What is the ideal hole punch size for FUE?

[crowngarden]

That has been shown to have the best yield in a transplant. Obviously the bigger the size, the bigger the scar. But have extra small punches shown any evidence of damaging follicles? Is there any thread on here that has a list of some sorts on what sizes the top doctors are using?

 

[arfy]

I don't recall it offhand, and different doctors will argue that their punch size is optimal, while the competition's punch size is inferior. Apparently, the difference in punch sizes can be significant, even though they are only incrementally larger or smaller. I will ask about this, and try to get an answer. Understand that it's a matter of opinion, and also based somewhat on the doctor's skill and experience.

If I'm not mistaken, besides creating larger scars, larger punches can risk collateral damage to neighboring follicles. Smaller punches risk transecting the follicle structure, or not bringing enough scalp tissue along that will allow the follicle to survive (realize that hair transplants are tiny skin grafts, which happen to contain a follicle too). When doing strip procedures, doctors don't dissect all the scalp tissue away from the follicles - that tissue is necessary to survive. "Plump" grafts are considered better at survival.

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The 0.9mm is a standard punch used at every clinic that I have worked at the last 9 years and has been used in 98% of all FUE cases. The last 2% was those patients that had an extraordinary large grouping, so a 1.0mm had to be used. Never anything larger.

In my opinion and being around and working in FUE since 2002, Yes too small can become problematic... this is why every clinic I have worked at never went below a 0.8mm. Personally our preference is a 0.9mm and is for most clinics.

^ These are the opinions of "Hairtech" Thomas Ortiz on another forum. I will ask him to post here. Thomas Ortiz probably knows what size punch the American doctors are doing, but other doctors outside the US (Woods) do not disclose their tools (as far as I know) and the standards in Europe may be different. He also says that the ARTAS robot has an internal diameter, but the external diameter is larger (and he suggests that is a problem). ARTAS may be quoting an internal size, while doing additional damage with a punch which is larger than the statistics suggest. The point is that internal punch size isn't the complete story, if I understand correctly.

 

[crowngarden]

Thanks for taking the time to ask people you know in the industry. Really appreciate it.

 

[Swoop]

0.7-0.8mm imo.

 

[arfy]

There's no way for patients to verify what size punch a doctor uses, and it's in the doctors' interests to lie about it, and say the punch is smaller than it is.

 

[Rizwan Younis]

0.7mm -0.9mm but you if your worry about hole size there is many other treatments available for hair transplant.

 

[crowngarden]

0.7mm -0.9mm but you if your worry about hole size there is many other treatments available for hair transplant.

What are the other current methods? I thought there were only 2. FUE and strip.

 

[buckthorn]

What are the other current methods? I thought there were only 2. FUE and strip.

Piloscopy bro... it will be hear any day now!! :uglylol:

 

[Charlie Brown]

Piloscopy bro... it will be hear any day now!! :uglylol:

What's Piloscopy? I'm still waiting for hair cloning. Has any clinic experimented with hair transplants from one person to another yet? I'm sure if face transplants are possible then so is hair. I can hear myself now "Hey mom, can ask you something?..."

 

[Hairloss23]

Piloscopy basically scarless hair transplant. By the time Hair Cloning is a thing there will be a cure already.

 

[Charlie Brown]

Piloscopy basically scarless hair transplant. By the time Hair Cloning is a thing there will be a cure already.

Thanks, I googled it and the name Carlos Wesley came up. I'll watch his video when I get home. Is this something he's practicing now?

 

[Hairloss23]

Thanks, I googled it and the name Carlos Wesley came up. I'll watch his video when I get home. Is this something he's practicing now?

Trials I believe.

 

[arfy]

Piloscopy looks scary as hell, and it's much more invasive than other harvesting methods, from what I can tell. Basically, it's harvesting the grafts from the inside-out. In order to do that, the scalp must be detached from the skull (in the areas where harvesting occurs). I would not be the first in line to try this procedure, let the doctors experiment on somebody else!

 

[Charlie Brown]

Piloscopy looks scary as hell, and it's much more invasive than other harvesting methods, from what I can tell. Basically, it's harvesting the grafts from the inside-out. In order to do that, the scalp must be detached from the skull (in the areas where harvesting occurs). I would not be the first in line to try this procedure, let the doctors experiment on somebody else!

Holy fukk! I'm cringing just reading that. How the hell do you detach a scalp from a skull and remain "scarless"? It sounds so gruesome. Probably a risk of messing up the circulation on your scalp and losing all your hair! At least you wouldn't have to shave your head every morning.

 

[kirklandism]

Piloscopy looks scary as hell, and it's much more invasive than other harvesting methods, from what I can tell. Basically, it's harvesting the grafts from the inside-out. In order to do that, the scalp must be detached from the skull (in the areas where harvesting occurs). I would not be the first in line to try this procedure, let the doctors experiment on somebody else!

:nono: errrr....did you make this up? Piloscopy does not involve detaching the scalp from the skull. It uses instruments like endoscopic cameras and microsurgical tools through a small slit cut into the scalp to remove the follicles from underneath. The follicles are removed without breaking through the skin (such as in FUE) so that no scarring is visible. Dr. Wesley is in trial stages with the technique trying to improve the instruments involved. This is not a new technique. A number of hair restoration surgeons have given it a go in the past but found that the current technology is too cumbersome. In its current iteration, only a small number of grafts can be harvested relative to the number that can be harvested via FUE/FUT in the same time period. This makes the technique too time consuming as to be cost effective. The hope is that the tools can be engineered to make this technique competitive with FUE/FUT. Only time will tell if that is the case.

 

[arfy]

:nono: errrr....did you make this up? Piloscopy does not involve detaching the scalp from the skull. It uses instruments like endoscopic cameras and microsurgical tools through a small slit cut into the scalp to remove the follicles from underneath. The follicles are removed without breaking through the skin (such as in FUE) so that no scarring is visible.

The scalp is connected to the skull. In order to access the follicles from below, the scalp is undermined... detached. I didn't say the entire scalp is detached (like it is with scalp reductions). I may have misspoken though - maybe all the grafts are harvested "from the side". I don't see how that's possible. I need to learn more. But even strip excision and old plug punch graft procedures require the doctor to cut the donor scalp away from the skull. I don't see how grafts can be harvested any other way.

Also, you misspoke when you said piloscopy was scarless. It's not scarless. The entry points will all have scars. And if the scalp is not undermined (like I believe) then there will need to be many entry points.