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If you were gaurenteed a pencil thin scar

Yep, I understand what you are saying and have thought about this a little in the past.

in my opinion you are defining an issue that has confused most posters (and I believe most surgeons) or at least it has not been distinguished. There is a difference between scalp “looseness” and scalp “stretchability”. I think the difference and its implications are clear. There is a remaining issue that I have not fully resolved but I do have a few ideas. If the scalp is loose but the area of skull covered is the same then either 80FU/cm2 of skin must actually be higher than the actual fu count or the skull must seem bigger. I did some calculations on the effect of the scalp looseness being the predominant factor (which is your argument) but the figures did not add up and a high proportion of the ability to close a wound must be due to scalp elasticity by my reckoning.

I think you will know what I mean???

It isn’t that people have a hard time grasping that strip doesn’t alter donor density, it’s that strip does, plain and simple.

With strip, we cut out a piece of skin, and then stitch the remaining skin together. The skin “stretches” to make up the difference. Either that stretching occurs in the donor area, in the recipient area, or both.

Let’s say we take out 2000 grafts via strip.

If all of the stretching occurs in the donor area, then the donor area will remain the same size. We now have a donor area of the same size, with 2000 fewer grafts, and therefore less density. The skin has stretched, the follicles in the donor are now further apart because of this, and the density has gone down.

If all the stretching occurs in the recipient area, then you are correct, the donor density doesn’t drop. Instead, the donor area has shrunk by whatever size of skin you took out, and the recipient area has grown by that amount. Both the density of the recipient area falls, and the recipient area becomes larger. In other words, the donor density doesn’t drop but we are faced with something equally worrisome, if not worse.

And of course, there is the likely situation where the stretching occurs in both the donor and the recipient. Here we just have a combination of the two previously described scenarios, and we get both a drop in donor density and a shrinkage of donor size combined with an increase in recipient area size and a drop in recipient density. This would obviously occur proportionally to how much stretch occurs in each respective area.

Seriously, no matter how many obfuscated arguments you give us as to how somehow strip doesn’t alter donor density, we all know that we have to lose that density from somewhere, and if it isn’t the donor area, it’s in the recipient area, combined with a shrinkage of the donor area, which hardly any better.

» It isn’t that people have a hard time grasping that strip doesn’t alter
» donor density, it’s that strip does, plain and simple.
»
» With strip, we cut out a piece of skin, and then stitch the remaining skin
» together. The skin “stretches” to make up the difference. Either that
» stretching occurs in the donor area, in the recipient area, or both.
»
» Let’s say we take out 2000 grafts via strip.
»
» If all of the stretching occurs in the donor area, then the donor area
» will remain the same size. We now have a donor area of the same size,
» with 2000 fewer grafts, and therefore less density. The skin has
» stretched, the follicles in the donor are now further apart because of
» this, and the density has gone down.
»
» If all the stretching occurs in the recipient area, then you are correct,
» the donor density doesn’t drop. Instead, the donor area has shrunk by
» whatever size of skin you took out, and the recipient area has grown by
» that amount. Both the density of the recipient area falls, and the
» recipient area becomes larger. In other words, the donor density doesn’t
» drop but we are faced with something equally worrisome, if not worse.
»
» And of course, there is the likely situation where the stretching occurs
» in both the donor and the recipient. Here we just have a combination of
» the two previously described scenarios, and we get both a drop in donor
» density and a shrinkage of donor size combined with an increase in
» recipient area size and a drop in recipient density. This would obviously
» occur proportionally to how much stretch occurs in each respective area.
»
» Seriously, no matter how many obfuscated arguments you give us as to how
» somehow strip doesn’t alter donor density, we all know that we have to
» lose that density from somewhere, and if it isn’t the donor area,
» it’s in the recipient area, combined with a shrinkage of the donor area,
» which hardly any better.

Bilo,

Good post and you will see that I actually agree with you if you have a good read of what I have written.

If you are guarenteed say a 1mm scar (which would never ever happen), then density in the donor ie FUs per cm2 are the same - your donor area / tissue has reduced by the dimensions of the strip.

If you have a bigger scar (I have seen one 1.5cm in width), then yes, your donor area density has reduced as now have the dimensions of the strip in the donor area as scar tissue and thus less FUs per cm2.

In my post, I was just trying to clarify the thinking behind why it is claimed that density is unaltered in the donor area if a very thin / successful trico scar is left. And from my post you would see that I am pro FUE in 99% of cases.

To me it is a mute point though. My firm believe is that strip will ALWAYS leave a scar. Strip will ALWAYS limit your future options. Despite the pro strip people saying there are no consistant FUE results - this is absolute BS. There are a great many. The reason there appears to be less is that 1) Strip is an easier option due to time (up until recently only 500 - 800 FUE could be performed in a day as opposed to 5000 with strip. 2) The costs involved - FUE is almost double the price in some cases.

It is not “strip” that causes the solid results from H&W despite the spin placed on it - “strip” is just an extraction method. I would guarentee that if I had a great FUE doctor extract my grafts, give them to Dr Hasson for the recipient, I would get EXACTLY the same results as an exclusive strip patient. More skill is required for FUE extraction than strip extraction - equal skill is required for the the recipient. Hasson and Wong are excellent at recipient placement but if those grafts were given to them after being extracted via FUE, you would get the same result - costs aside of course.

I think that the harvesting of the donor area in many cases is under utilised (thats why in my post stating that on the face of it, a strip + FUE combo will yield the most grafts does not tell the whole story - I think with careful donor extraction you could well get the same numbers with FUE exclusively and minus the scare) and a “shot gun” approach is used which is not necessarily the best method.

Like I say, I argue that a “strip” methodology could be employed in FUE extraction for maximum graft yield. Like I said, the very lowest part of you donor region could well be “over harvested” from ear to ear - this in my case with extracting 60% of the FUs available (I think you could go above this) would yield me the best part of 2000 grafts (30cm x 1 cm at 110FUs per cm2) leaving the “usual” donor area completely untouched. You could over harvest this area because 1) it can be tapered out with a haircut and 2) if that is not utilised you can simply grow the hair above it to cover it. In my case (transections aside) if I extract 60% of my FUS available here, it would still leave me approx 45 FUs per cm2.

The nape of the neck area (which I shave) would yield me about 2600 grafts. I have 4600 FUs available without ever touching my “usual” donor area.

Maxwell.

» » It isn’t that people have a hard time grasping that strip doesn’t alter
» » donor density, it’s that strip does, plain and simple.
» »
» » With strip, we cut out a piece of skin, and then stitch the remaining
» skin
» » together. The skin “stretches” to make up the difference. Either that
» » stretching occurs in the donor area, in the recipient area, or both.
» »
» » Let’s say we take out 2000 grafts via strip.
» »
» » If all of the stretching occurs in the donor area, then the donor area
» » will remain the same size. We now have a donor area of the same size,
» » with 2000 fewer grafts, and therefore less density. The skin has
» » stretched, the follicles in the donor are now further apart because of
» » this, and the density has gone down.
» »
» » If all the stretching occurs in the recipient area, then you are
» correct,
» » the donor density doesn’t drop. Instead, the donor area has shrunk by
» » whatever size of skin you took out, and the recipient area has grown by
» » that amount. Both the density of the recipient area falls, and the
» » recipient area becomes larger. In other words, the donor density
» doesn’t
» » drop but we are faced with something equally worrisome, if not worse.
» »
» » And of course, there is the likely situation where the stretching
» occurs
» » in both the donor and the recipient. Here we just have a combination
» of
» » the two previously described scenarios, and we get both a drop in donor
» » density and a shrinkage of donor size combined with an increase in
» » recipient area size and a drop in recipient density. This would
» obviously
» » occur proportionally to how much stretch occurs in each respective
» area.
» »
» » Seriously, no matter how many obfuscated arguments you give us as to
» how
» » somehow strip doesn’t alter donor density, we all know that we have to
» » lose that density from somewhere, and if it isn’t the donor
» area,
» » it’s in the recipient area, combined with a shrinkage of the donor
» area,
» » which hardly any better.
»
» Bilo,
»
» Good post and you will see that I actually agree with you if you have a
» good read of what I have written.
»
» If you are guarenteed say a 1mm scar (which would never ever happen), then
» density in the donor ie FUs per cm2 are the same - your donor area / tissue
» has reduced by the dimensions of the strip.
»
» If you have a bigger scar (I have seen one 1.5cm in width), then yes, your
» donor area density has reduced as now have the dimensions of the strip in
» the donor area as scar tissue and thus less FUs per cm2.
»
» In my post, I was just trying to clarify the thinking behind why it is
» claimed that density is unaltered in the donor area if a very thin /
» successful trico scar is left. And from my post you would see that I am
» pro FUE in 99% of cases.
»
» To me it is a mute point though. My firm believe is that strip will
» ALWAYS leave a scar. Strip will ALWAYS limit your future options.
» Despite the pro strip people saying there are no consistant FUE results -
» this is absolute BS. There are a great many. The reason there appears to
» be less is that 1) Strip is an easier option due to time (up until recently
» only 500 - 800 FUE could be performed in a day as opposed to 5000 with
» strip. 2) The costs involved - FUE is almost double the price in some
» cases.
»
» It is not “strip” that causes the solid results from H&W despite the spin
» placed on it - “strip” is just an extraction method. I would guarentee
» that if I had a great FUE doctor extract my grafts, give them to Dr Hasson
» for the recipient, I would get EXACTLY the same results as an exclusive
» strip patient. More skill is required for FUE extraction than strip
» extraction - equal skill is required for the the recipient. Hasson and
» Wong are excellent at recipient placement but if those grafts were given
» to them after being extracted via FUE, you would get the same result -
» costs aside of course.
»
» I think that the harvesting of the donor area in many cases is under
» utilised (thats why in my post stating that on the face of it, a strip +
» FUE combo will yield the most grafts does not tell the whole story - I
» think with careful donor extraction you could well get the same numbers
» with FUE exclusively and minus the scare) and a “shot gun” approach is
» used which is not necessarily the best method.
»
» Like I say, I argue that a “strip” methodology could be employed in FUE
» extraction for maximum graft yield. Like I said, the very lowest part of
» you donor region could well be “over harvested” from ear to ear - this in
» my case with extracting 60% of the FUs available (I think you could go
» above this) would yield me the best part of 2000 grafts (30cm x 1 cm at
» 110FUs per cm2) leaving the “usual” donor area completely untouched. You
» could over harvest this area because 1) it can be tapered out with a
» haircut and 2) if that is not utilised you can simply grow the hair above
» it to cover it. In my case (transections aside) if I extract 60% of my
» FUS available here, it would still leave me approx 45 FUs per cm2.
»
» The nape of the neck area (which I shave) would yield me about 2600
» grafts. I have 4600 FUs available without ever touching my “usual” donor
» area.
»
» Maxwell.

I think its pretty rare that the scar stays pencil thin forever all the way around. I think in time in some part of the scar you will see a bit of a stretch.

»
» I think its pretty rare that the scar stays pencil thin forever all the
» way around. I think in time in some part of the scar you will see a bit of
» a stretch.

Indeed, in my research I have seen a few that have stretched somewhat.

I have always wondered:

The amount of grafts taken with a strip is somewhat related to the scalp laxity of the patient (the other factor being donor density) - so the better your scalp laxity, the wider the strip can be in theory.

Now, with “scalp exercises” where by patients pre-op progressively attempt to stretch their scalp tissue to maximise the width of the strip and thus the grafts - I would have thought that over a period of time (say a strip was never performed), you stretch your scalp tissue and then stop for a period of time, won’t your tissue return back to its pre-stretch value?

Now, couple that with a strip extraction hair transplant, you stretch your scalp tissue - a very wide strip is taken and sealed. Won’t the scalp then attempt to return to its pre-stretch value and thus apply a pulling force on the scar, perhaps widening it (i.e. the strip taken was beyond your true “natural” scalp laxity limit - the flexibility of the scalp was merely temporary and artificial and over subsequent months / years, the scar will stretch)…

Or does a “triple” sealed trico scar limit this if it indeed occurs? Has anyone had any experience with this?

How effective are the scalp exercises in increasing strip yield?

Maxwell.

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