Watch the explicative video on Hybrid Flat Punch for FUE Hair Transplant
Basic movements (cut to the sides and dissect forward):
1-Simple Engagement (Harris) - align it (align the punch with the hair shaft angle), centralize it (put the hair inside the punch and center it), engage it (with gentle pressure to ensure that the entire punch borders are touching the skin) and initiate oscillation by pressing the pedal – keeping the punch still until it cuts the epidermis which enters inside the punch. Then, with a light movement let the punch penetrate the scalp, guided by the hair shaft, using just the hand piece weight, until reaching the dissection depth.
2- Edge Pressure (Devroye) – the same: align, centralize and engage it, but while starting the oscillation, apply gentle pressure on the edge, over the punch corner, before moving forward. This pressure on the scalp made with the corner of the punch takes advantage of the flat square border design and allows it to cut under low speeds. Once you break the skin, just move forward and penetrate smoothly. Again, with a light movement let the punch penetrate, guided by the hair shaft using just the hand piece’s weight, until completing the dissection depth.
Using a flat punch has one major difference: there is a frontal face. Totally different from a sharp punch, that cuts forward, this frontal face its flat and doesn't cut forward, therefore can press down the graft inside the scalp. If the graft doesn't have enough time to penetrate inside the punch lumen or the frontal pressure is too intense, the graft can be buried. On most times they will come up after a while, but this is not a rule. In order to address that issue, I developed some maneuvers that facilitate the graft to enter the punch lumen. These lateral movements should be done before cutting all anchor points, because once the graft is fully released, it’s easier to get buried with minimal pressure.
3- Back to Front Swing (Tykocinski) - the same as edge pressure, but instead of applying gentle pressure, this time you will perform a short and fast back swing after the engagement, while starting the oscillation. The swing should be enough to visibly stretch the scalp backwards until you break it. Then release the pressure and you will swing to the front. Very important: before moving forward to complete dissection, you will need to realign the punch with the hair shaft’s original position. Once realigned, move forward to complete the dissection, basically using just the weight of the hand piece. Hold it gently and let it go. Let the hair shaft guide the movement, not you! This extra swing helps to cut thick or firm scalps, where you would need to apply more pressure, more speed or rotation, consequently increasing transection. This Back to Front Swing movement resembles that of a “diver”: getting back and pushing down before jumping into.
4- Lateral Swing (Tykocinski) - the same, but instead of performing a Back to Front Swing movement, you will perform a Lateral Swing: first to one side than to the other, then realign and penetrate. This movement resembles "putting on tight jeans”: you have to swing side to side in order to get inside. This is useful for areas where the scalp is too thick and mushy, like in lower occipital area.
5- Circular Swing (Tykocinski) - instead of to the sides, the swing is all way around, like a "can opener"! Of course, this is the riskiest one concerning transecting hairs, but could help on exceptional cases with extra firm scalps. As always, realign with the hair shaft before penetrating.