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
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
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.
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.