(a) A patient who underwent the old round graft hair transplanting from 1980 to 1995 and who initially had very good cosmetic results in both recipient and donor areas. (b) By 2005 however, some scars in the donor area fringe, adjacent to the balding crown area, had become noticeable, especially when his hair was wet. This was due to the fringe hair gradually becoming less dense and finer textured, thereby decreasing camouflage of the scars by their surrounding hair. (c) Twenty-nine years after starting transplanting, the fringe hair had become sparse enough and fine enough that the problem also involved the temple areas. The hair has been parted in this photo to clarify the extent of scarring. The patient had unsuccessfully tried to improve the appearance in this area with inexpert tattooing. (d) This photo was taken at the same time as (c). Very little hair was left to camouflage the problem scars that were clearly noticeable with the hair dry or wet. In retrospect, too much donor hair had been harvested from the upper borders of the originally assessed fringe hair because the severity of hair loss had not been foreseen. At this point he was only 53 years old and could reasonably anticipate many years of a very serious and worsening cosmetic problem.
Another patient whose donor area looked excellent for many years but as the hairs within the highest portion of the fringe hair gradually became sparser and finer textured the donor scars became easily visible beginning approximately 20 years after his last hair transplant (his recipient area luckily had continued to look quite good at this point!). It is best to stay within the SDA (Figure 6) when harvesting grafts – whether by strip method or FUE.