How is the Hair Transplant Yield in Donor Strip Scar Tissue?

The only solution to treat strip (FUT) hair transplant scars is by grafting the scar with FUE to coverage, How is the Yield of the FUE Grafts in Donor Strip Scar Tissue?

Category: General Hair Transplant FAQs
Roberto
Asked 12 years ago
Roberto

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Donor area scar FUE

This is a case of scalp hair transferred by FIT to a small region of the scar. Only a small region was transplanted because the patient was very frightened about surgery due to the donor strip scar he received from his prior hair transplant. He was also very concerned about the appearance of his "pluggy", unnatural looking grafts on top of his head. Therefore, we took out a few of the unnatural grafts and we put some hair into the donor scar. Some of the hair in the donor scar is from the old plugs in his recipient area that was transferred to the donor area scar. He wanted to do a very small session to see how it would look in the long run. He was understandable "gun shy" after his first bad experience with hair transplant strip surgery.

It would be helpful to have a photo of the donor area pre-operatively to assess the growth here, but I recall the case well since I did the procedure in Greece. The grafts were extracted very cleanly and were very good. The area of scar at the end is wider and as is often the case. The end will widen when a suture is tied over the incision line. This is quite common and generally is due to poor technique though I've seen it occur occasionally even when the technique was good.

This case brings up a few good points worth making. First, when you transfer head hair to the head you expect a 75 - 90% yield. When you transfer head hair to the body, you can expect a 40 to 60% yield. The first-year survival rate of body hair to head hair is about 40 to 60%. We can expect it to approach 90%, but it is still too early to know for sure.

What is going on here? The number of hairs in the growing phase, anagen, varies from one region of the body to another. We find that it varies from 40% to 60% on the body though we recently found a much higher anagen rate on a patient who had 5400 grafts taken from his chest alone. He was quite hairy so it may be that the percentage of hairs in anagen is much higher in individuals who are quite hairy. Many of his grafts were two hair grafts, which is not as common on the chest. He also had a much higher percentage of three hair grafts on his chest. The anagen rate on the scalp is much higher. Here we see a rate of about 90% though it may be as low as 75% and still be within the normal rate. I don't think I've seen a rate this low, but I have seen a few guys with a rate in the 80s. The percentage of hairs in anagen also tends to decrease in the lower regions of the scalp.

When you move hair from one region to another, the hair tends to take on new characteristics. We know from studies that the percentage of hairs that grow and are in anagen is much less from head to the body. the one good study showed the rate was only 60%. It follows that we should see a much higher rate of growth from body to hair. the percentage of growing hairs should increase toward the 90% range though it may only get to 75%. It does not mean the hairs did not survive or that they will not grow. It means that they will not grow until they switch from resting (telogen) to growing (anagen).

When we do body hair transplants, the percentage of hairs in resting (telogen) is much higher. We still plant these hairs, but it may take them 2 or 3 years to grow. Woods has found that the percentage of growing body hairs increases in the second year. This is very interesting. We have seen up to 80% growth from body hairs (20 out of 25), but in this case, we transplanted only anagen hairs. This seems to confer our belief that the telogen hairs will not grow in the first year in most instances. We have also seen that the region we graft into tends to control the rate of growth. For instance, we transplanted hairs from the leg to the region above the ear on one patient. This patient had a lift and the scalp lift from Brandy elevated the region above the ears and gave him "white walls". We add the leg hair and a very high percentage grew from the beginning and it grew longer than when it was on the leg. Therefore, there appear to be factored in the dermis which controls the anagen ratio, the length of growth, and the time from transplantation to growth. Perhaps this is why some individuals get a much higher rate of growth immediately following transplant surgery. there is something in the dermis.

In this case, I count up to 11 growing grafts in the area of the scar. This is a growing rate of 85%. Of course, number 6 could be only a shadow so the rate could be slightly lower. I took this photo and zoomed in. I then circled the individual grafts. From many transplant studies done in the past, a rate of growth in the 70 percent range has been seen for the scalp to scalp transplant surgery. In some individuals, you will find that the rate of growth will continue to increase up to the 18-month mark. Therefore, it is possible that the rate will increase higher into the 80% range though I do not suspect it will hit the 90% range.

The next point is that the donor scar is taking on more of the color of the surrounding donor area. You can see that the non-grafted area is more white or pink. The grafted area of the scar takes on a different color more similar to the natural donor region. This is important for many reasons. The donor scar has a different color than the surrounding area. If the hair in the scar were not capable of changing the color of the scar, it would result in a much greater contrast from the surrounding donor area even if it were covered by new hair grafts. Taking on the surrounding color rather than the scar color helps to eliminate this contrast and create a more natural result that one can conceal with shorter hair.

All of these grafts were done with FUE so there is no new strip scar. By the way, this strip scar is about 2 to 3 mm wide (except for the grafted area which is much larger and is at the end of the strip scar). Two to three mm is the average width you can expect from strip scars. The best strip scars are 1 mm wide and these are quite less common. I outlined the strip scar in the zoomed-in photo so you can see it more clearly.

john
Answered 12 years ago
john

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