DHI, Stick and Place, Pre-made Slits Which is Better? Dr. Konior and Dr. Mwamba answer

[Melvin- Admin]

 

[kirkland]

What fascinates me about the pre-made slit technique is that it can take a longer amount of time for the wound to close than I thought. A surgeon can make slits on day 1 and implant into them on day 2. While I understand that there is no advantage of one technique over another with all other factors being equal (ie surgeon experience, handling of the grafts, etc), I wonder if, again all factors being equal, pre-made slits may have a slight advantage given that they have already started producing a whole bunch of growth factors that come into play when the body is going through its repair cycle.

 

 

[Melvin- Admin]

8 minutes ago, kirkland said:

What fascinates me about the pre-made slit technique is that it can take a longer amount of time for the wound to close than I thought. A surgeon can make slits on day 1 and implant into them on day 2. While I understand that there is no advantage of one technique over another with all other factors being equal (ie surgeon experience, handling of the grafts, etc), I wonder if, again all factors being equal, pre-made slits may have a slight advantage given that they have already started producing a whole bunch of growth factors that come into play when the body is going through its repair cycle.

 

 

Astute observation, in fact, this has been discussed by Dr. Bernstein and Dr. Rassman in this article

https://www.bernsteinmedical.com/news/dr-bernstein-patents-fue-hair-transplant-procedure/

Quote

During the first 24 hours following recipient wound creation, a flurry of biologic activities take place that facilitate healing. These include: the migration of platelets with subsequent release of cytokines, growth factors and pro-inflammatory proteins (histamine, serotonin, kinins, prostaglandins, etc.) that increase blood vessel permeability and stimulate cell migration. Allowing these processes to begin before implantation of the grafts should be beneficial to their healing and subsequent growth.1

I do think there's something to be said about creating sites and then harvesting the next day. 

[kirkland]

The clotting factors provide a more 'sticky' environment as well which could have the advantage of the grafts staying in place sooner. 

[Rahal Hair Transplant]

On 12/8/2021 at 7:29 PM, kirkland said:

What fascinates me about the pre-made slit technique is that it can take a longer amount of time for the wound to close than I thought. A surgeon can make slits on day 1 and implant into them on day 2. While I understand that there is no advantage of one technique over another with all other factors being equal (ie surgeon experience, handling of the grafts, etc), I wonder if, again all factors being equal, pre-made slits may have a slight advantage given that they have already started producing a whole bunch of growth factors that come into play when the body is going through its repair cycle.

 

 

While the wound doesn’t close all that quickly, making it possible to place follicular units a whole day later, the area of concern is keeping the grafts outside of the body for too long.   Now, I’m not suggesting that this makes the “stick and place” technique superior, but surgeons need to have safeguards in place to minimize risks of follicular dehydration. The type of storage solution plays a role in this as does making sure grafts extracted earlier during the procedure are placed first, etc.   With stick in place, grafts are extracted and put into the recipient area faster, substantially minimizing the amount of time grafts are stored outside of the body.

To repeat however, this doesn’t make one procedure superior over the other, it’s just that those researching the procedure should check with surgeons as to what type of safeguards they have in place to minimize damage and desiccation to the grafts.

Best wishes,

Rahal Hair Transplant.  

Edited January 20, 2022 by Rahal Hair Transplant

[Melvin- Admin]

Just now, Rahal Hair Transplant said:

While the wound doesn’t close all that quickly, making it possible to place follicular units a whole day later, the area of concern is keeping the grafts outside of the body for too long.   Now, I’m not suggesting that this makes the “stick and place” technique superior, but surgeons need to have safeguards in place to minimize risks of follicular dehydration. The type of storage solution plays a role in this as does making sure grafts extracted earlier during the procedure are placed first, etc.   with stick in place, graphs are extracted and put into the recipient area faster, substantially minimizing the amount of time grafts are outside of the body.

To repeat however, this doesn’t make one procedure superior over the other, it’s just that those researching the procedure should check with surgeons as to what type of safeguards they have in place to minimize damage and desiccation to the grafts.

Best wishes,

Rahal Hair Transplant.  

The grafts are not extracted at the same time that the slits are done. I agree, it would be concerning if the slits are made, while the grafts are extracted, and then placed the next day.

Dr. Bernstein actually patented this technique years ago with Dr. Rassman, the slits are made on one day, then the grafts are simultaneously extracted and implanted the next day. The thought behind this, is that as the sites begin to heal, there are growth factors that could help the yield. Interesting theory. 

https://www.bernsteinmedical.com/news/dr-bernstein-patents-fue-hair-transplant-procedure/

[MachoVato]

I was just discussing this the other day...

Bisanga uses pre-made incisions. His techs will then do the implantation. However, he uses the KEEP implantation tool (https://www.ke-ep.com/). It eliminates the concerns about bent grafts, as mentioned by Konior. I remember the feeling of my incisions being "opened" during this phase of the transplant. 

The tool was developed by Dr. Erdogan. Watch this video... interesting study about graft yield. 

https://www.youtube.com/watch?v=i0lZc_RBOow

 

[general-etwan]

Why isn't DHI used for every FUE procedure?

[Barnan12550]

What is DHI? 

[BaldDude]

11 hours ago, general-etwan said:

Why isn't DHI used for every FUE procedure?

Good question. I was told by clinics that DHI takes more time to cover large areas.  Also some docs said they believe there is no benefit to DHI over regular FUE technique.

[NARMAK]

14 hours ago, general-etwan said:

Why isn't DHI used for every FUE procedure?

I would rather a surgeon use the technique they are best versed in. DHI is simply one modified variant of FUE after all. 

Regardless of which techniques used, if its in the hands of an good/elite doctor, the results generally will be great. The artistry is the main other difference. 

[general-etwan]

43 minutes ago, NARMAK said:

I would rather a surgeon use the technique they are best versed in. DHI is simply one modified variant of FUE after all. 

Regardless of which techniques used, if its in the hands of an good/elite doctor, the results generally will be great. The artistry is the main other difference. 

So a procedure advertised as “DHT” like Eugenix isn’t really the DHI technique, is that right? Eugenix still makes incisions first and then implants the grafts second. It just would seem to me that true DHI would be the more efficient and less traumatic technique to use but then again I don’t claim to know all of this. 

[general-etwan]

3 hours ago, Barnan12550 said:

What is DHI? 

Grafts are loaded into a handheld tool that both punches incisions and implants that grafts at the same time. 

[NARMAK]

22 minutes ago, general-etwan said:

So a procedure advertised as “DHT” like Eugenix isn’t really the DHI technique, is that right? Eugenix still makes incisions first and then implants the grafts second. It just would seem to me that true DHI would be the more efficient and less traumatic technique to use but then again I don’t claim to know all of this. 

Eugenix make pre-made slits and then they load the grafts into an implanter pen of their own or modified design from what i understand to minimise handling of the grafts and trauma. Then implant that directly into the pre-made slits. 

Some people feel that making pre-made slits allows you to prime the recipient area with blood rushing to those sites and creating healing and growth factors so that when the follicles finally implanted a short moment later, they have the least out of body time and then also are primed into a zone ready to receive them. 

Taking a graft from the back of the head one at a time and then having to find a recipient site is much more time consuming but if you already made the slits, you already know the grafts you will be using and how dense roughly it gets packed. You can then punch the sites, leave them in the scalp to not completely start extraction until you are much closer to the implantation phase and also means select grafts are going to be left outside of the body less time even when being dissected. 

That's even compared to say where FUT strips have to be taken and harvested, the fatty scalp strip is designed to still keep the hair fed a supply of blood for a bit. Similar sort of principle i guess in what Eugenix do. 

However, as i said, the techniques only as good as the person who performs ot and a complete amateur can botch it regardless of which method is used. 

That's why even though FUE places like horror mills in Turkey claim "Sapphire super Dragon Ultimate FUE" have some pathetic results but they make the claims to maximise the income from you. 

"Yeah, you can have this package, but y'know if you pay another extra £500 for some super hair vitamins, some time in an oxygen tank and this extra super flashy looking scalpel, your grafts will be 200% survival rate(!)"