Introduction: Hair transplant is a common cosmetic surgical procedure. Finer and newer techniques are coming up very often. We have developed this (suction assisted hair implantation) technique mainly to avoid post-surgical dermal cysts formation due to hypodermic needle prick and to get bloodless operative field

Materials& methods:

752 clients underwent suction assisted hair implantation procedure for past 5 years. Around 744 were males and 8 were females with age group ranging from 23 to 55 yrs. inserting the hair grafts by Suction Assisted Implantation made the procedure faster, safer and easier

Harvesting was done by

1: Follicular unit transplant (FUT)

Or

2: Follicular unit extraction (FUE)

For inserting grafts, we used 19 – 21 gauge hypodermic needles to make holes and to insert the grafts. For easy insertion of the graft we used suction negative pressure. The needle was attached to a 14 size suction catheter which in turn was attached to a suction machine which produces a mild vacuum suction pressure (approximately 40 – 80mm of hg).The suction power sucks out the  blood making the field clear for easy visualization of the hole. It also removes the skin debris produced during piercing. The negative suction easily guides the graft to get into the hole during insertion

RESULTS

By this technique the epidermal cyst formation was almost totally prevented and we were able to do the procedure in a bloodless field with easy insertion of the grafts

Conclusion:

1: The suction sucks out the dermal skin debris produced by the piercing of the skin with hypo dermic needles, and hence avoids the formation of dermal inclusion cysts.

2: Sucks out the oozing blood and hence produces clear field for easy insertion.

3: The suction negative pressure automatically guides the hair graft to enter into the hole easily without much manipulation and hence faster surgery can be done

Vertex area is the most difficult area to treat and nearly always the least important area to transplant.

Vertex transplant is indicated in following cases

1. Above 40 years
2. Abundant donor reserves
3. No family history of Norwood V,VI,VII baldness

I personally delay treatment of vertex as long as possible. Initially first I start with medical treatment

This classification mainly helps in a simple way to define accurate
treatment for hair loss.
Grade I – No Treatment Required.
Grade II – Mostly dealt with medical treatment.
Grade III, IV, V– Requires Hair Transplant with medical treatment.

Grade VI – Relative contraindication for hair transplant.
Grade VII – Absolute contraindication for hair transplant.

There are numerous varieties of punches available in the market today. All punches vary from the size, shape and edges. Every FUE surgeons get into comfort zone by selecting a particular type of punches based on his/her skills. The trumpet punches will be the one of latest development under punch category. Its size varies from 0.70mm to 1.1mm and these punches can be classified into

1. Standard hybrid trumpet punch (inner smooth outer sharp) and

      2. External serrated trumpet punch (inner smooth outer serrated)

ADVANTAGES

1. MUCH LOWER TRANSECTION RATE

Hybrid Trumpet punch has almost 90° outer edge that allows you to penetrate the skin easily in acute angle. The smooth funnel shaped inner edge treats the graft carefully when working in a vertical motion.

2. REDUCED SCARS

Because of smooth inner edge no need to increase diameter of the punches to avoid transaction and in serrated edges there is even less tissue contact so less tissue damage so therefore faster wound healing and there are reduced scars.

3. FASTER HARVESTING

These high quality grafts make extraction process faster and easier resulting in overall time consumption.

4. LESS MISSING GRAFTS/ MORE GRAFTS AND HAIRS

Most of the time dull punches tend to bury the grafts and sharp punches tend to transect then but with hybrid trumpet punches with moderate pressure along with the sucking effect of the funnel shaped inside will reduce the missing grafts rate significantly and therefore more follicular units and follicles can be harvested.

DISADVANTAGES

1. More Chances of surrounding hair root damage and decreased grafts obtained because of the conical shape of the punch.
2. The diameter of the punches has to be kept as minimum as possible (0.8 to 1mm) to avoid neighboring hair root damage.