The infrared coagulator, a spin off of laser technology, has been used for more than a decade, first in Europe and then in the United States, for the in-office elimination of first and second degree hemorrhoids. Even more recently, it has been employed in the treatment and removal of unwanted tattoos. This device has been FDA approved for both anorectal and dermatologic applications. Within the last year, we have conducted a thorough study in our practice of the use and comparison of electrocoagulation, radiosurgical coagulation, and infrared coagulation during both hair transplantation and scalp reduction surgery. The infrared coagulator with its multiple-sized tips and pinpoint accuracy has proven to be superior (especially in a wet field) in providing excellent hemostasis, allowing minimal blood loss, and in allowing the clearest visual field in performing both hair transplant and scalp reduction surgery. Because no ground or antenna plates are necessary for the use of the device, it is extremely safe and effective and thus minimizes both patient risk and electrical shock. Its excellent effect in a wet field (it's used in bleeding hemorrhoids) as well as its uncumbersome size and versatility, makes it the ideal instrument for use during hair transplant and scalp reduction surgery. The device has been tested in the treatment of arteriovenous fistulas in the donor area of the scalp as well and has proved to be quite safe and effective. This paper presents a study encompassing 110 patients undergoing either hair transplant or scalp reduction surgery. Each different modality of coagulation is utilized for the various transplant or scalp reduction sessions on the same patient. Comparisons of effectiveness and postoperative complications are made. Detailed results and photographs are presented.

The linear punch creates recipient sites that avoid compression and allows for more hairs per graft without compromising naturalness. Healing is comparable to micrografts alone. It is the authors' opinion that a linear or elongated slot incision accommodates grafts created from donor strip harvesting more naturally than slits, small round incisions or punctures. The linear graft created is the precise size and shape to the recipient slot incision to which it is placed. This technique helps us avoid the old adage, "Trying to fit a square peg into a round hole." As stated by Unger, a slot incision created by a Ultrapulse laser produces superior results to those seen with conventional slit grafting (Dermatol Surg 1995;21:759-65). This approach is cost efficient and cosmetically appealing to the patient without the fear of the old "cornrow" appearance.

Many advancements have occurred in the hair transplant and scalp reduction field, including new instruments as well as newer techniques. Despite the effectiveness of the surgical procedure, camouflage of the surgical site during the recovery period is a problem that confronts the surgeon. For some patients, residual hair can be combed or brushed to cover the operative sites, while other patients prefer to wear hats to hide the effects of surgery. Scalp camouflage is a safe and effective aid for the hair restoration patient and usually consists of wigs, sprayers, makeup, and powders. The surgeon should have knowledge of the various means of camouflage in order to inform the patient of the options for postoperative concealment.

A technique of alopecia reduction utilizing a curvilinear ellipse employing a sequential excision and suture technique is described. Advantages of the technique over previously described procedures are presented. Measurements of individual scalp elasticity and alternating suture tension vectors help to produce an excellent cosmetic result with minimal complications.