Sagital vs. Lateral (revisited)

[Severn]

I know some Docs are doing primarily lateral now while others prefer sagital. And some do both.

 

Am I right in assuming that to create any semblence of a whirl pattern on the crown that lateral incisions would be required?

 

Thanks.

[mmhce]

One of the key advantages of the lateral incisions is the angulation. So I guess it would be employed in developing the swirl pattern of the crown.

[Bill - Seemiller]

Severn,

 

I'm not so sure that laterals would be required for a crown. Actually, I've seen some doctors use a combination of laterals and sagitals to restore a natural crown whirl.

 

Best wishes,

 

Bill

[aaron1234]

Could someone explain the difference between laterals and sagitals. I'm clueless. Thanks.

[Cam Simmons MD ABHRS]

Originally posted by aaron1234:

Could someone explain the difference between laterals and sagitals. I'm clueless. Thanks.

 

Hi aaron1234

 

When placing grafts in a 3-dimensional position, we talk about direction, angle, and orientation of follicular units (and depth).

 

Hair on the scalp has a flow to it much like the flow of water in a river. The hair grows in a direction that usually flows outward from 1 or 2 whorls. If we say that a particular graft grows forward and slightly toward the right, we are discussing the direction of that graft.

 

If we say that the graft is growing upward at a 30 degree angle to the surface of the scalp, we are discussing its angulation.

 

The orientation of the graft can be the most difficult concept to understand. A recipient site slit is longer in one direction and much narrower in another. The orientation of the slit is said to be "sagittal" or "parallel" if the slit is longest in the direction of hair growth. It is called "coronal", "lateral", or "perpendicular" if the slit is longest perpendicular to the hair direction. Technically, "sagittal" means in a line between front and back, and "coronal" means in a line from side-to-side. Because of tradition, the terms are still used even though sagittal slots aren't really sagittal and coronal slits aren't really coronal - especially in the whorl.

 

If the slit is longer than the graft is wide, there can be play that might affect the angulation more in a parallel slit than with a perpendicular slit but that play would affect the direction more with a lateral slit. If the graft and slit are well-matched there is less wiggle-room for either the direction or angulation to change.

 

Drs. Hasson and Wong first promoted the notion of creating lateral slits because they said the hairs in a follicular unit placed in a lateral slit would line up side-by-side and create more of a shingling effect than if they lined up front-to-back in a sagittal slit. While some follicular units do have parallel hairs, many have criss-crossing hairs or bundles. The orientation is clearly less important for those follicular units

 

I believe that in the whorl, just as in other parts of the scalp, the correct direction and angulation of the grafts are more important than the orientation.

[aaron1234]

Thanks Dr. Simmons for taking the time to write that up. Very informative indeed.

[swim]

Dear Dr.Simmons

 

What if your patient has curly hair? How do you manage to keep the direction of the transplanted hair curl(I understand the angulation's part) ,when it grows out of the skin?

[Cam Simmons MD ABHRS]

Originally posted by swim:

Dear Dr.Simmons

 

What if your patient has curly hair? How do you manage to keep the direction of the transplanted hair curl(I understand the angulation's part) ,when it grows out of the skin?

 

Swim

 

I answered this question in a thread on angles: http://hair-restoration-info.c...=599105553#599105553

 

but have pasted the answer here too:

 

Curly hair also curls under the skin. People with curly hair usually have "C"-shaped grafts.

 

Usually curly-haired grafts are placed so that the grafts exit the scalp at specified upward angles but the hairs tends to curl down toward the scalp.

 

Some doctors have created sites in a curving path with straight instruments and others have used curved instruments. Even if straight tunnels are used, the proper exit angle from the scalp and direction can be achieved if the graft is oriented to curl the right way.