This is a video I received which shows the use of nails to dilate the incisions in the scalp. This was more common years ago when doctors were learning the process. The nails were used to force open the recipient holes so that the doctor or his staff could place the grafts into the balding scalp easily.
Few, if any other doctors, use these today and those that did do it, eventually learned to do so with more delicacy. The use of dilators reflect the doctor’s comfort with the technique of placing grafts.
The first minute is worth watching… the ending part is an advertisement that I do not endorse. I’ve embedded the video below: