Is 1mm punch giving FUE a bad name?

[Raker]

Recently we’ve seen an increase in 1mm punch used to remove grafts in FUE procedures, it would appear that the argument is there’s less chance of transection however, the trade off is there’s more chance of post surgery scarring to the donor area. Is this all marketing nonsense and ultimately do the final results rest with the skill of the surgeon or tech? 

[Dr. Glenn Charles]

The size of the punch depends on several factors. Including but not limited to the type of hair the patients has and the skill of the doctor performing the procedure. In some cases a 1mm punch is necessary. However, most skilled hair transplant doctors will use the smallest punch possible. One that causes the least amount of damage to the follicles and gets the job done correctly.

[gillenator]

We have to keep in mind that there were virtually no surgeons in the U.S. performing FUE until roughly 2004.  Then, as some of you may remember, FUE hit North America like a tidal wave!

The 1 mm punch is the one that most surgeons favored to learn and refine their technique and skill, for the obvious reasons.  So there was quite a lot of havoc and at times panic in some of the initial results, both in terms of yield and donor scarring. 

Over the years, and as the degree of proficiency and skill advanced, many of them started to use smaller sizes as long as the rate of transection was not compromised.  Many patients have lots of single hair FUs and doubles...theses are not as difficult to extract as compared to multiple hair bearing FUs, all other factors considered equal (proximity of FUs to each other, scalp texture, etc).  So the larger FUs may require a larger punch size for safe extraction.

Unfortunately there are some who continue to use the 1mm and even larger sizes because the manual extraction process goes faster, and time is money.

[Raker]

11 minutes ago, gillenator said:

We have to keep in mind that there were virtually no surgeons in the U.S. performing FUE until roughly 2004.  Then, as some of you may remember, FUE hit North America like a tidal wave!

The 1 mm punch is the one that most surgeons favored to learn and refine their technique and skill, for the obvious reasons.  So there was quite a lot of havoc and at times panic in some of the initial results, both in terms of yield and donor scarring. 

Over the years, and as the degree of proficiency and skill advanced, many of them started to use smaller sizes as long as the rate of transection was not compromised.  Many patients have lots of single hair FUs and doubles...theses are not as difficult to extract as compared to multiple hair bearing FUs, all other factors considered equal (proximity of FUs to each other, scalp texture, etc).  So the larger FUs may require a larger punch size for safe extraction.

Unfortunately there are some who continue to use the 1mm and even larger sizes because the manual extraction process goes faster, and time is money.

My issue is there are forum members here that are convinced that no matter the size of punch used that FUSS scarring doesn’t exist. 

[Raker]

Also, it’s down to the skill of the surgeon to ensure there are no transactions. 

[gillenator]

Scarring will occur whether FUT or FUE as it's part of the healing process...the real issue is, "how visible?"