Extremely informative!

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*A Follicles Dying Wish To Clinics*

1 top-down, 1 portrait, 1 side-shot, 1 hairline....4 photos. No flash.

Follicles have asked for centuries, in ten languages, as many times so as to confuse a mathematician.

Enough is enough! Give me documentation or give me death!

It's great to see some of our quality doctors also offer their input on this important topic.

Thanks Dr. Shapiro and Dr. Beehner for your contributions.

Best wishes,

Bill

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Managing Publisher of the Hair Transplant Network, the Hair Loss Learning Center, the Hair Loss Q&A Blog and the Hair Loss Forum and Social Community

View our hair loss articles on EZineArticles.com

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To learn about how I restored my hair, view my my hair loss website.

Remember, true beauty radiates from within, not from the skin.

I am not a medical professional and my words should not be taken as medical advice. All opinions and views shared are my own.

Great responses by Drs Shapiro and Beehner, and Bill.

Blade size is the one area that most men can agree that bigger is not always better.

The issues Bill brings up about snuggness/popping are right on. You want the smallest slit to gently accomadate the graft such that when placing the next door neighbor graft, the first guy doesn't pop out.

The one thing not mentioned above though is bleeding. The smaller the hole, the less the bleeding. And it is not a 1:1 ratio either. For example a 0.7mm slit bleeds well more than half as little as a 1.4mm slit--I would guess it is 3 or 4 times less. Now its not blood loss that is the problem, rather it is visualization of the area, AND localized swelling of the transplant area. With smaller slits, the entire surgical field stays cleaner, and less swolen, letting placement occur efficiently and speedily.

Dr. Lindsey McLean VA

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William H. Lindsey, MD, FACS
McLean, VA

Dr. William Lindsey is a member of the Coalition of Independent Hair Restoration Physicians

Great points,

We need to have more of these discussions on this forum where the hair transplant surgeons can share their experiences.

I don't use custom blades in my practice. I either use 20 gauge needles for frontal hair line or 18 gauge needles for the grafts with more than one hair behind the hairline.

I believe solid wire needles have the smallest risk for transecting existing hair, so I use them especially when I am transplanting in a previously transplanted area or when I have to go between remaining native hair.

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Parsa Mohebi, M.D.
U.S. Hair Restoration

Since Dr. Mohebi mentioned needles and this thread is about the size of the instruments creating recipient sites, I thought I'd offer a conversion chart from gauges to diameter in inches and MM.

Conversion of Needle Gauges to Diameter

Gauge Size - Inch Equivalent - mm Equivalent

13 - 0.095 - 2.413
14 - 0.083 - 2.108
15 - 0.072 - 1.829
16 - 0.065 - 1.651
17 - 0.058 - 1.473
18 - 0.049 - 1.245
19 - 0.042 - 1.067
20 - 0.035 - 0.889
21 - 0.032 - 0.813
22 - 0.028 - 0.711
23 - 0.025 - 0.635
24 - 0.022 - 0.559
25 - 0.020 - 0.508
26 - 0.018 - 0.457
27 - 0.016 - 0.406

Best wishes,

__________________
Managing Publisher of the Hair Transplant Network, the Hair Loss Learning Center, the Hair Loss Q&A Blog and the Hair Loss Forum and Social Community

View our hair loss articles on EZineArticles.com

Follow us on Facebook | Twitter | YouTube

Subscribe to our Newsletters | How We Recommend Physicians

-----

To learn about how I restored my hair, view my my hair loss website.

Remember, true beauty radiates from within, not from the skin.

I am not a medical professional and my words should not be taken as medical advice. All opinions and views shared are my own.

I generally agree with what was discussed above.

However, many patients that I see have a HUGE concern that they will look pluggy. We do alot of singles just to avoid that. We do doubles and some triples, but rarely anything bigger.

Using a gardening analogy, follicular units are alot like dandilions or clovers. You see them in clumps and in 1s 2s and 3s. I rarely see a group of 4 buttercups for example. Same with hair. When I take the strip, I don't see a group of 4 very often.

So unlike most manly things, with hairline blades, smaller is better. We custom make our blades AFTER seeing the size of the grafts.

Lastly its counter-intuitive. It is actually easier to place into smaller slits packed closely together. There is less bleeding and less popping. As I place alot of our grafts, I say that with first hand knowledge on placement.

Dr. Lindsey McLean VA

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William H. Lindsey, MD, FACS
McLean, VA

Dr. William Lindsey is a member of the Coalition of Independent Hair Restoration Physicians

It is nice to have options, occasionally I employ cut to size blades especially in the patients with advance stage hair loss and little remaining hair. As I stated previously, the solid core needles, are very useful in creating sites between existing hairs, since the only part that can cut the follicle is the point, once pass this sharp point the needle shaft is blunt and will not transect the hair. When carefully introduced between hair follicles the needle wedges between the follicle creating the site without damaging the adjoining follicles. Dr. Mohebi, I too employ solid core 21g, 20g, 19g and 18g needles a lot, what a great value they are too. Dr. Lindsey, while the size is getting most of the attention, it is not all that matters. As a matter of fact, equally important is how deep. Dr. Arnold designed his Minde blades with this in mind. It is pivotal that the depth be controlled to prevent injury to the microvasculature, which lies below the follicles. When not using Minde blades I use my finger to minimize the depth of the incisions.

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Dr. Bernardino Arocha is a member of the Coalition of Independent Hair Restoration Physicians

Smaller = Better