implanter v custom blades

[Koot]

Hi Folks,

 

Anyone got any thoughts on the two processes. After my recent consult with Dr Lorenzo it occurred to me that the stick and place implanter technique means that as each blade enters the skin it does so next to an already implanted graft whereas with the custom blade method all slits are made before implantation therefore there is no danger of the blade damaging newly implanted grafts. I intend to ask Dr Lorenzo about this but wondered if any FUE aficionados had any views either way.

 

Thanks

Edited September 28, 2013 by Koot
typo

[jfables]

Not true. Less trauma, quicker surgery time, less time with grafts out of the body all with the implanter. Much easier on the patient.

[Koot]

I agree in principle with many of the benefits mentioned but was wondering if in the wrong hands or tired hands the implanter can actually harm a freshly implanted neighbouring graft. I assume the angle of each graft implanted has to be identical or else the point of the implanter will cause damage to the protective tissue of those surrounding. Higher risk in dense packing? I guess what I'm saying is that only two top surgeons are using this method and they implant all grafts personally, techs only assist.

[HARIRI]

In the hands of Lorenzo and Hakan, Implanter is much better than custom blades. It doesn't hurt the surrounding grafts plus leaves a very clean work with less blood. But keep in mind not every surgeon can use the implanter properly especially that the doctor handles all the recipient area work without any technician help while with custom blades he can create the slits and leave the implanting to the nurses which is somehow risky as well.

[Blake Bloxham]

I feel like this question is akin to walking into a music store and asking: "which is better - an electric guitar or drum kit?" In the hands of an expert drummer, an electric guitar is essentially useless; the professional drummer has dedicated his life to the drum kit and isn't likely to be much of a guitar player. However, if you put that same guitar in the hands of a trained, accomplished guitar master, he will work wonders.

 

The same can be said for the blades with forceps assisted placement versus implanter pens (Choi/Lion). Frankly, both are good tools and both can be used to produce excellent results. Some have dedicated themselves to using a tool like the implanter pen, and use it to create fantastic results. Others have trained with blades and forceps placement, and produce excellent results with this method. If you switched the methods or gave either to a novice, the results would probably suffer. However, this doesn't mean one is necessarily better than the other.

 

Having said that, there are some advantages and disadvantages to each method (if we want to try and make a straight "apples to apples" comparison). Here is a brief summary about some of the advantages and disadvantages of the implanter pen versus forceps assisted graft placement. Here is a longer, more in depth piece I wrote about different implantation methods (for those who are interested).

[Jotronic]

In this video I compare the incision size of a custom cut blade to that of a needle. The sizes are not the same as a Choi Implanter but the message is the same. It is true that the tool used is only guided by the hand of the surgeon so each can have good results but when you are looking at the amount of trauma between the two there is no contest.

 

http://www.youtube.com/watch?v=a7Zdv6kdtms

[TakingThePlunge]

Great vid Joe!

[Injertocapilar.com]

Popcorn and patience.

 

 

 

 

 

 

[Mickey85]

Amazing documentation by Lorenzo. Very little bleeing from the implanter.

[jfables]

I've never had blades but I had my share of needles that most docs use. I had FUE 3 months ago with Lorenzo using the implanter. I never experienced such a clean and barely painful procedure like this. I DID NOT have any scabs and obviously barely any bleeding from Lorenzo! In two days the recipient area looked only pink and the hairs from the grafts protruded out of the scalp looking like normal growing hair.

 

Also with the implanter, the incision and the insertion of the graft is done at the same time. This skips an entire step that is necessary in other methods (blades or needles). I can't emphasize enough how much is easier this is on the patient. I had 4 separate surgeries with other doctors before this last one. I would no longer ever undergo any other method than the implanter although only if it's in Lorenzo's hands. I can't really say about other surgeons who use implanters.

[HARIRI]

So Jotronic claims that Blades are better while ICC (Lorenzo) claims that Implanter is better. Quite confusing lol.

 

Jotronic, I agree that custom blades are better than needles but is the choi implanter is different than the traditional needles? Is there any advantage? Thanks Buddy. You look great in the profile PIC :-)

[Mickey85]

So Jotronic claims that Blades are better while ICC (Lorenzo) claims that Implanter is better. Quite confusing lol.

 

Jotronic, I agree that custom blades are better than needles but is the choi implanter is different than the traditional needles? Is there any advantage? Thanks Buddy. You look great in the profile PIC :-)

 

In principle, custom cut blades as less invasive due having less surface area compared to the Choi/Lion implanter which have the same radius all the way around. However, implanters allow the incision AND implanting to be performed in one motion, meaning the grafts are generally out of the body for less time than compared to custom blades. Implanters protect the graft and dermal papilla whilst making the incision and implanting. It avoids handling of the dermal papilla, overhandling of the dermal papilla can lead to a damaged graft.

 

There is some debate over which allows for better control over the angles and direction of the grafts but I would say that custom blades would be more suitable for the lateral slit technique due to its inherent design compared to implanters.

Edited January 14, 2014 by Mickey85

[HARIRI]

In principle, custom cut blades as less invasive due having less surface area compared to the Choi/Lion implanter which have the same radius all the way around. However, implanters allow the incision AND implanting to be performed in one motion, meaning the grafts are generally out of the body for less time than compared to custom blades.

 

There is some debate over which allows for better control over the angles and direction of the grafts but I would say that custom blades would be more suitable for the lateral slit technique due to its inherent design compared to implanters.

 

And the expert has spoken. Great answer Mickey85 :-)

 

Have you decided which surgeon will you perform your repair HT with?

[Mickey85]

Pending my friend. Have put a procedure off for a while. Just been enjoying life and all it has to offer Hope you have been well

 

I also wanted to add that implanters protect the graft and dermal papilla whilst making the incision and implanting. It avoids handling of the dermal papilla, overhandling of the dermal papilla can lead to a damaged graft.

Edited January 14, 2014 by Mickey85

[Jotronic]

With blades, they are being cut to size on the fly to match the size of the graft so the use of blades allows for a more customized procedure. When using the implanter the pens still have to be loaded so there is plenty of handling of the grafts not to mention, in the case of Dr. Lorenzo for sure, the pace is frantically fast so the chance of mishandling the grafts (i.e. damage) is potentially going to be higher.

 

Also keep in mind that the shape of a typical follicular unit is not round. I've shown this in the past as you can see the linear arrangement of follicles in a typical bundle while it is still in the scalp. Logically a coronal or lateral slit will be the better fit thus allowing for more precise control of angle and direction and even less compression of grafts when dense packing. Because the incision is flatter you also have a more shallow incision furthering the case for less trauma. As Mickey said, a flat blade has less surface area than a needle but this is the case for identically sized implanter pens as well because they are still round just like a typical needle.

 

However, all things being equal, I find that the tools are becoming less of an issue as each practitioner of hair restoration will find the best tool that suits their practice. Just because someone has a procedure with lateral slits does not mean that the result will be obviously better than his identical twin that had a procedure with needles or an implanter pen from a different doctor. I really like Dr. Lorenzo and I respect his work with the implanter. He has great results. Same goes for several other doctors that use needles such as Rahal and Shapiro. In the end, it comes down to finding a doctor that is comfortable with his tool of choice but more importantly is showing consistency with his work, day in and day out. If you find a doctor that has a deep library of results that makes you say "wow" regardless of technique or tools then that is all that really matters as long as the results are being presented in an honest and transparent fashion.

[Mickey85]

With blades, they are being cut to size on the fly to match the size of the graft so the use of blades allows for a more customized procedure. When using the implanter the pens still have to be loaded so there is plenty of handling of the grafts not to mention, in the case of Dr. Lorenzo for sure, the pace is frantically fast so the chance of mishandling the grafts (i.e. damage) is potentially going to be higher.

 

Also keep in mind that the shape of a typical follicular unit is not round. I've shown this in the past as you can see the linear arrangement of follicles in a typical bundle while it is still in the scalp. Logically a coronal or lateral slit will be the better fit thus allowing for more precise control of angle and direction and even less compression of grafts when dense packing. Because the incision is flatter you also have a more shallow incision furthering the case for less trauma. As Mickey said, a flat blade has less surface area than a needle but this is the case for identically sized implanter pens as well because they are still round just like a typical needle.

 

However, all things being equal, I find that the tools are becoming less of an issue as each practitioner of hair restoration will find the best tool that suits their practice. Just because someone has a procedure with lateral slits does not mean that the result will be obviously better than his identical twin that had a procedure with needles or an implanter pen from a different doctor. I really like Dr. Lorenzo and I respect his work with the implanter. He has great results. Same goes for several other doctors that use needles such as Rahal and Shapiro. In the end, it comes down to finding a doctor that is comfortable with his tool of choice but more importantly is showing consistency with his work, day in and day out. If you find a doctor that has a deep library of results that makes you say "wow" regardless of technique or tools then that is all that really matters as long as the results are being presented in an honest and transparent fashion.

 

I respectfully disagree with implanters having the potential for more damage compared to custom blades. You bring up Lorenzo's fast pace but let us not forget the techs that implant rapidly into the incisions made by custom cut blades. Whilst loading the graft into the implanter, the dermal papilla is not touched and is then protected by the implanter's sleeve as seen here:

 

 

The graft is held by the part opposite the dermal papilla whilst it is being loaded. I do personally see more potential for damage in the use of custom cut blades and forceps when grabbing and implanting the graft into a tiny incision. I can see that grabbing the graft with forceps(as needed with custom cut blades) the protective tissue could be damaged also. The handling of the graft into the implanter looks more precise and less handling required.

[Janna]

 

However, all things being equal, I find that the tools are becoming less of an issue as each practitioner of hair restoration will find the best tool that suits their practice. Just because someone has a procedure with lateral slits does not mean that the result will be obviously better than his identical twin that had a procedure with needles or an implanter pen from a different doctor. I really like Dr. Lorenzo and I respect his work with the implanter. He has great results. Same goes for several other doctors that use needles such as Rahal and Shapiro.

 

In the end, it comes down to finding a doctor that is comfortable with his tool of choice but more importantly is showing consistency with his work, day in and day out. If you find a doctor that has a deep library of results that makes you say "wow" regardless of technique or tools then that is all that really matters as long as the results are being presented in an honest and transparent fashion.

 

I agree with Joe on what's he's said above but I'd like to make a small correction that physicians at Shapiro Medical do not use needles to make incisions. We use custom cut blades but we typically use a combination of saggital and coronal incisions.

 

We've tried needles and various implanters but they did not suit us. With the implanter there will be times when implanting the surrounding grafts will pop out partially or all the way depending on the individual patient. It's not to say you don't encounter bleeding or popping issues with lateral or saggital incisions as well. The clinics who have trained and experienced technicians for planting properly will not likely use implanters. Implanters don't necessarily speed up the surgery time. I've mentioned before that I've visited Dr. Lorenso's clinic and that he's one of the hardest working physicians around because at the time of my visit he said he routinely works past 8-9pm. The night before my arrival he said he worked till midnight. The traditional way of planting with fine forceps can utilize up to 3 planters at once.

 

As Joe said above, producing consistent results in the right hands regardless of the tools is what matters. As we all know, poor results have been achieved when best tools were used.

[Jotronic]

We use custom cut blades but we typically use a combination of saggital and coronal incisions.

 

I knew that;)

[wibbles180]

Hi all ,

 

So would I be correct in thinking that using the pen implanter would leave more noticeable scar traces in the recipient area ?

[Michael Vories, MD]

There should be no visible scarring in the recipient area with either slits or Implanter pens. This is more a function of size, and recipient incisions of 1 mm or less should not be perceptible to the naked eye.

[KO]

I'm a year late to this thread, but my $0.02 nonetheless:

 

I think the key here is to remember that clinics like HW and Shapiro are strip clinics, while Lorenzo is FUE. Now these are harvesting techniques, however that can make an impact on insertion as well. Due to the different graft quality produced by FUT and FUE, FUT produces thick grafts with a lot of supportive tissue, and a technician can easily grasp the tissue with a forceps without damaging the graft, whereas thinner FUE grafts are more prone to damage when grasped at the dermal papilla. It is possible the implanter pen can reduce this trauma as they hold the graft by the shaft rather than the DP and load it on to the implanter.

 

 

But that's just my guess.

[wibbles180]

Hi dr vories , thank you for your informed reply , out of interest what is your preferred technique ?. I now find myself in a position of choosing between 2 surgeons .

Lorenzo= 2200 (1700 to hairline and mid scalp 500 to crown) conservative butterfly design.

 

Erdogan= 4000 ( 3200 to rebuild hairline and mid sc?lp , and 800 to crown) full restoration

 

I have had a physical consultation with dr lorenzo and only a virtual consultation with dr erdogan .

I'm 33 and have been in meds for approx 4 years with good effect .

I am trying to educate myself on both doctors methods as much as possible to make the best decision for my hairloss , my hair is quite fine but I have quite a lot of it if that makes sense .

 

Any advise would be greatly received in helping me make my desidion . I will attatch a couple of recent pics with my hair cropped short and one with longer hair .

 

Thanks in advance

[wibbles180]

Hair cropped

[wibbles180]

Crown with longer hair , hair slightly damp