Premade Incisions: When and Where to Begin

Abstract

A few years back we were routinely doing 6000+ graft cases. The excessive work and the long hours of these large cases began to cause shoulder, wrist, and back problems for the inserting staff. We still do the occasional 6000-graft case but these are not done routinely. Most of the time we try to limit the size of the surgeries to a maximum of 5500 grafts. As the first surgery is usually the largest session, it is a good idea to ease the workload and do only relatively easy areas: this is that vast area on the top of the head extending from the hairline back to the crown swirl. Because the hair in this area mostly faces the same direction and the area is large enough to allow two (occasionally three) inserters to work simultaneously, 4000 to 5000 grafts can usually be finished in 8 to 10 h. Crown swirls and temple restorations, which are more time consuming, are usually reserved for the second surgery when the session is much smaller. Asian hair, because of decreased density and laxity, will generally yield 3000 to 4000 grafts on average, and 4500 grafts are usually the maximum that is obtainable. Thus, we seldom have to worry about 6000-graft days.