Assessment of Safe Donor Zone of Scalp and Beard for Follicular Unit Extraction in Indian Men: A Study of 580 Cases

CONTEXT: Hair restoration surgery for androgenetic alopecia (AGA) essentially involves various forms of hair transplantation. There is paucity of studies assessing donor area in Indian men and also no simplified guidelines are available for the safe donor area for follicular unit extraction (FUE). Our study is an attempt to study the donor area in Indian men. AIMS: To assess the density of follicular units (FUs) in the donor area, that is, both scalp and beard in Indian men, and to propose simplified guidelines for FUE. MATERIALS AND METHODS: The study design was cross-sectional and was carried out for 2 years. All the consenting male patients with male pattern hair loss Hamilton Norwood grading III or more who consulted for a hair restoration surgery were recruited. FU density was assessed in the donor area of scalp by drawing a rectangle with its lower border being a straight line joining two points, which are 27–28mm from the line drawn perpendicular to tragus, passing through external occipital protuberance. Three squares of area 1cm(2) were drawn within the rectangle. Average of the FUs and follicles in the three squares was calculated to obtain mean density in the donor area of the scalp. Total number of FU was assessed, considering 25% extraction, total average number of extractable follicles was assessed. Total donor area was divided into three areas (areas 1, 2, and 3) and average number of extractable FU was assessed in each. Donor area in the beard, below the jawline, was divided into a triangle and rectangle. Average number of FU, total number of extractable FU was calculated similarly. RESULTS: A total of 580 male patients were recruited in the study. Mean FU density in the scalp and beard was 78.2/cm(2) and 49.7/cm(2), respectively. The total available number of FUs for extraction in the areas 1, 2, and 3 and beard considering 25% extraction was 2064, 3097, 3612, and 824, respectively. We propose three types of donor areas in the scalp, namely, limited, standard, and extended donor area.