Hair Restoration Methods-Strip Surgery

The issues that a hair transplant surgeon must pay attention to when removing a donor strip in strip surgery include (but are not limited to):

1. The tension of the target donor strip along the entire length of the incision. There are several layers of tissue in the donor scalp and the tension that this tissue is subject to varies along the path of the incision. When the doctor is using his scalpel he should stop every few centimeters and take note of where the tension increases and decreases. This allows the surgeon to adjust the width of the donor strip accordingly. The more tension there is one area the more narrow the incision becomes and the more laxity that is present the wider the strip can become. The point is to manage the tension to the point that no single area has a quantifiable degree of additional tension during the final wound closure than any other area of the donor strip. There are two areas of the donor zone that surgeons should pay particular attention to and these are called the mastoid processes. If you imagine your skull being in the shape of a box the mastoid processes would be on the lower back two corners. These areas historically have higher levels of tension than other areas of the donor zone thus careful attention must be paid to avoid removing too much tissue. Even when great care is taken and a narrow donor scar is the result shock loss will be a common occurrence due to the interruption of blood flow. Small patches of no growth will form and last for three or four months in many cases.
2. Donor zone transection. Great care must be taken in order to avoid transecting follicular bundles during strip surgery both in the donor strip and in the peripheral of the donor incision. If too many follicular bundles are transected this can lead to a permanent reduction in density and permanent shock loss. The ideal way to avoid transection is through the use of tumescence and by pushing a single blade scalpel along the target incision line as opposed to pulling. Tumescence of the donor zone creates large paths in between the follicular units making it easier to avoid transection and when the scalpel is pushed along these paths there is a clear field of view that reduces the chances of transection dramatically.

So what is it that doctors look at when they are assessing the candidacy of a strip surgery patient? Obviously they are first looking at the supply and demand of the situation that the patient presents. What is the area of hair loss and the patient’s expectations for a result and does the patient have the donor reserves to meet these expectations with one or multiple surgeries? The physician should also be assessing if the expectations of the patient are realistic and if they are considering the potential downsides of the procedure. Once this is considered the doctor will assess the potential for the procedure by gauging the laxity of the donor scalp. The doctor should be assessing the posterior donor zone as well as the lateral donor zones (above the ears). There have been attempts to create a standardized laxity test but in my opinion simple experience will tell the doctor (or consultant) what size surgery will be possible. In addition to laxity the doctor should also be assessing donor density as well as, to a lesser degree, the type of hair being transplanted. It is coarse? Is it fine? Wavy? Curly? Straight. All of these factors work together to determine the potential for success or failure.

Assuming you wind up having surgery there are two possible ways that the surgery will move forward. Once you are in the clinic and you are prepped you will either be laying face down on table that is similar to a massage table with an opening for your face or you will be sitting up in a chair similar to a dentist chair. When one is laying prone or face down the doctor will have the patient tuck their chin in or “down” as this helps to expose the target donor zone. Furthermore, at this angle the doctor can easily position the scalpel so that as he is pushing the scalpel though the donor zone he can maintain the angle of the scalpel at the same angle of hair growth as it exits the scalp. This helps to greatly reduce transection and allows for a cleaner cut. it is also easier to prevent excess bleeding as any bleeding that does occur will “pool” in the donor wound giving the assisting technician time to absorb the blood with a dabbing gauze. Many doctors prefer when patient’s sit up in the chair as they feel it is more comfortable for the patient, which is true, but in my opinion the benefits cease there.