Two types of incisions=one great results at nine months
A while ago Pat the publisher of this forum inquired about photos where Dr. Jerry Wong and Dr. Ron Shapiro were asked to perform a live surgery demonstration at the 2006 ISHRS Live Surgery Workshop. Pat asked if I could aid in getting some post op photos of this particular patient. The main objective of the live surgery was to showcase a side by side demonstration of sagital and coronal incisions while dense packing the hairline. The demonstration went extremely well, so well in fact that both doctors were asked to repeat this educational demonstration again at the 2007 European Conference in Paris last May. Since Dr. Shapiro went through the trouble of putting the pictures together for great side by side comparison, I thought there may be others interested in seeing if they can tell a difference between sides. Most of the physicians that have seen the photos as well as Dr Wong and Dr Shapiro feel that both sides look very good. I think it demonstrates that as long as fine grafts and tiny incision are used properly, the great majority of clinical results are due to the skill of the physicians rather than a specific incision type. All parties have consented to showing the pictures on the forum.
At SMG, Dr. Shapiro uses both sagital and coronal incisions. Most of the time he uses sagital incisions for the hairline. For him he finds them useful for following the rapidly changing direction of hairs in hairline cowlicks as well as the temporal corners. With the newer tinier blades used to make sagital incisions, it is easy to keep the exit angle of hair between-15 to 30 degrees. With the newer tinier blades it is also easier to make sagital incisions at densities ranging from 30-60+ FU/cm, especially with 1 hair FU grafts. However, Dr Shapiro will switch to coronals when he does temporal points where the angle of exit needs to be very flat (less than 15 degree). He will also (depending on the clinical situation ) use coronal incisions in the central core region. His decision whether or not to use coronal vs. sagital in the central area if is based on a number of factors but primarily is based on the amount of pre-existing hair a patient has and whether or not the patient will agree to shaving the area. If a patient has a lot of pre-existing hair at risk for shock loss and will not shave his hair then Dr Shapiro prefers to use sagitals as it is a little easier for him to get in-between existing hairs.
It is interesting that the same Cutting Edge Machine developed by Hasson and Wong to create the tiny customized chisel blades that have been so helpful in making coronal incisions so successful have also enabled the creation of tinier customized angled blades that make the sagital incisions better than before. I mentioned to Dr Shapiro that I was going to post this case and he told me to make sure I mentioned his great respect for both Dr Wong and Dr Hasson as far as their great clinical results and the innovations and new ideas that have added to the field.
As far as my opinion so far with respect to the results produced with different incisions: I’ve expressed in the past that when viewing follow-up patients after a year, it’s very hard to differentiate the two types of incisions when all is said and done. In the hands these two highly respected surgeons, what becomes more crucial is the angle and artistry of the incisions rather than whether the incisions are perpendicular or parallel. I’ve planted both types for Dr. Shapiro and now I’ve planted in Dr. Wong’s incisions on three occasions and find that either type of incision is fine. What I don’t find is that just because a doctor may be exclusive to one type that it’s superior over the other. It’s more about the doctor and how they utilize their skills in making the incisions. |
