Sequential Strip Removal

The following article is a study presented by Parsa Mohebi, M.D. in the 18th annual meeting of international society of hair restoration surgery (ISHRS) which was held in October of 2010 in Boston, Massachusetts.

Dr. Parsa Mohebi is the medical director for Parsa Mohebi Hair Restoration. Dr. Mohebi performed his surgical internship at University of North Dakota followed by surgical residency at University of New Mexico and York Hospital. Dr. Mohebi then continued his aspirations in surgical research by joining the Department of Surgical Sciences at Johns Hopkins School of Medicine. He performed several studies on wound healing and hair growth using growth factors and gene therapy techniques. Dr. Mohebi completed a fellowship in surgical hair restoration at New Hair Institute.


Today, we are capable of transplanting larger number of grafts in one session in comparison to what was considered the standard a few years ago. Giga-session surgeries are getting more attractive as the patient’s demand for higher number of grafts increases. Accurate measurement of scalp laxity is crucial in minimizing the chance of donor complications in larger sessions of hair transplant especially when the scalp laxity is less than perfect.

Previously, we have introduced a method to determine the maximum number of grafts that could be harvested safely in one session. We presented a study on 37 patients using sequential strip removal technique with no donor complication in the 17th annual meeting of ISHRS. The importance of the technique and the complexity of presenting it through only pictures made us instead elect to submit a high definition video to illustrate the details of the procedure.

Using the sequential strip removal and measuring the scalp laxity, we developed a safe method of determining and harvesting the maximum size of strip. In this technique, we removed one side of the donor strip based upon the maximum width that was considered safe. Laxity measurements were made before excision of the first portion on left, middle and right side of the strip. Then we closed the wound on primary strip area. Laxity measurements after closure of the primary portion were done at the not-yet -excised side. If scalp laxity on the secondary portion was reduced after closure of the primary portion, the width of the secondary portion would be adjusted accordingly. If closure of the primary portion did not affect the laxity of the secondary portion, we could carryon with removal of the secondary portion of the strip with the same width.

The sequential strip removal technique using the Laxometer is a great method to determine the maximum safe size of the strip. We have been able to maximize the number of grafts without sacrificing the safety of our patients. The Laxometer is being used routinely in our offices before and during surgery to increase the safety of larger hair transplants, which leads to more satisfaction for both patients and the surgeon.