template stamps to estimate recipient site density in hair transplantation
TRANSCRIPT
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HOW WE DO IT
Template Stamps to Estimate Recipient Site Density in HairTransplantation
FRANCISCO JIMENEZ, MD,* AND DARIO SOSA-CABRERA, PHD†
The authors have indicated no significant interest with commercial supporters.
There are two ways to prepare the recipient sites
that will hold follicular unit grafts: premade
sites, in which the surgeon prepares all of the sites
before graft insertion, and the “stick and place”
technique, in which the sites and grafts are made and
placed one at a time.1 Irrespective of the technique
that the surgeon uses, there is no reliable method of
preparing the sites that ensures homogenous distri-
bution and consistent density of the incisions in the
recipient zone. The surgeon usually relies on expe-
rience and good visual technique. Because of the
importance, and the difficulty, of creating the sites at
a specific density, we have developed a simple but
objective method based on the use of “stamp
templates,” which are painted onto the patient’s
scalp skin before making the incisions.
How the Stamps Are Used in Clinical Practice
The stamp with the desired density is painted with
gentian violet 1% solution and then stamped onto
the recipient scalp (Figures 1 and 2). Methylene blue
1% aqueous solution is another option that can be
used for painting the stamps. The reason for using
gentian violet or methylene blue is that many
surgeons already use both products to increase
visualization of the recipient sites.2,3 The pattern of
dots painted onto the recipient area accurately
reproduces the desired specific density. Once theFigure 2. The stamp with a dot pattern of 40 dots per cm2 isstamped onto the patient’s recipient area.
*Clınica Dr. Jimenez-Acosta, Gran Canaria, Canary Islands, Spain; †GIMET—CTIM, University of Las Palmas de GranCanaria, Las Palmas de Gran Canaria, Canary Islands, Spain
Figure 1. Painting the dot pattern stamp with gentian violet.
© 2012 by the American Society for Dermatologic Surgery, Inc. � Published by Wiley Periodicals, Inc. �ISSN: 1076-0512 � Dermatol Surg 2012;1–3 � DOI: 10.1111/j.1524-4725.2012.02449.x
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recipient area is numbed, the incisions are made
through the dots using the surgeon’s preferred
instrument. The author uses 1-mm blades or 19 G
needles to prepare the sites when using templates of
25 to 35 dots per cm2, 0.9-mm blades or 20 G
needles when using the template of 40 dots per cm2,
and up to 0.8-mm or 21 G needles when using the
patterns of 50 and 60 dots per cm2. While making
the sites, the surgeon should take care not to transect
any remaining terminal hairs that might coincide
with the dot pattern stained in the recipient scalp
area. Once the sites are prepared, the area is cleaned
with saline. Most sites retain gentian violet at the
skin surface, which helps to identify the recipient
sites (Figure 3).
The Process of Making the Templates and
Stamps
Using a photo edition software (Corel Draw,
Ottawa, Canada), we designed a variety of templates
with dot patterns at different densities so that
different densities could be selected according to the
clinical situation: 25, 30, 35, 40, 50, and 60 dots per
cm2 (Figure 4). These dot patterns follow a trian-
gular distribution, mimicking the natural distribu-
tion of human scalp hair.4
The dot patterns were then sent to the stamp
manufacturer for the process of fabrication of the
stamps. We use “clear stamps,” which are photo-
polymers normally used in rapid prototyping, stere-
olithography, and three-dimensional printing pro-
cesses. The process is as follows. First, a negative is
obtained from the template that was created using
the photo-editing software. The negative is covered
by the photopolymer, which is a resin sensitive to
ultraviolet light. The light illuminates only the
Figure 3. Recipient sites are made through the dots. Afterthe recipient area is cleaned, most of the slits retain thegentian violet, which helps to visualize the sites.
Figure 4. A variety of templates with different dot-pattern densities: 25, 30, 35, 40, 50, and 60 dots per cm2.
TEMPLATE STAMPS IN HAIR TRANSPLANTATION
DERMATOLOGIC SURGERY2
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photopolymer below the transparent areas, and it
reacts, solidifying the pattern. Once the clear stamps
have been made, transparent blocks are used to
stamp the dot pattern onto the patient’s skin.
Although the polymer stamps stick on the block
without any additional adhesive, for our purpose
and to have a robust stamp that lasts for a full 5- or
6-hour-long surgery, we stick the stamps to the
blocks using double-sided transparent tape. This
easy-to-remove tape avoids any possible damage
when removing the stamp from the transparent
acrylic block for sterilization.
Conclusion
This template stamp method offers the following
advantages. It helps the hair transplant surgeons
prepare the sites at a specific density, avoiding
reliance on subjective estimations. By showing the
dot pattern templates to the patient, the surgeon can
explain better to the patient how close the follicular
units need to be implanted to achieve a desired
density. The gentian violet staining of the slits helps
to visualize the recipient sites, which facilitates the
process of graft insertion.
References
1. Avram M, Rogers N. Contemporary hair transplantation.
Dermatol Surg 2009;35:1705–19.
2. Unger W. The recipient site. In: Unger WP, Shapiro R, Unger R,
et al., editors. Hair Transplantation. London, UK: Informa
Healthcare, 2011. pp. 349–93.
3. Rashid MN. Recipient site staining: a powerful tool in follicular
unit hair transplantation. Hair Transplant Forum 2005;15:196.
4. Jimenez F, Ruifernandez JM. Distribution of human hair in
follicular units: a mathematical model for estimating the donor size
in follicular unit transplantation. Dermatol Surg 1999;25:294–8.
Address correspondence and reprint requests to: FranciscoJimenez, MD, Calle Angel Guimera, 2, Las Palmas deGran Canaria 35003, Canary Islands, Spain, or e-mail:[email protected]
JIMENEZ AND SOSA-CABRERA
2012 3