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Linear Grafting - My $15 Laser
by Gary S. Hitzig, MD, Rockville Centre, New York, USA

Linear Grafting is, in simple terms, the creation of  slot incisions with a length of 2.5 to 6mm and a width of .5mm  to .75mm. These slot incisions are created by the use of a  a cold steel punch rather than an ultra pulse laser.  It's very origin was derived from watching Walter Unger demonstrate superior results with Laser slits (really slots) vs. the scalpel variety.  It essentially is an attempt to match the size and shape of the recipient site  to that of the graft we create from donor strip harvesting.

Over the past two years I have performed over two thousand of these procedures.  Like any new procedure or technology, my approach has changed as we followed up patients and monitored the results.

Before commenting on my total approach, I wish to answer a comment made by Dr. Beehner in his "TOP TEN" list in the Jan - Feb 97 Forum issue.  Dr. Beehner is quite correct that any graft, round, slit, square or "linear" of six to eight hairs along the lateral or inferior portions of the crown can look artificial.  Although this was performed in 1995, I no longer approach either the crown or part in this fashion.  I treat the part and crown (lateral & inferior) as I do the hairline.  Single hairs are first employed along the part and then two hair Linear grafts are placed in a zone both laterally and inferiorly in the vertex .

Larger linear grafts are placed more centrally angling them into a natural swirl to add density.  The results have been outstanding with this method.  I also agree that young men (or women) should not have transplants in the downward plane of the vertex.

I now perform between 400 to 700 linear grafts per transplant session.  This corresponds to approximately 2500 to 4800 hairs per session. Due in part to the narrowness of the new punches the grafts seem to heal more quickly with growth occurring in 2-3 months.  Density, along with the naturalness,  is achievable in fewer sessions (usually 2) .  The larger slot grafts are kept away from any border zone. Since the graft is not compressed (in a slit) or distorted (in a hole) hair distribution is  excellent (density and naturalness).

Most importantly 3000 to 4000 hairs can be transplanted in a single 2 1/2 to 3 1/2 hour session.  The shape of the recipient site allows the technician to insert the graft quickly with less trauma.  This assures the patient of consistent quality of growth and cost savings.

Key to using the Linear punch is the creation of a stagger pattern in the front as well as following any angling of natural remaining hair further back.  This I hope to demonstrate in further communications. Currently I am working with several physicians as test "beta" sites to assist in refining the instrument and technique.

Reprint: Hair Transplant Forum International May-June 1997

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