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What is Stick and Place?

stick and place choi implanter
Impanter pens make stick and place easier.

Stick and place is a technique for the placement of hair grafts of any kind. This included old fashioned 4mm punch plug grafts, mini-micro grafts, follicular unit grafts as harvested by strip surgery or FUE. The Choi and Lion implanter pens have made stick and place a much more popular placement technique for multiple reasons but it is not as common as traditional placement techniques in most countries.

 

How is a Stick and Place Hair Transplant Different?

The two methods are actually very similar. During a standard hair transplant, the follicular hair units are first removed from the donor zone (usually the back of the scalp known as the occipital region, but sometimes from other areas of the scalp and body as well). These follicular units are then transplanted onto the scalp by creating tiny incisions called recipient sites. This is where the difference comes into play.

For regular hair transplants, a surgeon typically makes all of the recipient site incisions first, or in stages, then transplants the follicular hair units into each recipient site on by one. With a stick and place technique, however, the surgeon will transplant the follicular hair unit immediately after the incision is made. The surgeon will continue to make a recipient site and then place the graft immediately after until the hair restoration procedure is complete.

 

What are the Advantages of Stick and Place?

When it comes to hair transplants, the scalp’s skin is very elastic. In fact, the incisions begin to shrink almost as soon as they are made. For a typical hair transplant, the surgeon compensates for this shrinkage by making the incisions slightly larger than the grafts. That way, the recipient sites will be the correct size for when the surgeon is ready to begin transplanting the follicular units.

With the stick and place technique, however, the recipient site incision has less time to shrink since the follicular unit is grafted into the scalp immediately after the recipient site is made. As such, a surgeon can make the incisions much smaller than normal. Smaller recipient sites have a few distinct advantages:

  • There is less bleeding, which lessens the chances of infections and vascular complications such as necrosis.
  • The smaller openings allow for the follicular units to be packed more closely together. This achieves a final look of denser hair.
  • Smaller openings tend to cause less damage to the skin, which minimizes scarring.
  • If the surgeon makes too deep of an incision, this beneficial trait is negated.

 

What are the Disadvantages of Stick and Place?

Some doctors have argued that stick and place reduces or even eliminates the ability of the surgeon to properly and accurately match the angle and direction of the neighboring hairs (native or transplanted) thus reducing the naturalness that can be achieved with the more common placement technique of making recipient sites first then placing grafts afterward. In addition, stick and place (in most cases) is not carried out by the surgeon and for years, even before the climax for FUSS, technicians would have the sole duty of making the incisions as well as placing the grafts thus giving complete control of the final outcome to the technicians and not the doctor. The doctor would simply remove the strip and be done. In FUE, this approach allows the doctor to be completely hands off and remain in a supervisory position only as technicians in many clinics today also remove the grafts from the donor zone.

How Common is Stick and Place?

Stick and place used to be fairly common, especially during the 1980's and 1990's. As follicular unit strip surgery (FUSS) gained in popularity, as well as the growing popularity of the internet for online research, stick and place fell out of favor. This is partly due to the negative appearance that stick and place had because it usually involved the use of technicians to make recipient sites during the procedure which meant the doctor removed the donor strip only.

Unfortunately, as follicular unit extraction (FUE) has become much more popular, the roles have reversed. Technicians in most clinics are tasked with performing graft extractions while the doctor makes incisions for the technicians to then place the graft in to. However, in many clinics outside of North America, primarily in Eastern Europe, Turkey, Mexico and some Asian countries, the technicians perform the entire procedure and will use stick and place to make incisions and place grafts. Doctors have little to nothing to do with the actual surgery.

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