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Donor density variation & Efficient donor harvesting


#1

Here is a two dimensional presentation (figure 1.) of an actual patient’s entire donor area. Each of the 14 boxes represents a region of the donor area and have all been magnified for easier viewing. You may notice that some follicles have been circled in a few of the boxes to simplify the task of counting each follicular unit. Also attached is a depiction of a 2nd patient’s donor area where 1400 CIT grafts were harvested from the entire donor area. By observing figure 1, you may find that hair densities are different from one region to another. Most patients will have an average hair density of about 180 hairs per square centimeter while other patients will have higher densities. The donor area shown as figure 1 has hairs that occur at an above average hair density of 286 hairs per square centimeter. Each box is a quarter of a square centimeter.

At any rate, CIT allows us to take advantage of harvesting specific follicular units to yield the best aesthetic result in the donor and recipient areas. We harvest from within the entire donor area to minimize noticeable decreases in donor density. Harvested donor hair follicles are best extracted where areas of denser hair growth are within the donor area. Dr. Cole has steadily improved on our method of harvesting and has perfected instruments used in harvesting numerous types of donor areas. No two donor areas are the exact same so instruments used during our procedures are constantly changing. Our new method of harvesting has allowed for the average number of hairs per follicular unit to be about 2.9 hairs per graft with a transection rate of about 2%. Transection occurs when follicles are critically injured at the bulb and have zero chance of survival. In a recent study, several strip surgeons completed strip (FUT) procedures with microscopes and without microscopes. In cases where microscopes were not used, 20% of 406 follicles (range 15% to 23%) were transected. However, in cases where microscopes were used, 10.2% of 343 follicles (range 0% to 25%) were transected. It is very important to know the statistics of your potential surgeon beforehand.

The importance of donor density is that it dictates how patients must realistically approach their hair loss. Donor density is a major factor in determining how much donor resource each patient has to combat hair loss. Dr. Cole typically advises younger patients to maximize medical therapy, focus on the frontal scalp and postpone goals of aggressive coverage in the crown. Since hair loss can be a progressive condition, lower density in certain areas allows for our patients to look natural in the event of additional hair loss. Dr. Cole favorably recommends that the conservative approach to hair restoration is in all patients’ best interests as there is no sure-fire way to predict that any patient can resolve hair loss in one procedure. We educate patients of the fact that donor area resource is finite. Our clinic offers to provide consistent quality results with fewer grafts transplanted and less grafts transected.



#2

wow, you or whoever did this must have spent a lot of time on this one.


#3

Great post Doc. Very informative.


#4

Do you ever purposely thin the donor area to blend better with the thinner recipient? Personally I’m ok with my donor area being thinner if it blends better with the result in the recipient area, basically leaving no visible transition from the donor to the newly transplated area.


#5

This was posted by another poster about telogen follicles during a hair transplant, what percentage of the telogen follicles do you think actually get transplanted to the recipient site?


#6

» Do you ever purposely thin the donor area to blend better with the thinner
» recipient? Personally I’m ok with my donor area being thinner if it blends
» better with the result in the recipient area, basically leaving no visible
» transition from the donor to the newly transplated area.

ChiaHead,

We absolutely have the ability to do such work if a patient fully understands the long-term effects. We haven’t had any patients that have this goal in hair transplant surgery.


#7

Here’s a thought, what if the difference is due to the patient having telogen effluvium in certain areas?


#8

Critically important information, and kudo’s to you for both realizing this and for sharing it with the rest of us.


#9

» This was posted by another poster about telogen follicles during a hair
» transplant, what percentage of the telogen follicles do you think actually
» get transplanted to the recipient site?

Hi Therapy,

Usually 8 to 12% of the transplanted follicles are in the telogen, but it can be as high as 25%.

My advice is not medical advice


#10

Often we tell patients after a session to come back a year later to evaluate the result as well as the donor situation.
I have personally been shocked several times that the donor area look extremely well, even on patients we did not expect to be able to harvest again.
Maybe this has to do with telegon follicles now in growing phase.

On the other side, if this is true than strip surgery destroys a massive amount of follicles > a follicular holocaust. Even under high magnification microscopes ‘sleeping’ follicles are nearly impossible to see. Therefore it can be expected that a lot of healthy follicles end up in the bin.


#11

» Often we tell patients after a session to come back a year later to
» evaluate the result as well as the donor situation.
» I have personally been shocked several times that the donor area look
» extremely well, even on patients we did not expect to be able to harvest
» again.
» Maybe this has to do with telegon follicles now in growing phase.
»
» On the other side, if this is true than strip surgery destroys a massive
» amount of follicles > a follicular holocaust. Even under high magnification
» microscopes ‘sleeping’ follicles are nearly impossible to see. Therefore it
» can be expected that a lot of healthy follicles end up in the bin.

Very interesting, remember Dr. Gho’s stem cells hair transplant? Maybe the donor regeneration that he saw was just telogen hair regrowth and had nothing to do with stem cells like he suggested.


#12

Cool presentation. I had no idea of the density variation. Strip is bad and doesn’t harvest as well as fue cit

» Here is a two dimensional presentation (figure 1.) of an actual patient’s
» entire donor area. Each of the 14 boxes represents a region of the donor
» area and have all been magnified for easier viewing. You may notice that
» some follicles have been circled in a few of the boxes to simplify the task
» of counting each follicular unit. Also attached is a depiction of a 2nd
» patient’s donor area where 1400 CIT grafts were harvested from the entire
» donor area. By observing figure 1, you may find that hair densities are
» different from one region to another. Most patients will have an average
» hair density of about 180 hairs per square centimeter while other patients
» will have higher densities. The donor area shown as figure 1 has hairs that
» occur at an above average hair density of 286 hairs per square centimeter.
» Each box is a quarter of a square centimeter.
»
» At any rate, CIT allows us to take advantage of harvesting specific
» follicular units to yield the best aesthetic result in the donor and
» recipient areas. We harvest from within the entire donor area to minimize
» noticeable decreases in donor density. Harvested donor hair follicles are
» best extracted where areas of denser hair growth are within the donor area.
» Dr. Cole has steadily improved on our method of harvesting and has
» perfected instruments used in harvesting numerous types of donor areas. No
» two donor areas are the exact same so instruments used during our
» procedures are constantly changing. Our new method of harvesting has
» allowed for the average number of hairs per follicular unit to be about 2.9
» hairs per graft with a transection rate of about 2%. Transection occurs
» when follicles are critically injured at the bulb and have zero chance of
» survival. In a recent study, several strip surgeons completed strip (FUT)
» procedures with microscopes and without microscopes. In cases where
» microscopes were not used, 20% of 406 follicles (range 15% to 23%) were
» transected. However, in cases where microscopes were used, 10.2% of 343
» follicles (range 0% to 25%) were transected. It is very important to know
» the statistics of your potential surgeon beforehand.
»
» The importance of donor density is that it dictates how patients must
» realistically approach their hair loss. Donor density is a major factor in
» determining how much donor resource each patient has to combat hair loss.
» Dr. Cole typically advises younger patients to maximize medical therapy,
» focus on the frontal scalp and postpone goals of aggressive coverage in the
» crown. Since hair loss can be a progressive condition, lower density in
» certain areas allows for our patients to look natural in the event of
» additional hair loss. Dr. Cole favorably recommends that the conservative
» approach to hair restoration is in all patients’ best interests as there is
» no sure-fire way to predict that any patient can resolve hair loss in one
» procedure. We educate patients of the fact that donor area resource is
» finite. Our clinic offers to provide consistent quality results with fewer
» grafts transplanted and less grafts transected.
»
»
»


»
»


#13

I noticed that this is almost like a bell curve, the density is low on either end (near the left/right ear) and around the middle is where the density is higher, this may be the same for everyone.


#14

As stated by Bverotti…

"On the other side, if this is true than strip surgery destroys a massive amount of follicles > a follicular holocaust. Even under high magnification microscopes ‘sleeping’ follicles are nearly impossible to see. Therefore it can be expected that a lot of healthy follicles end up in the bin. "

Has anyone stopped to think for a moment about how an FUE punch avoids these “sleeping” follicles as Bverotti describes them?

Take a four hair follicular unit as an example. When hair goes into telogen the entire FU does not necessarily disappear. It can be one or two hairs from this bundle that normally has four hairs when all hairs are in anagen phase thus a four hair bundle now looks like a two hair bundle.

Bverotti is known for being proud of the fact that his clinic uses very small diameter punches to remove these bundles and that the punches are chosen for each individual bundle as they are needed so they have as little “fat” (as he calls it) around the follicular unit when it is extracted. He has stated as much in the past.

If a punch is chosen for a two hair bundle what is to say that the two other follicles in this bundle that is actually a four hair bundle (remember, two are in telogen for argument’s sake) are not decimated in a “follicular holocaust”? Do FUE punches utilize some sort of “telogen” detector to avoid this issue?

Now, I know I’m going to get the “Oh this is from a strip clinic rep so it must be biased” line but for those reading this that have no agenda try to think about the actual logic behind this.


#15

» Very interesting, remember Dr. Gho’s stem cells hair transplant? Maybe
» the donor regeneration that he saw was just telogen hair regrowth and had
» nothing to do with stem cells like he suggested.

It’s not likely, because Gho’s donor hairs start regrowing immediately at the same rate and thickness of the original hairs. An in vitro study of transected follicles showed lower thirds exhibit the same behavior.

Also, if Gho’s phenomenon were fully due to telogen regrowth, there would be a lag between harvesting and regrowing of the hair, and the hair would have a tapered shaft at the end.

More likely, the telogen regrowth could add to the regrowth Gho is seeing from rejuvination of the lower thirds.


#16

Hi James bond,
I dont know if you understand Dutch. But if you do you should sign up to the Dutch forum haarweb. This forum and its members have come to the conclussion that there is no proof for dr. G stemcell practice. In fact some of his patient have already reported no donor regrowth, instead donor thinning.


#17

» As stated by Bverotti…
»
» "On the other side, if this is true than strip surgery destroys a massive
» amount of follicles > a follicular holocaust. Even under high magnification
» microscopes ‘sleeping’ follicles are nearly impossible to see. Therefore it
» can be expected that a lot of healthy follicles end up in the bin. "
»
» Has anyone stopped to think for a moment about how an FUE punch avoids
» these “sleeping” follicles as Bverotti describes them?
»
» Take a four hair follicular unit as an example. When hair goes into
» telogen the entire FU does not necessarily disappear. It can be one or two
» hairs from this bundle that normally has four hairs when all hairs are in
» anagen phase thus a four hair bundle now looks like a two hair bundle.
»
» Bverotti is known for being proud of the fact that his clinic uses very
» small diameter punches to remove these bundles and that the punches are
» chosen for each individual bundle as they are needed so they have as little
» “fat” (as he calls it) around the follicular unit when it is extracted. He
» has stated as much in the past.
»
» If a punch is chosen for a two hair bundle what is to say that the two
» other follicles in this bundle that is actually a four hair bundle
» (remember, two are in telogen for argument’s sake) are not decimated in a
» “follicular holocaust”? Do FUE punches utilize some sort of “telogen”
» detector to avoid this issue?
»
» Now, I know I’m going to get the “Oh this is from a strip clinic rep so it
» must be biased” line but for those reading this that have no agenda try to
» think about the actual logic behind this.

Hi Jo,
It is understandable that you seek to reason as you did.
However you have one serious flaw in your argumentation :

Unlike with strip, FUE does not go to the dermal papilla depth

In our version of FUE there is no way we could damage a dermal papila in telegon phase since the punch is never going to that depth.


#18

» Hi James bond,
» I dont know if you understand Dutch. But if you do you should sign up to
» the Dutch forum haarweb. This forum and its members have come to the
» conclussion that there is no proof for dr. G stemcell practice. In fact
» some of his patient have already reported no donor regrowth, instead donor
» thinning.

Beverotti and CIT:

I always wonder on what is the maximum number of grafts available with a NW 6 patient for FUE? (consider an average donor density)…


#19

» » Hi James bond,
» » I dont know if you understand Dutch. But if you do you should sign up
» to
» » the Dutch forum haarweb. This forum and its members have come to the
» » conclussion that there is no proof for dr. G stemcell practice. In
» fact
» » some of his patient have already reported no donor regrowth, instead
» donor
» » thinning.
»
» Beverotti and CIT:
»
» I always wonder on what is the maximum number of grafts available with a
» NW 6 patient for FUE? (consider an average donor density)…

It really depends on how far the patients is willing to thin out.
We have a NW6 patient in a couple of weeks that went to a Turkisch clinic and received 2500 grafts over a 5 day period.
During his consultation with us he said he wanted 3000 grafts more and nothing less. We explained that it would thin out his donor area quite a bit.
However he answered that this was exactly his goal. He ultimate goal is to have a donor density that matches his implant area so that there is little contrast.
So here we have a patient, a full blown nw6 who will receive about 5500 grafts with FUE alone.


#20

» » » Hi James bond,
» » » I dont know if you understand Dutch. But if you do you should sign up
» » to
» » » the Dutch forum haarweb. This forum and its members have come to the
» » » conclussion that there is no proof for dr. G stemcell practice. In
» » fact
» » » some of his patient have already reported no donor regrowth, instead
» » donor
» » » thinning.
» »
» » Beverotti and CIT:
» »
» » I always wonder on what is the maximum number of grafts available with
» a
» » NW 6 patient for FUE? (consider an average donor density)…
»
» It really depends on how far the patients is willing to thin out.
» We have a NW6 patient in a couple of weeks that went to a Turkisch clinic
» and received 2500 grafts over a 5 day period.
» During his consultation with us he said he wanted 3000 grafts more and
» nothing less. We explained that it would thin out his donor area quite a
» bit.
» However he answered that this was exactly his goal. He ultimate goal is
» to have a donor density that matches his implant area so that there is
» little contrast.
» So here we have a patient, a full blown nw6 who will receive about 5500
» grafts with FUE alone.

hmm…interesting…couple of guys in this forum NW 5+ (one of them is “burberry”)…Armani clinic has worked on him with 5800 FUE grafts till today and claims that he is going for another 2000+ grafts to cover Zone 3…I was wondering whether this is possible? Any comments…