This document discusses the concept of safe donor harvesting (SDH) for hair transplants. It defines the components of SDH as: 1) implanted follicles that stay permanently, grow naturally, and were harvested without compromising the donor aesthetic. It discusses defining the safe donor area and factors that determine its boundaries such as family baldness history and age. It emphasizes harvesting within safe excision density limits to prevent overharvesting defects and outlines techniques to minimize graft transection and damage during harvesting. The goal of SDH is to respect both the donor area and recipient results through careful planning and execution of the harvesting technique.

1. CONCEPT OF SAFE
DONOR
HARVESTING-SDH
Dr. Anil Garg MS., MCh, ABHRS, FISHRS, MA
Dr.Seema Garg MBBS.MSc, ABHRS, FISHRS
MEMBER ISHRS, AAHRS, IAHRS, WSRM, ISRM, APSI
REJUVENATE HAIR TRANSPLANT CENTRE,
INDORE, INDIA
E- mail----anil@anilgarg.com web www.anilgarg.com

2. Nothing to Disclose

3. CONCEPT SAFE DONOR HARVESTING—
SDH
“Implanted donor follicles shall stay
permanently, grows naturally and
should have been harvested without
compromising donor aesthetic”.

4. COMPONENTS OF SAFE DONOR
HARVESTING— SDH
A. Stay permanently—means--harvest from safe donor area
B. Grows naturally--means--harvest healthy HFs
C. Maintain donor aesthetic---means--harvest withing safe
excision limit

5. A. CONCEPT OF SAFE DONOR AREA
• The Unger, Bernstein, Rassman, Alt ,Cole----dis studies and explained
1. Hair follicles on back side of scalp are not androgen sensitive, and
are not liable to fall under effect of DHT, and because of “donor
dominance”, when implanted in androgen sensitive area, they remains
permanent.
2.Occipital, parietal and lateral side of scalp has different nerve supply
indicating these area has different embryological origin than skin on
the top of scalp.
3.The 25% of total scalp area is permanent, and a total 50% of this can
be harvested.
4.On an average a total of 5000 to 6500 grafts from a healthy donor
area can be harvested, in multiple sessions.
5.As per Cole SDA 203 SQ CM

6. SDA IS REALLY PERMANENT-?
• Unger suggested the global mean life expectancy was ≤80 years old and >80% of
men aged between 70 to 79 years manifested baldness that is less than Norwood
type VII.
• DEFINED SDA—is said to be permanent based on various studies but
• The width of SDA---family history of baldness, age and severity of baldness,
patient compliance for medical treatment
• Local examination of SDA- Anagen telogen ratio, Retrograde alopecia.
• for progressive thinning examination of SDA by wetting the scalp.
• A rough calculation of superior border of SDA 6cm below the center of whorl is
also one of criteria of occipital fringe of SDA.

9. Occipital region
Advantage of FUT
Donor area over FUE
DONOR AREA

10. OCIPITAL
PROTIBERANCE
MEATAL
LINE
2cm
6cm
OCIPITAL
PROTIBERANC
B
C C
C
B B
D
Mid occipital vertical line
nsverse
pra
ricular
e
Major zones

11. Major zones
Minor zones
COLE’S FUE.
SAFE DONOR AREA

12. LIMITED SHAVING OF SDA TO PREVENT
HARVESTING BEYOND SDA LIMIT

13. B-MENTAIN THE DONOR
AESTHETIC/COSMETIC DENSITY-
prevent over harvesting
Over harvesting leads to various donor area aesthetic defects secondary to
faulty technique of harvesting of hair follicles. This is mainly because of
1. Overshooting the safe excision limit
2. The use of relatively large size punches for harvesting.

14. Photo-Curtsey ,Dr.Bob True, Book-Practical guide to har transplant, Chapter 7

16. Harvesting very closely leads to necrosis.
Photo-Curtsey ,Dr.Bob True, Book-Practical guide to har transplant, Chapter 7

17. Overharvesting leading to significant scalp show

19. Why surgeon does over
harvesting
• 1. Lack of knowledge – safe excision density,
• 2. To meet with unrealistic demand of the patient
• 3. to compensate his high transection rate and
poor results--

20. Various donor defects because of
over harvesting

21. DONOR EFFLUVIUM-Case of FUT+FUE

22. Overharvesting leading to telogen effluvium

23. Extraction from limited area using large size punch

24. Hypopigmentation because of larger poor-quality punches.

25. Poor growth despite of overharvesting

26. Non uniform extraction leading to poor donor appearance

27. PATIENTS
EXPECATION
Surgeon shall make a balance between donor supply, recipient area demand and
Patient’s expectation's.

28. HOW TO AVOID OVERHARVESTING
The surgeon should know-
• Safe Excision limit
• Residual density
• Donor area evaluation
• Hair mass concept
• Optimum Punch size
• how to minimize transections
• How to produce Optimum results of hair transplant

29. IMPORTANT FACTORS FOR
GRAFT EXCISION

30. SAFE EXCISION DENSITY
Safe excision density is number of grafts harvested without compromising the
cometic density of donor area.
Most FUE experts recommend 10-15 excisions/cm² as a safe single pass density in
a person with a baseline average density of 65-75 grafts per square centimetres.
Dr James Harris reports a routine use of higher excision density in the range of 20-
25 grafts per square centimetres without problems.
A rough estimate of 20-25% of graft excision of existing density can be done,
although every donor area is different in terms of density, thickness, colour
contrast, curl of hair and MFUs density.

31. RESIDUAL DENSITY-
donor density left after grafts
excision
DONOR DENSITY LESS THAN 40/30 - VISIBLE THINNING
EXAMPLE-Donor density 70 Grafts per sq CM
FIRST PASS EXCISION density ----10-15 G/CM
RESIDUAL DENSITY-----------------70-15 =55 G/CM
SECOND PASS EXCISION DENSITY----10/15
II- RESIDUAL DENSITY-----------------55-15 =40 G/CM
III-PASS EXCISION DENSITY----10/15
II- RESIDUAL DENSITY-----------------40-15/10 =25/30 G/CM
Although scalp visibility depends on hair thickness, MFU density,
colour contrast and curl of hair.

32. COVERAGE VALUE—
•The scalp area covered by hair mass
unit = hair density X thickness of hair
• Hair density = 100 hair per square cm
•Thickness of hair. 0.05mm
•Coverage value. = 100 X 0.05. = 5.0
• Lower coverage value, limits the safe
excision density.

33. UNCOVERED SCALP AREA AFTER
EXTRACTION-USA
• USA = total area covered by hair - area of hair extracted
I feel hair is cylindrical structure, so length of hair
Shall also be considered, and more research is needed to
know USA.
Length
thickness

34. 1c
m
6X 4 cm = 24 Sq cm
1c
m
24-6 = 18 Sq cm
25% EXCISIN

35. 1c
m
24 Sq cm
1c
m
24-9. = 15
33%EXCISION

36. 1c
m
6X 4 cm = 24 Sq cm
1c
m
24-12 = 12
50% EXCISION

37. 1c
m
6X 4 cm = 24 Sq cm
1c
m
24-16 = 9
66% EXCISION SIGNIFICAN SCALP SHOW
USA

38. PUNCH SIZE
0.8
1mm
1mm punch
0.9 mm punch
1mm punch creates 60% larger scar than 8mm punch

39. LINEAR CUT--necrosis
UNIFORM EXCISION

40. Divide total SDA, into multiple segments
to prevent un uniform harvesting which leads to moth eaten
appearance

41. DO NOT EXCISE ALL MEMBERS
OF FAMILY
DO NOT EXCISIE ALL MFU OF
ONE AREA

42. SHADOW HAIR
ORPHAN HAIR
SECOND PASS
&
THIRD PASS
EXCISION
Excise shadow
Hair
(hair covered by
Another hair)
Do not excise
Orphan hair
(isolated hair
In skin zone)

43. C. HEALTHY HF
HARVESTING
PREVENT TRANSECTION
PREVENT INJURY TO GRAFT
WHILE SCORING AND
REMOVAL OF GRAFTS-

44. It is advisable to Engage Epidermal blush rather
than exit hair angle. This reduces the transection.
MORE TRANSECTION = MORE HARVESTING

45. LEARNING MODULE FOR FUE-JCAS

46. MORE DAMAGE TO GRAFTS DURING REMOVAL, WILL REQUIRE MORE HARVESTING

47. GRAFT INJURIES DURING DISSECTION
GRAFT INJURIES DURING REMOVAL OF DISSECTED GRAFTS

48. If we follow all
basic concepts of
follicles harvesting,
we can respect
donor as well as
recipient area.

49. 3032 GRAFTS

50. 2978 GRAFTS 1876 GRAFTS

51. 3245 GRAFTS EXTRACTED

52. 3135 GRAFTS

53. 3006 GRAFTS

54. 3336 GRAFTS

55. has license to
HAIR tranplant
But
does not know
But
Technician
knows HT

56. D
E
F
A
B
C
c-2cm above the superior aspect of helix along a
Line drawn vertically through anterior to tragus
CD- extensive lateral limit, EB-conservative lateral limit-
AF—width in mid occipital region
ABCDEF—SAFE DONOR AREA