I'm trying to grasp this but can't make any sense of it at all, it must be an illusion of sorts. I'm wondering what are the actual physical affects of the donor area that has has several strips taken out. Let me try to explain this..

A normal unstripped scalp has so many hairs on it. Now, after a couple strip surgeries, there has been substantial hairs/skin/fatty tissue removed, but the surface area remains visually the same. How come it isn't noticeable? Do we lose surface area or does the skin get stretched after surgeries pulling the individual folicules farther apart? If it pulls the hairs apart, why wouldn't look noticeably thinner?

I'm guessing the skin has enough laxity to keep from stretching so much, but that still leaves the fact that there are considerable less hairs there.

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Rambler,

It has everything to do with scalp elasticity. After the strip is removed, there is a gap of flesh missing. I realize that is a graphic thought, but it's true. The physician will only remove what can safely be harvested while preserving overall scalp elasticity to properly close the donor.

Using state of the art tools, a quality surgeon will pull the skin, closing the gap using staples or sutures to seal the wound. Using the trichophytic closure technique, one side of the wound overlaps the other so hair can successfully grow through it, camoflauging the scar. The scalp "tightness" in addition to some slight pain and later itching is a result of the loss of some skin elasticity since it has been stretched. Overstretching of the skin could cause all kinds of problems which is why hair loss doctors must be very careful in how much tissue they remove in a single hair transplant session.

In time, the wound will heal and some scalp elasticity will return, not as much as before, but in most cases, enough that allows a patient to return for a second hair transplant procedure.

In the end however, as you have rightly stated, hair follicles are slightly more spaced apart causing a slight decrease in hair density. In most cases, this will not be noticeable. This is due in part to the overlapping effect of hair when kept longer. However, when I compare pictures of the sides and back of my head now with shorter hair (after 7550 grafts) to before any surgery, I can notice a slight difference in density. But I highly doubt anyone would notice given the minimal impact it has made.

I hope this helps

Falc

Falceros,

No, I understand all of that. What I am wondering is say we take it to the extreme with miraculous unrealistic physiology to make my point.

Extract a 4 inch tall strip side to side. Now assume the scalp has the ability to pull the gap back together and be closed. With this much hair and scalp removed I would imagine the visual results of the donor would be very much noticeably smaller.

Well, on a smaller scale but those with 3-4 procedures I would think would almost fit into this category. I'm just wondering why the donor is immune to any visual impact, if not only for the fact that there are *substantial* hairs taken away from a "same area" mass.

[EDIT ADDED]
I just re-read your post and you say you do notice a very slight difference in density. I would think it would be more than slight, but good news that it isn't.

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Rambler,

Sorry, I added the last paragraph realizing I forgot to address that part of your question .

But given that I've had 7550 grafts taken (more than most) and only notice a slight decrease in the appearance of density when comparing pictures in the sides and back, I highly doubt anyone else would notice. Most patients won't even be able to notice a visual difference in their own scalp - but this will depend on the width of the strips taken in all procedures and virgin scalp hair density

Falc

Rambler, I think I understand what you are saying. Hypothetically speaking, if you were a NW7 with a 3" high horeshoe around your head and you had a couple HT's that removed a total of a 1" strip, would you now have a 2" high horeshoe? I know I exaggerated but I have wondered the same thing.

I also think that this article might help:

Scalp Exercises - Risks of Scar Stretching - and Observations of How Skin Works

Any thoughts?

Falc