An Innovative Training Model for Practicing Hairline Designing

INTRODUCTION

The global increase in the demand for hair transplantation (HT) has led to an increase in demand for trained hair transplant surgeons. As compared to the number of HT centers that are coming up all over the world, the number of training centers still remain scarce. Follicular unit HT has undergone several refinements to achieve its current form.[1]

Despite these recent developments, the dearth of precious operating time for the surgeon results in a paucity of teaching time inside the operation theatre. On one hand, we claim that surgical skills cannot be mastered by simple observation, and on the other hand, cadaver training is not easily available. To overcome these problems, simulation-based learning becomes a vital technique. Along with providing an opportunity to teach surgeons, it provides an opportunity to rehearse extensively and gain confidence before entering the operation theater and operating on live patients. It is also a useful method for the surgeons wanting to learn and upgrade new skills. The most crucial step in this surgery is the creation of recipient sites to receive the follicular unit grafts. Keeping this in mind, we have developed a very effective, user-friendly, economical model to learn and practice one of the most important steps in HT, which is the recipient-site area designing.

TRAINING OF RECIPIENT-SITE SLIT MAKING

Materials used for this training model are a papaya, “cut-to-size” blade, blade holder, and Gentian violet [Figure 1]. However, this innovation can be modified by using other objects such as boiled potato, watermelon, and 21/20 G needles.

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Figure 1

Materials used for recipient-site slit designing

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The advantages and disadvantages of other models as compared to papaya have been summarized in Table 1.

Table 1 Advantages and disadvantages of other models as compared to papaya

Traditionally, punches, Nokor needles,[1] and Yeh needles[2] have been used for recipient-site creation. Custom-cut blades[3] were then developed for creating a perfectly fitting slit to receive the follicular unit grafts.

Method of slit designing on papaya:

1. To practice different densities of recipient-site slits, make small square boxes of size 1×1cm on papaya.

2. To practice the frontal hairline or eyebrow designing of recipient-area slits, we need to trace the required template on the papaya using a pen or Gentian violet.

3. Hold the blade holder in dominant hand in pen-holding position, keeping the sharp edge of the blade at an angle of 30°–45° make an incision up to a depth of 4mm.

Scalp hair restoration

Step-by-step approach for practicing the frontal hairline designing on a papaya is as follows[4] [Figure 2]:

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Figure 2

Approach for practicing frontal hairline designing on a papaya model

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1. Mark three points to replicate the midfrontal point (MFP) and both frontal temporal angles (FTA), and connect these points with a gently curved line.

2. Make demarcations showing the transition zone (TZ), defined zone (DZ), frontal tuft (FT), micro- and macro-irregularities, and sentinel hairs.

Angle and direction of slits

Angle refers to the degree of emergence at which the hair exits the scalp, whereas direction refers to the way the hair points when leaving the scalp.[4] Angle and direction of hairline slits are given in Table 2.

Table 2 Angle and direction of hairline slits

With respect to direction of blade, slits can be made in either sagittal [Figure 3] or coronal [Figure 4] plane.[5] With respect to pattern of arrangement of slits, they can be made in linear/curvilinear pattern or staggered/brick pattern[5] [Figure 5]. Incision density for recipient area shows densities of 20, 30, 40, and 50 FU/cm² [Figure 6]. Thus, keeping in mind the above instructions, the pattern for recipient-site creation of the frontal hairline can be practiced on a papaya [Figure 7].

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Figure 3

Sagittal slits

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Figure 4

Coronal slits

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Figure 5

Linear and staggered pattern of slits

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Figure 6

Density for recipient area

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Figure 7

Frontal hairline slits practiced on a papaya

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Eyebrow restoration

Step-by-step approach for practicing eyebrow designing on a papaya is as follows[67]:

1. Draw two symmetrical outlines of left and right eyebrows by tracing the head, body, peak, and tail of the eyebrow.

Recipient-site slits size[6]: 0.6–0.8mm in “herringbone” pattern.

Graft count[6]: 100–400 grafts per eyebrow.

Angle and direction of eyebrow slits are given in Table 3.

Table 3 Angle and direction of slits of eyebrow

With the help of these guidelines, we may be able to master the intricate pattern of slit making to create the recipient zone for the eyebrow as shown in Figure 8.

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Figure 8

Eyebrow slits practiced on a papaya

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CONCLUSION

To keep up with the fast-pacing demand of HT across the globe, better training methods are required. This simple innovative module is a cost-effective, acceptable, and easily replicable refinement in creating hair transplant recipient sites without compromising on the aesthesis. The only drawback of this method is that we may not be trained to deal with the bleeding and oozing that occur while making slits in a patient. Nevertheless, besides, helping us practice the art of designing hairlines in different recipient areas, this method also teaches us the importance of using the appropriate angle, direction, depth, and density of incisions so that we may be confident and better equipped in doing so in a real-life scenario.