Incisions Determine Where & How the Hair Will Grow

One of the most important factors for a successful and natural hair transplant result are the incisions. This portion of the surgery requires a great deal of control and precision. Using a very fine blade, Dr. Sharma creates thousands of incisions into the scalp from which each individual graft will be placed. The depth and angle of each incision will determine how the hair will grow, hence it is of the utmost importance this step is performed with diligence and competence.

What is used to make each incision?

Each patient will require a different sized blade for their incisions based on a few factors. Graft thickness, quality, spacing, and straightness. To promote the best healing Dr. Sharma will attempt to use the smallest blade possible. This also creates a tight channel that allows each graft to sit securely throughout the surgery.

The blade shown in this image is an SP 89 Spear Blade. The diameter of the tip is only 1.25mm.

Hair Transplant Incision Size

The grafts removed from the donor site (located at the back of the head) are excised with a fixed punch that has a 0.8mm diameter. This ensures that each graft is thin enough to fit into each incision without compromising the integrity of the follicle. This is true for both the F.U.E. & F.U.T. hair transplant techniques.

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Incisions to The Recipient Area

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What makes the incision process different at our clinic?

Every clinic has different standards for its hair transplant techniques. At Sharma Skin & Hair Surgery every hair transplant is performed personally by Dr. Anil Sharma. During a surgery every incision is created by his hand with a fixed blade.

Reasons to select an experienced surgeon like Dr. Sharma.

  • Dr. Sharma performs each surgery himself.
  • The blades are modified to match the depth of the incision and the width of the follicular unit.
  • Every procedure is completed with the use of a blade, and never a needle.
  • Technical skill and an artistic eye are required when designing the new hairline.
  • Placement angle is of utmost importance. This will change depending on the recipient area and slowly shift throughout the procedure.
 

Lateral slit transplant technique

Natural hair does not grow in a random pattern. Hair gradually conforms to the shape of the head depending on the angle and area of the scalp. The lateral slit technique allows Dr. Sharma to mimic the unique growth patterns of each patient and make micro-adjustments throughout the incision process. As mentioned, both the angle, depth, and spacing of each incision will ultimately determine how the hair grows. With such a high amount of control Dr. Sharma is able to create an organic look – no matter where the transplanted hair is being placed.

This also remains true for the Beard Transplant procedure, where a smaller number of grafts are placed. When dealing with areas of lower density like the beard, it is integral that each incision matches the unique angles found on the cheek, chin, and neck.

Slit Orientation, parallel & lateral

Slit orientation for the F.U.E. hair transplant technique can be either lateral or parallel. 

  • Incisions made in a parallel direction are referred to as sagittal slits.
  • When made perpendicular to the direction of hair growth, they are called lateral slits.
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History of Graft Placement

“The follicular unit hair transplant procedure has continued to evolve, becoming more refined and minimally invasive as the size of the graft incisions have become smaller. These smaller and less invasive incisions enable surgeons to place a larger number of follicular unit grafts into a given area. With the new “gold standard” of ultra refined follicular unit hair transplantation, over 50 grafts can be placed per square centimeter, when appropriate for the patient.

Surgeons have also devoted more attention to the angle and orientation of the transplanted grafts. The adoption of the “lateral slit” technique in the early 2000s, enabled hair transplant surgeons to orient 2 to 4 hair follicular unit grafts so that they splay out across the scalp’s surface. This enabled the transplanted hair to lie better on the scalp and provide better coverage to the bald areas. One disadvantage however, is that lateral incisions also tend to disrupt the scalp’s vascularity more than sagittals. Thus sagittal incisions transect less hairs and blood vessels assuming the cutting instruments are of the same size. One of the big advantages of sagittals is that they do a much better job of sliding in and around existing hairs to avoid follicle transection.”

Source – “Hair Transplantation” Wikipedia, Evidence-Based Procedural Dermatology. Springer November 2011

 

Advantages of Lateral Placement

  • The vertical angle of the grafts placement creates minimal damage to the vasculature systems of the scalp.
  • The small placement site is small providing a quicker healing time.
  • The thinner incision allows for the highest amount of density.
  • The smaller gap allows for a tighter fit for the graft.
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Reducing Trauma During the Hair Transplant Procedure not only Allows for a Faster Recovery Time, but it Improves the Final Result.

With less trauma comes less blood loss. Dr. Sharma uses bifocals with magnification lenses which allow him to operate in such a small area but blood quickly obscures the recipient area obscuring his view. The reduced trauma caused by the lateral slit technique allows for greater visibility throughout the procedure and in turn higher precision. This becomes imperative when attempting to achieve the highest graft density possible at the scalp. 

Another factor alongside the angle is incision depth. Depending on the shape of the grafts the required depth can change. Someone with a curlier graft may require a less deep incision to host the follicular unit while a thinner and longer graft will require more depth. Dr. Sharma alone performs the incisions for each and every patient at our clinic – while our small surgical team assists throughout the entire procedure this step is mission critical and cannot be trusted to a technician. 

Having the highest success rate possible is especially important for patients with a limited donor supply. Hair transplants relocate hair, this means we are depleting one area of hair to populate another. For patients with significant hair loss, or the potential for more hair loss in the future must ensure their procedure is safely relocating the highest percentage of grafts, part of a safe journey is a properly sized incision for the graft to be placed. Too snug of a fit can cause the graft to dislodge itself when placed under pressure or even prevent proper access to blood.

Each Patient has a Finite Number Grafts which are Suitable for Relocation.

Having the highest success rate possible is especially important for patients with a limited donor supply. Hair transplants relocate hair, this means we are depleting one area of hair to populate another. For patients with significant hair loss, or the potential for more hair loss in the future must ensure their procedure is safely relocating the highest percentage of grafts, part of a safe journey is a properly sized incision for the graft to be placed. Too snug of a fit can cause the graft to dislodge itself when placed under pressure or even prevent proper access to blood.

Maximizing Density Gives a More Natural and Full Result

For patients whose main goals are achieving high density – typically for cases addressing the forward hairline, tighter packing of grafts is required. To achieve this effect we tailor each graft, trimming down the unneeded tissues and fats away from the follicle to allow it to fit into a smaller incision. If we are going for coverage and packing a large area we are able to use fatter grafts which would typically be trimmed down. This allows for a greater margin of error and is most commonly used for the crown and midzone areas of the scalp.

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What is a Graft?

While researching the hair transplant procedure you are sure to come across this term many times. A graft is a collection of hair follicles. During a hair transplant procedure, Dr. Sharma redistributes thousands of follicles which can contain a single or even multiple hairs. The method used to loosen and excise each graft is determined based on the unique requirements of each individual patient.

Learn more about grafts here

Hairline Design

Planning, and preparation are integral to any surgical procedure, and this one is no exception. Before entering surgery the hairline is painstakingly designed and drafted out allowing accurate measurements to be made. This also gives the patient the ability to adjust and confirm the newly formed hairline. View some of Dr. Sharma’s before & after images here.

Is it Painful?

Before moving forward with the procedure the area is completely blocked with local anesthetic which ensures a painless procedure. The average procedure requires 2,000 or more incisions and each one is created prior to the placement of the grafts. Despite the large number of incisions required, this portion of the surgery is often completed within 90 minutes.

Find some of our most frequently asked questions about hair transplant surgery here.

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Hair Loss Evaluation

A Comprehensive Consultation will Help Us Identify The Best Treatment Route For You

Treatment is a great option for most people, though, certain factors will need to be discussed with Dr. Sharma to determine if the treatment is right for you.

A consultation with Dr. Sharma will allow him to assess your hair loss in depth. He will be able to determine if you are eligible for the Hair Transplant procedure and create a custom plan to meet your goals.

Learn about Hair Loss Evaluation

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Send us your photos and tell us a brief history of your hair loss. Our team will be able to determine if you are eligible for a Hair Transplant procedure. Take the first step towards your Hair Restoration.

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