Method of Harvesting Grafts

There are four common methods of harvesting donor grafts. The original method, devised by Dr. Orentreich, used a hand punch to cut single grafts 4-mm in size that could contain up to 30 or more hairs. Each punch hole was separated by small islands of skin. Besides producing very large grafts, there was hair wastage around the periphery, due to transection and improper angling of the punch. This method is now rarely used. A second method utilizes a mechanical punch held in a small hand engine to core out a number of round grafts of known size. The punch turns at very high speeds; the torque and heat energy generated by this method will damage the donor grafts. The donor grafts obtained by the punch methods can be made into minigrafts by halving or quartering them. The donor area can then be closed by suturing or can be left open. If the donor sites are not closed, they develop significant scars. Most doctors have abandoned these techniques.

The third method uses multiple, parallel scalpels attached together on a handle, called a multi-bladed knife. Multiple thin strips of hair-bearing donor skin are removed simultaneously and then grafts of the desired size are cut from the thin strips of tissue produced by the multi-bladed knife. Using a scalpel does not produce any torque or heat energy; therefore, no heat or torque damage to the grafts can occur. This method is quick and simple and still quite popular. Unfortunately, this method can cause extensive damage to the donor tissue, as it is impossible to line up the multiple blades parallel to the hair follicles. Because of this there is unacceptable cutting of individual follicles (transection) and breaking up of naturally occurring follicular units.

In a fourth method, called single strip harvesting, the donor tissue is removed as a single strip. The great advantage of this method is that the tissue is removed from the scalp with the minimal amount of "blind" cutting. The only blind cutting is the single incision around the periphery of the donor strip as it is removed. All further dissection can be then performed by direct visualization using a dissecting stereomicroscope. This keeps potential damage to follicles at an absolute minimum and allows preservation of intact naturally occurring follicular units. In order to perform Follicular Unit Transplantation, single strip harvesting and stereo-microscopic dissectAppearance of the Donor Area

Unless the back and side hair is extremely short, the donor area will be covered by hair and will be unnoticeable after surgery. All donor "harvests" result in a scar, but if done properly, the scars may become, for all practical purposes, virtually invisible. Not only is it important for the scar to be closed meticulously, but also the scar must be placed in the proper position, in the mid-portion of the donor area. Scars that are place too low have an increased risk of stretching from the movement of the neck muscles. Scars that are placed very high run the risk of being visible if there is extensive balding. In addition, the hair that is obtained from these high incisions may not be permanent.

Re-harvesting the same area is important to keep visible scaring to a minimum and to keep the donor scar in the mid-portion of the permanent zone. Some doctors harvest a new area for each surgery. When many surgeries are done, these patients have a stepladder appearance of the back of the scalp from the multiple scars. Each scar distorts the hair shafts in either side of the adjacent skin. This distortion occurs because scars tend to contract. When contraction occurs, the microscopic structures around the scar are pulled. If different donor sites are chosen for each hair transplant procedure, the total area for distortion of the hair follicles becomes quite extensive. Such distortions can affect the surgeon's ability to maximize the donor hair supply for more extensive hair transplant restorations and often limit the surgeon's ability to keep the donor site undetectable. The following photographs demonstrate the contrast between extensive scarring associated with multiple procedures, when donor hair is taken from different areas for each procedure and a properly placed scar repeated from the same location.