I'm with Megatron (great name btw). It makes sense to me that stick and place would be the better technique because the grafts are placed immediately which can possibly do two things - one, not give the incision the opportunity to close (which would obviously prevent placement of the graft) and two, not allow a doc to miss an incision. Do you think these possibilities are greater with pre-made incisions?

I think that Bill has answered this quite well.

It is difficult to compare these techniques. Each technique has its own advantages and disadvantages. There are many theoretical arguments why one method may be better than the other but they are not supported by real science. It would be difficult to do an accurate comparison study of the two techniques because each doctor is most comfortable with the method that he or she uses. If I did a comparison study I am quite sure I would get better results with stick-and-place than with pre-made incisions and if, for example, Drs. Hasson or Wong did a comparison study they would get better results with pre-made incisions than stick-and-place. Unless we both operated on the same patient at the same time (in our own offices), there would not be a real comparison. If done well, you can get excellent results with either technique. The best way to judge a technique is not by theoretical arguments but by the final results that are produced.

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Cam Simmons MD ABHRS
Canadian Hair Transplant Centre,
Toronto, Ontario, Canada

Dr. Cam Simmons is a member of the Coalition of Independent Hair Restoration Physicians

I agree totally with what Bill and Cam stated above. For myself, the one big advantage of the stick-and-place method, which I take advantage of in certain unique cases, is the fact that it allows the surgeon to make the SMALLEST possible incision to place the graft in. This is because, at the instant you withdraw the needle or slit blade, you are immediately placing the graft into the opening before any elastic recoil or shrinkage can occur at the site. The benefits of this fact are two: One, you do the least possible damage to the vascular system of the scalp because of the smaller sites ,and two, you can place grafts closer together, because the sites are smaller and more will fit into a cubic centimeter than with a slightly larger site.
The big problem with stick-and-place is that it is not possible for the surgeon to personally perform the whole operation due to the time factor (time the grafts are out of the body) and the fatigue/exhaustion factor. He would be there for 16 hours till the wee hours of the morning and a lot of the grafts wouldn't survive because of the time out of the body. So this task has to be delegated or shared with ones assistants. I use the stick-and-place method mostly in doing "focal" areas in which I want maximum density with minimal scalp vascularity damage, most commonly in the "frontal core" area just behind the central hairline. In a handful of cases in patients who I thought had poor blood supply to the scalp due to multiple past scalp reductions and transplant sessions, I have done the whole case with stick-and-place and one of my assistants who is skilled at this would work one side while I worked the other.
For most transplant cases, especially where a large area of the scalp is being transplanted, the preferred method of choice in my practice and in the majority of them, is to make the incision sites first and then fill them. With skilled placers, the slight shrinkage of the site is not a major factor. But for some practices who become very adept at it, as Dr. Simmons stated, the stick-and-place method can work very well on a regular basis.
A compromise to these two methods described above is what Dr. Jerry Cooley calls the "modified stick-and-place" method, in which the sites are pre-made and then a small slightly blunted needle (to avoid puncture accidents to staff) is placed into the pre-made site to slightly dilate and hold it open. As it is withdrawn, the FU graft is then placed.
Mike Beehner, M.D.

Thanks for your responses. Dr. Simmons and Dr. Beehner, its great to hear feedback from physicians on these technical issues. I, as a layperson, may have some information and an opinion but it is the physician with specialized training, knowledge and practice who can help prevent the spread of misinformation, thanks again.

Really? This is what Dr. Cooley does? I had no idea, I obviously didn't do my homework, thank god his method works.

Plus when you're drugged and they're working on your recipient area (and the fact that you cannot see what they are doing). who would have thought...

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HT with Dr. Cooley