Is 0.9mm punch size too large?

[Mak Sergejev]

Hi HRNS,

Here goes my first post...

I am about to undergo my first FUE procedure and I am naturally quite nervous about it, and the more I read, the more I am concerned about the scarring.
My hair is quite weak and light, and I am of quite pale complexion, which could be good for the reasons of contrast but still might leave scars easier exposed.

In anycase, I have opted to undergo my surgery with Dr. Kayihan Sahinoglu in Turkey, as he does 1 patient per day, personally performs majority of the procedure, opts for more conservative hairlines and has many years of experience behind him (member of ABHRS).

One thing that I found a bit concerning while researching his work (not much available) is that pictures put online by his former patients all display pretty large punches. While speaking with the doctor, he informed me the punch size is 0.8mm on the sides and 0.9mm on the back.

He claims that this has proven to work the best in his experience, maximizing the graft survival compared to lower punches. His attitude was also "Do you plan to cut your hair short, e.g. undercut? No? Well, then you shouldnt really be concerned."

I find it a bit overly nonchalant of a comment, considering its possible scarring for life, and was contemplating to either continue my search for other options or negotiating with him to use the lower punch sizes.

I dont want to argue with 20+ years of experience, but in the end it is the trade-off I perhaps wish to go for. Or perhaps I shouldnt cause given the higher graft survival rate, I might never have a need to really go short, which renders doctors comment valid to some extent.

(P.S. most of his patients I managed to contact personally never seen the donor area with short cut)

[Melvin- Admin]

0.9 mm is not too large. Standard ranges are 0.8-1mm. The smaller the punch, the higher transection rate. Which means less growth. If you go to small 0.7 and below, you risk a lot. The ideal size is 0.8-0.9mm depending on hair thickness.

[Doron Harati]

I myself had 2 repair procedures by Dr. Maras at HDC clinic, in both procedures he used 0.9mm and I'm very happy.

My friend documented on this blog his experience with Dr. Christina at HDC clinic, since he has very thick hair, she used 1.0mm with no issues, this procedure was done in 2018:

 

https://www.hamushtalim.co.il/stories/2644/

 

 

 

 

 

 

Edited February 1, 2023 by Doron Harati

[Rafael Manelli]

The better the surgeon the smaller punches he can use while retaining low transaction rate.

bigger punch means more scarring and more damage to the donor, but thicker, sturdier grafts, less transaction.

smaller punch means small scars, all else being equal, and less trauma to the donor, but more precision is needed to avoid transaction.

calibre, texture and hairs per FU matter too. A straight fine single hair can be removed with a smaller punch. A coarse, curly, 4 hair graft will require a bigger punch to be safe.

[Mak Sergejev]

20 hours ago, Melvin- Moderator said:

0.9 mm is not too large. Standard ranges are 0.8-1mm. The smaller the punch, the higher transection rate. Which means less growth. If you go to small 0.7 and below, you risk a lot. The ideal size is 0.8-0.9mm depending on hair thickness.

Thank you for your answers. I was hoping of discussing with doctor going to 0.8-0.85 mm but not sure if that would make significant effect.
I have a very thin and weak hair, therefor I somehow believe that there might be no reason to use same punch size for me as for someone with thicker, stronger hair.
On the other hand, if the doctor is used to using 0.9mm punch size, perhaps he is not as skilled with lower punch sizes, hence insisting on it might result on higher transaction rates.

Based on your comments, I perhaps just stick to 0.9mm.

[Mak Sergejev]

Also, I have read that there is no standardized definition of what does a punch size mean.
Some sources I stumbled upon say that different doctors/clinics will refer to different diameters (either outer or inner).

I would post images I found from Dr. Sahinoglu's patients I have found on other forums, where people commented on the large punch size, but I am not sure if it is inline with the forum guideliness.

[Al - Moderator]

.9mm punch size is not large. Smaller punch sizes risks damaging the grafts. It's great if you end up with no visible donor scars, but not so great if the transplanted hair doesn't grow.

 

[shiba1985]

no. dont worry about the sizes of hte punch as long as you go to a doctor that is reputable. the size has to be adjusted to the persons hair characteristics and follicular splay underneath the skin. 

In fact using < 0.9 punch will have a lot less triples and quadruples, this is not bad, depending on what the surgical goal you are trying to accomplish. 

[JohnCasper]

0.8 or 0.9 is just fine.  You will not see any obvious scarring with these punch sizes.  Just a tiny white dot if your head is shaved.