Direction/rotation of the graft placed into the properly angled slit?

[giegnosiganoe]

@Gasthoerer mentioned this but I wanted to create a separate thread on this topic because it is something I had never heard of before.

11 hours ago, Gasthoerer said:

It is very hard to describe, especially as a non native speaker. But here is a pic from a repair case of Hattingen clinic. It shows 2 hairs which are bending in the total different direction while having a very similar angle: hattingen biegung haare alopezie.de - Google Search

I believe the top clinic have this right (+/- 45° is not acceptable IMO), but especially for patients with relatively straight grafts it is challenging. Yes, there are marks on the implanter pen (at least I have seen it at one clinic). Feriduni told me as a rule of thumb (if there are no other hairs around) the bending has do point towards the head. 

Assume that the perfect slit is made. When placing the graft into that slit, does it matter what direction/rotation (in the 360 degree plane) it is inserted in?

Most of the grafts I've seen online tend to look mostly straight - there isn't much curvature to them and so it doesn't seem to me like the direction of the graft inserted into the slit should matter too much. But I do also see some curved grafts online. Maybe some people genetically have curvier grafts and thus would require this extra consideration? I wonder how common this is.

Just based on what seems like a lot of effort required to get the right angle, and how many grafts are being done in such a short amount of time (2900 for Gas in 5.5 hours with Feriduni), I have a pretty hard time believing this.. Maybe the clinics are just that efficient.

I would love if a doc could comment on this, maybe @DrTBarghouthi? Also if any patients have knowledge about this or if/how it's done at other clinics.

Edit: Actually looking at these pics below, it also seems like the shorter you cut the donor area before extractions, the more difficult it would be to tell the curvature of the graft. The hair seems to be cut shorter in the first picture and longer in the second. If the grafts in the second picture were cut shorter, then the curvature wouldn't be as evident.

Edited January 2, 2021 by giegnosiganoe

[Gasthoerer]

Undervalued topic. I have a lot of naturally misbend and even misangled grafts and therefore I spoke a lot about it with the clinics.

My grafts a fairly straight but somehow, the clinic managed that most grafts bend in the right direction. Almost all have this natural curl after a certain length and all in the same direction. Actually, my hair is easier to comb and to style then when I had more natural hair on top^^

This pic highlights the discussed topic (hattingen biegung haare alopezie.de - Google Search

[giegnosiganoe]

@Gasthoerer can you share which other clinics did or didn't take this into consideration? If the graft was "mostly straight", did some clinics not bother finding the right angle? Oh and how did you discover that you had a lot of misbended and misangled grafts? Is it just from looking at how your hair behaved, or was it from observing your first 400 FUE procedure?

Personally, my hair is very straight. It sticks straight up like a porcupine when my hair is cut short. Only after I have 1.5+ inches of length does the hair start to lay flat due to gravity. So I haven't yet seen any of my grafts, but I'd feel inclined to say that I'm one of the cases where this doesn't matter as much.

Edited January 2, 2021 by giegnosiganoe

[DrTBarghouthi]

13 hours ago, giegnosiganoe said:

@Gasthoerer mentioned this but I wanted to create a separate thread on this topic because it is something I had never heard of before.

Assume that the perfect slit is made. When placing the graft into that slit, does it matter what direction/rotation (in the 360 degree plane) it is inserted in?

Most of the grafts I've seen online tend to look mostly straight - there isn't much curvature to them and so it doesn't seem to me like the direction of the graft inserted into the slit should matter too much. But I do also see some curved grafts online. Maybe some people genetically have curvier grafts and thus would require this extra consideration? I wonder how common this is.

Just based on what seems like a lot of effort required to get the right angle, and how many grafts are being done in such a short amount of time (2900 for Gas in 5.5 hours with Feriduni), I have a pretty hard time believing this.. Maybe the clinics are just that efficient.

I would love if a doc could comment on this, maybe @DrTBarghouthi? Also if any patients have knowledge about this or if/how it's done at other clinics.

Edit: Actually looking at these pics below, it also seems like the shorter you cut the donor area before extractions, the more difficult it would be to tell the curvature of the graft. The hair seems to be cut shorter in the first picture and longer in the second. If the grafts in the second picture were cut shorter, then the curvature wouldn't be as evident.

Interesting thoughts and thanks for the mention. The truth is that it is not easy at all in the scalp. First of all, as you rightly observed, a short shaved donor can in many cases yield straighter looking grafts. It is mostly the length on the hair is what gives an indication about the curl. Remember that the part under the skin can curve differently than over the skin. Nonetheless, the natural curve on the follicle makes it easier to slide in with the presumably right orientation. However, I think that trying to guess the right orientation on thousands of grafts is tricky. 
 

Also, in scalp hair, the curvature of the hair can’t be right or wrong unless you know exactly the style of hair needed. For example, imagine someone combing his hair forward, then ideally you’d want the follicle to curve inward towards the skin. The same is not true if someone combs back. If combing back, ideally you want it to curve upwards. Can you envision these scenarios? 
I do believe that hairs can get trained to settle in a nice direction eventually once they are styled continuously in the desired fashion. 
 

HOWEVER: this is not applicable to eyebrows and beards. For these, since there is no styling involved, it is important that the follicle curves inwards towards the skin. Leaving the hair a bit longer (FUT or FUE) will help a lot especially with eyebrow transplants. 

[Gasthoerer]

22 hours ago, giegnosiganoe said:

@Gasthoerer can you share which other clinics did or didn't take this into consideration? If the graft was "mostly straight", did some clinics not bother finding the right angle? Oh and how did you discover that you had a lot of misbended and misangled grafts? Is it just from looking at how your hair behaved, or was it from observing your first 400 FUE procedure?

Unfortunately, or fortunately 😉 I had only surgery with one clinic so I do not know the procedures of other clinics with my hair.  My hair is kind of special (as is my hairloss pattern) therefore the misangled/bend grafts are very obvious. It is hard to explain but I could sent a PM. And I discussed it a lot with Feriduni, because I straight out asked him in which direction slits and hairs would be in my case. Actually, it is not only in the hairline but also at the sides (around the are where you typically part to a side part). This makes my hair always difficult to comb and a lot of hairstyles simply impossible. 

[Gasthoerer]

16 hours ago, DrTBarghouthi said:

Interesting thoughts and thanks for the mention. The truth is that it is not easy at all in the scalp.

...

Also, in scalp hair, the curvature of the hair can’t be right or wrong unless you know exactly the style of hair needed.

...

While I understand your explanation, I am very surprised about it. It does not match the comments from Hattingen clinic and the feedback of Feriduni. I totally agree that it is difficult to detect the curve of the graft when cut short(which makes FUE more difficult than FUT), but hairstyle should NOT be part of this decision. Most people have a HT to CHANGE their actually hairstyle or at least to have more options. 

The information I have can be summarized as follows:

- Most hairs from my hairline transplant "bend" into the right/same direction. The few who doesn't are clearly detectable and look "wrong". More of them and the result would look unnatural IMO. 

- Hattingen clinic brought this topic up by themselves in a domestic forum. They shared the picture above, which clearly shows: Both hairs cannot be implanted correct as they are almost 180° differently orientated. 

- Unfortunately, they did not want to share how they detect the curvature and how they use this during placing. 

- Feriduni told me as a "rule of thumb": "the bending has to point towards the skin considering the angle of the slit". 

This is written on Hattingen's website (I translated with google):

Quote

What does the curvature of the hair shaft mean?

Each patient has a different thickness, color and structure of donor hair. In addition to these individual hair properties, each donor hair has an additional property: the curvature of the hair shaft. The curvature of the hair shaft is of great importance and must be observed when implanting the donor hair. It is by no means to be confused with the angle or the direction of the hair, but represents a property of its own. If the natural curvature of the hair shaft is taken into account, a covering power that is up to 30% higher is achieved.

Original text is here: Häufige Fragen | Hattingen Hair

 

[Gasthoerer]

Double Post.

Edited January 3, 2021 by Gasthoerer

[Gasthoerer]

Double POST

 

Edited January 3, 2021 by Gasthoerer

[DrTBarghouthi]

Exactly. Maybe I was not too clear, but I mentioned in my comment that there is a natural bend in the follicle that makes it the easiest to slide into the incision in that plane. This plane is usually the best indicator of having a natural bend because it usually orients the folllicle in the right plane in terms of sebaceous gland anatomy. What I mentioned is that even with this orientation some people may notice some difficulty with styling. Also in some cases even when placed in a good natural plane, they can have a slightly different curvature on top of the skin than to what the natural curve is under the skin. That is why it can be tricky to get them all right in some occasions. However, if you follow this rule you will most likely get a very pleasing result. 

[DenverBuff1989]

@giegnosiganoe @DrTBarghouthi imo this is a relatively common, definitely underreported issue. I think so many guys are just happy to have a full head of hair back that any curvature or bending issues are a secondary concern.

In so many post-op hair transplant pics, the hair is standing straight up or combed straight back. With this hairstyle, unnatural curvature or bending is hard to spot. So many guys post-op-even with great results- need to use product to style their hair. Maybe it's just a big coincidence, but its not often I see post-op pics where the guy has a classic side-part hairstyle; it is this hairstyle where bending or curly-ness is most prominent. 

Some of these issues may indeed be human-error or lack of experience, etc. However, there are many people naturally who have frontal hair that is tame/straight/compliant, but who also naturally have donor region hair that, at length, starts to curl and get rowdy. Look at pictures of mullets, and see how many of the people have frontal hair that behaves so differently from the back hair. So when this donor hair is placed in the front, the natural result is a shape and texture that is different from the native frontal hair. 

Edited January 3, 2021 by DenverBuff1989