Why don't they drill your head?

[Rafael Manelli]

Here's a riddle for you.

Graft excision in FUE is done with a punch, effectively a hollow drill. A large amount of total material is removed, in area and volume. 

But recipient incisions are done with a simple blade. They just stab your head. They don't remove an equal amount of material as they insert. To do that one would imagine they'd use a drill with roughly the same diameter as the punch.

So how are they able to fit grafts in the holes without expanding your head by the volume/area of the grafts?

[Anon94]

Skin is elastic and a living organ. Also, the grafts are - individually - quite small. 
 

 

[Rafael Manelli]

I don’t see how elasticity is an answer.

The grafts are small. But there are many of them. The can add up to many cm2

[TorontoMan]

the area needed to clear an extracted graft safely is greater than the area needed to put it into a slit.

Essentially a little statistics is involved as they're reducing the chance that a drill given its size will actually puncture the graft and kill it

Edited February 3, 2023 by TorontoMan

[Rafael Manelli]

4 minutes ago, TorontoMan said:

the area needed to clear an extracted graft safely is greater than the area needed to put it into a slit

Perhaps marginally, but you’re still implanting a large volume  into the recipient area without removing any volume from it. So why doesn’t it expand?

[TorontoMan]

5 minutes ago, Rafael Manelli said:

Perhaps marginally, but you’re still implanting a large volume  into the recipient area without removing any volume from it. So why doesn’t it expand?

Sorry I'm not following. What do you mean by not removing volume form it? 

If you mean the slits into the recipient, you are creating enough volume for the graft to be placed inside. The same diameter cannot be made for a punch intended to extract a graft because you cannot be that precise without risking a lot of grafts, you are likely to puncture grafts if you don't use a punch with a diameter big enough 

[Rafael Manelli]

The slits don't remove any tissue. They just open a slot that squeezes the grafts to hold them in place. 

[DrMunibAhmad]

 

While punching, you punch a part of the skin too, so that the hair can be removed with it's root. 

When you place, you only place the part of the graft that was under the skin, back in incision. The part of the skin (white dots) stays above the skin, and thus a incision is enough and there is no expanding of the tissue. (to be precise, technically there can be a expansion, if you have real fatty grafts, but this is just expansion of the subcutis fatty tissue so not noticeble)

When you don't make the incision that match the graft size, and stick the grafts to deep or to superficial, you can get cobblestoning or pitting, which is expansion that is noticable. 

 

[Parasol]

My understanding is, they do inject a substance that expands the tissue in the implantation zone. This makes it easier to place grafts closer together.

JT has a video on this on YouTube, using a balloon and a marker (in the video, he puts dots with the marker on the balloon without blowing it up, as closely as he can. Then, he blows air in the balloon, and you can clearly see how much closer he can place dots to one another with the ballon expanded).

I have no idea if all surgeons do this in all cases though!

EDIT: I tried to type “JT’s” full name, and it automatically uses his initials instead when posting? Are we not allowed to type his full name here? He’s an excellent resource.

 

Edited February 3, 2023 by Parasol

[Rafael Manelli]

53 minutes ago, DrMunibAhmad said:

 

While punching, you punch a part of the skin too, so that the hair can be removed with it's root. 

When you place, you only place the part of the graft that was under the skin, back in incision. The part of the skin (white dots) stays above the skin, and thus a incision is enough and there is no expanding of the tissue. (to be precise, technically there can be a expansion, if you have real fatty grafts, but this is just expansion of the subcutis fatty tissue so not noticeble)

When you don't make the incision that match the graft size, and stick the grafts to deep or to superficial, you can get cobblestoning or pitting, which is expansion that is noticable. 

 

So you trim the subcutaneous part of the graft with a microscope?

[DrMunibAhmad]

10 minutes ago, Rafael Manelli said:

So you trim the subcutaneous part of the graft with a microscope?

No. When you punch them at the perfect depth, there is no extra tissue on the follicle. 

[Al - Moderator]

When graft size was larger they did punch out holes in the recipient and then fill it in with a graft from the donor. I had 3.75mm grafts placed when I first started having hair transplants and that's how it was done. These days the graft sizes are too small to punch out a hole in the recipient area because then the graft wouldn't stay in place. The recipient hole has to be slightly smaller than that graft, so it will stay tight in the hole and not slide out. Making a slit or just poking a hole is enough when you have small graft sizes.

 

 

[Rafael Manelli]

3 hours ago, BeHappy said:

When graft size was larger they did punch out holes in the recipient and then fill it in with a graft from the donor. I had 3.75mm grafts placed when I first started having hair transplants and that's how it was done. These days the graft sizes are too small to punch out a hole in the recipient area because then the graft wouldn't stay in place. The recipient hole has to be slightly smaller than that graft, so it will stay tight in the hole and not slide out. Making a slit or just poking a hole is enough when you have small graft sizes.

 

 

Do you have photos of your old work? 

[Al - Moderator]

On 2/7/2023 at 11:29 AM, Rafael Manelli said:

Do you have photos of your old work? 

 

My hair transplants were done from September 1989 to December 1994. We didn't have cell phones then, so I don't have any any pictures that I took myself and I tried to stay out of most pictures. The clinic took their pictures with a polaroid instant camera, so the quality isn't the best and there's no negative to make duplicates. The reason a polaroid camera was used was because you get a developed photo in just a few minutes. That way you could then look at them and discuss the plan, how well it was coming along so far, what areas needed to be worked on next, etc. There were no digital photos then. They didn't shave your head back then either, so you won't get any good pics of the work just after being done. I do have a couple of black and white photocopies, but the quality is very low. I'll post a few here for fun. Most of these are just progress pics from when I went back for additional sessions.  Due to them being black and white photocopies my hair looks much thicker than it actually was.

 

9/7/1989

Starting point. This is the first photo taken just prior to starting hair transplant #1.

 

 

3/4/1991

This is the pluggy hairline (Later it was lowered slightly). This is after 7 hair transplants and getting ready for #8. I only had 60 grafts done on the first session, 65 on the 2nd, and 51 on the 3rd session. What they used to do is place grafts far apart and then place additional grafts in between on later sessions. This is after several sessions of placing grafts to create a hair line.

 

This is also 3/4/1991 and shows grafts that have just been transplanted into the midscalp.

 

 

 

8/6/1992

Transplant #11. Pluggy crown. The photo got washed out with the light, so you don't see all of the crown grafts very well, but you can see how pluggy it is. Some of these were later removed to try to fill in the frontal half better. These were the largest grafts at 3.75mm as they were done early on, so they later decided to remove these, cut them into smaller grafts, and then come back later and refill this area with 2.5mm grafts.

 

 

 

3/1/1995

3 months after transplant #25. This is one of a series of final photos taken. This is some time after the hairline was lowered. You can see how pluggy it is. I didn't have any work done at this time. This was during a consultation with several of their Drs and consultants trying to figure out what they can do for me. I had 25 transplants done by this time and had no further work done by them. I didn't have any further work at all until 2014 when I started using body hair grafts.

 

 

[Dr. Guncel Ozturk]

That recipient incisions are not meant to remove equal amount of material as grafts that inserted. Instead, the incisions made to create tiny slits in scalp that can accommodate transplanted follicles.

The recipient incisions are designed to create tiny pockets for the transplanted follicles without expanding the head. The reason incisions do not expand the head by volume or area is because transplanted follicles are much smaller than the punch used for graft extraction with FUE. Additionally, the scalp is very dynamic and elastic tissue that can accommodate transplanted follicles without any significant expansion.

 

[Xanadu]

On 2/3/2023 at 3:52 PM, Rafael Manelli said:

Here's a riddle for you.

Graft excision in FUE is done with a punch, effectively a hollow drill. A large amount of total material is removed, in area and volume. 

But recipient incisions are done with a simple blade. They just stab your head. They don't remove an equal amount of material as they insert. To do that one would imagine they'd use a drill with roughly the same diameter as the punch.

So how are they able to fit grafts in the holes without expanding your head by the volume/area of the grafts?

All the answers about how and why a drill and slits are used, I think you already know.

I understand your question, and you are of course right that more is added than taken away. The only answer is elasticity I believe.