Using Different Sized Punch Tools in Follicular Unit Extraction (FUE) Hair Transplant Surgery?

Tue 5 Feb 2013

This question, from a member of our hair loss social community and discussion forums, was answered by Coalition hair transplant surgeon Dr. Jean Devroye

During a recent consultation, a hair restoration surgeon told me that different sized punch tools should be used during a Follicular Unit Extraction (FUE) procedure. Is this true?

Dr. Devroye: 

FUE toolObviously, we have to adapt the size of punches to each patient.

I do not use one size punch tool. I almost always use two sizes of punch for each of my FUE patients – one for the big grafts and another for the smaller ones. Altogether, I believe this allows me to extract a bigger number of grafts.

I use the following principle: choose the smaller size if the harvest of 3-4 hair follicular unit grafts (naturally occurring hair groupings in the scalp) is possible with minimal transection/graft damage.

In my opinion, it is better not to choose too small of a punch tool, because a very small punch requires the surgeon to select the smaller follicle unit grafts and it can also increase the rate of transection. For the same number of grafts, the patient receives less hair.

However, this topic is still very controversial, and it’s one I’m currently researching with a newly formed FUE research committee.

Blake – aka Future_HT_Doc

Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Hair Loss Learning

Center, the Hair Loss Q&A Blog, and the Hair Restoration Forum

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