Recipient Site Creation Research Articles

Recipient site creation for hair transplantation: A prospective half-side comparison study of hole versus slit

Follicular unit strip surgery and FUE (follicular unit extraction) are techniques used for donor harvesting in hair transplantation. For recipient site creation, the slit technique is now commonly used. The hole technique is an alternative technique in which holes are created in the tissue at the recipient site. This study compared these techniques in order to evaluate the effectiveness of the hole technique. Mean time for recipient site creation was significantly shorter with the hole technique than with the slit technique (95.5 s vs. 121 s; p = 0.021). This can be explained by better visibility of the holes compared with slits. This study focused on recipient site creation and found that the hole technique was a rapid and effective for recipient site creation.

Letter to the Editors

RE: Logical nomenclature for hair transplant recipient area slits: parallel and perpendicular instead of sagittal and coronal! Slit creation is one of the most important steps in a hair transplant. The recipient site creation process is an art and ultimately decides the impact of the result. The

Robotically Assisted Recipient Site Preparation in Hair Restoration Surgery: Surgical Safety and Clinical Outcomes in 31 Consecutive Patients.

Recent advances in robotic surgery have extended to hair restoration surgery, using a robotic recipient site creation device. This study aimed to assess the surgical safety and postoperative clinical outcomes of using this robotic system. Thirty-one men diagnosed with androgenetic alopecia, who underwent hair transplantation with robotic recipient site creation, were retrospectively reviewed. Their mean age was 38.7 ± 9.5 (range, 22‒67) years. The total number of robotically created recipient sites was 36,273. The average site creation speed was 1,593 ± 544 sites per hour. Postoperative crusting (54.8%) was the most frequent complication in the recipient area, followed by pruritus (12.9%), asymmetry (6.5%), and folliculitis (6.5%). The mean score of cosmetic outcomes and patient satisfaction, scored on a 5-point scale, was 4.10 ± 0.54 and 4.13 ± 0.85, respectively. No significant differences in cosmetic outcomes and patient satisfaction were found between 3 operators. The current device can automatically make slit incisions in the recipient area with speed and consistency noninferior to manual site creation. It is both safe and reliable for clinical use, and it is also easily managed by different hair surgeons without a long learning curve.

Effect of different shapes of recipient site creation micro-blades at varying angles and wound injury.

Wound injury is a critical issue in hair restoration. The shape and size of blades cause varying degree of tissue trauma. To check (mathematically) the tissue trauma (injury) caused by different shapes of the blades at varying angles. The trigonometric theories were applied to each shape and angles to calculate the surface area (correlating with the tissue injury). These shapes included rectangular blade, 30°-angled blades, 60°-angled blade, 30°-sapphire blade, and 60°-sapphire blade. The surface areas were calculated at 90°, 45°, 30°, and 15° insertion angles. The 30°-sapphire blade caused the least injury followed by 30°-angled blade. The rectangular blade had the largest surface area and hence will produce the maximum amount of tissue injury. The blade at 90° produced maximum injury whereas the blade entering at 15°, produced lowest amount of tissue injury. The blade in sagittal direction caused less injury as compared to the blade in coronal direction. The 30°-sapphire blade caused the least tissue injury whereas the rectangular blade caused maximum injury. The amount of tissue injury decreases as the angle of insertion decreases and vice versa.

Reducing Surgical Time: An Innovative and Versatile Instrument for Creating Multiple Brick-Pattern Sagittal Recipient Sites in a Single Stroke

<b><i>Introduction:</i></b> Recipient-site creation is a very important step in the hair transplant procedure as it ultimately decides the density, direction, and exit angle of the implanted hair and the final result of the procedure. It can be done with knives or needles. The slits can be <i>sagittal</i> (parallel to hair direction) or <i>coronal</i> (perpendicular to hair direction). For better visual density and coverage, the majority of hair restoration surgeons use sagittal slits. <b><i>Methods:</i></b> Recipient-site creation takes up a significant amount of the surgeon9s time. A considerable reduction in surgical time for coronal slit creation has been described using a multi-slit knife.¹ A multi-slit knife for sagittal slits has not been described until this paper. Our technique reduces surgical time by the use of an innovative and versatile new instrument that enables the creation of single rows of equidistant “brick-pattern” sagittal slits of the same direction, angle, and depth in a single stroke. <b><i>Results:</i></b> The device that we have designed enables the surgeon to reduce the time needed for recipient-site creation while increasing precision. It is a versatile instrument that can be used with appropriate configurations in bald, thinning, and vertex regions. <b><i>Discussion:</i></b> The vast majority of hair restoration surgeons typically use cut-to-size knife blades to create recipient sites, which is repetitive and time-consuming. Brick-pattern slits are preferred to minimize the “see-through effect,” which adds time and challenges.³ Our instrument is easy to assemble and use, and can create slits at desired density, depth, and angle.

Letters to the EditorsRe: Two-step, double-action recipient site creationRe: Coronal vs. sagittal incisions

# Re: Two-step, double-action recipient site creation {#article-title-2} The article, “Coronal or Sagittal Incisions: A Mathematical Approach to the Problem” (Vol. 30, No. 2; pp. 37,43-44), published by Dr. Georgios Zontos in the March/April 2020 Forum provides insight into the mathematical

Modifications of Multi Slit Knife for enhanced versatility in balding and vertex area hair transplant

In hair transplantation, recipient-site creation is an important step. It is a repetitive and time-consuming step, which increased the “out-of-body time” for the grafts, which could hamper their survival. To solve this problem, we had devised an instrument called the Multi Slit Knife (MSK). The MSK has advantages of creating a high-density brick pattern of recipient sites in significantly less time. It had the undesirable side effect of damaging the preexisting hair follicles while making slits in the balding region. The MSK had some limitations. It was also difficult to maneuver the MSK in the vertex region where maintaining the natural whorl pattern of hair is important to obtain optimal aesthetic results. To overcome the shortcomings of the original MSK, we made a few changes to it to make a new modified MSK. It has fewer knives and a smaller platform as compared to the original MSK, better ergonomics, and more customizability with choices for blade sizes, number, and spacing. It tries to retain the advantages of the original MSK while reducing the damage to the preexisting hairs in the recipient regions. It is also better adapted at creating the recipient sites in a whorl pattern, closely mimicking the natural direction and angles of the hair in the vertex region. The modified MSK can be used singly or in combination with the original MSK, based on the patient’s recipient areas, making it a versatile set of instrument for making multiple coronal slits for hair transplant.

Lecture Synopsis: Critical and Non-critical Factors in Recipient Site Creation and Graft Placement

1. Vance Elliott, MD (drbarusco{at}tempushair.com) 1. Port Orange, Florida, USA Consider the many factors that contribute to our results in hair restoration. Are they all of equal importance? Are some factors responsible for the majority of the aesthetic success, or failure, and others for

Robotic Recipient Site Creation in Hair Transplantation

using new software called the ARTAS Hair Studio™, the images and markings are converted into a 3-D model of the patient. The robot uses the inter-pupillary distance (IPD) to match dimensions of the model with the actual dimensions of the patient. To determine how the hair will ultimately grow, the physician uses the software to specify the angle of the recipient site incisions (relative to the plane of the scalp), incision direction, site depth, average density, and total number of incisions. The site spacing can then be easily modified to create variations in density in different parts of the scalp while the computer keeps the total number of sites constant. An important feature of the ARTAS® system is that the robot uses image-guided technology to avoid hairs of a specific diameter when making recipient sites. In this way, the distribution of sites that are created in the procedure can be made to complement the distribution of existing terminal hairs (or the hair from prior hair transplant procedures), while ignoring hair that is miniaturized or vellus. The physician can specify the cut-off diameter based upon the diameter of the patient’s full terminal hairs. Partially miniaturized hair may also be included in the group of hairs to be avoided. Once this parameter is set, the robot will proceed to create sites at a minimum distance from the selected existing hair and do so randomly throughout the areas where the hair is finer or the scalp is bald. The imaging software is currently used to translate the design the physician makes directly on the patient scalp into a computerized algorithm that directs the creation of recipient sites in the operating room. In the future, the system will also have the capability of simulating, in advance of the surgery, what the actual hair transplant will look like so that it can be used as tool to aid the physician during the consultation.

Co-editors’ Messages

1. Robert H. True, MD, MPH (editors{at}ISHRS.org) 1. New York, New York, USA </br>![][1]</img> This issue’s lead article and columns highlight the critical importance of recipient site creation and graft placement. In his wonderfully detailed article, Dr. Brad Wolf rightly points out

The Art and Craft of Recipient Site Creation and Graft Placement

1. Bradley R. Wolf, MD (wolf{at}wolfhair.com) 1. Cincinnati, Ohio, USA The hair transplantation process consists of two parts: 1) removing the donor follicles, and 2) placing them back into the skin. Both are rate-limiting steps of the process. The patient pays a great price, monetarily, for

Lichen Planopilaris After Hair Transplantation: Report of 17 Cases

Lichen planopilaris (LPP) is a type of primary scarring alopecia. The pathogenesis is poorly understood, although traumatic skin injury has been implicated in some cases. To present 17 patients diagnosed with LPP after hair transplant surgery. A retrospective review of the records of patients referred for evaluation of suboptimal growth after hair transplantation and diagnosed with LPP. Patients' scalps were evaluated using dermoscopy, and scalp biopsies were performed in all patients to confirm the diagnosis of LPP. Seventeen patients (15 male, 2 female) were diagnosed with LPP after hair transplant surgery. The timing of disease occurrence was variable--4 to 36 months after hair transplantation. The most common symptom was itching. Perifollicular erythema or perifollicular scale, the classical dermatoscopic signs of LPP,was present in 12 patients (70%). These data provide further support for an association between hair transplant surgery and the development of LPP. Traumatic skin injury from recipient site creation may be relevant to the pathogenesis. The incidence of this phenomenon and risk factors remain to be clarified.

Insertion Force of Articular Cartilage Transplantation Systems

This study compared the insertion force, plug harvest consistency, and recipient site creation consistency of 4 different articular cartilage transplantation systems (COR, OATS, Mosaicplasty, and New COR2) during plug insertion using a single-impaction technique. Maximum insertion forces fell into 3 statistically different groups: group 1, OATS 8-mm (238 N) and 10-mm (215 N) systems; group 2, COR 6-mm (133 N) and 8-mm (176 N), Mosaicplasty, 6.5-mm (147 N) and 8.5-mm (134 N), and OATS 6-mm (137 N) systems; and group 3, New COR2 6-mm (68 N), 8-mm (55 N), and 10-mm (54 N) systems (P < or = .05). OATS compaction pressures were 172 N (6 mm), 353 N (8 mm), and 550 N (10 mm). COR, New COR2, and Mosaicplasty donor plugs were created consistently, but the Mosaicplasty system required toggling. OATS plugs had inconsistent lengths but required no toggling. Insertion forces with the New COR2 system were statistically the lowest. Compaction significantly increased surface forces.

Polarized Light-Emitting Diode Magnification for Optimal Recipient Site Creation during Hair Transplant

Background. For several years, magnification has been used to separate follicular groupings from donor strips to minimize transection of hair follicles. There has been no discussion regarding the use of magnification to create recipient sites to limit transection of existing hair follicles in recipient zones. Objective. The study was performed to evaluate the role of magnification when creating hundreds or thousands of recipient sites in patients with existing hair. Methods. A 2× magnified polarized light-emitting diode (LED) for graft and recipient site creation (Syris Scientific, Gray, Maine) was used in 75 consecutive male and female patients. A team of four experienced surgical assistants and the author evaluated the device for graft creation, recipient site creation, and insertion of grafts. Results. There was no perceived advantage in creating grafts or placing grafts compared with other magnification devices and traditional methods. There was less eye strain and greater ease in creating recipient sites using polarized magnification compared with traditional surgical lights and no magnification. Conclusion. In an era of medications that slow or stop hair loss, magnification in recipient sites can reduce transection of existing hair follicles in recipient zones, leading to maximum density from a procedure. Further studies are needed to confirm the reduced transection rate of hair follicles and determine the ideal magnification. The use of magnification with LED polarized light in the recipient zone is an important new tool in hair transplant.

Polarized Light-Emitting Diode Magnification for Optimal Recipient Site Creation during Hair Transplant

For several years, magnification has been used to separate follicular groupings from donor strips to minimize transection of hair follicles. There has been no discussion regarding the use of magnification to create recipient sites to limit transection of existing hair follicles in recipient zones. The study was performed to evaluate the role of magnification when creating hundreds or thousands of recipient sites in patients with existing hair. A 2x magnified polarized light-emitting diode (LED) for graft and recipient site creation (Syris Scientific, Gray, Maine) was used in 75 consecutive male and female patients. A team of four experienced surgical assistants and the author evaluated the device for graft creation, recipient site creation, and insertion of grafts. There was no perceived advantage in creating grafts or placing grafts compared with other magnification devices and traditional methods. There was less eye strain and greater ease in creating recipient sites using polarized magnification compared with traditional surgical lights and no magnification. In an era of medications that slow or stop hair loss, magnification in recipient sites can reduce transection of existing hair follicles in recipient zones, leading to maximum density from a procedure. Further studies are needed to confirm the reduced transection rate of hair follicles and determine the ideal magnification. The use of magnification with LED polarized light in the recipient zone is an important new tool in hair transplant.