Author Bio: Dr. Sanusi Umar MD is the author of this article.
FUE Hair Transplant: The Truth About FUE Punch Size: As you consider undergoing Follicular Unit Excision (also called FUE hair transplant), one term you’ll encounter frequently in your research is “FUE punch” and the different sizes they come in. What is an FUE punch, and how will its size affect the outcome of your FUE hair transplant? In an FUE hair transplant, a hollow, cylindrical punch is the primary tool used. Its purpose is to separate a follicle graft from the surrounding tissue. The size of the FUE punch influences two main factors:
- The bulkiness of the grafts collected, which affects the yield and their regrowth rate.
- The size of the wounds created, which influences the size of the scar footprint left behind.
With the concept of FUE punch sizes in mind, you may wonder what questions you should ask your FUE doctor that are relevant to punch sizes and the outcome of your FUE hair transplant. Oftentimes, when patients ask their doctor about the size of the FUE punch they will be using, they will get different values, even for the same punch. Why? It may be for any of the following reasons:
- Your provider is using the numbers given to them by their supplier and has not measured it first-hand to know for sure. Sadly, manufacturers of punches have the habit of underrepresented their punch sizes in order to gain market advantage.
- Your provider has measured the punch size, but may be reporting readings for measurements of different parts of the punch (e.g., internal diameter vs. outer diameter).
- The manufacturer supplied the provider with the size of the tool used in drilling into the punch to create the punch cutting tip. This number is, of course, much smaller than the actual punch size and has no value to the patient. The patient is only interested in the measurements that will influence the regrowth rate of the grafts and the aesthetics of the scars created.
In the interest of the consumer, Dr. U has written this article backed with a video animation to guide all FUE patients to the right questions to ask regarding FUE punch sizes. This is mainly to empower them during their consultation and decision-making process. A fully informed patient is less likely to end up with poor results. Much of Dr. U’s work involves inventing new and innovative tools to be utilized in such cosmetic procedures. One of the topics he’s most passionate about is the importance of FUE punch sizes in FUE hair transplant and their impact on FUE hair transplant wounding and scarring.
What Aspects of the FUE Punch Matter When it Comes to Minimizing FUE Scars?
An FUE punch is something akin to a very wide needle. The live follicle is swallowed by the open mouth at one end and a sharp cutting surface excises it. This frees the graft to be harvested and used elsewhere on the body. The use of this instrument creates a small incision around the specimen. A similarly-sized wound remains when all is said and done. The graft ascends up the lumen, or inner chamber, of the punch in the process.
The following video explains FUE punch size, the most important part of any FUE punch.
Relevant Diameters of FUE Punches: Inner and Outer Diameter
There are two diameters that play a significant role in the success of your FUE hair transplant procedure. These two diameters are:
- The inner punch cutting tip diameter (Inner Diameter or ID)
- The outer punch cutting tip diameter (Outer Diameter or OD)
The inner punch cutting tip diameter (Inner Diameter or ID): The inner diameter (ID) of the punch consists of the width of the opening itself. It measures from one side of the inner lining of the tip to the farthest point across from it. This value determines the amount of tissue that will be collected with each punch. It influences the bulk of the graft the FUE punch is capable of taking into its lumen.
The bulkier the graft, the greater the odds of its eventual survival when embedded into the flesh of the recipient area. This influences the viability of the grafts collected with it and by consequence the type of regrowth or yield you can hope for in the wake of your FUE hair transplant.
The outer punch cutting tip diameter (Outer Diameter or OD): The outer diameter (OD) of the punch is a measure of the largest width when taking the entire FUE punch tip into account. Since the wound created is defined by this diameter, it is generally the one that patients will be most interested in. This diameter is the one that inflicts the wound itself. It ultimately decides the size of the FUE donor scars caused by the punch. The outer diameter is usually the one most patients are thinking about when asking their doctor about the FUE punch size they intend to use.
A careful balance must be found between using an FUE punch big enough to excise appropriately bulky grafts while at the same imposing the smallest and least-invasive wound possible.
What is the Relevant Punch Size to know in Two-Step FUE Hair Transplant Punch Systems Such as Found In Robotic FUE and Manual Two-Step FUE
In FUE hair transplant systems that operate under a two-punch technique (in the case of a manual two-step method or those utilized by robotic FUE hair transplant systems, for example), a small, sharp FUE punch first scores the skin initially and is followed by a blunter punch tip to make the final, deepest, and widest cut. The premise for this is that the sharp punch is shallow and does not transect the graft. It makes the initial cut which paves the way for the blunt punch to enter the skin more easily. The sharp punch also stays in place to secure and stabilize the follicle for the blunt punch to engage with the skin more smoothly. This system, invented by Dr. Harris, was a very good development in FUE advancement at the time. When it comes to knowing punch sizes in this context however, the patient is often given the size of the smaller sharp punch. While this may influence the bulkiness of the grafts, it is not relevant to the size of the wound and ultimately the scar which is the primary concern of most patients. Why? Because, the diameter that would ultimately determine the wound size and scar left behind will be the outer diameter (OD) of the last punch to enter the skin (the blunt punch). Thus patients should also be informed of the size of the outer diameter of the blunt punch when going for this kind of procedure.
The patient undergoing Robotic FUE may be given the smaller inner punch diameter when the ask the provider for the punch size. This gives the impression of a smaller overall punch diameter. Thus, the patient may not realize that that this smaller punch will not be the one that determines the size of the final wound. The wound and scar size would be influenced by the larger blunt punch which delivers the final cut and coup the gras to the follilce attachments. That said, the drive for robotic FUE continues to improve and it is encouraging to see the improving and innovative trends over the past several years.
The following progression lays out both processes graphically:
Manual Two-Step FUE Punch
Robotic Two-Step FUE Punch
What is the Ideal Punch Size for an FUE Hair Transplant? How Does the Intelligent Punch™ Minimize FUE Donor Scars?
Naturally, the bigger the gauge of the punch, the larger the FUE donor scars left behind. This presents an interesting challenge, as bulkier grafts tend to have a higher rate of regrowth and are more likely to thrive where embedded. So the ideal FUE punch would be that which is designed to create minimal wounding and scarring while still harvesting bulky grafts. This brings to fore the subject of smart and intelligent FUE punches. The poster child for this group of evolved FE punches is The Dr.UPunch i™ (The Intelligent Punch™) which fulfills this criteria for an ideal FUE punch and then some. The intelligent punch is imbued with several design features, such as the hybrid, textured, and roomed forms that all contribute to several ground-breaking functional capabilities that until now were hitherto unknown in the field of FUE.
So, What Exactly is The Relevant Diameter of the Intelligent Punch™?
New FUE practitioners may find the design of the Intelligent Punch™ intimidating, and even practiced providers may think it confusing. Why, because of it bazooka shape and varying diameters as it penetrates the skin. So, what impact does the expanded bazooka shape and roomed upper portion have on the wound inflicted? This unique design incorporates an expanded inner chamber just above the mouth of the punch. This expansion affords the Intelligent Punch™ many advantages over those of competing brands that include but are not limited to:
- More room to accommodate the punched graft. This allows it to enter the lumen without getting attached to the inner wall of the punch. Avoiding friction in this vital area means that the punch can rotate independently of the graft. This prevents it from twisting it and rendering it impotent.
- The expanded outer diameter pushes away the surrounding structures previously holding the follicle in its natural place. It is a smooth transition that does not cut further into the skin. The separation is a blunt dissection that does not increase the size of the wound. The result is a wound that expands while the punch remains in the skin. It retracts back to the diameter of the original initial cutting tip once withdrawn.
- The roomed inner volume also causes increases the resistance the operator feels while working in a manner. This resistance is directly proportional to the depth of penetration. The result is innate, intuitive depth control that makes excising viable grafts without punching too deeply into the skin effortless.
How Does the Intelligent Punch™ Minimize FUE Scars?
This frustoconical design is unlike any other FUE punch tip available on the market today. The primary flared cutting edge at the mouth of the lumen, referred to as Outer Diameter 1 (OD1), harbors the sharp cutting edge and makes the initial incision around the follicle, creating a physical wound at the smallest possible gauge. The punch then expands internally to a larger diameter, Outer Diameter 2 (OD2). The wound is gently stretched to this new diameter, allowing more of the surrounding flesh to be gathered along with the follicle without cutting further into the flesh. This helps the patient avoid FUE donor scars after healing.
Thus, this intelligent design offers each patient the best of both worlds. The graft collected is bulky enough to survive once transplanted. The wounds created leave much less noticeable FUE scars than conventional FUE punches of the past.
VIDEO: See the Dr.UPunch i™ in Action
The following video is an overall introduction to the revolutionary Dr.UPunch i™.
Click the button below to schedule a free consultation with the Dr. U Hair Clinic. As an internationally-renowned specialist in the field of FUE hair transplant methodology and dermatology, Dr. U has restored the youthful appearance of patients the world over from his Los Angeles-based practice in Redondo Beach.
Frequently-Asked Questions About FUE Punch Size:
Will an FUE hair transplant leave me with FUE donor scars? What effect does FUE punch size have on the way I will heal after the fact?
Yes, you will have scars in any surgery, including FUE. However, the goal is to minimize them to be less visible. One important factor that will determine the amount of FUE scars your FUE hair transplant will leave you with is the diameter of the punch your doctor uses. The larger the punch, the more likely you are to develop FUE scars. However, nuanced FUE punches are such as Dr. U’s have been optimized to create less visible scarring when compared to wounds created by other punches of the same outer cutting tip diameter.
What makes the Dr.UPunch i™ different from conventional means of FUE hair transplant? How can it help me avoid donor scars?
Scars cannot be avoided in any surgery. As long as the skin is breached, a scar will be left behind. Measures can, however, be taken to minimize their appearance. Most FUE hair transplant systems utilize a mechanical punch with straight, parallel, cylinderical walls that lead up to cutting tips that point toward the skin. These punches favor the creation of more everted wounds, especially if they are beveled outwardly. The Dr.UPunch i™’s flared tips create less everted wounds relative to those of conventional punch counterparts. The result is smaller wounds that result in relatively smaller visible scars.
How will I know if my hair transplant doctor is using the correct FUE punch size for me?
Most specialists will bring you in for a consultation sometime before the day of the procedure itself. They will assess your case and determine the best way to minimize scarring. If you’re ever unsure, it’s always a good idea to ask. They will be able to give you the precise FUE punch size they intend to use.
Interested in learning more?
If you have more questions about FUE scars or hair transplant tools in general and don’t see them answered here, feel free to get into contact with Dr. U by clicking the button below:
Further Reading on Dr. U and FUE Hair Transplant