Lateral Slits and Shingling

[notgoing2gobald]

I have noticed that many patients who have had hair transplants in more recent years appear to have a much more dense and aesthetically pleasing result than others who had a compererable amount of grafts moved from similar coalition docs years back.

 

So I was wondering how recently were the techniques such as lateral slit incision and shingling introduced into hair transplantation? I believe H&W introduced them and were thought as the single most important advent in hair transplantation since the follicular unit, correct? How long ago did other clinics pick up these techniques? Do most of the coalition doctors use these techniques?

 

I ask because this would be a logical explanation for the discrepancy in cosmetic results from patients.

[notgoing2gobald]

I have noticed that many patients who have had hair transplants in more recent years appear to have a much more dense and aesthetically pleasing result than others who had a compererable amount of grafts moved from similar coalition docs years back.

 

So I was wondering how recently were the techniques such as lateral slit incision and shingling introduced into hair transplantation? I believe H&W introduced them and were thought as the single most important advent in hair transplantation since the follicular unit, correct? How long ago did other clinics pick up these techniques? Do most of the coalition doctors use these techniques?

 

I ask because this would be a logical explanation for the discrepancy in cosmetic results from patients.

[Bill - Seemiller]

Ng2gb,

 

Interesting topic, thanks for posting it.

 

Physicians typically use perpendicular (lateral/coronal) incisions or parallel (sagital) incisions to make recipient sites. A case has been made for both methods, but overall, seemingly, there doesn't appear to be much difference in the result based on the type of slit alone overall from what I have seen.

 

I'm not sure exactly when shingling was introduced or who introduced it however, in my opinion, it clearly helps with the illusion of hair density verses hair being placed in rows or columns.

 

I look forward to other answers on this.

 

Bill

[notgoing2gobald]

Bill,

 

thanks. From my understanding lateral slits completely revolutionized the industry---

 

for any one interested check out Feller's explanation----

 

 

http://www.fellermedical.com/Lateral_Slits.htm

 

see also Hasson and Wong Article

 

http://hassonandwong.com/pdfs/lateral_slit.pdf

 

as it allowed the surgeon to not only exercise greater control over the direction of each individual hair follicle but almost more importantly allows for the hairs to grow in a direction which allows for shingling and thus allows for an exponentially greater amount of coverage. I believe that the vertical incisions result in hair growing in a direction which would only allow for a small percentage of coverage when compared to lateral incisions. This is why I believe more recent ht's from *SOME* of the coalition docs allows for a much more dense appearance.

 

In addition the custom made blades which H&W created for lateral slits allowed for much smaller incisions which resulted in folicular units to be placed closer together (dense packing) and by creating smaller incisions there was less trauma to the scalp which enabled them to perform mega-sessions with less scarring and trauma to the scalp then 2-3 "smaller" sessions performed by their predecessors with larger blades...

 

any one know some time-tables and which surgeons adapted these techniques apart from Feller?

[Bill - Seemiller]

NG2GB, many hair restoration physicians who create sagital slits, also used small custom cut ultra refied blades.

 

A much better description of these incisions is parallel (sagital) and perpendicular (coronal/lateral).

 

The sagital incisions run parallel (vertical) along side and in between existing hairs while the lateral incisions bisect existing hairs perpendicular (horizontal) like a T.

 

Since some advantages of lateral slits were mentioned above, below I have mentioned some of the advantages of sagitals.

 

One of the big advantages of sagitals is that they do a much better job of sliding in and around existing hairs to avoid transection. This certainly makes a strong case for physicians who do not require shaving of the recipient area.

 

In addition lateral incisions also tend to disrupt the scalps vascularity more than saggital incisions. Thus sagital incisions transect less hairs and blood vessels, assuming the same size blades.

 

Many physicians also use a combination of both lateral and sagital insicions. I have found that many hair restoration physicians who use a combination of the two use perpendicular (lateral/coronal) incisions in areas of little or no existing natural hair and paralel (sagital) incisions in denser areas.

 

For those reading, I am not posting this to argue against the lateral slit technique which clearly has great benefit, only to show that the sagital slit technique has equal benefit.

 

Click here to see a picture of a patient who received lateral slits on one side with Dr. Wong and coronal slits on the other side with Dr. Shapiro. From the pictures, in my opinion, there seems to be no difference in naturalness or hair density from one side to the other.

 

The bottom line is that both lateral and sagital incisions have benefits and drawbacks. Therefore it is the skill of the surgeon and their staff that determines the quality of the hair transplant result, not so much one type of incision over another.

 

Bill

[Janna]

Bill,

 

You took the words right out of my mouth. From my experience, and since we've routinely use both types of incisions, it truly is more the skill of the physician than one type of incision over the other. I think in recent years, the session sizes have become bigger and incision sizes have become smaller to explain the differences in the before and after pictures.

 

We actually performed both types of incisions on one patient with one side lateral and the other sagital. I will post this sometime soon as Dr. Shapiro has all the "test" info on his computer and I need to pull specific info to give accurate data from them. We even presented this patient at the HT conference in Vancouver couple years ago. None of the doctors were not able to tell which side was which.

[notgoing2gobald]

maybe we can chalk it up to a difference of opinion because both Feller and H&W appear to think Lateral's are the: cadillac margherita, the rolls royce, the summon bonum, the Godfather;

 

Indeed--- the jessica abla of incisions...