Hair Transplant Fundamentals: Planning and Harvesting the Donor Tissue By Bernard Arocha, MD on March 17, 2015

If you have been involved in strategic planning, you have an idea how Dr. Bernardino Arocha or Arocha Hair Restoration approaches a hair transplant. The first priority is to envision the end result -- begin with the end in mind. Of course, that's easier said than done. In hair transplants, the end result depends on many factors, but the biggest is what the patient wants to accomplish -- with an emphasis on restoring the hairline, frontal forelock, frontal region and mid scalp region.

This is an imperative step because the patient must have realistic expectations. The fact is that the crown area will likely not be able to be covered with any significant density. Dr. Arocha explains it this way:

"For the crown, we prefer to rely on pharmacologic therapy , hair system or comb over from anteriorly transplanted hair. The exception is for the fortunate few with great donor density that permits harvesting in excess of 4,000 follicular units (fu). The breakdown of a 4,000 fu transplant is to do between 1,500 to 2,100 fu in the hairline and frontal forelock areas, and the remaining 2,000 fu is distributed between the remaining frontal and mid scalp regions."

Determining what density is necessary to achieve the patient's desired results is essential in order to begin designing the dimensions of the donor tissue area to be harvested. Recently, Dr. Arocha served as faculty for a workshop on that subject at the International Society of Hair Restoration Surgery's 18th Annual Scientific Meeting in Boston. We talked with Dr. Arocha about it:

Dr. Arocha's workshop focused on the design and harvesting of the donor tissue area -- how to determine how much tissue is necessary to meet the goals of the patient, how to determine hair follicle density and from where on the back of the scalp it should be extracted.

Tension and elasticity change along the length of the donor strip, which Dr. Arocha explains must be accounted in order to close without tension and complete the procedure with a fine, undetectable scar.

Everything Dr. Arocha and his team do is focused on maximizing positive patient results. Typically, he starts the hair transplant procedure by scoring the surface of the patient's scalp with a single blade rather than cutting all the way down past the base of the follicles. Dr. Arocha gently separates the follicles in the donor strip away from the underlying donor area using forceps to minimize the chance of transecting the precious donor follicles along the edge of the donor strip.

To minimize the time the donor tissue and follicles are out of the body, Dr. Arocha typically extracts one section of donor tissue at a time.

Another method Dr. Arocha often uses to maximize positive results is a double layer closure technique. He closes the donor area by first using internal sutures to pull the subcutaneous tissues beneath the skin together. This takes more time, but is optimal for the patient's healing and comfort, reducing the tension on the surface of the skin so it can be sutured together under minimal tension. As a result, there is less tension and pulling on the external skin level sutures, which reduces the chances of stretching and scarring along the donor scar.