Anyone noticing the weird new design of H&W graft placement?

[Fue3361]

4 hours ago, Chrisno said:

Here you go, count them. Red area is exactly 1 sq cm of my scalp, that was completely bald before my transplant, i.e., no native hairs there. 85 grafts. My entire transplant is this dense.

Photo is from 8 days post op when all scabs were off. As you can see, no visible 'rows'.

This is a great transplant in terms of density.  But going along with the topic, you have no rows (which at least aesthetically speaking, is objectively superior).

 

edit: although to be fair, hard to see if there are rows without a zoomed out photo of a bigger area.

Edited August 23, 2023 by Fue3361

[Dr. Jerry Wong]

85/cm2 is possible. Your healing is truely amazing. Photo of entire grafted area please. Who is your doctor BaldV

[Rawkerboi]

Always a pleasure to hear from Dr. Wong

15 hours ago, Dr. Jerry Wong said:

One of the most enjoyable aspect of this job is the opportunity to try out new ideas. Lots of ideas simply did not work but the ones that do have let to advancements like custom cut blades, depth control for recipient sites, mega and giga sessions, and lateral/coronal slits for angle control all of which had been major advancements in our field. I have learned that over the years scalp have different tolerances to trauma which is why the same parameters that grow well in one person may do poorly in another. Sometimes we know about risk factors such as smoking and diabetes and take precautions in advance but often there are no advance warnings nor signs that hair may grow poorly in any one individual. The search for consistent hair growth is ongoing no matter how experienced or how good we are as hair surgeons. I don't and will never bat 100% but my bating average has improved and are still improving. 

I would like to discus some of the changes I made in the last 8 years that have made my work better. Cutting thousands of sites on the scalp in one session is extremely stressful for the skin and any changes that can reduce skin or vascular damage even by a small percentage is significant. By switching from single 0.2 mm thick) to double edge  (0.1 mm) razor blades there were less bruising and slight improvement in hair growth as the thinner blades cuts cleaner with less trauma. 7 years ago I modified an implanter that enable me to place grafts into much smaller slits. Smaller blades =less trauma to the skin and implanters eliminates possible forceps trauma to the bulb. This made a major improvement in growth consistency esp. when grafts are dense packed. The last few years have been spend fine tuning slit size, depth and density.

I have always cut slits in rows. I have compared random and row slits and have found rows ( in my hands) provide better coverage and density. Making rows with single blade seldom looks like rows as the rows are never straight and there are slight variations between side to side and front to back cuts which means some spots on the skin will be more damaged than others which might explain why some transplants have areas of uneven growth. If the spacing can be controlled and more evenly spaced would the growth be more consistent. I have been looking for a 3 blade handle for years to hold the thinner blades that I'm currently using. 2 years ago I managed to develop one that works. Unlike multi handles that came before where blade size and spacing is fixed my handle adjust for any sized bade and spacing allowing surgeon to choose the perfect sized blade for the graft size. I cut the rows as straight as possible to keep the front to back spacing as even as possible produce and the handle provide perfectly even spacing side to side. I almost never see bruising of the skin as I now have very accurate control of spacing which was not possible with single blade. Even spacing prevents localized stressed spots on the skin (area cut too close with single blade).  From 2 years of observation I have found growth is more consistent with 3 blade handle as compared to single blade handle. The concern that hair will look artificial has not not materialized provides that the density is kept above 35 to 40/cm2. Row effect is seen during early healing phase. 10 to 12 days post op once the crusts are washed off the rows are no longer  seen. Cutting slits below 30/cm2 best to use single handle and cut at random. 

I'm the only person at Hasson and Wong that uses the multi handle Dr. Hasson does not use it and has nothing to do with this devise. I know that there will be pushback and a lot of people can only see the negative side of this devise. Any negative feedback should be directed at me and not Hasson and Wong. This handles biggest advantage is that it does reduce skin damage and provide more consistent growth.  In 1996 when I introduced the lateral slit technique with the feedback being mostly either negative or why would you want o do that? But I knew that by controlling the hair angle the cosmetic result is far superior than any current technique. A lot of my patients are concerned when they see the row post op but once the crusts are gone it looks fine. How natural a transplant looks has more to do with angle control than anything else, if a surgeon does not understand angles and how to control it what you end up is a mess no matter what else you do. I do not imposed my techniques on anyone and if patient tells me he does not want row effect even foe a few days I will cut with single blade handle. There are pros and cons to any technique I know that with this instrument the pros far out weight the cons. 

 

 

[Chrisno]

1 hour ago, Dr. Jerry Wong said:

85/cm2 is possible. Your healing is truely amazing. Photo of entire grafted area please. Who is your doctor BaldV

Hello @Dr. Jerry Wong, if you are refering to the close up I posted of my 85 g/cm2 transplant, please see below for a few more photos. I'm sorry it's not full face photos since I want to remain anonymous. The surgery as performed by your collegaue, Dr. Victor Hasson end of June this year. I also met you very briefly in the lobby as well, and it was a pleasure meeting you.

First photo is taken at 8 days post op, same day as the previous photo I posted in this thread. Top of my right hand side eyebrow and my nose can be seen in the corner of the photo.

Second photo is taken 14 days post op, showing my left hand side hairline corner.