A Slot By Any Other Name

Robert M. Bernstein, MD (New York, NY, USA), William R. Rassman, MD, (Los Angeles, California, USA), Emanuel Marritt, MD (Englewood, Colorado, USA), David Seager, MD (Toronto, Canada), James A. Harris, MD, (Englewood, Colorado, USA), Bobby L. Limmer, MD (San Antonio, Texas, USA), Ron Shapiro, MD (Minneapolis, Minnesota, USA)

Hair Transplant Forum International 1999; 9(6): 175.

What a creative group we are! The latest example is “Follicular Unit Coupling – The Role of Slot Grafting in Hair Transplantation” which recently appeared in Hair Transplant Forum International, 1999; 9(4): 112-113. In this article, the author tries to confuse the reader by attaching the buzzword “Follicular Unit” to an old Slot-Graft method. Come on; let’s call a spade a spade. To hop on the follicular unit bandwagon one should actually perform the technique.

As we all know, the hair in the scalp grows in follicular units. But, to use them in the transplant, one must preserve them, and for this one needs single strip harvesting and microscopic dissection. Fine linear slivers cut from a strip harvested with a multibladed-knife can’t generate intact follicular units any better than one can fix a watch with ones eyes closed.

The dimensions of the linear grafts used in the “Follicular Unit Coupling-Slot Grafting” technique are quite an interesting size for the generation of follicular units. They measure 2.5mm (the dimension produced by the multi-bladed knife) x 0.5 cm (the dimension cut by hand). With follicular units spaced randomly at 1 unit per mm, follicular transection and follicular unit carnage are unavoidable.

“Follicular Unit Coupling” is an interesting choice of terminology. The Slot-Grafting technique should more appropriately be termed “Follicular Unit Sectioning” and one might refer to the aesthetic result as “Follicular Unit Tufting.” What will be next? According to this article, we should probably rename Orentreich’s original Punch-Graft method “Cylindrically Bundled Follicular Unit Transplantation.”

In another slight-of-hand, Slot Grafting is compared to laser-made sites. With all the concern about laser-induced tissue damage and poor growth and with its use in decline, why would one choose this, of all procedures, for comparison?

Possibly the most incredulous statement made is “With the use of the Redfield Slot Punch, a similar size sliver of bald recipient tissue is removed creating a perfect fit for the linear graft. The receptor scalp integrity is not altered or compromised because corresponding tissue replaces the bald tissue removed…” Give us a break. We know the Forum is not peer reviewed, but it is still a publication with predominant physician readership. Not only does this author want to re-write medical terminology, he seems to want to re-invent the biology of wound healing itself.

It’s ironic that this article appears in the same issue of the Forum as “Unified Terminology for Hair Transplantation,” a group effort of hair restoration surgeons (some of which are listed above) to clarify terms for both the medical profession and the public.

Re-working the name of the Slot Graft Technique takes us back to the 60’s, when we used to put Mercedes hood ornaments on the front of Volkswagens. As we approach the new millennium, we have finally arrived at a level of scientific sophistication in hair restoration surgery that we can be proud of, and where follicular re-labeling just won’t be tolerated. A slot by any other name is still a slot.