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Page 2 of 8 Kayiran et al. Plast Aesthet Res 2018;5:9 I http://dx.doi.org/10.20517/2347-9264.2017.86

INTRODUCTION
Hair transplantation has gone through a big revolution with the pioneers in this field . To achieve a good cosmetic
[1-5]
result in hair transplantation, a natural-looking hairline with adequate density shall be established. There are
numerous modifications of defined techniques with each one explaining and suggesting verified solutions.

This note describes the available options in hair loss surgery and the concepts of non-surgical approaches,
and an experience is shared with a few patients grafted via direct hair implantation (DHI) method. Moreover,
to us, this is the only study demonstrating the opening of the nests with sliced razor blade just before the
implantation of the hair follicles. Thus, the evolution with the future of hair transplantation is summarized
as well. Moreover, this article focuses on the surgical techniques. The medical management of hair loss is
out-of-scope.

METHODS
Between January and December 2014, hair transplantation was carried out in 207 patients. The patients with
beard and/or moustache transplantation, multisession transplantations and female patients were excluded.
The harvested grafts out of the scalp were also not evaluated.

All the procedures were carried out under local anesthesia. The hair was cut 1-2 mm in length. Micromotor
[6]
system was used in the harvesting of the hair follicles . This system consists of punches attached to the
hand-piece of the micromotor system (1500-3000 rpm). Punches were chosen according to the diameter of
the follicles ranging between 0.8 and 1.2 mm. Harvesting of the follicles was handled in supine position. With
the aid of the sharp punch attached to the motorized system, the follicle was detached from the surrounding
tissue (approximately 3-4 mm in depth=deep dermis layer). Later on, it is released manually with fine-curved
microforceps produced for this purpose. Temporooccipital region was used as donor site.

The harvested grafts were aligned in Petri dishes with cooled saline (4 °C). A dressing is made with sterile
saline coated gauze to the donor area and the patient was turned to the supine position.

In follicular unit extraction (FUE) technique, razor blade that was cut into pieces was used to open the
nests in vertically-oriented fashion that are to be grafted [Figure 1]. With this, we aimed to diminish the
incarceration of the implanted follicles. However, in DHI technique, the grafts were loaded to the DHI
pens with one charged staff for this purpose [Video 1]. The implantation of the follicles was carried out in
accordance with the natural hair angles by the author under loupe magnification [Videos 2 and 3].

After the entire implantation was established, the patient was dressed with antibiotic coated, moisturized
gauze to both donor and recipient areas that were removed 3 days later at which the first hair washing would
also be carried out. The patients were recommended to have their first hair-cut 15 days later.

RESULTS
A total number of 615,400 grafts were transplanted in 207 patients. Of these, 38 were DHI (19%) and 169 had
FUE (81%).

Patients were classified as Norwood III, IV and V in 1 (0.5%), 30 (14.5%) and 176 (85%) patients, respectively.
The main reasons of hair loss were androgenetic alopecia and cicatricial alopecia in our patients.

An average number of 2973 grafts were transplanted. Mean graft numbers transplanted in FUE and DHI
methods were 2982 and 2934, respectively. The mean density was observed around 75 units/cm for DHI
2
technique and 50 units/cm for FUE method.
2