Cut-to-Size Blades for Recipient Sites: A Practical Guide

Cut-to-size blades are one of the oldest tools in modern recipient site creation, and one of the most adaptable: a surgeon can set the width of every incision to the grafts in front of them, in steps of a tenth of a millimetre. This guide covers what cut-to-size blades are, how experienced surgeons size and use them, and what the published evidence does and does not say.

It is written as a companion to our article on sapphire and steel blades. The short version of that article still applies: the literature supports the geometry of the incision, meaning its width, depth, angle and orientation, far more than the material of the blade that makes it.

What a cut-to-size blade is

A cut-to-size blade is a narrow strip cut to a chosen width from a larger steel blade, either a double-edge razor blade or a single-edge prep blade. It is then held in a needle holder, a dedicated blade holder or a handle with adjustable depth, so that only a set length of blade protrudes (Wolf, 2014; Wong, 2002; Marwah and Mysore, 2018).

Surgeons who cut their own blades use a blade cutter that can vary the width in 0.1 mm steps (Wolf, 2014). A low-cost variant, cutting thin razor blades with scissors after sterilisation and holding the pieces in a needle holder, has also been described (Lourdhurajan et al., 2014). Pre-cut blades in a range of fixed widths remove the cutting step altogether.

Matching the width to the graft

The principle is simple and widely agreed: the incision should match the graft, large enough to accept it without compression and no larger than necessary (Atodaria et al., 2021). In practice this means using several widths in one session, smaller for single-hair grafts in the hairline and larger for multi-hair grafts behind it (Marwah and Mysore, 2018).

How wide is a matter of experience rather than trials. As an example, Wolf uses the following widths for follicular unit grafts, and up to six different blade sizes in a single patient (Wolf, 2014):

• Single-hair grafts: 0.7 to 0.9 mm
• Two-hair grafts: 0.9 to 1.1 mm
• Three- and four-hair grafts: 1.1 to 1.3 mm

Other experienced surgeons report somewhat different ranges, and wider blades for larger grafts (Wong, 2002). No study has compared width settings against graft survival, so these figures are a starting point, not a standard. Wolf's advice is to confirm the choice in each case by making a small number of test sites and checking how the grafts seat before creating the rest (Wolf, 2014).

Setting the depth

With a cut-to-size blade, depth is set by how much blade protrudes from the holder. Published advice varies:

• about the length of the graft, or up to 0.1 mm shorter, measured against the grafts themselves (Wolf, 2014)
• slightly shorter than the graft (Atodaria et al., 2021)
• about 1 mm shorter than the graft length (Marwah and Mysore, 2018)

All three agree on the direction: not deeper than the graft. Sites that are too deep invite buried grafts and folliculitis; sites that are too shallow lead to popping and cobblestoning (Atodaria et al., 2021; Marwah and Mysore, 2018).

Square end or angled tip

Cut-to-size blades come with a square (chisel) end or an angled, pointed tip, and experienced surgeons disagree about which is better. Wolf now prefers chisel-point blades because they keep the incision the same width down to the bulbs, and suggests this can reduce compression of the follicles (Wolf, 2014). Twelve years earlier, the same author preferred pointed blades, because chisel points caused more bleeding in his hands (Wolf, 2002).

The theoretical literature describes a trade-off. A straight-edged blade reaches the required depth with a shallower incision, which may spare deeper blood vessels, but it may also give more popping; a tapered, semiconical profile transects fewer of the fibres that hold a graft in place (Atodaria et al., 2021). Neither has been compared on graft survival. We therefore see the choice as a matter of technique and preference, which is why we supply both.

Angle and orientation

Cut-to-size blades can be used in either orientation, including coronal (lateral) slits (Wong, 2002; Dua et al., 2021). Geometry favours coronal slits where density matters: a coronal slit keeps the surface incision equal to the blade width at any angle, while a sagittal slit made at an acute angle lengthens it considerably (Atodaria et al., 2021). A mathematical model has argued the opposite, that sagittal slits cause less injury (Ahmad and Ismail, 2021), and experienced surgeons have defended both (Wong, 2002; Wolf, 2002). This is a live debate, not a settled question.

What the evidence shows

No randomised trial has compared cut-to-size blades with needles or with sapphire blades on graft survival. The published comparisons are small or indirect:

• In a split-scalp study of twelve patients, handmade razor blade slits caused significantly less tissue damage than sapphire blades, measured by laser Doppler blood flow. Graft survival was not measured (Balik, 2023).
• A prospective observational study of 1,000 patients reported higher graft survival with sapphire than with steel blades (94.7% against 88.9%). Patients were grouped rather than randomised, and the full paper was not yet available to us; the type of steel blade is not stated in the abstract (Saket, 2026).
• A mathematical model found that a rectangular blade profile has the largest cut surface area of the profiles studied (Ahmad and Ismail, 2021). This is a calculation, not a clinical measurement.

The two clinical findings point in different directions and measure different things. Neither settles the question, and we would not base a choice of blade on either alone.

Claims we will not make

We do not claim that cut-to-size blades improve graft survival, healing or density, that they cause less trauma than needles or sapphire blades, that a chisel or pointed tip increases survival, or that any particular width is optimal for a given graft. What cut-to-size blades offer is control over the width and over the depth the surgeon sets, and that is how we present them.

In our range

We supply pre-cut CTS blades with a square end and with a 45-degree angled tip, each in widths from 0.7 to 1.5 mm in 0.1 mm steps, in boxes of 50. They are cut from Personna blades and supplied non-sterile, so they must be sterilised before use. We also supply a dedicated cut-to-size blade holder, and Personna double-edge razor blades with holders for surgeons who prefer to cut their own.

References

Ahmad M, Ismail M. Effect of different shapes of recipient site creation micro-blades at varying angles and wound injury. J Cosmet Dermatol. 2021;20(11):3610-3615. PMID 33599101. DOI 10.1111/jocd.14006.

Atodaria PR, Venkataram A, Mysore V, Atodaria KP. Optimal Hair Transplant Recipient Site Slit Design: Minimizing Vascular Damage. Indian J Plast Surg. 2021;54(4):471-476. PMID 34984087. DOI 10.1055/s-0041-1739251.

Balik O. Determination of Scalp Vascular Topography by Laser Doppler Flowmetry and Comparison of Vascular Damage by Different Blades in Hair Transplantation. J Craniofac Surg. 2023;34(8):e803-e806. PMID 37811982. DOI 10.1097/SCS.0000000000009765.

Dua K, Verma P, Dua A. Beard and Moustache Reconstruction. Indian J Plast Surg. 2021;54(4):483-488. PMID 34984089. DOI 10.1055/s-0041-1739248.

Lourdhurajan R, Subramanian S, Swaminathan A, Ganesh R. Creating recipient sites using custom cut razor blades in hair transplantation. J Cutan Aesthet Surg. 2014;7(3):184-186. PMID 25538449. DOI 10.4103/0974-2077.146692.

Marwah MK, Mysore V. Recipient Area. J Cutan Aesthet Surg. 2018;11(4):202-210. PMID 30886474. DOI 10.4103/JCAS.JCAS_124_18.

Saket K. Accuracy in Hair Repair: Assessing Sapphire FUE, Forceps Methods, and Treatment Times in Contemporary Hair Transplantation. J Maxillofac Oral Surg. 2026;25(4):1155-1165. PMID 42528810. DOI 10.1007/s12663-025-02874-w.

Wolf BR. The Art and Craft of Recipient Site Creation and Graft Placement. Hair Transplant Forum International. 2014;24(2):41-49. DOI 10.33589/24.2.0041.

Wolf BR. Incisions: Coronal vs Sagittal (Pro Sagittal). Hair Transplant Forum International. 2002;12(2):39. DOI 10.33589/12.2.0039.

Wong J. Sagittal vs Coronal Slits in the Coronal Corner. Hair Transplant Forum International. 2002;12(2):37. DOI 10.33589/12.2.0037.