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I’ve heard these terms used quite often, but what exactly is the difference between the Pre-Made Incision technique and the “Stick-and-Place” method? Is one better than the other?

This question was answered by Dr. Mike Beehner of Saratoga Springs, New York who is one of our recommended hair restoration physicians. Follow the original topic on our Hair Restoration Discussion Forum to also see expert replies from Coalition surgeon Dr. Cam Simmons and our managing publisher,   Bill Seemiller .

For myself, the one big advantage of the stick-and-place method, which I take advantage of in certain unique cases, is the fact that it allows the hair transplant surgeon to make the SMALLEST possible incision to place the graft in. This is because, at the instant you withdraw the needle or slit blade, you are immediately placing the graft into the opening before any elastic recoil or shrinkage can occur at the site. The benefits of this fact are two: One, you do the least possible damage to the vascular system of the scalp because of the smaller sites, and two, you can place grafts closer together, because the sites are smaller and more will fit into a cubic centimeter than with a slightly larger site.

The big problem with stick-and-place is that it is not possible for the surgeon to personally perform the whole hair restoration operation due to the time factor (time the grafts are out of the body) and the fatigue/exhaustion factor. He would be there for 16 hours (till the wee hours of the morning) and a lot of the grafts wouldn’t survive because of the time out of the body. So this task has to be delegated or shared with one’s assistants.

I use the stick-and-place method mostly in doing “focal” areas in which I want maximum density with minimal scalp vascularity damage, most commonly in the “frontal core” area just behind the central hairline. In a handful of cases in patients who I thought had poor blood supply to the scalp due to multiple past scalp reductions and hair transplant sessions, I have done the whole case with stick-and-place and one of my assistants who is skilled at this would work one side while I worked the other.

For most transplant cases, especially where a large area of the scalp is being transplanted, the preferred method of choice in my practice and in the majority of them, is to make the incision sites first and then fill them. With skilled placers, the slight shrinkage of the site is not a major factor. But for some practices who become very adept at it, as Dr. Simmons stated, the stick-and-place method can work very well on a regular basis.

A compromise to these two methods described above is what Dr. Jerry Cooley calls the “modified stick-and-place” method, in which the sites are pre-made and then a small slightly blunted needle (to avoid puncture accidents to staff) is placed into the pre-made site to slightly dilate and hold it open. As it is withdrawn, the FU graft is then placed.

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Anthony – Editorial Assistant / Forum Co-Moderator of the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q&A Blog.
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