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Dr. Bisanga - Donor Extraction Approach Explained



Valued member
There has recently been some discussion and questions regarding the pattern of extraction that is often employed by Dr. Bisanga. This is where Dr. Bisanga will harvest on one side of the donor area and not the opposing side.
I wanted to address this question and explain the approach behind the method.

There are various motivations why Dr. Bisanga will at times take the approach of only extracting from one side of the patient´s donor.

If we start by explaining that much more commonly, we will see patients who have undergone FUE surgery, and the main focus of their extraction pattern is centred on the occipital (back) donor region, oftentimes not extending even slightly to the parietal (side) area.

The reason that this is a common approach is that the occipital donor area has the highest density, higher hair groupings and is the richest area of the entire donor. When a doctor is looking to achieve the best result possible, he has therefore chosen the best quality grafts. The concern with this approach is that the strongest area of the donor has been heavily relied upon in that first surgery, meaning that subsequent procedures do not have the advantage of utilising this area to any extent.

One of the beauties of FUE surgery, is that it allows the doctor to “cherry-pick” the most suitable and appropriate hairs for specific areas of the restoration. This is essential for designing hairlines and temple points. The most appropriate soft and single hair grafts can be found in the parietal/temporal area of the donor (above the ear). This is one of the reasons why Dr. Bisanga will look to extract from this area. To be able to provide natural and optimal single hair grafts, as opposed to having to dissect thicker multiple hair grafts from the occipital to meet the necessary demands/count of singles for the hairline for example.

The question of why we may only extract from one side of the donor, and not the other comes down to several factors. The most simple and obvious is the total graft count of surgery. Taking into account the reasons explained above why Dr. Bisanga will avoid harvesting only from the occipital region, and also prefers to harvest the most appropriate follicles from the temporal/parietal area, due to spreading the extraction pattern over this significant band, there may be no need to extract from both sides. If the desired graft count can be achieved with a very well distributed extraction pattern, then there are more positives to leave an untouched area of donor, with a more specific type of follicle, that can be better utilised for a potential subsequent surgery.

We do not from any of our surgeries have cases whereby the extracted side shows visibly less density than the non touched area, and as explained, this is due to still in keeping with an extraction pattern that is sufficiently spread to not contribute to any real visible concern and especially not when the hair has any length.

Additionally, before extraction, the donor area must be well numbed. Administering anaesthetic and epinephrine to a donor area can in some patients cause shock loss. As we have already explained that the temporal/parietal area has more softer follicles, and is also an area that can be prone to hair loss and recession the closer to the temporal point. This means that some patients may be more susceptible to shock loss in this area.
If a particular patient has a significant graft demand that requires harvesting from both sides, then the reward far outweighs the risk of temporary shock loss. However, in patients whose graft demands can be met by utilising and extracting from just one side, then there is no need to “disturb” both sides at this time. As long as the extraction pattern can be managed in a way that no real visible distinction can be made from one side to the other, then this is Dr. Bisanga´s preferred approach with appropriate patients.
Should a patient then in the future experience further loss into his temple points for example or would like to “tweak” his hairline, then we have the advantage of being able to again harvest the most appropriate single hair grafts from that untouched donor area.
Our approach also allows a second pass even on previously harvested areas, so does in essence maximise the donor without over harvesting and choking any area or over spreading with needless extra injections, swelling and potential shock loss.

It is an approach that has served Dr. Bisanga well in many of his patients.

I will link some cases below where this approach has been used. There are many more on the forum. The cases below show hair at different lengths throughout the growth phases to reinforce that there are no donor concerns.

I think that it is fair to say that the quality of these results and the appearance of the donor area post surgery are optimal.



Staff member
Thanks for posting this explanation of Dr Bisanga`s protocol on his approach to donor extraction. It`s a very interesting read. I`m pleased you covered anaesthetic and epinephrine which can lead to shock loss, especially if the patient receives a high volume. I believe many inexperienced clinics do this and clinics who allow unqualified people to administer it.
Thanks for linking to some patients. It will help people who are busy researching understand the importance of a correct donor extraction and hopefully avoid the pitfalls.