This question, asked by a member of our Hair LossSocial Community and Discussion Forums, was answered by recommended hair transplant surgeon Dr. Sanusi Umar:

I have noticed more and more cases recently of surgeons like Dr. Umar showing some impressive hair transplants using nape hair in addition to hair from the “safe zone”. I am curious as to what people’s views are regarding the use of nape hair in hair restoration surgery.

For most individuals, nape hair* is more DHT (dihydrotestosterone) resistant than the hair in the area of baldness. In other words, nape hair is not necessarily lost in all cases of male pattern baldness (MPB) and what’s more, the safe donor area (SDA) is functionally the area bordering the fringe of hair that would be left in a terminally bald person such as a Norwood 7 or higher. Yet, we know that the majority of individuals do not experience this degree of hair loss.

The role of nape hair has hitherto been defined by:

  1. The notion that it is generally DHT susceptible.
  2. It is not typically an area subject to harvest given the limitations of the strip harvesting methods available.

The second factor has been cancelled by the advent of follicular unit extraction (FUE). Since then, nape and temple hair (donor areas outside the SDA) have been widely used in successful repairs of strip-donor-depleted patients: Those would-be patients whose capacity for further follicular unit transplant (FUT) surgeries has been exhausted. It is the extension of these experiences with repairs that opened the prospect of using nape hair as the vanguard hair of transplanted hairlines. Obviously, patient selection is key. Using criteria such as the degree of balding relative to age, visual evidence etc. nape hair can play an important role in hair transplantation.

* For the purpose of this discussion, nape hair use in hairline and temple creation refers to hair in the area below the SDA including areas around the ears.

Dr. Sanusi Umar

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David (TakingThePlunge)
Forum Co-Moderator and Editorial Assistant for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q & A Blog.

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