Today I would like to discuss donor scars in the “strip harvesting” technique in hair restoration surgery and how to approach them. The trend in many clinics is towards larger procedures which many patients request. Most people would like to get as much done as possible in one sitting, and for the clinic this can mean larger fees. However, this is not always in the best interest of the patient for many reasons. Firstly, there is a diminishing return in graft growth as the grafts are kept outside of the body for long periods of time. In “mega-sessions” of 3000+ follicles, this tends to become an issue. In addition, the only way to harvest 3000+ follicles in most people, is take a width of donor strip that exceeds 1.7 cm and in many cases even 2.0 cm. The studies have clearly shown that with donor strips this wide, even if all the other necessary precautions are taken in wound closure, there is a much higher incidence of scar widening, hair shock, and various other problems that can be encountered in the donor region. It is for this very reason that the largest case size I will perform is about 3000 follicles in a single session, and this is usually only on a first time patient with excellent donor density. More often, my large procedures are in the 2500-2800 graft range. I limit the width of my donor strip to 1.5 cm maximum, and try to keep it between 1.0-1.3cm whenever possible. The studies have shown that when the donor strip is kept below 1.2cm there is a very low risk of scar widening or any other complications. In patients with low scalp laxity, or even hyper-elastic scalp, it is sometimes necessary to place deep retention dissolvable sutures to decrease the tension on the skin edges. This can also decrease the incidence of scar widening. Typically on repeated procedures, the scalp tends to lose elasticity, which should make the physician think twice about how wide a donor strip to take in these cases. The typical donor scar should be between 1mm-3mm when everything goes as planned. Sometimes even though all the rules are followed the patient can still end up with a donor scar that is wider than we would like. In these cases the first step is usually to resect and revise the donor scar by just taking out the old scar and trying to limit the width to 10mm or less. If that is not possible, or the patient requests another option, a great way to treat this is by harvesting follicles by FUE (Follicular Unit Extraction), which involves using a special tool to harvest one follicle at a time, and then placing the grafts into the scar. Transplanted hair follicles grow very well through most scars and this treatment can be effective in minimizing the appearance of a wide donor scar. I hope this brief overview clearly explains how I approach “strip harvesting” in Hair Restoration Surgery.
All the best,
Marc Dauer, MD