Fat Grafting Using a Hair Transplant Model for Understanding Part 3: Donor Dominance

A new concept that really did not mature fully until I was preparing for my Vegas lecture in mid-2010 and then refined further as I was finishing my prep work for my St. Louis lecture in November 2010 was the concept of donor dominance in fat grafting.  Again, I looked back at hair grafting for a model through which I could understand fat grafts, and I am convinced that there are other similarities than what was discussed in the first two parts of this article series.

Let’s start again with understanding how a hair transplant works.  Back in the 1950s a New York dermatologist Norman Orentreich discovered that hairs transplanted from the back of the head and moved to the front of the head would not be lost like the hairs that were originally there in the front of the head.  In short, the donor hairs would act just like the donor hairs from the back of the head and grow and flourish in an area of genetic susceptible hair loss, condition which he termed donor dominance.

Looking at fat grafts that come from the belly and/or thighs I see a similarity to the concept of donor dominance.  Fat taken from the lower body is very hearty and robust:  it is not easily lost if transplanted by an experienced fat grafting surgeon.  However, if you think about weight gain and weight loss issues someone who gains weight tends to gain it in the belly first and it is also the last place to be lost.  Accordingly, fat grafting is very safe in someone with a steady weight or one that fluctuates very little in weight (say 10 to 15 pounds) but not a great option in someone who tends to fluctuate frequently up and down by 20 to 30 pounds since the facial fat acts like the belly fat.  As a case in point, my mother has lost 12 pounds since I performed her fat transfer nearly 4 years ago and she looks just as good as the day I did it if not actually much better.  I try to communicate these weight considerations to every prospective patient who is interested in a fat grafting procedure with me.

Donor dominance may have other repercussions as well.  In the world of hair restoration, a transplanted graft can still be influenced by the recipient area.  For example, a hair graft transplanted into an area of scar can influence the scar to soften and be reduced over time.  Further, a hair graft can draw in new blood supply and make future hair transplants in the same area sometimes have better take.  I believe that I have seen the same phenomenon with fat grafts.  I look at the skin texture and tone in areas that I have transplanted and they can look mildly to significantly better over time.  Is that due to the touted stem cell effect?  I am uncertain but something about the face looks better.  I have argued also that it could simply be due to the volumization of the face creating a better way that light interacts with the face but all of this remains only my theory, or model.  I just think it is fascinating how grafts can be influenced or influence other areas, and I leverage those benefits and caution my patients about the related limitations.

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