intricacies of the single-scar technique for donor harvesting
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Intricacies of the single-scar technique for donor harvesting

Harvesting of hair follicles for hair transplantation is carried out by three commonly used techniques such as the traditional donor-strip harvesting, refined donor strip harvesting and the single scar technique. Scarring in hair transplantation is a very common phenomenon and hence the traditional method has been improved upon to produce less scarring.

In the traditional donor strip harvesting technique, the hair for transplantation is harvested from above and behind the ears. According to the amount needed the hair can be harvested in strips just above the initial harvest. Hair from back of the head is harvested only when required. This method however leaves many scars on healing which is cosmetically unappealing.

The refined donor harvesting technique is a modification of the traditional technique. In this method, the hair follicles are harvested from back of the ear towards the mid section of back of the head. The subsequent harvests are carried out below the initial harvest. However this method is also develops lots of scars, more in number as compared to traditional method.

In the above two techniques, the quality of hair is not taken into consideration. So when the balding pattern advances, the scars might reveal their ugly selves due to variation in the hair thinning patterns. Those who have undergone these procedures often get upset while in activities such as swimming or surfing due to the scars.

The single scar technique is carried out by harvesting hair follicles from the back of the head. This technique is refined in such a way that only a single scar is visible even after multiple harvests. Here, the first harvest of follicles is from the lowest point at the back of the head where the hair is always of good quality. This part of the head always has a luxuriant growth even if the rest of the head is balding. Subsequent harvests if necessary are done just above the previous harvests alongside removal of the previous scar.

The actual procedure of single scar technique:

1. The pattern of male baldness is evaluated by soaking the patient’s hair with alcohol or water. This helps the surgeon demarcate the lines of future balding pattern to a large extent.

2. The donor site on the back of the head is determined where the hair growth is luxuriant. Usually the lower most portion of the region is selected and the subsequent harvests done just above the previous. The average size of the first harvest measures 1cm x 20 cm.

The back of the head can be divided into two regions such as the galea and no galea region. The no galea region is the one where the skin has lot of flexibility and hence the skin can fuse easily and the scar produced is very negligible. This region begins just where the hair line ends at the back of the head moving upwards about an inch and a half. The region above this area is called the galea and the skin here looses the flexibility and hence fusing of skin is often puckered. Single scar technique uses this anatomical advantage to use and hence the donor site falls in the no galea region.

3. After anesthesia has taken effect the marked donor region is harvested. With the help of a microscope the skin is cut open in such a way not to damage the nerves and vessels and the wound healed by heat so that the hair follicles remain intact.

4. The skin is closed using fast absorbing gut sutures. This completes the first harvest.

5. During the second harvest, a 1.2 cm x 20 cm area is marked. The new lower line for harvest falls below the already existing scar and the upper line 1.2 cm above the scar. The depth of the cut area is 2mm so that the region can be undermined. In this procedure, the patient is made to sleep on a pron pillo so that the surgeon can see the donor region as clearly as possible. The scalp area is pulled slightly while the surgeon uses a suction device to raise the flap and simultaneously clean the region of blood. The idea of undermining is mainly to retain normal tension of the skin along with minimizing of scars.

6. The harvested area is taken away for hair follicle separation while the surgeon fuses the area undermined using staples and fast absorbing gut sutures. The process of undermining, stapling for precision and suturing go hand in hand until the length of 20 cm is completed.

7. If a third or fourth session is necessary, then a similar procedure as the second harvest is carried out.

Main advantages of single scar technique is that by minimizing the number of scars, better blood supply and less edema [is a fluid collection that normally occurs after surgery] of the sutured region is possible. Although the single scar method is a very cosmetically advantageous one, most surgeons prefer the previous two methods for the following reasons:-

1. Time consuming - single scar method is time consuming to most surgeons as it needs intricacy and fineness in its performance. This holds especially when the area needs to be undermined. However this can be overcome by practice. An experienced surgeon takes an extra 5 minutes to finish undermining every centimeter of harvested area.

2. Knowlegde of anatomy – most surgeons do not want to venture into the anatomical details of the area from which hair can be harvested. This is because of the fear of damaging any nerves or blood vessels. This can be taken care of by cutting the skin just above the fat region so that there is no chance of damaging any vessels. Use of magnification similar to the one used in teasing follicles during the procedure can be of immense help and lessen mistakes.

3. Use of pron pillo – in most of the procedures, the patient is in sitting position which makes it difficult for the surgeon to get a clear view of the area under work. Use of a pron pillo may be considered an extra investment.


Intricacies of the single-scar technique for donor harvesting references

  • Brandy DA. Intricacies of the single-scar technique for donor harvesting in hair transplantation surgery. Dermatol Surg. 2004 Jun;30(6):837-44; discussion 844-5. PMID: 15171760
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