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Everything You Need To Know About Direct Hair Implantation (DHI) Hair Transplant Surgery

    If you are looking for a DHI hair transplant- this article will give you everything you need to know about them. It is important you know the difference between implanter pens and recipient site creation when it comes to FUE hair transplant surgery.

    What is a DHI Hair Transplant?

    DHI stands for “Direct Hair Implantation” and is ultimately a marketing term used by many clinics. It often refers to when your hair transplant surgeon utilises a specialised sharp implanter pen to re-implant hair into the scalp and the latest guidance by the International Society of Hair Restoration Surgery advises that DHI does not actually refer to any specific hair transplant method and is ultimately a marketing term.

    The Treatment Rooms London has always specialised in the use of implanter pens in hair transplant surgery. Specifically, our Surgeons utilise dull implanter pens to reinsert grafts into pre-made incision sites. All patients are operated on by our Surgeons using this technique to help attain high quality results that match natural hair direction, angulation and flow. This means results in the end result blends nicely with existing hair.

    If you wanted to find out more and view our results then please navigate the following links:

    1. FUE Hair Transplants
    2. Are You A Candidate For Hair Transplant Surgery?
    3. Who We’ve Helped
    4. Before & After Hair Transplantation
    This patient underwent an implanter pen hair transplant to repair his frontal hairline. He had surgery previously in another hair transplant clinic with poor results. His result shown here is 1 year post his repair surgery in our clinic

    Hair Transplant Surgery using Implanter Pens

    In a hair transplant, grafts are extracted by Follicular Unit Excision (FUE) or Follicular Unit Transplantation (FUT). The grafts will then need to be re-implanted into recipient sites (holes where hair grafts are put into) and this can be done by 2 main methods- sharp or dull needle implanter pens.

    Hair Transplant Surgery Using Sharp Implanter Pens

    Implanter pens re-insert grafts into the scalp at the same time a recipient site is created using a sharp needle. This can be misleadingly called Direct Hair Implantation (DHI) as hairs are described to be “directly implanted” with a needle/ sharp implanter pen (1). There are two types- Choi Implanter Pens and Lion Implanter Pens- both are very similar and don’t appear to make a difference to the outcome of a hair transplant (2).

    Pre-Made Recipient Sites & Placing of Grafts Using Dull Implanter Pens

    Grafts can be reinserted into the scalp with “pre-made” holes or recipient sites created by a needle. This technique generally occurs 2 stages. The first stage requires the surgeon to create holes or “recipient sites” using a needle or blade. A Surgeon, nurse or a hair technician then comes and places the extracted grafts into each of these sites using a dull implanter pen in the second stage (3).

    How Do Implanter Pens Work?

    The image below shows what a Lion implanter pen looks like. They come in different sizes depending on the size of the hair being implanted. Your hair transplant surgeon will decide which size is best for you on your surgery day. Implanter pens have a needle with a hollow tip. The graft can be placed into this hollow tip.

    loading hair grafts onto an implanter pen dhi hair transplant surgery
    Implanter pen close up with hair graft being loaded into the hollowed needle

    When the end of the pen is inserted into the scalp it places the graft into the hole. In DHI or sharp implanter pen use the hole is created and the graft placed into it simultaneously- this is demonstrated in the infographic below. In dull implanter pen use, the pen simply introduces the graft into the skin into a pre-made skin incision.

    reinsertion of hair graft using implanter pen into skin
    Hair graft inside implanter pen being reinserted into the skin

    Are Implanter Pen Hair Transplants Better?

    Surgeon-Led Care

    In order for your hair transplant to be carried out using implanter pens, you will require both a nurse/technician and a hair transplant surgeon to operate on your scalp throughout your operation. Using implanter pens requires a high degree of skill and experience and our Surgeons will only provide this technique. This means you can be assured that you have someone who is a qualified Surgeon performing your hair transplant at all times- giving you the best possible chance of a result you are happy with.

    We have historically always used implanter pens when carrying out hair transplant surgery in our clinic. We find patients recover faster and have better quality results with the technique. Whilst the technique is more laborious, we don’t mind and are happy to go the extra mile for our patients

    Dr Vara, Hair Transplant Surgeon and Director at The Treatment Rooms London

    Depth, Angulation and Density of Hair Transplantation

    A Surgeon will be able to control the depth, angulation and density of the implantation meticulously using an implanter pen. This also leads to natural results blending new transplanted grafts into existing hair in the hairline, crown, beard or eyebrows.

    Increased Survival Rate of the Graft during Hair Transplantation

    As the graft spends less time outside the body and are handled less there is an increase rate of its survival (4). This means the transplanted follicle is given every chance to survive the operation.

    Better Healing Times after Hair Transplantation

    With less trauma to the transplanted grafts there is less incidence of shock loss and shedding of transplanted hair compared to grafts re-implanted using forceps.

    Implantation Between Hairs

    As the implanter pen allows a surgeon to be more precise in his placement of the graft, if you wanted transplantation into a zone of thinning hair this can be achieved. This allows for even better coverage and precision when it comes to hair transplantation.

    Downsides to implanter pen hair transplant surgery:

    • Higher price for the patient
    • Longer surgery time

    Implanter pen hair transplant surgery tends to be more expensive. This is because the surgery requires the presence of 1 or 2 surgeons and the surgical process can be more time- consuming. Whilst you have extra assurance that your transplant is being given every chance to be natural and successful, these two factors mean the surgery comes at an increased price and can take longer to complete.

    Should you choose to have an implanter pen hair transplant with The Treatment Rooms London?

    At The Treatment Rooms London we have historically always used implanter pens for our transplants. This has resulted in dense, natural results for our patients with better recovery times. We have an open conversation with each of our patients around the different techniques of hair transplant surgery. Below you will see an example of a hair transplant result by using implanter pens.

    receding hairline dhi hair transplant before and after 1724 grafts
    12 months post implanter pen hair transplant

    As a guide for patients looking to choose between the two techniques, one of the main considerations is the size of transplantation. As implanter pens transfer each graft individually into the recipient site the surgery takes longer. As a result, if you require a large area to be transplanted you may be required to have your transplant over 2 sessions.

    Choosing to undergo a hair transplant should be based on a number of considerations. You can find out more by reading our page on whether you are a candidate for an FUE hair transplant or, for more information about costs, take a look at our hair transplant cost page.

    If you wanted to book a consultation with our hair transplant surgeon, please feel free to contact us today.

    References

    1. Sethi and Bansal, 2013, Direct Hair Transplantation: A Modified Follicular Unit Extraction Technique, J Cutan Aesthet Surg, 6(2):100-105
    2. Marwah and Mysore, 2018. Recipient Area, J Cutan Aesthet Surg 11 (4): 202-210
    3. Zito and Raggio 2021, Hair Transplantation
    4. Lee et all, 2001, Evaluation of survival rate after follicular unit transplantation, Dermatol Surg Aug 27 (8): 716-20
    5. https://ishrs.org/patients/treatments-for-hair-loss/surgical-treatments/

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