» » You have some justification with your concern; but when performed to a
» » high standard there should be little to no concerns. Dense packing
» within
» » existing strong hair is a skill and can be performed with long or
» shaved
» » hair; shaved hair certainly makes it easier because less length to have
» to
» » work within, it is also easier to measure the angulations of the hairs
» from
» » the scalp under micro loop. Dense packing is all relative to hair
» » characteristics anyway and will alter dependent on the area placed,
» hairs
» » per FU as well as hair calibre.
» »
» » An important aspect to working within existing hair to ensure yield
» from
» » both is to follow the simple principle of following the natural hair
» » characteristics and not trying to cheat nature, slit placement running
» » parallel with existing growth will not only ensure high yield but also
» » ensure a natural result and continuity within existing growth. If you
» try
» » to “design” new angles within existing hair then the problem begin.
» Follow
» » theses skilled principles and it should not be a concern.
»
» A key word here is “Strong”. Most hair in thinning areas is not strong.
» All the same, if the hair is not “strong” then it will probably be lost and
» I would rather replace it earlier than wait for it to go so I would not be
» too concerned.
»
» BHR, do you use slits for the recipient area of FUE and strip? Why did you
» opt for slits as opposed to needles preferred by woods cole and Arvind for
» FUE since the donor are extracted as cylindrical cores?
marco,
As you say, no good working around the miniaturised hair only for it to fall out in the near future and having to go back again in the same area potentially increasing skin trauma and taking longer to reach the desired result.
As for blades, needles etc;
Site making has to coincide with the size of the graft, especially with FUT when they are individually cut from the strip by the techs and have more licence to be large or small. FUE the doctor will know more so at the time of extraction, assuming he is the one performing the punch & extraction. So, , graft size is looked at under the scopes then Dr Bisanga will make a decision on what would be best, be it disposal needles, custom made blades and chisel-shapes blades. Skin characteristics can make placing easier or harder dependent on elasticity also. The important factor is the graft and the slit correspond and the placement is neat and habitual for the graft to rest in. If the graft size and placement site are not made to correspond then you can end with a graft floating in a large hole popping because the slit is too small.
This presentation was made a few years ago at the ISHRS
Comparison of Different Instruments to Make Recipient Sites: Needles vs. Blades
SUMMARY of Dr. Perez-Meza’s Abstract from his presentation at the International Society of Hair Restoration Surgery, 2005 – Sidney, Australia
There have been great advances in hair restoration surgery over the past decade. New surgical techniques, instruments and medications have been developed to treat patients with hair loss. Some surgeons use needles to create the recipient sites and others use blades – both groups obtaining great results. There is some controversy, however, about the “ideal” instrument to make the recipient sites.
The objective of this study was to evaluate three different blades and three different needles used to make sites in the recipient area and to compare the wound healing and hair growth after the hair transplant.
Recipient sites were made using the following instruments: 18-, 19- and, 20-gauge needles, Sharpoint 22.5˚, Minde 1.3 mm and Custom blades. Each instrument was used to make sites at a depth of 4 mm and at an angle of 30-45˚. Two-hair follicular units were placed in pre-made incisions.
We evaluated intra-operative bleeding from the recipient sites (bleeding makes it more difficult to place the grafts). We also examined the patient at 10 days post-op for redness, swelling and scabbing, and at 6 and 12 months for terminal hair counts.
The results showed that there were no differences between the two groups with respect to intra-operative bleeding and, at 10 days, there was similar healing for each of the instruments. In addition, at 6 and 12 months, the hair counts were similar.
Our conclusions were that all of the instruments produced similar hair growth and survival. None of the instruments produced cysts, ingrown hairs, pitting or cobblestoning. There was similar naturalness, quality of hair and cosmesis. In sum, if one uses very small instruments in the hair transplant, similar results will be observed regardless of the specific type of instrument used.