Hair Talk

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I’m working on some talks right now for India and Mumbai, where I’m going to be giving some lectures in about three weeks. So I thought I would go ahead and talk about this concept of recipient and donor dominance. So the principle of modern hair restoration is based on the concept of donor dominance espouse by Norman Orin trike in the 1950s. What he found is that hair is moved from the back of the head and moved to the front of the head, maintain the result of the donor hair, even though it’s sitting in a different area. That’s why you can be completely bald with the front stick hair on the front and still maintain that result over time. The concept of recipient dominance is the fact that sometimes the local skin area does influence the hair.

So how is that possible? So a few things that have been noticed. I cannot say it’s uniformly so, but when you put hair from the back of the head into the eyebrows, if you put in the eyebrow region, the eyebrows can be softer over time even and start slowing down in their growth. And that is a recipient influence. Other recipient influences for example, is that when you put body hair up into the top of the hair, top of the scalp, body hair typically grows very slowly. But as it starts to get into the scalp, it can start growing much faster because of recipient influences are there. So that’s a concept of recipient influences. There are other concepts of donor influences beyond the concept of just donor dominance. So one example of donor influences would be a colleague of mine has actually done some work where he’s taken grafts out from the back of the head and moved it to like diabetic ulcers.

And because the hair itself has a lot of STEM cells in them and that the bulge is a region which is the middle section of the hair has STEM cells that can actually regenerate tissues. He’s found that diabetic ulcers can reverse by just putting hair grafts in there. You can actually have scars lesson. So if you place grafts into a scar, the scar can actually begin to become softer because actually regenerating the scars. And I’ve found that, you know, if you go back and do a second transplant into those scars, that there’s actually oftentimes even improvement in grafts take and improvement in the scar quality, but of course there are hairs there. So you don’t want hairs non hair bearing tissue, unless you’re okay with that for the sake of purpose of trying to regenerate tissues. So that’s another donor influence that has not been talked about as much.

We just think about donor dominance, the idea that I mentioned that if you move donor hair to another place, that it retains those donor characteristics. Another concept that people blame on recipient influence is that sometimes people believe that if you move donor hair to the front of the scalp, that sometimes those recipient influences can cause those hairs to be lost over time. I have not found that to be the case. However, I have had in a very small select group of patients, and I’m going to be talking about this in Mumbai, that they actually looks as if they’ve lost some of their grafts. I believe the reason for this is not a recipient influence, but because in patients of significant hair advancement, like there are Norwood six, seven. Sometimes if you think about it, like my wife’s father, when he was alive, I looked at his donor areas.

The whole donor area was actually thinned out as well. Now I didn’t do any transplants for him. I’m just saying his back of his head not only had that horseshoe fringe, but the hair itself was miniaturized. We call that diffuse on patterned alopecia Dupa and that’s a contraindication. In other words, you cannot do a transplant and someone without donor hair. But I believe that in some cases in patients that either don’t receive medical therapy or they just have advanced baldness, that some of the grafts could actually be lost over time if the donor hair is actually a lost as well. So for me, when I’m evaluating a patient, looking at the donor hair is so important, not just assuming that the donor hair is there and looks fine and they’ve got some hair there. I actually look very carefully with magnification, the quality of donor hair.

And then during hair transplantation, of course everything is under huge magnification to look for those hairs. So during FUE for example, I’m looking for hair and miniaturized and avoiding those during the transplantation process. And during FUT if I’m harvesting hairs already that are miniaturized, I do use those hairs, because they’re always viable and they can be resuscitated with medical therapy, but I don’t put those in critical zones. I put those as supplements to everything else that I’m doing. So hopefully this concept of donor and recipient influences was not too confusing for you. It’s probably a little bit more of a sophisticated topic that a hair surgeons would understand more than the people out there that are just listening to this podcast. But I think it’s worth worthy to understand how complex and interesting our anatomy is.