Punch sizes and punch depth

[kirkland]

I've asked this question before about how small can punch sizes go before you are not extracting enough tissue around the graft to be viable for regrowth. How about punch depth? How deep does a surgeon have to penetrate the skin before they have cut to the necessary depth to safely remove the graft?

[Melvin- Admin]

You need to go beyond the hair cell matrix

[kirkland]

Thanks. What I was trying to ascertain is how deep (in mm) a surgeon needs to penetrate the skin in order to remove a graft. Looks like terminal hair follicles are anywhere between 4 mm and 7 mm below the surface of the skin. So if the surgeon has to penetrate beyond the hair matrix, they are going at least 4 mm deep and possibly more.

On another forum, there was talk about Dr. Zarev's ability to remove a high number of grafts with very little scarring visible. A forum poster, who recently visited Dr. Zarev for a consultation, was trying to explain his extraction technique. I don't think I am allowed to copy and paste his text but, to paraphrase, he claims that Dr. Zarev's punches allow for the wound to heal with very little scarring since the puncture is so tiny in diameter. I was then wondering if, besides using a smaller punch size, the depth of the extraction could be more closely controlled to reduce scarring.

Edited April 21, 2021 by kirkland
Just to add the word 'thanks'.

[kirkland]

This is the geek in me always curious about how systems can be better engineered.

[Melvin- Admin]

1 hour ago, kirkland said:

Thanks. What I was trying to ascertain is how deep (in mm) a surgeon needs to penetrate the skin in order to remove a graft. Looks like terminal hair follicles are anywhere between 4 mm and 7 mm below the surface of the skin. So if the surgeon has to penetrate beyond the hair matrix, they are going at least 4 mm deep and possibly more.

On another forum, there was talk about Dr. Zarev's ability to remove a high number of grafts with very little scarring visible. A forum poster, who recently visited Dr. Zarev for a consultation, was trying to explain his extraction technique. I don't think I am allowed to copy and paste his text but, to paraphrase, he claims that Dr. Zarev's punches allow for the wound to heal with very little scarring since the puncture is so tiny in diameter. I was then wondering if, besides using a smaller punch size, the depth of the extraction could be more closely controlled to reduce scarring.

That sounds like nonsense. There was another surgeon who was claiming hair regeneration in the donor. He used a tiny punch and essentially what he was doing was splitting hairs. I'm not saying that is what Zarev is doing, but he has already said himself that large numbers are dependent on the patient, which is true. He has a handful of large cases. The average person should not expect to reach those numbers, unless they use BHT.

[Dr. Neil Verma]

Depth is variable individual to individual.  Depth is variable on an individual patient as well ie. where the finer hairs are at the bottom of the donor region tend to be more shallow than the multiple follicle hairs at the top of the donor region.  If you go too deep you can bury the graft.  If you go to shallow you don’t get nice soft tissue surrounding the root.  The size of punch also is a balance between minimum scar as well as sufficient tissue surrounding the graft to enhance graft survival rate.  Size of punch varies in the 0.1mm range so it’s not anything that is noticeable as long as the hand holding the device is an experienced one.