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Craft of Facial Plastic Surgery | January 1999

The State of the Art: Donor Site Harvest, Graft Yield Estimation, and Recipient Site Preparation for Follicular-Unit Hair Transplantation

Jason Swerdloff, MD; Sheldon Kabaker, MD

Arch Facial Plast Surg. 1999;1(1):49-52. doi:10.1001/archfaci.1.1.49.

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ABSTRACT

The field of hair transplantation has moved beyond the provision of a dense frontal hairline to techniques that are designed to provide a natural appearance in as few sessions as possible. The concept of the follicular unit has revolutionized the preparation of both the grafts and the recipient sites. We will describe the mathematics of hair restoration and our techniques for determining the length and height of the donor strip for a given number of desired follicular-unit grafts. We will also elucidate our technique for cutting the follicular-unit grafts using microscopes and transillumination. We now use specially designed blades or punches to make shallow slits or slots for recipient sites. Striving for teamwork and efficiency is of paramount importance in hair transplantation, and we will describe our coordination and training methods as well as the role of the surgeon.

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Figure 1.

Follicular units can be seen exiting the epidermis in close proximity but can be widely spaced within the subcutaneous fat.

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Figure 2.

The occipital donor site is centered either in the midline or to one side ending at the midline.

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Figure 3.

Triangles are marked at the ends of the rectangular donor strip to provide for quasi-elliptical closure.

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Figure 4.

Tumescent solution is infiltrated just below the dermis.

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Figure 5.

The guarded scalpel is used to make the strip incisions.

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Figure 6.

The angle of the incision is less acute near the midline, mimicking the natural pattern of the hair shafts leaving the scalp.

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Figure 7.

The donor strip is excised in the subcutaneous plane just below the hair follicles.

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Figure 8.

The donor strip is excised in the subcutaneous plane just below the hair follicles.

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Figure 9.

Towel clamps are used to approximate the wound edges.

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Figure 10.

Staples or monofilament suture are used to douse the donor site in layers. Undermining is not generally necessary.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit^TM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 Credit^TM.

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Swerdloff J, Kabaker S. The State of the Art: Donor Site Harvest, Graft Yield Estimation, and Recipient Site Preparation for Follicular-Unit Hair Transplantation. Arch Facial Plast Surg. 1999;1(1):49-52. doi:10.1001/archfaci.1.1.49.

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The State of the Art: Donor Site Harvest, Graft Yield Estimation, and Recipient Site Preparation for Follicular-Unit Hair Transplantation

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