How are FUE Implanter Pens loaded?

[PupDaddy]

Some FUE docs have adopted the use of implanter pens to simultaneously make recipient sites and implant grafts (e.g., Doganay, Lorenzo, Vories, etc.). The other common approach is to create recipient sites with custom cut blades or beveled needles into which grafts are then implanted (placed) by the doc or techs using forceps.

 

One of the purported benefits of using the implanter pen is that the delicate (skeletonized) FUE grafts undergo less handling trauma than if they were placed in pre-cut recipient sites using forceps.

 

QUESTION 1:

 

Don’t the FUE grafts have to be loaded into the implanter pens using forceps?

 

The video I’ve seen of the loading process appears to show techs using forceps to load grafts into the hollow needle of the implanter pen at the needle's pointy end-– presumably a snug fit. How is the handling trauma to the graft less this way than if the grafts were being placed into pre-cut recipient sites using forceps? (I have a guess, but it would only be a guess.)

 

QUESTION 2:

 

Also, by what mechanism is a graft ejected from the implanter pen’s needle into the recipient hole made by the needle? Each implanter pen has a plunger. Does the plunger itself contact the graft and physically push it out of the end of the needle? Or does something else “push” the graft out of the needle? I suppose my question is, does the graft not experience trauma from the act of being ejected from the needle?

 

Anyway, I’d be interested to know more about this. Dr. Vories? Someone else that knows?

 

Thanks!

[KO]

1) they do not grasp the follicle by the all important bulge or DP, and it fits snugly inside the tube, as you note, so with the right diameter, no crushing.

 

2)I'm not sure what type of plunger pushes the graft but the act of ejection is gentle, the insertion is hard and fast, but once the needle is in, the release is slower.

[PupDaddy]

1) they do not grasp the follicle by the all important bulge or DP, and it fits snugly inside the tube, as you note, so with the right diameter, no crushing.

 

2)I'm not sure what type of plunger pushes the graft but the act of ejection is gentle, the insertion is hard and fast, but once the needle is in, the release is slower.

 

Your answer no. 1 was my guess, but I wasn't sure. So the graft is gripped with the forceps by the trimmed hairs growing from it, or maybe by the top of the graft tissue where the hairs exit it, rather than from the bulb base or farther down the surrounding tissue, I suppose.

 

I wonder if there is a slit or channel on the side of the needle for the tips of the forceps to pass through so they don't have to let go or re-grip or push the graft at the bulb part to get the graft completely into the needle.

[SySperling10]

Pupdaddy,

 

Before this thread was hijacked by non-sense, it contained some good dialogue from Dr. Vories & Blake that may answer all or parts of your questions:

 

http://www.hairrestorationnetwork.com/eve/175105-cost-fue-increasing-decreasing-6.html

 

I personally chose Dr. Vories for my surgery partly due to his use of the implanter pen, experience with FUE and his successful large cases... price was an added plus.

 

Regardless, the implanter pen appears to somewhat correct/off set the myth related to lack of survival rate between FUE and FUT.

[hairweare]

I had always assumed perhaps incorrectly that the manual extraction process performed by an experienced clinician such as Dr. Lorenzo was the most important variable affecting the yield for FUE. Apparently since it is now established that in Madrid Lorenzo only extracts some of the grafts and is assisted by techs, the only fixed variable is the implanter pen, which other than being loaded by techs is always in his hands The consistent phenomenal results produced there may therefore be entirely attributed to the implanter pen. Other than Dr. Vories I don't think any other doctor in NA is using it. I am not sure whether there is a YouTube video showing the amazing speed and rhythm of his implanting technique but it is certainly a sight to behold.

[PupDaddy]

Ah. Thanks, Sy!

 

Dr. Vories pretty well answered my question in the thread you linked to. He says that only the upper third of the FUE graft is gripped with the forceps when loading the graft into the implanter pen, thus avoiding gripping the graft by its dermal papilla as apparently is necessary for traditional manual implantation.

 

I still think that better cosmetic refinement is achieved using custom cut blades and manual placement, especially for hairline restoration, but I now better understand the argument for implanter pens reducing the risk of critically traumatizing delicate FUE grafts during implantation.

 

Interesting stuff.

[1978matt]

Some FUE docs have adopted the use of implanter pens to simultaneously make recipient sites and implant grafts (e.g., Doganay, Lorenzo, Vories, etc.). The other common approach is to create recipient sites with custom cut blades or beveled needles into which grafts are then implanted (placed) by the doc or techs using forceps.

 

One of the purported benefits of using the implanter pen is that the delicate (skeletonized) FUE grafts undergo less handling trauma than if they were placed in pre-cut recipient sites using forceps.

 

QUESTION 1:

 

Don’t the FUE grafts have to be loaded into the implanter pens using forceps?

 

The video I’ve seen of the loading process appears to show techs using forceps to load grafts into the hollow needle of the implanter pen at the needle's pointy end-– presumably a snug fit. How is the handling trauma to the graft less this way than if the grafts were being placed into pre-cut recipient sites using forceps? (I have a guess, but it would only be a guess.)

 

QUESTION 2:

 

Also, by what mechanism is a graft ejected from the implanter pen’s needle into the recipient hole made by the needle? Each implanter pen has a plunger. Does the plunger itself contact the graft and physically push it out of the end of the needle? Or does something else “push” the graft out of the needle? I suppose my question is, does the graft not experience trauma from the act of being ejected from the needle?

 

Anyway, I’d be interested to know more about this. Dr. Vories? Someone else that knows?

 

Thanks!

 

The first 5 minutes of this should help:

 

 

hansbiomed dot com is also useful in the products section

[KO]

Ah. Thanks, Sy!

 

Dr. Vories pretty well answered my question in the thread you linked to. He says that only the upper third of the FUE graft is gripped with the forceps when loading the graft into the implanter pen, thus avoiding gripping the graft by its dermal papilla as apparently is necessary for traditional manual implantation.

 

I still think that better cosmetic refinement is achieved using custom cut blades and manual placement, especially for hairline restoration, but I now better understand the argument for implanter pens reducing the risk of critically traumatizing delicate FUE grafts during implantation.

 

Interesting stuff.

Yep, as you can see in that thread via the image I posted, gripping grafts with a forceps is different due to differing amounts of protective tissue. With a FUT graft you can grab a graft by the fat, and leave the DP untouched.

[PupDaddy]

Thanks, guys. Really good info.

[SySperling10]

 

I still think that better cosmetic refinement is achieved using custom cut blades and manual placement, especially for hairline restoration, but I now better understand the argument for implanter pens reducing the risk of critically traumatizing delicate FUE grafts during implantation.

 

Interesting stuff.

Out of pure curiosity and not differing opinion, how do you conclude there is better cosmetic refinement with the custom cut blades?

[KO]

I think it is bc the implanter is trickier as you are doing two things in one step. That said I think Lorenzo's more recent hairline work is good.

[hairweare]

Those that use it seem to coordinate the cadence,placement and angulation in a very fluid motion.

[PupDaddy]

Out of pure curiosity and not differing opinion, how do you conclude there is better cosmetic refinement with the custom cut blades?

 

Purely subjectively, enhanced with hubris. With that caveat . . .

 

To my eye, the hairline work of the notable docs using these pens doesn’t quite reach the level of naturalness and refinement of the best hairline work out there, be it via strip or FUE. It seems that the round holes created by these pens don’t allow for the density of packing, fine angulation and direction control, ultra fine micro-irregularity, and precise layering effects achievable with tiny flat slit incisions, mostly oriented laterally (aka the lateral slit technique).

 

Implanter pens have been around for quite awhile, but only a tiny handful of top ht docs have adopted them, and the ones that have are FUE-only docs. In this sense I think they have become something of a niche tool, more an accommodation to the particular challenges of FUE than a superior tool for creating recipient incisions that yield more cosmetically appealing results. I think that the higher rates of graft survival claimed by the FUE docs using these pens come at a price, or at least with a compromise.

 

I’m not saying that Lorenzo’s and Doganay’s hairline work is bad, not by any means, just that it isn’t quite so natural, undetectable, and refined as my favorite FUE and strip hairline work—and the common denominator appears to be the use of implanter pens.

 

Others may, and likely do disagree.

[KO]

Actually implants have been widely adopted, just not in the West, but continue to be popular in Korea. Personally, I don't believe it is for any technical reasons that clinics prefer one over the other, just inertia. Doctors that are comfortable using forceps will not want to switch to pens or vice versa. That said, supposedly the Lion implanter has sharper needles which allows denser packing.

[hairweare]

In my opinion ones hair characteristics such as waviness, color, caliber and amount of preexisting hair play more a role in how natural a HT hairline will appear than whether it was attained by either slits or an implanter pen. Density is not generally an issue as too dense a hairline will look unnatural particularly in contrast to a thinning of the zones posterior to it. As long as single follicles are used anteriorly and the angles are correct with all other factors equal it would be difficult to discern a difference.between the two techniques.

[PupDaddy]

I hear what you're saying, and I agree that hair characteristics play a huge role in the outcome, as does transplanting at a density equal to the average density of the surrounding hair, but time after time I see hairline restorations executed with implanter pens that yield hair but look transplanted--at least compared to the "best" hairline work (in quotes because best is a subjective conclusion).

 

Take a look sometime at immediate post-op pics of hairline restorations executed by top surgeons using implanter pens vs. immediate post-op pics of hairline restorations executed by top surgeons using slits and forceps placement. There's quite a contrast, which I think is reflected in the matured results. I could be completely wrong, of course.

 

Here's another, related observation and question:

 

Several top docs don't use implanter pens but use needles (rather than custom cut blades) to make their recipient sites. I believe that Rahal, Diep, and Maras fall into this group. My understanding is that the needles they use are somewhat flattish at the point, which makes possible a type of lateral slit-making by orienting the needle that way. (Please correct me if I'm mistaken.) Maras says he uses needles as small as 21 gauge for single hair grafts and uses 20 gauge needles for multiple follicle fu's. Diep says he uses 20 gauge needles to make his recipient incisions. I couldn't find what Rahal uses.

 

Question: Are the needles used by these docs different in characteristics, design, size, shape, function, etc. than the needles of the implanter pens? I think they must be, because when comparing the immediate post-op photos of these docs' work with immediate post-op photos of the implanter pen docs' work, I detect similar differences as I do when comparing immediate post-op custom cut blade work to implanter pen work.

 

Thoughts and info?

[KO]

I agree that Lorenzo and Hakans hairlines are not in the level of Konior or Rahal, but how much of that is due to their stylistic focus vs the tool used? I think it is an open question.

 

Here is I think a more irregular hairline, not high density, but he shows it with wet hair.

Norwood 1 - 2 - 2303 FU's. Hair Transplant by FUE Technique. Injertocapilar.com. 227/2009

[hairweare]

Definitely not one of his better cases. I don't particularly care for the design or density although the immediate post-op looked better I think.

[PupDaddy]

I agree that Lorenzo and Hakans hairlines are not in the level of Konior or Rahal, but how much of that is due to their stylistic focus vs the tool used? I think it is an open question.

 

Fair question.

 

My working theory is that implanter pens, as a tool for recipient site creation and graft placement, fall somewhat short of custom cut blades (or the types of needles used by Maras, Diep, and Rahal) and forceps placement -- in terms of best achievable cosmetic result for surgical hairline restoration.

 

For example, I wonder whether Rahal's or Konior's hairline work, or that of other top docs known for their hairline work, would suffer if they were required to use implanter pens and were given plenty of time and opportunity to adapt to them? I recall Janna of SMG mentioning that they tried but rejected implanter pens, although I'm not sure what the circumstances were.

 

It would be interesting to hear from docs and clinics here that have experience with both, or at least knowledge of both.

[hairweare]

It was my assumption that the pen was specifically designed for the skeletonized FUE grafts.

[rev333]

in my opinion ones hair characteristics such as waviness, color, caliber and amount of preexisting hair play more a role in how natural a ht hairline will appear than whether it was attained by either slits or an implanter pen. Density is not generally an issue as too dense a hairline will look unnatural particularly in contrast to a thinning of the zones posterior to it. As long as single follicles are used anteriorly and the angles are correct with all other factors equal it would be difficult to discern a difference.between the two techniques.

 

^^^^^^

bump

[wibbles180]

Hi all , what are your thoughts on dr koray erdogans hairlines ?