This chapter on the PDF below was co-written by John Cole and Walter Unger. Both authors will refer to themselves as third persons throughout the chapter because their views and practices are not always the same. References to “Unger” and “Cole” should be understood to represent the views of only that co-author unless otherwise indicated. In addition, both authors contacted many practitioners, privately, and their opinions are presented as “private communications” after obtaining their approval.
Perhaps the most important factor in predicting successful hair restoration surgery is appropriate patient selection by the physician and physician selection by the patient.
There are four elements to this selection process: understanding the patient’s goals, the physician’s ability to meet the patient’s goals, conveying those abilities to the patient, and the patient’s physical examination. Three of these elements involve communication skills and a psychological or personal assessment but are meaningless without the physical exam of both the recipient and potential donor areas, which is in fact the basis of a scientific approach to hair restoration surgery. This chapter deals with the examination and management of the latter.
Every donor region has specific characteristics that allow the informed hair restoration surgeon to customize an approach to the individual patient. Failure to recognize these individual characteristics does not always doom the hair restoration process, but it does limit the physician’s ability to precisely control it.
At one time, few truly objective findings were included in the assessment of the donor area. This is no longer the case. Alt, Unger, Rassman, and Bernstein might be considered the “fathers” of modern donor area assessment. Alt and Unger researched the limits of the safe donor area. Unger championed the concept of multiple donor sites for a variation in hair caliber and color. .1 Rassman introduced the need for accurate measurement of the donor hair density and attempted to accurately quantify the available donor area. Bernstein introduced the important concept of hair volume.
Collectively, their work has laid the foundation for the scientific assessment of the donor area and more accurate predictions of anticipated coverage. Unfortunately, despite their efforts, few physicians seem to recognize the importance of accurate donor area measurements.
Donor area management may be broken into the following individual components:
delineating the “safe” donor area, the physical examination of the “safe” donor area and recipient area, the method of harvest and closure, subsequent procedures, the efficiency of the technique, and complications. Present knowledge as it relates to each component is presented in this chapter but it is worthwhile emphasizing that each requires further study.
This is a detailed discussion of the donor region, its science, and how we approach it from a diagnostic, as well as, surgical point of view. This is very detailed for the discriminating consumer, which is who we cater to.
By John P. Cole, MD