What are dilators? Elliot and True uses them but do others?

[Guest]

I live in NYC and have decided to look at the docs recommended on this site and Spencers. I see that this site does not recommend Dr. True but Spencer does. I went to the Elliot and True site but they don't mention using microscopes. But they talk about using dilators. Until them I had never heard of dilators. Do any of the doctors recommended on this site use these dilators? If they don't why don't they? Any experiences with Elliot and True and these dilators.

[Guest]

I live in NYC and have decided to look at the docs recommended on this site and Spencers. I see that this site does not recommend Dr. True but Spencer does. I went to the Elliot and True site but they don't mention using microscopes. But they talk about using dilators. Until them I had never heard of dilators. Do any of the doctors recommended on this site use these dilators? If they don't why don't they? Any experiences with Elliot and True and these dilators.

[Pat - Community Publisher]

Hal,

 

Dilators are essentially small nails that have been modified for use in holding the graft incisions open until the grafts can later be inserted typically by medical techs.

 

The practice of using dilators is virtually extinct as most surgeons consider them obsolete, unrefined, and a bit barbaric. Having seen them in use in Chicago last summer (see my previous posts on this topic from last summer) I happen to agree. This is one of the main reasons why I have been unwilling to endorse Elliot and True. None of the surgeons recommended on this site use dilators and for many good reasons.

 

The dilators tend to create a much bigger wound in the scalp than the much more refined incisions resulting from the tiny blades most surgeons use. They also tend to produce disruptions and cobblestoning in the scalp. In addition, when dilators are used grafts cannot be placed very close together to create density and natural refined patterns.

 

I suggest anyone considering this procedure think twice.

 

Pat - Publisher of the Hair Transplant Network

 

Thanks for reading this post. But it's your posts that make this discussion group real and vital. Please jump into the discussion. Just pick a topic and click the reply button.

[Guest]

Pat,

 

Thanks for your ideas on dilators. The idea of some doctor pounding nails into my scalp doesn't appeal to me.

[Guest]

I went to Dr. Elliot. He did a fine job. The dialators are definitely different. They take time. I am pleased with results. His website explains the dialators and why they are used. I guess it helps with the placement of the grafts. They form a pocket or something like that. Who knows. Shop around. Get your info and make a decision.

 

 

Ron

[Pat - Community Publisher]

Regarding the above topic of the use of dialators and Elliot and True I recieved the below posted thoughtful reply from Dr. True.

 

I'm am happy to hear that he personally no longer uses dilators and does microscopically disected follicular unit grafting. In addition, apparently the dilators and the way they are used by Dr. Elliot are much more refined than how I had seen them used last summer at a different clinic.

 

I apologize for the misunderstanding and my assumption based on the Elliot and True web site that all their surgeons are using dilators.

 

I have only heard good reports from the patients of Dr. True in the past. So I will be interested in learning more about Dr. True, with a new fresh perception. I suspect his work and reputation may even merit recommendation and inclusion in on our community some day.

 

Pat Hennnessey - Publisher of the Hair Transplant Network

 

 

"Pat,

 

I want to set the record straight with you about my practices and the practice of the Elliott & True Medical Group.

 

Our group is an affiliation of solo practices. We share a common philosophy of commitment to achieving the best possible results for our patients. There are technical differences among us in how we do our treatments.

 

In my practice in New York, I have not used dilators for the past four years. Microscopic graft dissection has been a routine feature of my practice since 2000. On the other hand, Dr. Elliott uses dilators routinely.

 

Dr. Wentland has not been affiliated with our group for several years. Granted, I did participate in his training. However, that was many years ago. Even when he worked with our group he did not do treatments as dense as the rest of us. His design concepts were also unique.His receptor sites were generally larger and the dilators he used were larger. His sites were further apart. I have not had any contact with him since we parted ways, so I cannot speak to how he conducts treatments now. I can say that the treatments he performed while part of the group were not representative of how Dr. Elliott or I performed cases.

 

Both Dr. Elliott and I approach our practices dynamically, we continuously evolve and look for better approaches. The methods we use now have moved beyond those we employed when Dr. Wentland was part of the group.

 

As I mentioned, my technique has evolved without dilators. While I don't use them, I do want to defend their use in Dr. Elliott's hands. He uses them in a very refined way. I am comfortable enough with his technique that I have been transplanted by him three times, most recently last July. Dilators have been used in all treatments. I have no pits or bumps and I am very happy with my hairline. Dr. Elliott makes 1mm receptor sites very close together at the hairline. The dilators are very small and fine. Properly selected and used the dilators do not tear or enlarge the receptor sites; they only temporarily stretch the skin. It isn't the use of dilators that produces pits or bumps. They occur because of improper graft adjustment at the end of the procedure

 

No technique is perfect and skill in using the technique may vary considerably. For example, there is some follicular wastage with microscopic dissection in the best of hands. I don't think anyone else has ever used dilators in the way they have been used inour practice, so when they reject their use they are either reponding to their own experience or rejecting a technique simply because it is unfamiliar.

 

I was offended and saddened at the comment on your web site of the prospective patient that he concluded he wouldn't let "some doctor pound nails into his head." - such a grossly distorted perception.

 

Ultimately the test of any technique is the cosmetic quality of the result and the level of patient satisfaction. You have every reason to be a staunch advocate of Dr. Shapiro. His work is very good. Despite our differences in approach our work is also very good. Given the length of time we have been in practice and the thousands of patients we have treated we have justified pride the high level of patient happiness we consistently achieve.

 

You may feel free to post this communication on your web site. I'll leave that up to you. I hope you will be open minded enough to use this information in you effort to provide accurate advice on your site.

 

Please feel to contact me if you have further questions."

 

Robert True, M.D.

 

Thanks for reading this post. But it's your posts that make this discussion group real and vital. Please jump into the discussion. Just pick a topic and click the reply button.

[perry]

Hello Dr. True,

I had a consult with you this past Sat.(using a different name here)and came away very impressed. There were a few questions that I forgot to ask in my visit. What kind of density can you achieve in the frontal hairline in a bald/near bald area? What do you use to cleanse the recipient area? I have heard hydrogen peroxide spray can be harmful. By the way, I sent an email to your website and have not heard back...

[Guest]

Perry,

 

Peroxide can be harmful to open tissue. We use saline only during the procedure. During the day after we may use a little dilute peroxide to the stich area only to clean away any larger scabs which may be forming.This is a safe and generally accepted practice.

 

Hairline density is done in the range of 25 grafts/ cm. sq. I' m not a dense packer by some standards but the grafts virtuslly all survive. Remeber the outermost hair line is composed of sparse single hairs the hairline density builds as you move the interior of the hairline zone.

 

Dr. True