I've noticed that some docs use ~.7 (e.g.) custom blades, whereas others utilize .9-1+ (e.g.)custom blades. Is it logical to follow the intuition of "the smaller the better"?

Doctor skill always reigns paramount when discussing something like this, or loupes/scopes, but assuming doctors of "equal" ability, is there any reason why smaller blades/incisions is not optimal? And, are there actual attributes for using the larger blades like I referenced (other than, perhaps, it is easier for a doc...which isn't to say that is the worst thing in the world)?

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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!

thanatopsis,

In my opinion, the surrounding tissue on each follicular unit should be trimmed as much as possible while preserving the integrity of the follicular unit. Some of the surrounding tissue needs to be preserved however, elite physicians who regularly use ultra refined follicular unit "skinny" grafts have proven to get high growth yield and a greater ability to dense pack.

The number of hairs per follicular unit also plays a significant role in the size of the blad needed. Surgeons who regularly make .7mm incisions do so for single hairs. In many cases, even surgeons using ultra refined methods will use up to 1.1mm or 1.2mm for the larger 3 and 4 haired follicular units. I'd have to see it to believe it if a surgeon tells me they can fit a 3 or 4 haired follicular unit into a .7mm incision.

It's highly important for grafts to fit perfectly into recipient incisions. The fit should be "snug", but not forced. A forced fit often results in "popping", and as a result, cobblestoning. That's why not only the size, but the depth of the incision is vital.

Larger incisions create a greater risk for scalp trauma and eliminates close graft proximity (dense packing).

Hair charateristics will also play a role in the size of the graft, and thus, the size of the incision.

Custom cut blades in my opinion are ideal because you can cut the blade to meet the needs of the patient.

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

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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.

Ahh, makes sense; thx for the pointed answer!

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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!

Thana you knew the answer .
You just want to get this months trophy for the new topic starter.

Great answer on Bill's part. .7mm is for singles whereas larger grafts will need larger incisions.

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I am employed by Hasson & Wong as a patient educator. My opinions are my own and might not be that of Dr. Hasson & Dr. Wong.

Hasson & Wong-The More You Look The Better We Look.

Dr. Hasson and Dr. Wong are members of the Coalition of Independent Hair Restoration Physicians

PGP, either I plead myself ignorant or I cop to tinkering with the the monthly HTN elections...not good either way!

__________________
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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!

Good thread guys, right on. Sometimes it's best to use a larger blade to accommodate families to create density, like the forelock area or behind the hair line. Other times it's best to not use a blade, and use a solid core needle instead like when working to increase density in a diffuse thinner with a lot of remaining hairs.

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

Honestly, I thought it was a great question! I think I'll add this thread to the frequently asked questions section.

Best wishes,

Bill

__________________
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

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.

Thanatopsis_awry:

The answer to your question is that sometimes smaller blades are more optimal, and sometimes not. It depends on many factors. What is more important then the size of the blade is how the Follicular Unit fits in the incision. The graft should fit snugly, but not too tight to cause compression. Also, the incision size should be such that the FU grafts can be planted into the skin with as little trauma as possible. The texture and thickness of ones skin and the size of the graft determine what size blade should be used to make the incisions. Some patients have tough, non-forgiving skin that does not have much stretch to it. In these patients I would usually cut my blades a bit larger. Some patients have follicular units which splay at the bottom. I find they get squashed a bit if the incision size is too small and I have to use larger incisions for this type of FU. A person who has thin blond hair will have much smaller FU's then a person who has thick, black hair. Persons with very curly or kinky hair will have a curve to the FU and will need larger incisions. Also, a FU with 4 hairs will be larger then a one hair FU and will need a larger incision to fit properly.

At Shapiro Medical Group we cut our blades and they usually range in size .6mm to 1.2 mm. On average we use a .7 or .8 mm blade when we are making incisions for the one hair FU in the hairline. For the 2 hair FU we usually use .8 to 1.0 cm. For 3 and 4 hair FU we usually use .9 to 1.2cm blades.

What I do is estimate what size blade I will need for a 1,2,3, and 4 hair FU. Then I make about 10 incisions and place some FU's into the incision. Sometimes the fit is perfect. Sometimes I need increase or decrease the width of my blade. I would say that in half my patients I use a .7mm blade for my one hair FU's. The other times I use a .8 and sometimes even a .9mm blade. Very rarely I have used a .6mm blade for one hair FU's.

The smaller blades are great. We can make incisions closer together when we want to do dense packing. In patients with existing hair in the area of the transplant, the smaller the blade the easier it is to get between the existing hairs. Also, the smaller the blade, the less trauma there is with each incision. But also the smaller the blade, the more chance it will be difficult to place the FU without any trauma.

So as you see, ONE SIZE DOES NOT FIT ALL.

I hope this answers your question

Dr. Paul

The answers above by Bill and Dr. Paul Shapiro are excellent and I agree with everything they have said.
I just wanted to add that a very important factor in blade size (or needle size) selection is the COARSENESS of the hair (the hair shaft diameter). Very fine 1-hair FU's can be placed into 0.6mm blade incisions, whereas coarse ones require a 0.8mm one. Same goes for 2-hair and 3-hair FU's. The blade width is significantly larger for these grafts when the hair is coarse.
And one more factor that is significant. Some patients have FU structures in which the hairs are very straight, parallel to each other, and situated "tightly" together. Other patients have what we term "teepee-ing" of the grafts, with the hairs curving off from each other in various directions. This affects what size blade is chosen also.
Mike Beehner, M.D.