Does FUE Change Donor Planning?

Let’s firstly consider the rationale of strip harvesting. In this technique we harvest all the donor hairs in a selected area. If we choose the strongest donor hairs from the “safest” zone we can be more confident of the longevity of the result. This makes it an efficient harvest of the safest zone. Post strip harvest, there is minor thinning of surrounding areas but the same area can be re-harvested including removal of the previous linear scar.

Let’s now consider the rationale of FUE harvesting. In this technique we partially remove hair from the donor zone. The harvest is typically in the 25-35% range of available hairs. Overharvesting of any individual area produces a significant variation between donor zones leading to the desire to harvest the stronger areas in future surgeries. This is unlikely to be a problem in smaller cases with small harvests, but in extensive balding requiring large harvests, this theoretically creates a problem.

So, how do we deal with this potential problem? It is my view that extensively bald, younger patients should be encouraged to maintain long-term medical therapy to limit further possible hair loss. They should be properly warned as to the possibility of future thinning of some of the grafted hairs. This is probably wise regardless of donor harvesting technique, to prevent extension of the balding area, however with FUE it may also act to preserve the grafts harvested from the less safe areas and reduce the possibility of unmasking of FUE donor scars.