Where on the scalp is the best place to remove the strip for a hair transplant?
This question was posed by a hair loss sufferer on our hair restoration forum and answered by Dr. Michael Beehner of Saratoga Springs, NY who is one of our recommended hair restoration physicians. His professional answer is below.
Nine out of ten times, it turns out that the best place to mark the lower border of the donor strip to be taken does in fact lie just over the level of the occipital tubercle (“bump”) on the back of the head. This level corresponds to a point, below which lies around 1/3 of the dense donor hair and above which lies around 2/3 of the same. Assuming at least a couple of sessions are done and that the hair transplant surgeon takes the second strip just above the first scar (removing the initial scar at the same time), this is usually a good point to mark this lower strip level. But there are exceptions.
Some men show evidence of hair thinning up from the nape of the neck. In these sometimes the strip is taken slightly higher up if there is a sufficient height of “safe” donor hair there. In each hair transplant patient an experienced hair surgeon uses a great deal of judgement in choosing at which level the best hair to take is located.
The scalp below the level of that bump doesn’t have a galea layer (the layer of “gristle” that is tough and is the continuation of where the neck and forehead muscles extend over the scalp) and thus in many male patients scars placed in this lower territory have a tendency to stretch out into a wide donor scar. The other mistake that is sometimes made is to take the donor strip too high in the donor area of a man who will go on to bald down into the area where the strip was taken – which results in these transplanted hairs later being lost .
The only time I will take the donor hair below the level of the occipital tubercle is occasionally in a female patient in whom the hair density in this lower region is the best donor hair in terms of density and caliber of the hairs. Most women with female pattern baldness don’t have great density in the side areas of their scalp, so the great majority of the donor hair has to come from the back wall of hair. Since they wear their hair longer than men, if the scar down there is 2-3mm wide, it isn’t quite as big a problem.
In some young men the hair restoration surgeon might notice hair thinning coming up from the nape of the neck and also see the vertex (crown) in back “scooping” down pretty low, leaving a fairly narrow area of dense hair. In these men, it is important to always leave some amount of thick hair there to “shingle” down in back, so I mark off the central two inches of the back of the head and don’t harvest in that small middle section of hair, but instead harvest two separate strips to each side of that area, where the height of donor hair is higher and the donor scar will be well hidden by hair above and below.
Mike Beehner, M.D.
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