Premade slits vs DHI vs Stick and Place

[Fue3361]

Can we have a discussion about the advantages of DHI and Stick and Place, when compared to premade slits using an implanter pen?

From my understanding (what I read on another thread), the issue with implanting into premade slits is the following (I'm quoting @BDK081522 )

"Using this technique, the surgeon uses larger incisions to account for the wounds closing before grafts are placed."

 

DHI has no premade slits, so no wound closing, and Stick and Place has the graft implanted immediately after opening the incision (again, no would closing).

 

I can totally understand how a would closing would be an issue if you're working with forceps.  BUT, why would this be any kind of issue if you're using an implanter pen.  Why would you have to make a larger incision at all?  A constricted wound will still open up and stretch to accommodate an implanter pen just fine, regardless of size, and there should be no more trauma to the hair graft here than there would be in DHI (maybe even less, as you're implanting into a premade slit, instead of breaking the skin using the implanter.

Edited November 19, 2021 by Fue3361

[Melvin- Admin]

I asked this question to Dr. Konior, I’ll try and make a video on YouTube with the clips.

[Fue3361]

20 minutes ago, Melvin- Moderator said:

I asked this question to Dr. Konior, I’ll try and make a video on YouTube with the clips.

So what did Dr. Konior say? 

[Melvin- Admin]

3 minutes ago, Fue3361 said:

So what did Dr. Konior say? 

It’s pretty intricate, but suffice to say they all have merit. 

[digi23]

41 minutes ago, Fue3361 said:

Can we have a discussion about the advantages of DHI and Stick and Place, when compared to premade slits using an implanter pen?

From my understanding (what I read on another thread), the issue with implanting into premade slits is the following (I'm quoting @BDK081522 )

"Using this technique, the surgeon uses larger incisions to account for the wounds closing before grafts are placed."

 

DHI has no premade slits, so no wound closing, and Stick and Place has the graft implanted immediately after opening the incision (again, no would closing).

 

I can totally understand how a would closing would be an issue if you're working with forceps.  BUT, why would this be any kind of issue if you're using an implanter pen.  Why would you have to make a larger incision at all?  A constricted wound will still open up and stretch to accommodate an implanter pen just fine, regardless of size, and there should be no more trauma to the hair graft here than there would be in DHI (maybe even less, as you're implanting into a premade slit, instead of breaking the skin using the implanter.

There are also Drs doing "DHI" with premade slits, this is some sort of "not true DHI" but still counts as DHI. I think its something like they extract a smaller amount of grafts, say 1000. Then implant all 1000, then do the same again until they have implanted all.

Someone with a little more insight in this can reply on this.

Edited November 19, 2021 by digi23

[Fue3361]

Because I'm not 100% sure on this, but I think in my case, premade slits were made first, then the grafts were extracted + implanted.

[BDK081522]

3 hours ago, Fue3361 said:

Can we have a discussion about the advantages of DHI and Stick and Place, when compared to premade slits using an implanter pen?

From my understanding (what I read on another thread), the issue with implanting into premade slits is the following (I'm quoting @BDK081522 )

"Using this technique, the surgeon uses larger incisions to account for the wounds closing before grafts are placed."

 

DHI has no premade slits, so no wound closing, and Stick and Place has the graft implanted immediately after opening the incision (again, no would closing).

 

I can totally understand how a would closing would be an issue if you're working with forceps.  BUT, why would this be any kind of issue if you're using an implanter pen.  Why would you have to make a larger incision at all?  A constricted wound will still open up and stretch to accommodate an implanter pen just fine, regardless of size, and there should be no more trauma to the hair graft here than there would be in DHI (maybe even less, as you're implanting into a premade slit, instead of breaking the skin using the implanter.

You bring up a valid point. It very well may be the case that pre-made incisions can be kept smaller if the surgeon is going to use an implanter pen instead of forceps. I didn't realize that surgeons were using this technique but it seems to make sense. As Melvin mentioned all techniques have merit and the surgeon ultimately chooses which technique is appropriate for each individual patient. I think rather than implantation technique, what's more important is surgeon experience and how comfortable they are performing the operation the way they've been taught. Ultimately results dictate who are considered the elite surgeons and this takes years of experience. The focus should be on which surgeon produces results that you find personally to be the most aesthetic and not so much about which tool or technique is used. 

[Gasthoerer]

I have yet to see the proof for the advantage of implanter versus pre-made slits. I'd say if you take the recent top ten in fan favourites, there is a 50/50 split too.

Obviously this "larger incisions" argument comes quite often. On the other hand a surgeon once told me: "if you cut yourself with a blade versus a puncture...what heals better? And: Are your sure that the created wound is really smaller?". Plus: the loading into the implanter also could create trauma to the grafts. 

[Fue3361]

14 hours ago, Gasthoerer said:

I have yet to see the proof for the advantage of implanter versus pre-made slits. I'd say if you take the recent top ten in fan favourites, there is a 50/50 split too.

Obviously this "larger incisions" argument comes quite often. On the other hand a surgeon once told me: "if you cut yourself with a blade versus a puncture...what heals better? And: Are your sure that the created wound is really smaller?". Plus: the loading into the implanter also could create trauma to the grafts. 

My point is, that if you use an implanter pen into pre-made slits, you don't need to make the incisions any larger...  Implanter pen doesn't have an issue with incision size the way forceps do, since they stretch the incision when they enter.

[Gasthoerer]

5 hours ago, Fue3361 said:

My point is, that if you use an implanter pen into pre-made slits, you don't need to make the incisions any larger...  Implanter pen doesn't have an issue with incision size the way forceps do, since they stretch the incision when they enter.

I got your point! But my answer is: 

a) Maybe wound healing is better with a clean straight cut, then with the round one of an implanter. I tend to scar very poorly (keloid style) but my incisions healed mega fast and without visible scaring

b) Are you sure that the actual length of the scar is really shorter with an implanter?

[Fue3361]

1 hour ago, Gasthoerer said:

I got your point! But my answer is: 

a) Maybe wound healing is better with a clean straight cut, then with the round one of an implanter. I tend to scar very poorly (keloid style) but my incisions healed mega fast and without visible scaring

b) Are you sure that the actual length of the scar is really shorter with an implanter?

Why would premade slits not be straight cuts?  You make a straight cut with a proper blade, then you simply implant with dull implanter pen.

[Gasthoerer]

21 minutes ago, Fue3361 said:

Why would premade slits not be straight cuts?  You make a straight cut with a proper blade, then you simply implant with dull implanter pen.

Sorry, misread your post. Didn't get you are talking about pre-made slit + implanter but about slit vs. implanter only. 

[Fue3361]

50 minutes ago, Gasthoerer said:

Sorry, misread your post. Didn't get you are talking about pre-made slit + implanter but about slit vs. implanter only. 

Yeah.  I get the argument about slits vs implanter only. 

My surgeon does both, where he makes slits, then uses implanter into said slits.  I was told that this was inferior to DHI, which to me makes no sense, as the reasoning they gave was slit size having to be larger, but that to me logically doesn't follow if you're using an implanter pen, only if you're using forceps.