Artas turkey hair transplant
Minigraft recipient sites:
slits vs. holes
Holes and slits each have their place in high-quality hair transplantation. In the bald scalp, holes offer a theoretical advantage over slits because bald skin is removed and replaced by skin that contains hair.
Arguments about the superiority of holes or slits often reflect the comfort and convenience of the particular process for a particular surgeon. Slits are easier to create, but the increased difficulty of placing grafts into slits more than offsets this advantage.
Slits can be placed in areas where additional density is needed and where it is important to preserve the existing hair. When slits are placed in a scalp that has low hair density, e.g., 1.3 hairs per mm2, the overall density per square inch can be increased.
However, when punches are used to remove bald skin and replace it with skin containing a hair density of 2 hairs per mm2, the benefit is offset by the hair removed, and the gain is substantially diminished.14
In our opinion, the use of holes for the initial procedure is preferable to obtain the highest apparent density, particularly in the frontal hairline.
Using punched recipient sites in the frontal hairline avoids an appearance of slit scars and minimizes the compression that may be evident when grafts are placed into slits.
Compression makes grafts more noticeable, especially those in the frontal hairline. This method, which can nullify the purpose behind the use of minigrafts, was clearly documented by Marritt.15 Larger grafts, especially in dark-haired individuals, should not be placed into holes or slits in the frontal hairline.
It has been said
that using punches to create recipient sites damages the subcutaneous vascular network and any adjacent hair follicles in the recipient area.4 Logically, then, a larger punch will be more disruptive to the involved microcirculation, will cause greater tissue trauma, and will damage a larger number of adjacent hair follicles.
With minigrafts, existing hair can be preserved by carefully siting the holes or slits between existing hairs (or previously placed grafts). When holes are created in tight areas, the hole size and the corresponding graft size should be adjusted to the space that needs to be filled.
It is appropriate to vary the sizes of the recipient sites as the graft population increases. Several punch sizes should be available during each procedure. This is critically important for the patient who has decreasing hair density due to thinning hair. These patients want to preserve whatever hair they have left, and they will be unhappy if they lose large amounts of existing hair during the restoration process.
Punched recipient sites for traditional hair transplants, by design, remove balding scalp and, therefore, damage a larger number of surrounding hair follicles than the smaller punched recipient sites for minigrafts.
Therefore, minigrafts are the best choice for supplementing density in areas where hair is being lost. The use of small, punched recipient sites for the first two treatment sessions is recommended in areas where the scalp is bare.
In the third and any subsequent treatment sessions, minigrafts or micrografts can be placed in slits or holes. In thinning hairlines, it is important to determine whether the patient wants to identify and preserve all reasonable existing hair.
By doing so,
the process will be made less noticeable. This approach, i.e., gradual and incremental hair transplantation should, when applicable, be explained to the patient so that it may be considered among the treatment options being offered.
One complication often not discussed is one we call “accelerated hair loss” which at times accompanies various hair restoration procedures.
This phenomenon is quite common in scalp reductions (more common as patients have more of them) and less common in hair transplantation with smaller grafts. The underlying rationale is discussed above. Small minigrafts and slits minimize this complication considerably.
For later treatment sessions, the choice of slit or punched recipient sites may be critical to the final result. Care must be taken in selecting the best method for the addition of supplemental density.
A slit or a punch, and a minigraft or a micrograft in the recipient site, requires assessment of the appropriate approach to the treatment area in concert with the patient’s wishes.
As the recipient area becomes more crowded with hair grafts, slits or micrografts may be preferable to increase density. Skill and experience are needed to make this judgment.
Some treatment sessions may require a mixture of slits and holes, smaller and larger minigrafts, and micrografts for an optimal result. It is important to note that the density ordinarily achieved with traditional grafts or minigrafts cannot exceed the density in the donor area without the use of micrografts or minigrafts in slits.
Another method for increasing the density in a limited part of the recipient area is to do punch excisions of contiguous small areas of bald scalp and to close the resulting skin defect with sutures; this produces a limited “mini-scalp reduction”.16