DHI vs Manual Slits with Forceps: Practical Differences in Daily Practice

Hey everyone, wanted to start a thread on DHI (Direct Hair Implantation) using Choi implanter pens versus the more traditional method of making recipient sites first with blades or needles and then placing grafts with forceps. There is a lot of marketing out there making one sound like absolute magic over the other, but when you break down how these techniques actually work on the table, it mostly comes down to tool handling, pacing, and how the clinic manages graft handling time. With traditional manual placement, the tech or doc makes all the incisions first. They might use a custom sapphire blade or a micro-needle. Once the whole recipient area is mapped out and opened, the team goes back in with jeweler's forceps to slide each graft into the holes. With DHI, you skip that separate incision step for each graft. The technician loads a single graft into the hollow needle of the Choi pen. The person performing the procedure then pushes the plunger to insert the graft directly into the scalp while simultaneously creating the channel. One thing people often talk about with DHI is density and angle control. Because the implanter pen holds the graft securely right up until insertion, the angle and depth can sometimes be controlled very precisely, assuming the person operating the pen has a steady hand and a lot of reps under their belt. Proponents say this is great for packing grafts closely together between existing miniaturized hairs because the needle is so fine. On the flip side, the learning curve for implanter pens is pretty steep for the staff. Loading every single graft into a pen takes time. If the clinic team isn't well-practiced, graft out-of-body time can creep up, which is never ideal for graft survival. Manual placement can sometimes go faster if you have an experienced team splitting up the incision and placement steps efficiently. Also, bleeding management can look different between the two. Making all incisions first lets the clinic gauge oozing and manage it before any grafts go in. With DHI, you are puncturing and placing simultaneously, so the approach to hemostasis has to be adapted on the fly. Neither method fixes poor donor management or an unrealistic hairline design. Both rely heavily on the manual skill of whoever is holding the tool, whether it's a forceps tip or an implanter pen spring. How did your clinic handle the placement phase, and did they explain why they chose pens versus manual slits for your case? For those who have researched both, what made you lean one way or the other? Drop your thoughts below. Educational only.

This content is for educational purposes only and does not constitute medical advice. Always consult a qualified hair restoration surgeon before making treatment decisions.