The Critical Science of Donor Capacity Assessment in Hair Restoration
For most patients, a hair transplant is a means to an end. There is a mental image that they hope to achieve of a full head of hair, a younger, more confident version of themselves. Potential customers are certainly drawn in by glossy before and after photos and talk of exciting new technology. But at the end of the day, only one thing really matters to patients and that is the result. It is the combination of the scientific elements of a hair transplant and its artistic execution that makes the difference between a successful surgery and a disaster.
Hair Transplant Donor Analysis is one of the most important, and often most overlooked scientific elements of a hair transplant surgery. It is essential to preserve long-term hair quantity and quality. There is a risk of negative consequences for both over-harvesting the donor area as well as under-harvesting it. This article will provide insight into what makes up an accurate and honest assessment of the donor capacity, and its importance for a successful hair restoration surgery.
Hair Transplant Donor Analysis (Donor Capacity Assessment)
Hair transplant donor analysis involves assessing all of the unique features of a patient’s hair and follicles to come to an accurate and honest understanding of the total biologically available and sustainable hair supply available for the transplant. This helps to determine the maximum number of grafts that can be safely and ethically harvested and also what they will look like once they are transplanted into the scalp. This should be the starting point of the surgical plan and is key to avoiding over-harvesting and subsequent devastating effects.
Hair transplant donor analysis is not simply a total graft count, rather, it should be an in-depth evaluation of a patient’s permanent donor area (back and sides of the scalp) to include quantity, quality and viability. This is the most critical component of a successful surgery and should be a no-skips step in the process of hair restoration. It involves a detailed and accurate analysis of a few key components which include.
Hair Transplant Donor Density and Hair Follicle Unit Composition
Hair transplant donor analysis begins with an understanding of density and more specifically follicular unit density. The surgeon will use a handheld densitometer or video dermatoscope to magnify an area of the donor region (usually 1 cm squared) and count the number of follicular units (single groupings of 1-4 hairs) present, as well as the composition of these units. Follicular units should be counted rather than single hairs, as two or three hair units can take up the same amount of space as a single hair unit and give the illusion of high density when in actuality the follicular unit density is low.
Hair caliber (thickness), color, and contrast with the scalp color are other important variables that greatly affect the visual result. Hair caliber is a big multiplier effect when it comes to hair coverage and visual density. A patient with lower total hair density but very coarse, thick, and dark hair will be able to yield a similar visual result as a patient with a high density of thin hair. Darker hair on light skin is more contrasted against the scalp, so the surgeon may need to place more grafts to achieve the appearance of density. Light hair on white skin is less contrasted so the surgeon will need to place fewer grafts to create the appearance of density. Curly hair also has better coverage and volume than straight hair and is also a more important variable to take into consideration.
Hair transplant surgeon also examines the scalp laxity of the donor area as this is another very important variable. Scalp laxity is the looseness or looseness and flexibility of the scalp skin. It is an especially important factor for Follicular Unit Transplantation (FUT or strip) as it will directly affect the maximum width of tissue that can be safely harvested and closed with the least tension (least scarring and visible thinning). This is also a factor with FUE as FUE on poor laxity scalp is more technically difficult and will often have a higher transection rate during extraction as well as longer healing times. Scalp laxity can be improved with exercise. These are just a few important factors and variables that the surgeon should assess and examine during a hair transplant donor analysis.
Recipient site planning and graft placement strategy
Hair transplant donor analysis is an essential step in the surgical process and should be the starting point of every surgical plan. The surgeon should use the data collected from the donor assessment to carefully plan a patient’s procedure. This starts by setting realistic goals. The total number of grafts available in the donor area (the donor budget) immediately and biologically determines how much coverage and what is possible to achieve with a single session. It also immediately sets a realistic plan and goal. This prevents the unethical practice of over-promising and poaching, where the surgeon will take every single graft that a patient has and leave them with a thinned-out donor area and no grafts for future coverage.
Hair transplant donor analysis also guides and directs the surgical technique. There are very objective reasons why a patient would be a good FUT candidate (high density, excellent laxity, no desire for a shaved hair style) and a reason a patient may be a better FUE candidate (lower laxity, desire for shaved look, a small number of grafts needed).
Hair transplant donor assessment will also allow for the most precise and artistic planning of the recipient site and graft placement strategy. For example, the donor analysis will help the surgeon know how many single hair grafts are available for the creation of the most soft, irregular hairline possible. The surgeon also knows the composition of the grafts available and can place finer hairs in some areas and the coarser in others, to mimic the natural growth pattern of hair density. The best hair transplant surgeries also strive to create more of a gradient and transition between bald and dense areas of the scalp to mimic that of natural hair.
Hair transplant donor assessment will also allow the surgeon to make the best long-term, master plan for the patient. Hair loss is a progressive condition. An ethical surgeon will use the donor assessment to plan for the patient’s future of decades, not just the coming year. There should always be an effort to conserve the donor bank and leave some grafts for potential future sessions as native hair continues to thin. The aim should always be to create a result that ages with the patient gracefully and looks natural and not the dreaded “isolated tuft” look, where the transplanted hair stands alone as the rest of the surrounding native hair continues to fall out over the years.
Hair Transplant Donor Assessment: The starting point of any surgical plan
Hair transplant donor assessment is an essential step that should not be skipped. In fact, it is the most important aspect and variable to any hair transplant surgery and has the most impact on the outcome. The assessment should be a no skips step in every hair transplant and is the starting point of every surgical plan. Neglecting to complete an accurate donor assessment can result in a number of negative consequences including.
Over-harvesting of the donor area: The worst outcome and the greatest risk to the patient is the over-harvesting of the donor area. This will lead to an irreversible and devastating destruction of the donor area. It will often be visibly thin, patchy, and scarred. A compromised donor area will be impossible to cover with short hair and it will eliminate the patient’s future options for repair or even the ability to add density with future sessions.
Failure and poor growth: Harvesting miniaturizing hair or from a poor quality donor area with poor extraction methods will lead to a poor graft survival rate. In other words, all the effort and recovery of the surgery and a disappointing result.
Artificial and Unnatural Transplant Aesthetics: Finally, a poor hair transplant donor assessment may lead to transplanting with poor aesthetics. These transplants look artificial and “obvious” to the trained eye. Some examples of this would be transplanting obviously thick three-hair grafts in the hairline. Another example would be creating a solid uniform unnatural-looking density.
Hair transplant donor analysis is a key element to achieving a successful hair transplant. It is also a key part of understanding the experience of any reputable and ethical hair transplant clinic and surgeon. A surgeon who will spend significant time and effort doing an analysis of a patient’s donor area and provide that data, as well as an objective surgical plan, is a good sign of an expert surgeon.
