Why do Some Hair Transplant Surgeons Create Larger Incisions than Others? Aren’t Smaller Blades Better?
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?
This hair loss question was answered on our hair restoration forum by Dr. Paul Shapiro of Bloomington, MN who is a member of the Coalition of Independent Hair Restoration Physicians. His professional answer is below.
The answer to your question is that sometimes smaller blades are more optimal, and sometimes not. It depends on many factors. What is more important then the size of the blade is how the follicular unit (FU) fits in the incision. The graft should fit snugly, but not too tight to cause compression. Also, the incision size should be such that the follicular unit grafts can be planted into the skin with as little trauma as possible. The texture and thickness of ones skin and the size of the graft determine what size blade should be used to make the incisions. Some patients have tough, non-forgiving skin that does not have much stretch to it. In these hair transplant patients I would usually cut my blades a bit larger. Some patients have follicular units which splay at the bottom. I find they get squashed a bit if the incision size is too small and I have to use larger incisions for this type of follicular unit. A person who has thin blond hair will have much smaller follicular units then a person who has thick, black hair. Persons with very curly or kinky hair will have a curve to the follicular unit and will need larger incisions. Also, a FU with 4 hairs will be larger then a one hair FU and will need a larger incision to fit properly.
At Shapiro Medical Group we cut our blades and they usually range in size .6mm to 1.2 mm. On average we use a .7 or .8 mm blade when we are making incisions for the one hair FU in the hairline. For the 2 hair FU we usually use .8 to 1.0 cm. For 3 and 4 hair FU we usually use .9 to 1.2cm blades.
What I do is estimate what size blade I will need for a 1,2,3, and 4 hair FU. Then I make about 10 incisions and place some follicular units into the incision. Sometimes the fit is perfect. Sometimes I need to increase or decrease the width of my blade.
The smaller blades are great. We can make incisions closer together when we want to do hair transplant dense packing. In patients with existing hair in the area of the transplant, the smaller the blade the easier it is to get between the existing hairs. Also, the smaller the blade, the less trauma there is with each incision. But also the smaller the blade, the more chance it will be difficult to place the follicular unit without any trauma.
So as you can see, one size does not fit all.
I hope this answers your question.
Paul Shapiro, MD