for signs of miniaturization. Lol the way Umar makes it sound is like it's some novel innovative process. 

Edited August 8, 2023 by GoliGoliGoli

[BackFromTheBrink]

14 minutes ago, GoliGoliGoli said:

Ok ya, basically just shaving the retrograde area and looking for signs of miniaturization. Lol the way Umar makes it sound is like it's some novel innovative process. 

Elon Musk: we are the first manufacturer to achieve autonomous driving that is 5 times safer that a human driver

 

GoliGoliGoli: ok, ya, you used maths to predict what stuff is using a camera as input and copied how real drivers react, I thought you'd done something impressive for a second there.

[GoliGoliGoli]

1 minute ago, BackFromTheBrink said:

Elon Musk: we are the first manufacturer to achieve autonomous driving that is 5 times safer that a human driver

 

GoliGoliGoli: ok, ya, you used maths to predict what stuff is using a camera as input and copied how real drivers react, I thought you'd done something impressive for a second there.

Are you really comparing designing a self driving car with shaving someone’s head and scanning visually for signs of miniaturization? You’ll go far kid, keep it up 

[BackFromTheBrink]

1 minute ago, GoliGoliGoli said:

Are you really comparing designing a self driving car with shaving someone’s head and scanning visually for signs of miniaturization? You’ll go far kid, keep it up 

No. Self driving is a very complex problem. I'm sure you're an expert too (please tell me you are since we are looking for engineers). Happy to discuss how far we've both gone if you want, though sadly I'm far from a kid. 

It was an exaggeration to make a point.

If it wasn't clear, the point was you're oversimplifying the research massively, which I found rather arrogant. 

[GoliGoliGoli]

5 minutes ago, BackFromTheBrink said:

No. Self driving is a very complex problem. I'm sure you're an expert too (please tell me you are since we are looking for engineers). Happy to discuss how far we've both gone if you want, though sadly I'm far from a kid. 

It was an exaggeration to make a point.

If it wasn't clear, the point was you're oversimplifying the research massively, which I found rather arrogant. 

Argument by analogy is a really poor way to make an argument. I get that you were exaggerating to make a point, but the analogy and the point you're trying to make is not as good as you think it is. 

How am I over simplifying? It's literally shaving someone's head, and visually scanning for miniaturization in the retrograde area. What about the process or the research am I over simplifying? 

[Patrick_Joyce]

On 8/8/2023 at 3:40 PM, GoliGoliGoli said:

Argument by analogy is a really poor way to make an argument. I get that you were exaggerating to make a point, but the analogy and the point you're trying to make is not as good as you think it is. 

How am I over simplifying? It's literally shaving someone's head, and visually scanning for miniaturization in the retrograde area. What about the process or the research am I over simplifying? 

I guess my thought it how does it know that area also won't miniaturize in the future?