Straub: Fine donor line all the time
Paul Straub is a former president of ISHRS and holds several
posts on hair transplant committees. His first speech of
the day discussed the pros and cons of donor scars from
both FUE/FIT and strip surgeries.
began by discussing the Woods' Technique, created by Dr.
Ray Woods from Australia. The Woods technique is described
as donor harvesting without scars and uses a small punch
to remove single follicular units. The small holes heal
by secondary intention, or the wound edges granulate in
on their own instead of being closed by sutures.
Woods Technique has been very popular with patients and
the subject of much discussion on the Internet. However,
Dr. Straub feels the Woods Technique has several disadvantages
including the following:
small numbers can be done at one session
- Many follicles are possibly transected
- The incisions actually makes hundreds small scars which are hidden between
Straub went on to discuss the benefits of traditional strip
scars and how to ensure a fine, pencil line scar results
every time in the strip donor area. The tension of closure
on the inner suture is paramount as the outer layer must
appear no other suture is necessary. Dr. Straub's strip
technique is the product of many years of evolution, but
even with perfect technique skin quality plays an important
role in scarring. Dr. Straub commented that he has been
using a harvesting and closing technique which has produced
no "known unsatisfactory scars for the past 3 years."
has taught us that very tight, tough skin causes wide donor
scars and very loose, soft skin also causes wide scars.
A physician should thoroughly examine scalp laxity to ensure
a prospective patient is an ideal candidate for strip surgery.
Previous surgery tightens the skin because of the existing
excision and because of scarring in the fibrous layer.
matter how perfect the technique there will always be a
variation in how patients heal. Some patients always have
small scars and some are keloid formers.
the early days of plug grafts, doctors extracted large "Open
donor sites." On rare occasions the scars contracted
to make the scars nearly undetectable, but most ended up
severely damaging the donor area requiring repair work
later. Open donor harvesting has thus been abandoned by
most physicians. FUE/FIT has replaced open donor harvesting
due to its minimally invasive qualities, rapid healing,
and precision of micro-surgical instruments. However, Dr.
Straub feels the strip is superior now that pencil line
scars can be created with every operation.
he addressed the evolution of donor harvesting and closing
such as aligning the punch wounds properly, matching the
tongue with the groove, and the preferential use of single
or two bladed knives to multi bladed knives to produce
strip ellipses. He compared staples versus nylon closures
and found similar results of scar quality. The length of
time the sutures are left in proved be the most important
factor. Leaving the sutures in for 14 days instead of 7
days increases the probability of creating a perfect donor
scar by 10-15%. By adding deep absorbable permanent sutures,
perfect donor scars are created 99% to 100% of the time.
conclusion, Dr. Straub commented that his demonstrated
techniques produce a fine line scar 99% to 100% of the
time. If every scar is a pencil thin fine line, he feels
there is no advantage to the Wood’s technique and
no need to abandon the current method of strip practice
to start using the Woods technique