What are Recipient Sites?
During a surgical hair restoration procedure, recipient sites are the specific areas on the recipient scalp where grafts are to be placed. This involves making a hole or a slit via one of any various tools that are available that are designed to accommodate each hair graft.
How are Recipient Sites Created?
Recipient sites are made by using one of three instruments:
- Hypodermic Needle – This is the worldwide standard for making hair transplant recipient sites. The needles vary in size depending on the size of the grafts and the expertise of the doctor. Sizes usually range from 18g on the large size to 23g on the small size.
- Blades – These are usually cut during the surgery to match the size of the graft. When incisions by blades are made in a coronal fashion the incisions are known as "lateral slits". This is a technique developed by Dr. Jerry Wong during the 1990's.
- Implanter pens – developed in the 1990's in Korea, this needlelike device allows the physician to instantly create recipient sites by depressing a plunger. Implanter pens are as equally effective as traditional blades and needles and allow for a technique known as "stick and place" to be carried out with great efficiency.
There is no “correct” hair transplant instrument – it is completely up to the physician which to choose.
The History of Recipient Sites
In the early days of hair restoration, recipient sites were very large in order to accommodate the much larger size of grafts that were in use. This included punch plugs and mini grafts. The shear size of these incisions prevented the grafts from being placed closely to each other so dense packing was not possible. In addition, the large size of the recipient sites meant that more trauma was inflicted on the patient's recipient scalp and more scarring would develop. Now, however, the sites are small enough that a person can comfortably wear a close-cut hairstyle without fear of being noticed. These advances in hair restoration are due to significant improvements in both the equipment and techniques involved, most notably the invention of the stereoscopic microscope in the mid-1990s, which allowed physicians to create smaller grafts. Smaller grafts, in return, allowed for smaller recipient sites. Currently, the recipient sites made for grafts harvested via FUSS and FUE alike are small enough that high densities can be achieved with minimal overall trauma and subsequent scarring.
The Right Fit
Due to the skin’s tendency to retract once cut, recipient sites are made slightly larger than the graft itself. That way, by the time the graft is ready to be transplanted, the incision site will have shrunk to the same size. It is absolutely crucial that the graft and the recipient site are the exact same size during transplantation. The graft must fit into the recipient site as snugly as possible or else issues can arise. If the graft is not placed correctly, the following problems can occur:
- Ridging – this is when there is an excessive amount of skin tissue attached to the grafts. A recipient scalp with this problem will appear uneven and slightly raised. This happens more likely if the grafts are simply too big which is expected with older procedures such as minigrafting.
- Cobblestoning – this is when the hair graft is placed at too shallow of a depth. This causes the transplanted hair to look like a bumpy cobblestone street.
- Pitting – this is when the hair graft is placed too deeply into the recipient site. This creates a noticeable divot, almost the opposite of cobblestoning and ridging. The scar literally inverts below the surface of the skin.
- Incorrect angles – if the recipient sites are not made at a correct angle, the hair will not grow in a natural direction, and the overall hair pattern will be noticeably off.
- Compression - If incisions are made too small and the grafts are forced or stuffed into the recipient sites the grafts can become compressed. This means the hairs can be forced to be closer to each other than normal because the tissue itself is being squeezed. When this happens the hairs can look pluggy and unnatural. In addition, compression can cause a reduction of yield as the increased pressure pushes blood flow away from the graft thus it can lose nutrients that are so badly needed in the first crucial days after placement. This is why some results can have hairs that not only look pluggy, even with modern techniques, but the hairs can appear wiry because they were damaged from a lack of nutrition.
Recipient Sites and Scar Tissue
As a 2005 overview notes, recipient sites have the remarkable ability to grow hair in scar tissue. However, scarred tissue is often thinner than ordinary, healthy scalp tissue, which can make graft insertions more difficult. Nonetheless, this ability to grow hair scar tissue allows physicians to perform hair transplants on disfigured patients (provided that they have a suitable amount of donor hair left).