Use of implanter (CHOI/Lion) in baldness surgery – BOLA article

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An implanter pen is an instrument used by surgeons to transfer a follicular unit into the scalp. It can be used by both surgeons who perform the procedure with FUT technique and surgeons who use FUE as the extraction method.

The instrument was invented in 1990 by Yung Chul Choi at Kiungpook National University with the goal of reducing the time of hair transplantation as well as minimizing the trauma to the follicular unit by reducing its handling.

As the name implies, the implanter pen has a pen-like structure and consists of a plastic protective shell inside which is a hollow needle connected to a small plunger. The implanter combines the step of incision in the recipient area and the step of positioning the follicular unit. The first step is to place the follicular unit from 1-2-3-4 hairs inside the implanter, this operation is performed in most cases by assistant technicians.

This operation is performed by gently taking the top of the follicular unit (epithelial/infundibulum region) with forceps and gently placing the unit inside the hollow needle. Multiple implanters are “loaded” at the same time. Once the follicular unit has been introduced inside the implanter it is passed to the balding surgeon who makes the incision by inserting, at a specific angle, the sharp needle into the scalp and engages the follicular unit by pressing down on the plunger (see image below):

There are several types of implanters in circulation but the most important ones are the Choi Implanter and the Lion implanter let’s see their advantages and disadvantages:

 

CHOI IMPLANTER:

It is the first model of implanter to be launched on the market and bears the name of its inventor.
Its operation is as described above, and several advantages and disadvantages can be enumerated.

The advantages of using the Choi implanter include:

  • Excellent graft survival rate
  • Less bleeding of the recipient area during incision
  • Vital structures of the follicular unit such as the dermal papilla are not touched, and this less manipulation increases the survival rate of the grafts.
  • Lower risk of posttransplant infections and folliculitis
  • Follicular units stay less time outside the body because the incision and grafting steps are performed simultaneously.
    There are, of course, also some disadvantages associated with the use of the choi implanter among which we can list:
  • If the surgical team is not close-knit, the times can be longer
  • It has been reported that needles “pop out” prematurely during surgery
  • Incisions too wide for triple follicular units (1.1 mm and an 18-gauge needle)
  • If the surgeon lacks the proper experience the units may be grafted too deeply and the angle and direction of the grafted hair may be unnatural.
  • Some surgeons believe that the use of the Choi implanter produces better results in Asian patients because of the characteristics of their donor area and not in European patients who have a finer hair caliber and sometimes curly hair that makes it more difficult to load the implanter by involving more manipulation.

 

LION IMPLANTER

It was developed by Hans Biomedical in collaboration with Dr.José Lorenzo, although the mechanism is similar it has design changes from the Choi implanter that improve the end result.

In particular, it features a “clip “that wraps around the instrument and makes it much easier to change the needle when it pops out. This eliminates one of the disadvantages of the Choi Implanter.

Special attention has also been paid to the needles, which are sharper than those of competitors manufactured with better surgical steel to reduce trauma during grafting.

The needles are sterilized with ethylene oxide, which further reduces the risk of infection for the patient.

The Lion implanter also has an improved internal groove that facilitates insertion of the follicular unit.

Dr.Lorenzo uses 0.8 mm Lion Implanter for single and double units and 1 mm for multiple. These values refer to the outer diameter of the needle.

The disadvantages of the Lion Implanter are similar to those of the Choi, with the difference that the better quality and sharper needle reducing trauma and bleeding allows the units to be grafted at a higher density.

The main disadvantage still remains related to the fact that a great deal of experience is required to use the implanter in one’s surgical practice. The staff supporting the surgeon must be highly trained to properly load the implanter, and a series of procedures must be followed to speed the process safely, keep the follicular units hydrated, and prevent the patient’s position from increasing bleeding.

This explains why few surgeons in the world use this system.
This video shows how the Lion Implanter works.

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