New Instrumentation for Hair Transplantation Surgery

DIFFERENTIAL SPEAR BLADES

One of the realities of hair transplantation surgery is that patients with differing hair densities will yield different size dimensions to the graft. For instance, a sixhaired minigraft obtained from an individual with sparse hair density will be much larger than a sixhaired minigraft from an individual with thick density.

One of the problems with the incisional technique up to this point has been that there has not been enough adaptability of the instrumentation to meet the needs of the wide variation in graft sizes. That is why the author urged Ellis Instruments (Madison, NJ) to develop a series of spear blades with 0.5-mm differentials. Over a period of 1 year, a series of blades have been created that are extremely effective at meeting all of the needs of the hair restoration surgeon who is utilizing an incisional approach.

These blades come in widths of 1.0, 1.5, 2.0, 2.5, 3.0, 3.5, and 4.0 mm (Figure 1). They are constructed of stainless steel and have a steep bevel on all edges of the spear. The configuration and preciseness is such that one blade will last through an entire case of over 1,000 incisions. An advantage of the spear shape over Bard Parker #11, 15, and 15C blades is that when the incision is angled, the length of the incision does not elongate nearly to the degree as it does with the Bard Parker blades. The primary disadvantage of the spear shape is that it penetrates more deeply than a round-tipped blade, causing slightly more bleeding. The better accuracy and precision of the spear, however, more than compensates for this disadvantage.

Figure 1. The new spear blades come in widths of 1.0, 1.5, 2.0, 2.5, 3.0, 3.5, and 4.0 mm.	Figure 2. This graft counter is placed on a sink matt so that it does not move during the case. This instrument can facilitate the counting process.

On an average patient, with average density, the author usually utilizes a 1.0- or 1.5-mm blade for onehaired micrografts, a 2.0-mm blade for two-haired micrografts, a 2.5-mm blade for three to four-haired minigrafts, a 3.0-mm for four to five-haired minigrafts, and a 3.5-mm for six-haired minigrafts. The 4.0-mm blade is occasionally used for seven- to eight-haired minigrafts.

The beauty of this array of exquisitely sharp spear blades is that the incisions can be customized to the patient by making trial recipient incisions before the remaining incisions are made. Thus, the perfect recipient size can be found for that specific patient.

GRAFT COUNTER

BLADE HOLDER WITH DIRECTION GUIDE

To counter this problem, a blade holder (Robbins Instruments) was developed with two vertical lines that line up directly with the blade (Figure 3). These lines were added so that the hair restoration surgeon could very quickly glance at the blade handle before making the final incision. If the blade is slightly off, it becomes very evident to the operator because the red line is tilted to one side or the other. The appropriate correction can then be made very quickly and easily.

Figure 3. A newly developed blade holder with directional guiding lines. These lines help the surgeon know when he/she is slightly off the intended direction of the incision.	Figure 4. A cushioned forcep for minigraft placement. This instrument softens the trauma to the hair graft and limits Hfactor to the hair grafts.

CUSHIONED FORCEPS

To help avert this problem, the author simply took a Jewelers forcep (Ellis Instruments and Robbins Instruments) and added a rubber cushion to the distal tips (Figure 4). This simple addition softens the crush caused by the hard sharp metal forcep tips. This rubber cushion can also be applied to the surgeon's preferred forcep.

TEMPERATURE PROBE WITH ALARM

The cooling system that the author utilizes is the Arkansas cooler (A-Z Instruments) (Figure 5). The system works well, but as the ice water in the system warms, there is no indicator to dictate when to add new ice.

To counter this problem, the author began utilizing a temperature probe (Radio Shack) that is placed into the Arkansas cooler (Figure 5). The settings on the probe are adjusted so that when the temperature reaches 4°C² ice is added to all of the coolers that are in use on that specific patient. Once the temperature again reaches 4°C, an alarm will sound, which tells the surgeon that it is time to add more ice. It is not very expensive, but it can be very advantageous to the final results.

Figure 5. The Arkansas cooler with a temperature probe purchased from Radio Shack. When the temperature hits a set degree, an alarm signals the staff to add more ice to the cooler.	Figure 6. A compass helps accurately configure the posterior crown.

COMPASS

The surgeon simply breaks off the lead pencil tip and continuously dips the remaining wooden end into the ink of choice. A circular configuration is then scribed from the center point (Figure 6).

SUMMARY

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