Why do Some Hair Transplant Surgeons Create Larger Incisions than Others? Aren’t Smaller Blades Better?
This question was posed by a hair loss sufferer seeking hair loss help on our hair restoration forum and answered by Dr. Michael Beehner of Saratoga Springs, NY who is one of our recommended hair restoration physicians. His professional answer is below.
I’ve noticed that some hair transplant surgeons use .7mm custom blades while others use .9mm to 1mm custom blades. Is it logical to follow the intuition of “the smaller the better”?
A doctor’s skill always reigns paramount when discussing something like this, or loupes verses microscopes. But assuming the hair restoration physicians are of equal ability, is there any reason why smaller blades/incisions are not optimal? Are there actual attributes for using the larger blades I referenced, other than that it’s easier for a doctor?
The answers on this hair loss forum thread by Bill Seemiller and Dr. Paul Shapiro are excellent and I agree with everything they have said.
I just wanted to add that a very important factor in hair transplant blade size (or needle size) selection is the coarseness of the hair (the hair shaft diameter). Very fine 1-hair follicular units can be placed into 0.6mm blade incisions, whereas coarse ones require a 0.8mm one. Same goes for 2-hair and 3-hair follicular unit. The blade width is significantly larger for these grafts when the hair is coarse.
And one more factor that is significant. Some patients have follicular unit structures in which the hairs are very straight, parallel to each other, and situated “tightly” together. Other patients have what we term “teepee-ing” of the grafts, with the hairs curving off from each other in various directions. This affects what size blade is chosen also.
Mike Beehner, M.D.