Recipient Site Formation in Hair Restoration Surgery
In hair restoration surgery, the creation of recipient sites is a key step that influences the natural appearance of the transplanted hair. Recipient sites are precise incisions in the scalp where follicular unit grafts are placed. When performed accurately, these sites ensure proper graft positioning, spacing, direction, and angle, allowing the new hair to integrate with existing hair.
Poor site creation—such as inconsistent angles, depths, or patterns—can result in an unnatural look, even with high-quality grafts.
What Are Recipient Sites?
A recipient site is a small incision where the follicular unit graft (hairs) are placed in a hair restoration surgical procedure. The recipient site must be tailored to the patient’s grafts size and shape, the scalp’s properties (e.g., thickness, laxity, vascularity), and the natural hair pattern (direction, angle, transitions). These are controlled incisions, not simple holes, designed to secure grafts with minimal trauma.
Step 1: Planning and Design
Design precedes incision creation.
– For hairline restoration: Consider facial proportions, age-appropriate placement, temporal patterns, irregularity, and density transitions (softer single hairs anteriorly).
– For crown or other areas: Account for swirl patterns, existing hair, predicted future loss, and donor availability.
The plan is mapped based on current loss, miniaturization, and long-term progression.
Step 2: Instrument Selection
Recipient sites must precisely match the dimensions of each patient’s grafts, as follicular units vary in size and shape between individuals and even within the same patient.
No “one size fits all” approach is used. The primary method employs custom-cut flat blades; sapphire blades or needles are used in select cases.
Dr. Gabel personally measures the extracted grafts intraoperatively and fabricates custom flat blades tailored specifically to that patient’s graft geometry. This ensures each site is sized exactly—preventing graft damage from oversized or undersized incisions while minimizing trauma and optimizing consistency.
Step 3: Controlling Depth, Angle, and Direction
Each site requires attention to:
- Depth: Matched to graft and scalp to promote seating, growth, and minimize complications like pitting.
- Angle: Typically acute to mimic natural emergence, especially in frontal and temporal areas.
- Direction: Aligned with native patterns, including regional variations, transitions, and crown swirls.
Mismatches can lead to unnatural flow or styling issues.
Precision and Team Support
Site creation involves real-time counting for accurate graft distribution and controlled scalp tension for clean incisions.
Physician Involvement
Recipient site creation involves incisions and requires surgical judgment. In many jurisdictions, it constitutes the practice of medicine. At the Gabel Hair Restoration Center, Dr. Gabel performs all recipient sites personally.
Common Considerations
– Site size: Should fit the graft without excess trauma.
– Impact of technique: Errors here can compromise results despite perfectly extracted grafts.
Recipient site creation combines technical precision with aesthetic planning to achieve natural, durable outcomes. At the Gabel Hair Restoration Center in Portland, Oregon, this step is handled directly by Dr. Gabel.
