Sign in

How the FUE Shave Test May Forever Change How Hair Transplant Grafts Are Selected And Harvested

Place more value on your own questions and insights

For those of you who have ever thought seriously about undergoing a hair transplant procedure, you’ve probably realized that the newly inserted hair follicles which provide your renewed coverage, must come from your own scalp. But, have you ever wondered exactly what region they are extracted from?

If you are suffering from androgenic hair loss, you may already realize that the issues of thinning and balding are the result of hair follicles which are miniaturizing due to a compound in your blood called DHT. So the general challenge faced by hair transplant doctors is being able to choose donor grafts that will not be affected by these miniaturization processes and can produce healthy, long term growth.

To source these follicles, surgeons have been taught to rely on a region on the back of the head called the Safe Donor Area (SDA).

While this construct has been used as a time-tested method for identifying permanent, long-term donor hair follicles, the borders of the SDA, which have been conventionally defined by certain anatomical landmarks, are not as reliable as most would assume.

We discovered that many individuals will reveal additional regions of permanent grafts, such as the follicles within the nape and periauricular area. (NPA). According to our own direct experience about 75–80% of men will pass the Shave Test and become eligible for the use of nape hair grafts.

Yet, by adopting a strict and uncompromising dependence on the traditional confines of the SDA zone, this causes many patients to be denied of the use of nape hair grafts, due to the fear that they will not last. Clearly, there is a dire need to accurately determine which individuals can or cannot benefit from the usage of nape hair.

At my office, the Dr.U Hair Clinic in Los Angeles, we developed a diagnostic assessment called the FUE Shave Test. This evaluation is performed by shaving the patient’s scalp and closely assessing their hair distribution patterns.

To test the conclusions provided by the FUE Shave Test, our clinic conducted an actual experiment.

A Study on the FUE Shave Test and the Permanency of NPA Hair Beyond the Safe Donor Zone

We performed the FUE Shave Test to qualify a group of 128 male subjects for the use of finer nape hair in the hairline and temples. These individuals then underwent hairline and temple restoration surgery, where follow up assessments were then performed at about 4.5 years following their procedure which found that their nape hair was, in fact, able to survive as permanent donor grafts. The overall methodology and findings of this study were published in the Aesthetic Surgery Journal.

With a basic understanding of how the Shave Test works, it is then possible to see how additional regions of permanent donor graft regions can exist beyond the traditional borders of the Safe Donor Area.

When performed on men with pattern baldness, the Shave Test will reveal one of two types of hair distribution patterns. Either the hair density will be more or less uniformly even throughout the scalp. Or, it will decline sharply towards the nape and periauricular area, past a visible line of demarcation. For this latter group, this drop-off in hair density is due to the miniaturization of hair follicles that have taken place. These particular individuals will not qualify for the use of nape and periauricular hair since these grafts cannot be expected to last on a permanent basis.

The significance of nape hair is that it is, by far, much thinner than regular head hair. If you’ve ever noticed the edge of natural hairlines, you’ll find that it consists of very fine, soft hair and gradually increases in hair thickness. By failing to recreate this subtle detail and selecting regular head hair for the hairline edge, the end result can appear very harsh or stiff. In some cases, the outcome can even look pluggy, if follicular units consisting of multiple follicles are extracted and applied.

Through the ability to use thinner, single hairs from regions like the nape, patients are given a second chance of regaining the original natural quality of their hairline and temples

The subjects in the study reported an average satisfaction rating of 8.5. A fraction of the individuals did report some loss of transplanted hair. But upon closer examination, it was found that these hairs were actually from the SDA, and not from the nape hair region.

The Use of Observation, Not Rules to Identify Permanent Versus Non-Permanent Donor Grafts

Although the Safe Donor Area is a rule-driven concept that is widely depended on in conventional hair transplant procedures, it is a rather limited construct since it excludes the use of neighboring regions as a source of permanent donor grafts.

According to my own direct experience across patients, I’ve found that about 75% of men who suffer from genetic pattern baldness will pass the FUE Shave Test and be able to have nape hair transplanted into the hairline and temples. This is consistent with the findings of Ungar, who conducted a study where the findings suggest that 80% of males will not reach the stage of severe Norwood 6–7 baldness within their lifetime.

Hair loss in the nape and preauricular area (retrograde alopecia) is often closely associated with severe baldness. However, the two conditions don’t always necessarily go hand in hand in every single instance.

In any case, if the vast majority males will not become severely bald or show any decline in their nape and periauricular region, and thus pass the FUE Shave Test, then these individuals will be eligible for receiving nape hair to be used as hair transplant grafts. For most men, the confines of the Safe Donor Area are not an accurate reference for sourcing the full extent of permanent donor grafts which could be made available to them.

Although the SDA is defined through rules, the actual process of observing a patient’s scalp, first hand, will, more often than not, reveal exceptions to these assumptions used to identify permanent versus non-permanent donor grafts. On a shaved surface, it becomes easy to see the regions consisting of healthy growth versus those containing follicles that cannot be relied upon, long term.

Through observation, it is possible to see which individuals illustrate the text-book confines of the SDA as a source of permanent and which ones deviate from these boundaries, due to the presence of thriving, healthy nape and periauricular hair.

In many life contexts, it becomes important to look past surface information either by asking and finding the answers to your own questions or by making your own direct observations.

The SDA region in hair restoration is just one illustration which serves as an immensely important example of where assumed truths, taken at face value, may not always be relevant across each and every instance. Certainly it has been relied upon as a heavily trusted construct in hair transplant surgery. But it is also severely limited in its ability to define a more comprehensive range of hair grafts which could also serve as permanent, useful resources for the patient.

For the end goal of helping patients realize the full potential of what a hair transplant procedure could offer them, it then becomes necessary to actually observe the individual characteristics of their condition in order to determine permanent versus non-permanent graft regions as appropriate solutions to reverse their hair loss situation and produce the most natural looking results that could be attained.

As a tool which enables observations and clear conclusions to be made on sourcing long-term grafts, the FUE Shave Test makes it possible for most male hair transplant patients to achieve an even higher graft count through the use of finer caliber nape hair that would otherwise be considered ineligible for inclusion as a donor graft. Likewise, it also indicates cases where these hairs should not be harvested at all.

Rather than regarding nape hair as an unsafe, or unfit choice across all instances, or taking undiscerning risks and extracting this graft in any patient, the FUE Shave Test provides the information needed on where to find permanent versus non-permanent grafts for specific individuals. And by revealing the SDA as a dynamic concept, not fixed, the Shave Test assessment may alter the way surgeons select hair transplant grafts from here on out.

Get the Medium app

A button that says 'Download on the App Store', and if clicked it will lead you to the iOS App store
A button that says 'Get it on, Google Play', and if clicked it will lead you to the Google Play store