"Dr. Arvind donor site pic (shaved)" Wed Aug-18-04 08:45 AM by HairSite
Donor site photos - courtesy of Dr. Arvind
10-DAY POST OP, AFTER 300 FUE GRAFTS
28-DAY POST OP, AFTER 200 FUE GRAFTS
FUE DONOR SCARRING - TECHNICAL DISCUSSION - BY DR. ARVIND
Dear Forum members,
Since we started the net based teaching of the FUSE technique , we have received heartening response – from ht surgeons as well as the general public. However, we feel some ht doctors are still hesistant about taking the plunge.
They have some valid questions/doubts.
1. FUSE/fue graft survival rates- some fear that the fue grafts may have a lesser survival rate
2. Graft density- some feel that the FUSE grafts cannot be placed as closely as traditional strip FUs.
3. Donor area scarring- some feel extraction of the FUSE grafts may lead to pinpoint numerous scars in the donor area giving a moth eaten appearance to the donor area, if it is shaved.
Today, we shall address one of the concerns-
Donor area scarring.
Different terms have been used, mainly suggesting that there may be numerous minute scars all over the donor area instead of one linear scar that occurs in strip surgery. That is not so.
There are 3 views we wish to submit on this-
1. In FUSE, the follicular units are extracted in an alternate fashion. That is, no 2 adjacent FUs are taken out. As a result, there is no large scalp area with FUs missing and empty skin visible. Moreover, if care is taken to use micropunches of less than 0.9mm diameter, the skin totally heals itself without any hypopigmentation or pock mark scars.
(If one uses punches >/= 1mm diameter, it is more likely to give some visible scarring).
How would the donor area compare visually after having taken out thousands of FUs by FUSE vis a vis by strip?
In one sentence, If one takes out, say, 3000 FUSE grafts from the scalp and shaves off at a later date, a human eye won’t be able to make out that feared moth eaten appearance at even 2 feet distance from the person.
The reason is that human eye’s visual acuity is comparatively less. Peering very closely, with maybe some sort of magnification, one will see small empty areas where the FUs were. But nothing comparable to a long (albeit thin) scar of strip surgery.
A helpful analogy would be to take the example of looking at a row of trees vis a vis a hedge. The tree trunks can be compared to old fashioned 4mm punch scars (or the linear strip scar of FUSE). No matter how thin the linear scar is, it will be visible if the person keeps his hair short- 2to3mm, because it clearly demarcates itself as a line.
Just like one can always make out the tree trunk against the skyline. FUSE grafts sites are, on the other hand, comparable, to a hedge. Since the micro holes are diffusely spread out and minute, with hair growing in between, it is difficult for the human eye to make them out except under very close inspection. (Just as in a hedge, it is impossible, on a casual glance, to see the wooden branches.)
2. The patient’s perspective : Most of the patients today agree that they would like to retain the choice of being able to keep the hair on the back side of the head to a length of 2-3 mm.
If hair are kept to that length, the strip scar being in a straight line draws attention, even if it is very fine (Anything in a straight line looks unnatural).
Whereas, FUSE/fue microscars, even if visible on close inspection , will not be visible with hair at 2-3 mm length.
100:60:10. (results of survey at our clinic)
For every 100 people opting for hair restoration surgery, 60 would like the FREEDOM to be able to keep short hair on the back side of their head.
10 persons out of 100 felt that they will even like the freedom to be able to shave off their scalp occasionally without attracting attention to any linear scar.
We cannot dismiss this large percentage’s preference just by saying, ” Why would anyone like to keep short hair after having a hair surgery to get hair back?”
3. The visibility of the donor scars
a. Increases with time in a strip FUHT owing to the stretch on the scar.
b. Decreases in a FUSE/fue graft owing to melonocyte migration (leading to reduction or absence of any hypopigmentation.)
FUSE graft donor site typically follows the following pattern:
2-3 weeks: Mild hypo/hyper pigmentation in donor area micro-holes.
3 months: The pigment level matches the surrounding skin. But minute scarring may be visible on close inspection.
6 months: No visible scarring even on close inspection.
It may still be pointed out that since the FU’s have been taken out empty spaces would be left where they were. Won’t it be visible to the naked eye?
No. Again the visual acuity of the human eye contributes to this happy situation.
a) It has been previously documented by ht surgeons, that even with 50% of the hair removed/ trimmed from an area of scalp, the untrained casual observer cannot notice any visible thinning.
b) FU’s are placed in the recipient area at a density comparatively less than what nature gave initially. On shaving off the recipient area (or keeping very short hair), the scalp hair growth in the recipient area does NOT look unnatural.
Similarly, in the donor area too, if even 50% FUs are taken out and the hair trimmed short, it does not look unnatural.
One must, therefore, realize that it is not whether any microscars will be visible on shaving off ones scalp after FUSE/fue. The patient’s important consideration is that if he opts for a strip FUHT, the linear scar will always be visible if he shaves off or cuts the hair to 2-3 mm in the area from where the strip has been taken.
Focussing on that patient requirement, I feel, ht doctors should see the option to use the FUSE/fue in a different light and pursue it with more vigour and enthusiasm.
Next I would like to address the other two fears namely graft survival and density (with appropriate pics). That I plan to defer for the time being as I think this post is long enough already.
#5. "RE: Dr. Arvind donor site pic (shaved)" In response to Reply # 4
I say thats wonderful. I had seen pictures of patients just after surgery. Seeing them after a couple of months makes one realize why FUSE is so much more better than strip. I have made up my mind.If I go ahead with transplants it will be fuse and never strip. Can we see some more pics hairsite. And what about bht photos.
#6. "Looks untouched but" In response to Reply # 5
200-300 grafts what else do you expect
is Dr Arvind capable of doing fue mega sessions. Nobody could restore their head with 200-300 grafts its equivalent to an eyebrow. Which taken over that large area isnt going to show up any problems. Donor damage does appear limited & non issue but more grafts needed for fair assesment.