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» Isn’t anyone going to comment on my hairline design skills??? 
haha, I am not going to comment on your hairline design skills, but I have to say it’s pretty funny watching you in and out of the shower in one of the videos Good job with the site buddy, good info and very entertainting!
Hey man, I do what’s necessary to answer even the most basic of questions:) Seriously, I get this question all the time so I decided to show the goods. That’s what I love about doing the videos. Words on screen can and have done a lot of good but video adds such unique dynamic that cannot be typed. It’s like the adage, seeing is believing. I’ve got loads more planned so stay tuned.
» Dr. Arvind,
»
» What did you use to cut your blades?
»
»
»
»
OMG jotronic, thanks for explaining. Even I was fuzzy on the differences and how these terms have been used in the past few years.
The lateral slits as you have explained them here are the best way for natural results in most cases.
By the way, are your pictures upside down? It seems that the hairs are growing straight up and back. This is the donor area, correct?
The lines show the x and y axis of the site creation. It is the doctor who decides the z axis, influencing growth angulation. Typically, the z axis is parallel to the hair while the x and y are perpendicular (for the math nerds out there, like me).
You can see how if the z axis is off even slightly, you can knick the nearby follicles or transect them. This is one of the causes of shock loss.
Jessica,
I’m glad you get it. Yes, this is the donor area and it is upside down. The patient was lying in a prone position with his feet pointed away from Dr. Hasson. The photo was taken immediately after the donor area shave and just prior to the subsequent donor strip removal.
I’m writing the next video to go further into this issue of blades vs. needles.
Marco,
Not sure what your question is referencing. Dr. Arvind said that up until six years ago he used custom cut blades before he switched to needles. My question is asking what he used to cut the blades to the very fine tolerances that would qualify custom cutting as being useful much less effective.
» Marco,
»
» Not sure what your question is referencing. Dr. Arvind said that up until
» six years ago he used custom cut blades before he switched to needles. My
» question is asking what he used to cut the blades to the very fine
» tolerances that would qualify custom cutting as being useful much less
» effective.
O.K, cutting blades is an HT phrase, I guess. So it means manufacturing the blade.
Fascinating. What if the doctor is working on an area that is totally bald? How does he determine the Z-axis or what direction the hair should be angulated in the incision?
Therapy,
Very good question. Even when someone appears to be REALLY bald they usually have a degree of velous hairs that are visible with magnification. These give a good indication of how the hair direction flowed when the hair was stronger so this is how the new grafts will be placed. There are those cases where there just is not enough hair to tell us anything so in those cases the experience and artistry of the surgeon is all that is left to rely upon.
» Therapy,
»
» Very good question. Even when someone appears to be REALLY bald they
» usually have a degree of velous hairs that are visible with magnification.
» These give a good indication of how the hair direction flowed when the hair
» was stronger so this is how the new grafts will be placed. There are those
» cases where there just is not enough hair to tell us anything so in those
» cases the experience and artistry of the surgeon is all that is left to
» rely upon.
agreed.
It helps to have a picture of what your hair was like when you were younger. The doctor will look at your existing hair around the bald area for clues on what hair growth patterns used to exist. For the frontal third and middle, most people are generally the same. Hair lines are designed to suit your face, age, and goals - this is where artistic skill comes into play. Reconstructing the swirl of the crown is also an artistic design.
Joe (H&W) have shown that blades cause less trauma IN A MODEL SYSTEM. They also have this experience in practise. Dr. A has experience with all of these techniques but has opted for the blunt dilation of the wound at the same time as incision using a needle. Dr. Cole uses blades but according to the study posted a wile back he has better success with lower densities on the first visit compared with H&W. My suspicion and it is unsubstantiated is that Dr. Armani uses a similar technique to H&W using blades but goes in a little deeper.
Doubtless all of these surgeons have a similar degree of technical capability but have opted for disparate techniques. As a scientist, when results are not consistent within a lab or between labs then there is usually a missing parameter that accounts for the variability.
In this case I am wondering if the nature of the application of adrenalin could be of importance. Several clinics have reported problems with grafts “popping out” when using slits and packing at high density. Since adrenalin is a vasoconstrictor and will reduce the local volume around an incision, is it possible that the choice of technique is impacted by the axis between good blood supply-trauma-volume/inflammatory control where the inflammatory control has not been bought into the equation?
» Joe (H&W) have shown that blades cause less trauma IN A MODEL SYSTEM. They
» also have this experience in practise. Dr. A has experience with all of
» these techniques but has opted for the blunt dilation of the wound at the
» same time as incision using a needle. Dr. Cole uses blades but according
» to the study posted a wile back he has better success with lower densities
» on the first visit compared with H&W. My suspicion and it is
» unsubstantiated is that Dr. Armani uses a similar technique to H&W using
» blades but goes in a little deeper.
Not from what I have seen.
» Doubtless all of these surgeons have a similar degree of technical
» capability but have opted for disparate techniques. As a scientist, when
» results are not consistent within a lab or between labs then there is
» usually a missing parameter that accounts for the variability.
I have my doubts about the “missing parameter”. If it was that easy, the docs would have found it by now. It is more likely to be a range of variations on several parameters, changing from patient to patient.
» In this case I am wondering if the nature of the application of adrenalin
» could be of importance. Several clinics have reported problems with grafts
» “popping out” when using slits and packing at high density. Since adrenalin
» is a vasoconstrictor and will reduce the local volume around an incision,
» is it possible that the choice of technique is impacted by the axis
» between good blood supply-trauma-volume/inflammatory control where the
» inflammatory control has not been bought into the equation?
The introduction of adrenalin helps with mostly with visualization and affects local volume to a much lesser degree.
» The introduction of adrenalin helps with mostly with visualization and
» affects local volume to a much lesser degree.
That just is NOT the case as anyone with anaphylaxis will tell you! Just in case it was not clear in presenting these thoughts, an increase in the local volume translates to a change in the pressure around tissues and the room for graft insertion as well as affecting the initiation of inflammatory responses.
»
» I have my doubts about the “missing parameter”. If it was that easy, the
» docs would have found it by now. It is more likely to be a range of
» variations on several parameters, changing from patient to patient.
There are clearly many parameters / variations that effect a patients results. I think that goes without saying. It’s never easy to find one or more parameter that you are not aware of. This is how new models are made, new discoveries and then inventions. When one has the complete landscape of detail then an event IS ALLWAYS PREDICTABLE. If it were patient to patient variation (I assume you refer to skin and hair structure rather than biochemical or reactive) then surgeons would use needles for one patient and blades for another otherwise certain patients would do better with Dr who use blades and others would do better with needles. Is this what you are suggesting?
Bear in mind that a patients reaction to trauma or a drug biochemically is a parameter that varies from on patient to another and this is absolutely always more difficult to detect than physical structural differences even at the simplest level!
» My suspicion and it is
» » unsubstantiated is that Dr. Armani uses a similar technique to H&W
» using
» » blades but goes in a little deeper.
» Not from what I have seen.
»
Oh, what have you seen?
» » Therapy,
» »
» » Very good question. Even when someone appears to be REALLY bald they
» » usually have a degree of velous hairs that are visible with
» magnification.
» » These give a good indication of how the hair direction flowed when the
» hair
» » was stronger so this is how the new grafts will be placed. There are
» those
» » cases where there just is not enough hair to tell us anything so in
» those
» » cases the experience and artistry of the surgeon is all that is left to
» » rely upon.
»
» agreed.
»
» It helps to have a picture of what your hair was like when you were
» younger. The doctor will look at your existing hair around the bald area
» for clues on what hair growth patterns used to exist. For the frontal
» third and middle, most people are generally the same. Hair lines are
» designed to suit your face, age, and goals - this is where artistic skill
» comes into play. Reconstructing the swirl of the crown is also an
» artistic design.
I believe reconstructing the crown swirl is one of the toughest parts of a transplant.
»
» I believe reconstructing the crown swirl is one of the toughest parts of a
» transplant.
Absolutely.
» an increase in the
» local volume translates to a change in the pressure around tissues and the
» room for graft insertion as well as affecting the initiation of
» inflammatory responses.
An increase in volume raises the area, allowing grafts to be placed closer together. This is why the area that is to be treated is pumped up with fluid before creating the recipient sites. It is the fluid that creates the volume, not the absence or presence of adrenalin.
Adrenalin acts as a hemostatic agent, reducing the bleeding to establish visualization. Some people need very minimal amounts and some need a bit more. If there is bleeding under the grafts, it can cause enough pressure to “pop” or dislodge the grafts. Whenever the techs see this, they notify the doctor and the doctor decides which parameters need to be adjusted.
Inflammation, which can result in swelling, does not usually occur until after the placing in that area is finished. Swelling by itself does not dislodge grafts. But, increased blood flow to the scalp can. This is why we tell our patients not to bend over to pick things up, lift weights, or have sex for a few days after the surgery. It can dislodge the grafts.
» If it were patient to patient variation (I assume you refer to skin and hair structure rather than
» biochemical or reactive) then surgeons would use needles for one patient
» and blades for another otherwise certain patients would do better with Dr
» who use blades and others would do better with needles. Is this what you
» are suggesting?
»
With Dr. Cole and Dr. Mwamba, needles vs. blades is more likely to change from one area of the scalp to another rather than from one patient to another. I understand that the methods used to create recipient sites is important to you because you had stated in another thread that you wanted to transplant into existing density. It is the angle of the site that is most important for reducing the chance of shock loss rather than blades vs. needles. If you knick the surrounding hair beneath the scalp, it can cause shock loss. Correct angles will prevent this. When transplanting around existing hair, I personally would prefer blades to minimize tissue trauma.
But, if the hair has curl or wave to it, it can sometimes curl or change direction under the scalp. When it is hard to predict the position of the hair and sheath cells beneath the scalp, it makes it harder to get the angle just right. In this case, Drs. Cole and Mwamba will switch to needles. This is because of the blunt dissection aspect. With blunt dissection, it is more likely that the sheath cells beneath the scalp will roll away from the incision rather than being sliced as with a super sharp blade. This might be why Dr. Armani prefers needles overall, I’m not sure.
»
»
» » My suspicion and it is
» » » unsubstantiated is that Dr. Armani uses a similar technique to H&W
» » using
» » » blades but goes in a little deeper.
»
»
» » Not from what I have seen.
» »
»
» Oh, what have you seen?
H&W, Armani, and Cole and Mwamba all use similar techniques when making sites. The difference is how they approach the surgery overall. H&W and Armani tend to be more aggressive; Cole and Mwamba are more conservative. The clinics will sway their surgical plans towards the other direction if that is what the patient wants and they are aware of the consequences. Armani likes needles; H&W likes blades; Cole/Mwamba like blades, but switch to needles for some situations. The densities that are achieved are mostly due to approach, not site creation technique.
The depth is pretty much agreed across the board to be around 4mm. Then this depth is adjusted to fit the depth of the individual patient’s graft length. I had one patient who had 6mm deep grafts! While the blade has a depth control, needles (in the right hands) are not going to give you a great variance in depth. Because of the magnification and repetitive motion of creating sites, it is very likely that needle sites are not much different in depth to blade sites. Also, if a doctor wants to be sure of the depth, they can mark the needle at a specific point.
—I am generalizing here for the clinics, please correct me if I am under the wrong impression—
Jessica,
Is is correct then that Dr. Cole uses both needles and blades during single transplant? Thanks in advance.
» » » N/T
No problem. I like your questions. They are challenging.
Jessica,
Sorry but I just added a question to the post above. You are online so you may allready have answered it.
If you have a melonhead, literally, then take note of that jotronic video.
If you have a human head , then it doesn’t apply to you.
The hypodermic needle enters the skin via a curved incision slit. As the BEVEL of the needle advances, the skin edges are STRETCHED APART. An internal tunnel is produced UNDER the surface. When the needle is withdrawn, the skin edges COME TOGETHER , creating a curved slit seal.
They do not punch holes as jotronic would have you believe. Otherwise, everytime you have a blood test, a hole would be punched in your vein and the bleeding from a simple blood test would be horrendous requiring compression bandages instead of a 5 minute bandaid.
And afterwards, with standard needles, the injection site is invisible
Anyone on the planet who has ever had a penicillin shot, vaccination , blood test, IV line, cannula or ANY other hypodermic injection has witnessed this.
You cannot compare what happens in elastic skin and flesh to a stiff fruit.
Hairsite, could you provide the series of photos we put up several years ago demonstrating what happens in reality when incisions are made in skin.
Dr Ray Woods
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