Most patients come to the office for a consultation primarily concerned about what the area of their head that will be receiving the transplanted hairs will look like.  Certainly the recipient area is very important, but so is the donor area.  The art and science of hair restoration involves the knowledge and experience to balance the maximum amount of hair for the recipient area while maintaining a healthy and attractive donor area.

Dr. Stoller exams a patients donor area with a densometer to evaluate his donor quality and density.

Especially since FUE procedures have increased in recent years, the donor area can be adversely and permanently affected.  Two problems have resulted from overharvesting. One is that the area can be left cosmetically unappealing; areas may look patchy or even bald.  Secondly, areas may have become necrotic (dead), from overaggressive FUE.

Physicians must take into consideration many factors when making decisions about your transplant.  There are some clearly defined variables, like the hair shaft diameter and hair follicle density.  The hair shaft diameter can vary among the hairs on the same head and sometimes even within the same hair.  The hair follicle density can vary on different parts of the head.  This is even more complicated if you have already had surgery.  It is a time when the experience and skills of the surgeon are particularly important.

You have a limited number of donor follicles.  If you are destined for future hair loss in addition to the loss that you are seeing the physician for at your present office visit, this is an important factor in making a knowledgeable decision.  Predicting the donor area that will most likely be needed in the future, based on your present age, your family history and the pattern that you have been developing with your own hair loss, is a critical part of formulating a strategy.  These natural factors of hair loss have to be put in the formula since you will be deciding how much of the donor area will be used now or needed in the future.  Not all physicians make the patient aware of the usage of the donor area in the procedure they recommend and what this means to your future needs.  They may just want to get you to have a procedure or they may not be experienced or knowledgeable enough to know or to have seen the problems that can occur.  You may be promised more than is even possible.

  • Your doctor should be able to explain his or her specific vision for you.
  • Will the donor follicles left be in a pattern and distribution that will be as cosmetically appealing as possible for you?
  • Will the area be left in as healthy and usable a condition as possible?

In addition to considering the density and diameter of each hair shaft and the distribution of the follicles, other factors play a role in evaluating your donor area. The color of the hair and the underlying scalp is a factor; this most potentially affects patients with dark hair and light scalp. Methods of camouflaging a light scalp, including micropigmentation, can be valuable in this case.

Some 3-D features can be considered. Hair texture can play a role with curly or wavy hair providing a better cover for the scalp.  The exit angle of the hair is a feature that can affect the look of the donor area.  A more acute angle gives a shingling effect and may be helpful to cover the scalp. The patient’s preference for hairstyle and length is to be considered. Your physician should be taking all these factors into consideration when discussing the possibilities for you in your donor area.

Having a hair restoration procedure is a multifaceted surgical procedure.  It requires an ethical approach to restoring your thinning hair or balding head.  It is not just a matter of addressing the recipient area and maximizing the number of hairs to be placed there.  It requires a thorough evaluation of the donor area that your head provides.  Whether it is your first procedure or not, care must be taken to preserve the donor area so that it is aesthetically pleasing, as well as maintaining a healthy environment if an additional transplant is needed as well.

Realistically, the relationship that you have with your hair restoration physician is not a one-time event.  It should be viewed as a long term and trusted relationship. Hair loss doesn’t just go away all of a sudden.  Whether you’ve had a surgical procedure or not, optimizing your current hair status and preventing as much future loss as possible should be the goal.  Your physician is your source of education about ancillary treatments, and your personal expert in providing individualized, ongoing advice for your hair health.