Creating Recipient Sites Using Custom Cut Razor Blades in Hair Transplantation

Dear Editor,

Follicular unit hair transplantation has undergone multiple refinements to achieve its current form.[1] An important step in this surgery is the creation of recipient sites to receive the isolated follicular unit grafts. We describe the use of a low cost tool to create these recipient sites.

Traditionally, punches were used to create recipient sites for placing the mini grafts. This produced a "doll's hair"/"cornrow" appearance, and soon fell out of favour. Nokor needles[1] and Yeh needles[2] have also 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. These blades created rectangular recipient areas and were able to avoid deeper punctures as with the needle, while creating adequate room for the graft to sit.

The authors’ technique involves the use of razor blades, shown in Figure 1, to create custom cut blades. The razor or shaving blades are made of stainless steel and are autoclaved prior to use. With a thickness of 0.02 mm, the blades can easily be cut using scissors down to the required sizes of 7 mm, 8 mm, 9 mm and larger sizes depending on the size of the grafts [Figure 1]. The cutting blade or "bit" has one sharp edge, and can be easily mounted on needle holding forceps [Figure 2] and used for recipient site creation [Figure 3]. Care should be taken to ensure that the sharp cutting edge is even. Though the sides of the bit are blunt, as is the case with any custom cut blade, as long as the advancing sharp edge is kept even, the resulting slits will be very precise. One shaving blade will provide more than 20 bits, of which the best are chosen based on size and the presence of even edges, and the rest discarded. With practice, it is possible to produce perfectly even bits in the required sizes. For a transplant session of 2000 grafts, not more than 4 to 5 bits are required.

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Figure 1

The razor blade with the “bits”

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Figure 2

The bit mounted on a needle holder

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Figure 3

Making the slits

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Currently available custom cut blades measure around 140-230 microns in thickness, and the diameter of a 19 G Nokor needle is 1070 microns. At a thickness of 20 microns, the razor blade is thinner. Also, the other blades require a custom-made blade cutter, which is expensive and difficult to source. At Rs 2/- per unit (for up to 20 bits), this blade is cheaper than any other comparable tool, currently available. In our experience of using these blades for making recipient sites in over 30 hair transplantation surgeries, no bogginess or pitted appearance was noted [Figure 4].

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Figure 4

Post operative healing without bogginess

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This tool is a small cost-effective refinement in the use of custom cut blades in creating hair transplant recipient sites without compromising on the aesthesis. Though the razor blade has been in use in dermatosurgery for shave excisions/biopsies and in vitiligo skin grafting, its use as a tool for hair transplant surgery has not been hithertofore recorded.