1.Are needles custom manufactured for each individual patient?

(I doubt this; I think it's industrially mass produced?)

2.How do the needle sizes correlate to the follicular unit graft sizes?

Mmhce,

There are clinics that custom cut blades, mine did/does. I doubt all clinics do this but I'd like to think all the top clinics do.

-edit-wrong info

From what I understand many clinics use custom cut blades.

Quote from Falc.

quote:

I do strongly suggest (like the others) that you see a coalition doctor who refines the FU by cutting them thin and then using smaller custom cut blades to make recipient sites

They cut the blades there and then rather then ordering blades for each patient.

Quote from another site

quote:

Using blades cut to the size of the grafts

Some of our members use custom blade cutters to create tiny blades to make incisions that match the size and depth of each follicular unit graft being transplanted. This enables a surgeon to safely dense pack more grafts into a given area during a surgical session. Healing time is also more rapid, with minimal scarring.

This is true, H&W worked with a medical supply group and invented the blade cutting device approx 5-6 years ago....Dr John Cole was one of the first to start using custom made blades.

Each day for every patient the blades are made in relationship to the size of the patient’s individual grafts to provide a custom fit. It has been a excellent addition in bring this procedure, in the hands of the industry leaders to an end point....once we are down to a trimmed FU, in the hands of skilled techs and proper magnification there is nothing smaller and more refined to go too (this is an end point). If we can't make the graft any smaller and the incision is made in relationship to the graft we can not made the incision any smaller either this also is an end point. What this ultimately means is it is refined to the Nth most degree...good to know, right. What this means to the patient is the smaller the unit, the smaller the incision the closer we can place the grafts, which is important both with aesthetics and density. Similar to rocks in a jar versus sand in a jar, the sands will be packed closer.

quote:

Each day for every patient the blades are made in relationship to the size of the patient’s individual grafts to provide a custom fit.

Zup,
Can the blades be manufactured the same day, or must a patient visit the clinic sometime in advance (a few days, months), in order to determine a sizing?

Thanks.

Mmhce,

The blades are cut during surgery at the clinic, by the staff working at the clinic.

Not 100% sure if you are allowed to link to other sites, but this is the first site that came up in google showing a picture.

Cutting machine

Towards the bottom of the page is a picture of the equipment used to cut the blades.

Good post Maxxy! Thanks.

I've talked to Bill about this before. It's ok to post this link.

Hello mmhce, you may have had this answered, but the answer is yes, they are made in the morning the day of surgery....not prior

Needles are pre-fabbed at a manufacturing facility in various sizes but for hair restoration the most common sizes are 18 gauge, 21 gauge and 23 gauge. The higher the gauge the smaller the circumference of the needle.

I made a video about this some time ago comparing not only the differences in size for needles vs. blades but the difference in how they affect tissue. I used a melon for the comparison. The video is here.. Needle Size vs. Blade Size

Below is a three frame image showing the blade cutting in it's latest iteration as designed by H&W. I believe the first cutters were manufactured roughly eight or nine years ago as they were in full use during my first procedure seven years ago.



For many years Dr. Hasson and Dr. Wong pushed for their colleagues to embrace lateral slit technology. Dr. Wong gave the first presentation regarding custom blades and lateral slits roughly twelve years ago at the Barcelona ISHRS conference.

cutterandblades.JPG (109 KB, 285 downloads)

Though we do allow links to third party sites when they aren't blatantly promotional, the Hair Loss Learning Center is our website, so you are still linking to one of our sites. I just thought I'd point that out. :-)

Onto the topic, members have already given a number of excellent replies.

Though I'm personally a fan of custom cut blades (which are cut and prepared the day of the surgery), several leading clinics do use pre-fab needles.

Joe made some excellent points both in his post and his video however, I thought it might be interesting to read an alternative point of view.

Below, Ailene from Coalition member Dr. Jerry Cooley's clinic shares their experience with needles verses flat blades.

See Do Needles or Flat Blades Cause Less Trauma?

Best wishes,

Bill (Falc)

The key to a good result with your hair transplant is to see no visible scaring where the new hair is growing. In order to do this, you have to take the up most care in causing as little trauma to the area as possible. This can only be done with a custom cut blade, cut as small as possible to get the graft in safely. If you look at the shape of a follicle you will notice how well the chisel custom blade resembles the shape of the follicle. There is no reason to use a sharp needle because you have to penetrate too deep in order to get the graft to sit properly. This will cause undo trauma to the deep vascular bed. Also, the cut of the custom cut blade is very clean and straight allowing the edges to heal quickly and beautifully. Needles are round and beveled so not only do they dilate the area, but they can also tear the skin’s surface microscopically. This can cause more unnecessary trauma. The other great attribute is that it’s custom and cut during the surgery. If your follicles are big, you can cut your blade to the appropriate size. On the other hand, if your follicles are small, you can cut your blades smaller to help cause even less trauma to the scalp.

Post-op from all my surgeries, I had the typical scabs form. My last HT, w/ custom blades, I had no scabs form, only some dry, flaking skin a week later. Other surgeries were with needles and what ever they used in the mini/micro days (though it sure wasn't custom). This leads me to realize how little trauma was caused from cc blades.

Posted by Ailene, a member of our hair transplant community and personal assistant for Dr. Jerry Cooley of Charlotte, NC who is a member of the Coalition of Independent Hair Restoration Physicians.
" we prefer the needles because the sharp point can be directed precisely and the larger caliber of the needle ‘pushes’ the hair apart, minimizing the risk of hair transplant shock loss. We use different size needles ranging in size from 19 gauge being the largest and 22g or 23g be the smallest." Thanks for posting this opinion Bill. Maybe that is why I had no shockloss? Anyway in the end it is all about the result.

Thanks for posting the video Jo.
It was insightful to see the lower amount of trauma inposed by blades as opposed to needles.

I have used both needles and blades for over ten years. Sometimes I prefer one over the other. In many cases, I use both and when the patient returns in a year for followup, there is no difference in the appearance of the hair growing from one site versus the other. If I'm working on slick bald skin, I tend to use custom cut blades. If I'm working in existing hair, I prefer needles. Most of my patients don't want to shave their head and I find that needles allow me to more easily make sites in between existing hair. The quality of results has to do with graft preparation and handling, careful creation of sites in the natural direction and angle of natural hair growth, and gentle graft placement. It has nothing to do with needles versus blades.

Our choice of whether to use needles or custom-cut lateral slit blades is identical to what Dr. Cooley stated. When I want to "dense pack" in a limited area, which is usually up front or in the temples, I like the small custom blades, but when making FU sites amongst existing native hairs, we also prefer the solid core needles for the exact reasons Dr. Cooley stated - the fact that they are more precise than the blunt, squared end of a lateral slit blade and they push the hairs away from the path of the needle. Also, there is the benefit that they slightly dilate the hole more than a lateral slit does, which facilitates in visually seeing the site when the tech or I are placing grafts.
Mike Beehner, M.D.