I had the honor to visit the world renowned Limmer clinic in San Antonio, Texas on Tuesday, March 20th of 2007. In many respects the Limmer clinic is the birth place of "follicular unit grafting" since it was Dr. Bobby Limmer and his staff who first began using microscopes to visualize and trim naturally occurring follicular units into follicular unit grafts.

Dr. Bobby Limmer's significant contributions to the refinement and advancement of follicular unit hair transplantation are well documented, including in the "History of Hair Transplantation" section of the Coalition Hair Loss Learning Center.

Dr. Bobby Limmer shared his techniques and findings with his peers and was a persuasive advocate for the follicular unit procedure. For his part in pioneering this excellent surgical procedure Dr. Bobby Limmer was awarded the “Platinum Follicle Award” by the International Society of Hair Restoration Surgery in 1996.

Over 14 years ago Dr. Bobby Limmer was joined by his son Dr. Brad Limmer who also has a strong background in dermatology. By joining his father's hair transplant practice Brad was able to study under his renowned father and learn what would later become accepted as the “Gold Standard” in hair transplantation. He also learned his father’s emphasis upon honest and upfront education with all patients.

The Limmer clinic has continued to refine their follicular unit technique and today create minimally invasive incisions that are as small as 0.7 mm for the one hair grafts. These tiny incisions enable them to place more grafts closer together when appropriate for the patient. Patients now experience more rapid healing.

The Limmer clinic also using a technique referred to as "stick and place" in which the grafts are inserted immediately after the incision is made. Since the fresh incision is still dilated and has not begun to contract it is easier for the staff to place tiny grafts into very tiny incisions.

In general I was impressed by how refined, clean and minimally invasive the incisions and graft placements were.

They also typically remove a donor strip that is 1.2 cm wide and do not like to exceed this width because they feel it increases the risks of a visible donor scar. They also use internal and external sutures that are dissolvable. They feel that the internal sutures remove much of the tension from the external skin layer closure and thus minimize any potential scarring.

Dr. Bobby Limmer was not at the clinic on the day of my visit. But I was impressed by Brad Limmer and their very experienced staff.

Good info Pat. While I have much respect for the Dr. Limmer family, I would not feel comfortable with the tech making incisions. Does the doctor make most of the incisions and then the tech do a final stick and place?

Gorpy,

The tech create both the incisions and place the grafts. This was the same "Stick and Place" technique used by the Seager clinic for years.

However, the design of the hairline and where the hair will be added is planned by the surgeon.

Pat

Pat,

Very interesting. I am with Gorpy on this one. I'm not sure if I'd feel comfortable having the techs make the incisions, especially since the incisions determine the the way in which the hair is inserted and how it ultimately will grow. Did Dr. Limmer (or Seager in the past) give reasons to why they don't make the incisions themselves or why they feel it's appropriate for the techs to make the incisions? I look forward to your reply.

Falc

who would be considered a better surgeon for the most natural hairline, Limmer or Shapiro in Minnesota or someone else?

Falc and Gorpy,

I know that most of us are more comfortable with the idea of the surgeon whose name is on the door making the incisions.

Some patients would even prefer that their surgeon place at least some of their grafts. But often, especially now in the era of big sessions, all the grafts are typically placed by techs. Often these highly experienced techs are better at placing than the surgeon.

This can also be true of the process of making the incisions. At the Limmer Clinic I did watch Anna, who has ten plus years experience, making the incisions and then immediately placing the grafts into these fresh and still dialated incisions. I was very impressed by how extremely clean and minimally invasive the incisions and graft placements were.

My sense is that her incisions and placing are on pare with that of the very best surgeons. Using the "Stick and Place" technique in which grafts are placed immediately after the incision is made does have the avantage of allowing the tech to make a smaller incision for a given size graft since the graft is immediately placed into the incision before it can contract and or clot. This makes the procedure less invasive and the grafts can be placed more easily and without added struggle or damage.

Thus there are pros and cons to the "Stick and Place" technique which has typically been performed by the lead techs rather than the surgeons. But in my opinion, if the lead tech creating the incisions and placing the grafts is highly experienced and skilled the final out come will be excellent. I believe that this is the case at the Limmer clinic.

P.S. Willie, Determining who has the best hairlines is a subjective process. I suggest you view the photos of various surgeons and select those you feel are optimal.

As long as the tech making the incisions and placing the grafts had this kind of experience, and I was comfortable with the results I'd seen produced by that person (hugely important IMO), I don't see any problem with the Tech's making the incisions AND placing the grafts.

Initially when I had heard this in the past, I admit, I was a little alarmed. Before any of my HT's, I went in thinking the Doc did EVERYTHING from start to finish. I was sadly mistaken after watching 4 Techs place all my grafts for HT #1. As I educated myself more about HT's, while I do desire a certain amount of detail, I'm a results-oriented person and tend to focus my efforts in looking at the "finished product" that a clinic produces.

I do believe a prospective HT patient should be aware of the practices of a clinic which they would hopefully learn when consulting with that particular clinic. Whether or not a person would know to ask whether or not a Tech makes incicions/places grafts is something else. I suppose the more concerned or uneducated a prospective HT patient, the more they may want to ask those types of questions before getting in the chair.

Again, to me, consistent great results from the clinic are where my eye tends to focus.

quote:

As long as the tech making the incisions and placing the grafts had this kind of experience, and I was comfortable with the results I'd seen produced by that person (hugely important IMO), I don't see any problem with the Tech's making the incisions AND placing the grafts.

I echo this sentiment. This goes back to my opinion on techs placing the grafts verses the doctor themselves. As long as the results yielded from a particular clinic are consistently positive, I don't have a problem with it.

HOWEVER, I do admit, since this technique seems to be more unusual (aka: not the norm) at this point, I wouldn't be personally comfortable with it for me. I typically like to see newer techniques and methods become more readily adopted by other leading clinics BEFORE I am fully comfortable. That does NOT mean that their method has little merit...it's a very personal statement. That being said...I do hope we'll see more of Dr. Limmers work over time yielding positive results and thus the comfort level will go up.

Falc

Tough subject

I am sure there are some talented techs who could place the grafts quite nicely BUT for me, this would not go over well. The purpose of me going to a doctor is for the doctor to design, and place the incisions.. Once these are made the graft can only go in one way , hence my acceptance of tech's placing the grafts..

Call me old school but I would not be comfortable with techs making my incisions