0.9mm FUE Punch - Thoughts?

[zenmunk]

Thank you for your reply, Dr. Wesley.

[NW3VKY]

My understanding is the thickness of the graft, the amount of tissue where the stem cells live, etc., is important for yield. It follows that the smaller the punch, the thinner the graft. Does this concern anyone?

 

 

Yes, it does me. Even if you extract a 2 unit, and the bulb is not transected, have very little fatty tissue around the graft seems like it could, at a minimum cause for greater delay in taking root at the implanted site.

 

Maybe this is why we see it take longer periods, 6-8 months with FUE, v. 4-6 months with FUT, for follicles to start growing ?

[NW3VKY]

Follicle transection rates depend on the patient characteristics as well as the inner diameter of the punch. Among the field's most experienced practitioners of FUE, transection rates range from 2% to 8.5% for the 1-mm punch and from 3% to 10% using the 0.75-mm punch. A 1-mm punch can exact an average graft of 2.5 hairs/graft, while a 0.75-mm punch yields approximately 2.1 hairs per graft. I think most of us on this forum agree, however, that punches of 1mm or larger can result in visually unacceptable donor area scarring.

 

 

So, for density, in the crown area, generally speaking, would you go with a .9 mm to try and get as many 2, 3 and 4 units and still minimize the scar ? Assuming, caucasion with medium density ?

[Bill - Seemiller]

In my personal opinion, a physician should customize his/her hair transplant technique for each patient. In other words, punch size will vary (typically ranging between .75mm and 1mm) from patient to patient and even during a single procedure depending on the size of the graft he's/she's extracting, hair characteristics, etc.

 

Clearly a one haired follicular unit doesn't require as large of a punch as a three haired follicular unit. Thus, it's probably safer and more effective for physicians to use several punch sizes for extracting grafts just as they do when creating recipient incisions.

 

The only disadvantage in using different punch sizes in a single procedure is that it will likely decrease the rate of extraction and maximum number of grafts attainable during a single day/procedure. But 'm a firm believer in quality over quantity any day.

 

Best wishes,

 

Bill

[Bill - Seemiller]

The underlying concerns here are obviously regarding growth yield versus visible scarring. The good news is, scarring is typically minimal and virtually undetectable at very short lengths using punches ranging between .75mm and 1mm. Furthermore, in experienced hands and with optimal patient physiology, harvested follicular units are healthy and growth yield is optimal.

 

Visible scarring can be a problem if one of the following conditions are true:

 

1) A physician extracts too many follicular units in one area of the scalp

2) A patient's physiology typically produces bad scarring (not just with hair transplant surgery, but in general)

3. Complications occur during the procedure or afterwards (infection, etc.)

4. Too large a punch is used

5. Hair to scalp color contrast ratio is too high (this can be corrected by extracting fewer follicular units in one area of the scalp and using smaller extraction punches)

6. An extraction tool/punch is used incorrectly due to lack of skill regardless of the size

 

Growth yield can be a problem if one of the following conditions are true:

 

1. Too small of a punch is used causing transection or leaving too little tissue surrounding the follicular unit causing dessication before implantation.

2. Too large of a punch is used causing transection to surrounding follicles affecting future procedures and donor supply

3. A physician lacks the experience and skill necessary to perform the procedure

4. Dessication/dehydration of the grafts prior to transplanting by keeping the grafts outside of the body too long or using certain tools incorrectly

5. Healthy follicles/grafts are crushed during the transplantation process

6. Patient physiology (ex: soft skin) prevents healthy follicular extraction or an "X" factor stunts growth

 

The above is not an exhaustive list, but they are some of the ones that just came to me.

 

Best wishes,

 

Bill

[zenmunk]

Thanks for your replies, Bill. Excellent list.

[GNX1]

The underlying concerns here are obviously regarding growth yield versus visible scarring. The good news is, scarring is typically minimal and virtually undetectable at very short lengths using punches ranging between .75mm and 1mm. Furthermore, in experienced hands and with optimal patient physiology, harvested follicular units are healthy and growth yield is optimal.

 

Visible scarring can be a problem if one of the following conditions are true:

 

1) A physician extracts too many follicular units in one area of the scalp

2) A patient's physiology typically produces bad scarring (not just with hair transplant surgery, but in general)

3. Complications occur during the procedure or afterwards (infection, etc.)

4. Too large a punch is used

5. Hair to scalp color contrast ratio is too high (this can be corrected by extracting fewer follicular units in one area of the scalp and using smaller extraction punches)

6. An extraction tool/punch is used incorrectly due to lack of skill regardless of the size

 

Growth yield can be a problem if one of the following conditions are true:

 

1. Too small of a punch is used causing transection or leaving too little tissue surrounding the follicular unit causing dessication before implantation.

2. Too large of a punch is used causing transection to surrounding follicles affecting future procedures and donor supply

3. A physician lacks the experience and skill necessary to perform the procedure

4. Dessication/dehydration of the grafts prior to transplanting by keeping the grafts outside of the body too long or using certain tools incorrectly

5. Healthy follicles/grafts are crushed during the transplantation process

6. Patient physiology (ex: soft skin) prevents healthy follicular extraction or an "X" factor stunts growth

 

The above is not an exhaustive list, but they are some of the ones that just came to me.

 

Best wishes,

 

Bill

excellent post Bill.