I keep reading a lot of references to whether or not someone might be a candidate for a hair transplant based on whether or not they have “strong donor hair”. Can someone explain, in a little more detail, what this means exactly? Does it have to do with the quantity, density, quality, location? What exactly? What would exclude someone from getting a procedure? And does this apply to follicular unit transplantation (FUT) as well as follicular unit extraction (FUE)?
Personally, I feel that I have very “fine” hair. I’m sure a personal consultation would give me a definitive answer as to whether or not I would be a hair transplant candidate, but I’m just trying to get a general idea of what is acceptable.
First, you can indeed get a good idea of donor quality looking at the physical findings of how thick and coarse the donor hair is. The thicker and curlier the better. As I’ve posted a number of times, a wiry-haired Middle Eastern or Indian patient is really the ideal candidate and a thin straight-haired northern Chinese patient is possibly the worst. It’s simply a matter of the bulk of the transplanted hair covering underlying scalp (remember, we’re not curing baldness, we’re covering bald skin) and the color match of the hair and underlying skin.
Next, you can get a decent guess as to your yield looking at the density of the donor region. High density in thick hair is best, but high density in thinner, straighter, hair can overcome the straightness factor simply by putting more hair in the recipient area.
It’s very similar to all of the tree analogies that I give. If you want to cover an acre of land, it’s far easier with 10 willow trees than with 100 skinny pine (arbor vitae) trees. With the skinny trees, you’ll cover the land but not as satisfyingly as with willow trees (thick wiry hair). This should all be discussed at the initial consultation so that patients can have proper expectations and the hair restoration physician can do his/her best to meet them.
Lastly though, scalp skin thickness “seems” to play a role in the result as well. It may be only anecdotal but, of the patients that I see back that have what I’d consider weaker results—when I look back at my notes and strip pictures, a common finding is the scalp is just thinner. And, I’ve seen this in a number of 2nd cases done to increase density that have come from other highly regarded surgeons recommended on various forums. I don’t think they did a bad job in those cases, I find that I think the patient has really thin scalp tissue and then I always worry that my result on that second case may not be enough.
I just haven’t figured out a way to study this. Once you inject the scalp with local anesthesia, and everyone needs a different amount, you really can’t take measurements that would allow good comparisons of scalp thickness.
But, I do strongly believe that the weakest results are more commonly seen in people who have really thin scalp tissue in their donor region regardless of the density of the donor hair.
I hope this helps with the question above.
Dr. William Lindsey – McLean, VA
Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q & A Blog.
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