Can you have lateral slit after having choi?

[James]

Looking to have a second procedure but can I have lateral slit after having choi done - my 2nd procdure needs to be done in the same area as where I already have choi, I am just looking for more density. Do I need to stay with choi?

[Dr. Glenn Charles]

I think what Dr. Feller meant is that YES you can still have the lateral slit technique even though you had a procedure using the Choi Implanter Pen. With the newer man made blades that range from .6 mm to .9 mm is is very easy to get in between just about any prior hair transplant grafts.

[gillenator]

And these custom-sized blades make exact sized slit incisions for the grafts to fit into. The best docs have techs who microscopically dissect these grafts to accomodate each incision size.

In other words, the grafts are cut to perfect size for each recipient site.

[kwc]

Finally - a thread discussing my main area of concern

I am glad i found this thread. I have been thinking about this for a while. Assuming that all other factors are equal (e.g. extraction, FU treatment in between extraction and implantation, quality and artistry, doctor / tech skill levels, etc.), it seems to me that the process of making the recipient-incision and inserting the FU into it - the technique of actual graft-insertion - is very important – that this is a step which can have a big effect on viability (of both FUs and native follicles), and perhaps even ‘make or break' a good HT surgery. Yet it does not seem to be ‘standard across the board’. Of course each doctor has his/her own preferences for this step, and it is the overall efficacy of the insertion step that is most important for results: all other things being equal, I suspect that the best insertion technique is that which (A) produces the most natural, lasting results, (B) minimizes the percentage of FUs that survive the transplant, and (C) minimizes the percentage of native follicles that are killed. I know that some doctors use a flat-blade to make (straight) incisions, some use a hypodermic needle to make ('C'-shaped) incisions, and others use 'other tools'. I have begun to suspect that a technique that involves actually creating the incision and then ‘shoe-horning’-in the FU (either as the incision is made or as the incision tool is pulled from the incision) might hold inherent advantages over techniques which involve ‘stuffing’ the FU into a ‘slit’ incision with jeweler’s forceps. Especially since I suspect the FU should not be handled by the bulb, meaning, if forceps are used to insert the FU, it must be 'grabbed' with the forceps ABOVE the bulb, making it more difficult to insert (for basic mechanical reasons, largely because the FU is flexible, the bulb is of larger diameter than the shaft, and that bulb must be inserted into an incision which is naturally 'closed' when the scalp skin is relaxed). So I wonder if this is the reason the ‘choi’ tool was developed. Does the choi tool (A) make the implant incision, inserting the FU as it does, and then leave the FU implanted as it is pulled from the scalp? If so, might it not hold inherent advantages, should the tool actually work well, and the doctor actually WANT to use it? I have also been told that improvements have been made on this tool over the last 15 years or so, and that the tool now comes in various 'sizes', e.g. for different sizes of FU implantation, which would seem to be advantageous also. Is it still only available in sizes larger than the newest ‘slit-blades’?

[ejj]

I had the choi used on myself and got zero growth , like you I was ` told ` a lot of things about the choi, in my case by the "salesmen" who get paid commmission by there Drs who use the Choi

Regarding improvements being made it reminds me of the comment about putting lipstick on a pig ... " its still a pig "...

The choi is mainly used in big chain clinics that generally should be avoided !

I dont know if you have seen the video of a choi being used on youtube but its a pretty ` violent ` way of implanting a graft , probably the most forceful way to implant a graft ever , in my opinion , while your there run a search for " death of a follicle " another extremely beneficial video to watch stressing the importance of implantation . The choi does not make the incision it just ` rams home a graft ` into a pre made hole , similar to a regular syringe .

I would look at a Drs results first and formost , and then look at what implantation method was used to consistantly achive great results

all the best

ejj

[Follicle Death Row]

Shame we don't get to see Dr. Feller posting on the forums these days. I'm sure he's too busy.

As for the choi implanter pen, I've seen some horrible results and I've only come across one doc that uses it well. Apparently a lot of the grafts are damaged during the loading process so they never even have a chance before they reach the recipient.

I would be interested to hear about a discussion about lateral vs. saggital. When I think lateral, Dr. Wong, Dr. Hasson, Dr. Feller and Dr. Rahal come to mind. When I think saggital, I think Dr. Shapiro and Dr. Feriduni. I've read some stuff on the pros and cons of each but would be interested to hear from some of the docs.

[kwc]

I dont know if you have seen the video of a choi being used on youtube but its a pretty ` violent ` way of implanting a graft , probably the most forceful way to implant a graft ever , in my opinion , while your there run a search for " death of a follicle " another extremely beneficial video to watch stressing the importance of implantation . The choi does not make the incision it just ` rams home a graft ` into a pre made hole , similar to a regular syringe ejj

Hi Ejj and Follicle Death Row (can i call you FDR? . Thanks to both of you for replying. Wow, so I take ti that the use of jeweler's forceps to insert FU grafts into pre-made incisions is less 'violent' than the choi tool? i must be seeing different videos than you. (I searched Youtube and found 2 videos of the choi doing insertions, one by Dr. Lorenzo), and from them, it seems as though the tool does a clean one-step insertion with minimum trauma, but perhaps i should watch some other videos, and some more videos of the std 'forceps' insertion too.

Interestingly, it was the very 'Death of a Follicle' video you mention that alerted me to the importance of the insertion technique in the first place: I don't believe the Dr. was actually using a choi tool - I think he was using a syringe and forceps very skillfully, and the crux of his technique was to begin the insertion with the forceps AS he removed the syringe, allowing a 'shoe-horning' effect to occur, resulting in a nice clean insertion. Of course in the video he then contrasts that with an ill-fated attempt to use forceps alone to insert a FU graft into a pre-made incision, showing how difficult it can be, (due largely to the fact that the tech must grab the FU above the bulb for the FU to survive, and that means the FU wants to bend and ot go in). And so the main point of the video seemed to be that to get a good clean insertion, it is important to have some way of guiding the FU into the incision. Now, I don't know how realistic the 'ill-fated' attempt portion of the video actually is, but it does seem like the guiding / shoe-horning aspect could be very helpful, and I wonder how many doctors do that. Also, taken to its natural extent, I'm sure the 'birth' of the choi tool was someone thinking "well, why not actually just use the same tool to do the insertion AS it makes the incision?" (and sure enough, it seems the choi tool is basically a syringe with a slotted needle-tube to allow the pre-insertion of the FU) So naturally, I am still trying to understand why this seems to be held in low regard by so many, and FDR may have provided one of the reasons: if the slot in the choi tool's 'needle' causes damage to the FU during the 'loading' or even upon implantation / tool-extraction. Thoughts? Any links to youtube videos of drs. / tech using other techniques would be greatly appreciated.

Also in that video by Lorenzo, they seem to be leaning toward FUE as becoming a high-survival-rate method of obtaining grafts. They mention their 'findings a 2006 study, #2 of which surprised me: "the partial section of the gland and muscle in the superior segment does not significantly influence the survival of the follicular unit" Thoughts?

[ejj]

no worries , the video showing the "death of a follicle" showed the ` stick and place ` technique , it was an 8 gauge needle used to make the incisions followed by a tech ( or the Dr himself ) placing the graft immediatly . Im aware there are lots of debate over technique , thats why i would advise to look at who has consistantly good results time after time ,and then work back on the techniques used to achieve those results .

I think the choi is basically for less skilled Drs , kind of like go on a weekend course and off you go ! for me its like precision engineering , highly skilled , and some Drs have it and some dont ...... and the Drs using choi or any similar contraption ... dont ..

hope this helps

ejj

[Follicle Death Row]

Wasn't sure if I should mention his name but yeah Dr. Lorenzo is the only guy getting some nice results with the choi implanter. He gives demos of how to use it but still it would be better to avoid it in my opinion. Actually Dr. Feller knows Dr. Lorenzo quite well and says his work is very good but that still doesn't mean you're not putting the grafts at an increased risk.

[kwc]

I would be interested to hear about a discussion about lateral vs. saggital. When I think lateral, Dr. Wong, Dr. Hasson, Dr. Feller and Dr. Rahal come to mind. When I think saggital, I think Dr. Shapiro and Dr. Feriduni. I've read some stuff on the pros and cons of each but would be interested to hear from some of the docs.

Hi FDR, and thanks for the thoughts. i think I will talk with Dr. lorenzo if possible. I want to understand why the more skilled doctors would stay away from the choi (perhaps due to thier skill it simply does them no good?) and also why Lorenzo uses it.

By the way, can you pls explain what 'letteral' and 'saggital' mean? where can I find out about those terms?

[kwc]

Thanks, i'll try tot talk with Lorenzo and Feller. By the way, what do 'lateral' and 'saggital' mean?

[gillenator]

You can simply do a search on most forums for lateral and saggital. They are two types of incisions that surgeons potentially use to create their recipient sites for the grafts to be placed in.

There have been arguments on both sides depending on the doctor/surgeon. I personally believe that both types of incisions have their place and use.

[gillenator]

The Choi Implanter from what I understand and observed in the past is the instrument used for implanting grafts. It was first introduced by DHI when they first started offering FUE in Greece.

I have never been a proponent of the instrument and saw it more as a marketing tool than anything else. Just my opinion for whatever it's worth.

I still feel that recipient sites created with a combimation of custom-sized blades along with carefully selected hypdermic tools (needles) produce the best and most natural appearing final result. This affords careful microscopic dissection of the grafts that are "cut to size" providing the team cutting the grafts are experts and very proficient in their skills. Then the careful placement "one by one" of the grafts into their respective recipient sites at perfected angulations and inspected by the surgeon.