Does Lateral Slit Technique provide beter yield than Sagittal Slit Technique?

[azn_guy]

I've been on this site for a while now and never seen this question asked.

 

Does anyone know if Lateral Slit Technique produces better yield than Sagittal Slit Technique?

 

I know some Coalition HT surgeons have transitioned to Lateral because you can dense pack better, while other Coalition HT surgeons continue to use Sagittal Slit Technique because you can fit grafts in between existing native hairs.

 

Has there been any studies on this?

 

There are only 3 answers here

1. LST produces better Yield

2. LST and SST should yield the same results

3. Sagittal Technique produces better yield than Lateral Slit Technique

 

I know people will say it all depends on the doctor, but let's assume Coalitions doctors since they are the best of the best.

[RCWest]

Here it says that lateral slit allows denser packing. Hasson & Wong pioneered it.

Lateral Slit Technique

[Tsakalos]

Here it says that lateral slit allows denser packing. Hasson & Wong pioneered it.

Lateral Slit Technique

 

Instead of believing anything u read arround the net its better to make comments based on personal experience . I had done both of the things mentioned here and i can tell u for sure that the truth is far away from the way it has been presented in various interent sites.

[azn_guy]

RCWest, as I mentioned, I understand that dense packing is a "pro"

 

but my question is about yield. Is yield better?

 

Tsakalos, please elaborate, what's your story?

 

I'm surprised not more people on this site are responding, especially the newbies, this is actually a very important topic and something you all really should understand especially when choosing a HT surgeon.

 

I "believe" doctors such as Alexander, Shapiro, Cooley mainly use Sagittal

 

While, H&W, Feller, Arocha use Lateral Slit Technique.

 

if I'm incorrect, please correct me with my assumptions about the HT Surgeons

[EpilepticSceptic]

tsakalos,

 

Can you please be more specific ?

 

Was lateral slit better for you, or sagittal slit ?

[Rhino3]

Yeah -- Tsakalos, what is this truth you speak of? What a tease to leave it at that...

[Blake Bloxham]

Azn_guy,

 

Several months ago, I asked this same question and was given a good answer by recommended hair transplant surgeon Dr. Parsa Mohebi:

 

"I use sagittal incision on the very front of my hairlines only to make the hairline (that will be receiving single hair follicular units). Sagittal incisions are used to minimize the level of injury to the small dermal blood vessels that travel from front to top. The reason we do not use sagittal incisions on the more posterior areas and behind the hairline is to increase the appearance of fullness in those areas. "

 

Hopefully this helps answer your question!

[Tsakalos]

in my case the lateral slit produced bad results. the yield was low, and some of the very few grafts that grew were thin and wispy, almost invisible to the naked eye producing no cosmetic improvent. i have arround 4000 pics from the last ht (YES 4000 pics - 10 GB and many close ups) and i can show this anytime, also in several other spots, marks from the incisions are visible . Now i dont know the exact cause of this, but since i had other transplants before and since my last donor strip was taken above the previous (meaning at least same or better quality hairs) i whould be expecting the grafts that seem to grow to be at least the same in diameter as the previous (assuming they were transplanted exactly as extracted and havent been manipulated or splitted etc) i am at 14 months post op now. i think maybe the failure of my surgery maybe is not related to the lateral slits, but to other factors related to the donor management - meaning that i think that miscalculations regarding the laxity limit that might have been made, caused my scalp to stretch SO BADLY that probably have affected the blood circulation (since my scalp feeled like someone was pushing it backwards untill the 8th - 9th month) + serious donor complications that require 1 or even more additional corrective work, which after the latest bad experience i am really hesitant to undergo.

Edited October 5, 2010 by Tsakalos

[azn_guy]

Future,

 

Many of us understand that when using Sagittal, needles are used while Lateral Slits use custom blades are used

 

I dont know any HT doctors that are staffed to handle both methods since they are two different techniques.

 

Interesting comment from Dr. Mohebi though...

 

Also don't forget Lateral Slit Technique, Doctors require shaving of the recipient area

Sagittal Slit Technique, shaving is NOT required

[scar5]

I don't know whether the needle vs custom-made blades thing and the post-2000 lateral slit popularity are science, intuition or just plain co-incidental. I do suspect this ; there has been a bias towards sacrificing weak minaturized hair in the NW2,3 zones for the 'greater good', that being, the well-angled growth of hair splayed out to create the illusion of volume. Compromising vascular integrity has gone slightly behind the priority to start on a fresh slate and create the architecture of a well-made illusion. Patients at some clinics are told to stop Minox months before a transplant. To weak hairs, the combination of a minox drought and shockloss of an HT is a death warrant, but it doesn't matter, because take a bow, newly transplanted, flat and splayed lateral follicle. No doubt, sagittal slits protect the existing follicles much, much more because they are parallel.

[j1j9j85]

great thread ive stumbled upon here? i also have a few questions

 

could some one explain the difference between the 2 ways? i dont fully understand???? and why is the one safer for existing follicles than the other??

 

also

 

who did tsakalose's HT?

[j1j9j85]

Say for example you have a mega session that yielded good results using lateral slit but you desided to go for a top up HT for density....

 

would it not be a good idea to choose a dr who uses sagital slit as to protect the established lateral grafts from the first transplant........

 

as sagital lsit is said to protect the existing hair follicles more!!!!????

 

any thoughts on this!!!!!

 

also in regards to which method produces better yeilds

 

i have to say after looking at the patient websites and the results for almost every single pateint and every dr pn the list!!!

 

i have to say dr hassons results make more of an impact than any others then followed by dr alexander in my opinion!!!

 

and its intresting as they both use diff slit techniques!!! how ever dr wongs results are also very good i have heared of more unsatisfied customers from his surgerys than dr hassons???

 

this could be coincedence but they both use the same technique...

 

its very confusing

[j1j9j85]

but the main question is when 500 grafts are transplanted using lateral slit how many survive and when 500 are transplanted using sagittal slit how many survive?

 

which yeilds better results.....................

 

one protects native hair more

one increases the illusion of density

 

 

but all in all which is best?

[EpilepticSceptic]

I think that who the doc is performing the HT is more important than what technique is used. Then also the techs' experience and talent comes in 2nd place. Technique would probably be third on the list IMO.

 

I remember early on in my HT that morning the master tech (Jodi w/ 15 years under her belt) told Dr. Hasson that his slits were a little too small. The way she told him was very authoritative as if she was his peer, not a subordinate. I seriously believe if it wasn't for her high level of experience and comfort working with Dr. Hasson my yield may have been compromised. A truly great HT cannot simply depend on the skill of the doc as there are just too many variables and he is only human no matter how great he is; you need a system of checks and balances all throughout the process and the best clinics have this and THAT is why they are more expensive! You truly get what you pay for.

 

Also, two different docs performing lateral slit will NOT acheive the same results! Just like two different painters using oil based paints will not paint the same picture. One will paint a masterpiece and the other will paint a run-of-the-mill painting.

 

That's why I don't get too caught up in the technical details concerning HTs. This is what the great clinics are getting paid for so that you don't have to stress out thinking about it yourself too much. Either a clinic has the PROOF of a multitude of consistent successful outcomes or they are just talking intellectual mumbo-jumbo BS.

 

IMO the proof is all that matters. And if they can't show it then you have to wonder to yourself -- WHY ???

Edited October 7, 2010 by EpilepticSceptic

[j1j9j85]

great ethic.... and sound reasoning.

 

i some times think the team is as important as the doc as the techs, disected the follicles and plant them....

 

some times no matter how good the dr is if the grafts have been miss handled the out come will only be as good as the techs performance...

[Bill - Seemiller]

j1j9j85,

 

I've posted the below before, but I suspect this will help explain the differences between the lateral slit technique and sagital incisions.

 

----

 

There has been a lot of debate on our hair restoration forum about the benefits and drawbacks between coronal (lateral) slits and sagital slits. Hair transplant surgeon’s that prefer one technique over the other have often emphasize the benefits of their preferred technique without mentioning the drawbacks.

 

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 (in another topic), 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 sagital 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 incisions. 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 parallel (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.

 

Best wishes,

 

Bill

[j1j9j85]

thanks for that Bill it really did help me alot!!!!!!!!!!

 

i think for my next hair transplant im going to choose a dr that does sagital mainly as i dont want to shave down or risk the established grafts that H&W did using lateral incisions in the same area, by having more lateral to risk disection or compromised blood flow.....

 

also by choosing a dr that does sagital next time i can clearly rate both methods and i can keep my hair longer thus be less noticable to my friends in regards to noticing ive messed with my hair!!!!!

[j1j9j85]

after looking at dr alexanders site he too also uses lateral slit?

[Tsakalos]

 

 

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

 

 

 

 

 

if i knew this i whouldnt have done my 3rd ht using lateral, considering that most grafts were placed in already transplanted areas, if what u say its true and cosnidering that an area thats has been already grafted in the past, has decreased blood flow than a virgin area, it makes a possible for the poor result (poor growth, thin almost invinsible to the naked eye hairs etc)

[Janna]

 

Many of us understand that when using Sagittal, needles are used while Lateral Slits use custom blades are used

 

I dont know any HT doctors that are staffed to handle both methods since they are two different techniques.

 

 

 

Hi,

 

Custom cut blades can be used for Sagital or Coronal incisions. The type of blade used for coronal incisions are chisled without any angle to them. You can technically make Sagital or Coronal incisions when needles are used. I believe they are in a category by themselves. At SMG, we do not use needles for incisions but our doctors utilize both sagital and coronal incisions to just about every case. Here is a pic of the two types of blades:

 

 

Here is a picture of the two different types of incisions:

 

 

 

This picture depicts what grafts look like once they are planted.

 

[TakingThePlunge]

Janna,

 

Thanks for providing that detailed response! I certainly enjoyed getting a closeup view of both the tools and the resulting incisions. I'm sure I'll be referencing this post quite often.

 

All the best,

[j1j9j85]

wow, thanks again jana! that was really helpfull!!!

 

i can clearly see how lateral would give the illusion of more density now as the hairs are side by side thus covering more scalp in a way,

 

when compared to sagital when they line up on top of each other???

 

 

how ever im still not totally getting how lateral is more dangerouse to existing hair?

 

and is it true that sagital really is safer for planting in an around existing hairs? and if so why?

 

thanks for your time and for helping nice pics:D

[Bill - Seemiller]

Both sagital and coronal incisions both have proven to produce excellent results. There are pros and cons to both approaches but the reality is, those who regularly use one over the other have mastered the art and take all the precautions necessary to ensure the best possible result. My last 2 procedures were done by Dr. Hasson via the lateral slit technique and while each follicular unit was placed in between existing hair, I had no problem with damage to the existing hairs. Such minimally invasive incisions and careful placement significantly minimizes the risk to existing hair. But that is one reason why physicians who use the lateral slit technique tend to require shaving more frequently than those who use sagitals. But even many physicians who use sagitals do sometimes require shaving on occasion.

 

Best wishes,

 

Bill

[Tsakalos]

actually when i had sagital i was aslo required to shave the head

[Bill - Seemiller]

Tsakalos,

 

I covered that in my last post in the last sentence :-). Depending on the density of the existing hair, even some physicians who regularly use sagitals require patients to shave their head prior to the procedure.

 

Best wishes,

 

Bill