graft planting - depth determined by doc or techs?

[nobuzz4me]

I have a question regarding the graft placement. In order to plant the graft at the right depth, is that on the doc to make the incision the right depth or the tech to place it properly? Seems like a combination of both but maybe this is more on the tech to get it right.

 

To avoid cobblestoning or pitting this is a crucial step. What if the graft is too long for the incision?? Or, are all incisions cut deep enough so this is never an issue??

[the B spot]

Depends on each patient--- I would say that most patients fall between 3.5-4.5mm deep, with docs using needles using the deepest incisions.

 

It is the Doctor's responsibility to make sure each incision is properly made, which includes proper depth. This information is based on the information from the cutters as they prepare the grafts--- a size for 1,2,3,4 hair grafts are measured and then customer blades are cut to size (for docs that use custom blades)--I would imagine docs using needles find the closest match.

 

However, it is then the placing technicians responsibility to inform the doc as to how the width and depth of the grafts are "fitting"---Once again another reason to KNOW your docs staff and their experience.

 

Your right Buzz-- pitting and cobblestoning are a terrible issue.

 

It is important to see patients of a doc in order to make sure this is not happening.

 

Later buddy,

Jason

[Steven Gabel, MD, FACS]

No Buzz

 

This is an excellent question. In my clinic, I make all the incisions and determine the depth that the grafts will be placed at. After the strip is taken, it is slivered and the grafts are produced from the slivers. This is all done under microscopes to minimize any transection and maximize the yield from the strip. Next, I will physically measure the length of the grafts. The measurement can vary between 3.7 mm and 4.5 mm; each patient is different and therefore measurements are taken for each case; and in some cases, I'll take measurements for the different sized follicular units as this can vary as well. As a final step, I will test the fit of the graft for all the different sized follicular units to make sure they sit well before I proceed with making a majority of the slits for the case.

 

Steven Gabel, M.D.

Portland, Oregon

503-693-1118

[nobuzz4me]

Thanks for the responses Dr. Gabel and Dr BSpot!

 

As a follow up, how long once planted will a graft have to set once placed - I mean can the graft pop out some after a few hours post op. I know grafts are fully secure after 9 days or so but can they sink or pop meantime??

[Steven Gabel, MD, FACS]

The time that the grafts seed and are difficult to "pull out or pop out" varies from patient to patient. After transplant surgery, I give my patients a detailed instruction sheet that outlines what they are to do each day after surgery. When patients are finished with surgery, I make sure each graft is in proper position and seeded correctly. I ask them to come into the office the day after surgery to make sure all the grafts remain in the correct position, and if a few need adjusting, we do it at that time. We also do an extensive washing for them so the transplanted and donor area are clean. For the two weeks following surgery, I ask them not to scrub or rub their scalp just in case there are some loose grafts that need more time to lock into position. This time can vary after surgery so when they return for staple or suture removal, I will instruct them on their further post-operative care.

 

Steve Gabel, M.D.

Portland, Oregon

503-693-1118

[Bill - Seemiller]

Nobuzz,

 

This is a great question and often not asked on our discussion forum. Typically the majority of questions have to do with size (diameter) of the incision made rather than the depth.

 

Thanks to B Spot and Dr. Gabel for their excellent answers.

 

Best wishes,

 

Bill

[HK500]

Yes, very good question and responses, thanks to all. Unfortunately my incisions were too deep during my first HT by Dr. Straub and I now have the awful pitting/cobblestoning which I like to compare to the dimples on a golf ball.... There is no way to reverse it and had I known about this site before, well, you know the rest.

[Bill - Seemiller]

HK500,

 

It sounds like you have experienced pitting, not cobblestoning. Cobblestoning is the opposite of pitting where you will feel and see small bumps where the hair follicle is growing. Cobblestoning results in the incisions being made too shallow where Pitting typically occurs when incisions are made too deep.

 

I'm sorry to hear about your bad experience.

 

Bill