An Analysis of Follicular Punches, Mechanics, and Dynamics in Follicular Unit Extraction

    August 2013 in “ Facial Plastic Surgery Clinics of North America ”
    John P. Cole
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    TLDR Using sharp tools and the right techniques in hair transplant surgery leads to less damage to hair follicles.
    The 2013 document analyzes the tools and techniques in Follicular Unit Extraction (FUE), highlighting the importance of sharp trephine punches to minimize damage to hair follicles. It discusses the variability in punch sharpness among manufacturers and the need for customized punch size and incision depth due to differences in follicular group size and hair splay. The study from 2003 within the document showed that using smaller punches (0.75 mm) led to higher transection rates than larger punches (1.25 mm), but by adjusting punch size and sharpness, the author reduced transection rates from 8% to less than 3% by 2006. Factors such as individual follicle anatomy, skin elasticity, and the strength of attachment of the ORS to adipose tissue also affect transection rates. The conclusion is that high graft quality in FUE requires technical skill, understanding of punch and tissue dynamics, and the ability to use both manual and mechanical methods to adapt to patient differences, aiming for transection rates below 3%.
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