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

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:fjimenez@clinicadelpelo.com

JIMENEZ AND SOSA-CABRERA

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