The logic of FUE: As explained by a landmark paper by Headington,[
12,
13] the follicular unit comprises 1–4 hair follicles, their arrector pilorum muscle, surrounding connective tissue, nerves, and vessels [
Figure 1]. The logic of FUE is to excise a column of tissue or a circular skin flap having hair and all layers of skin by releasing the fold of arrectores and by severing the adherence of surrounding dermal collagen through a circular punch.
As the shape of the follicular unit is pyramidal, it is the narrowest in the upper part till the attachment of arrectores; hence, a small punch of less than 1mm is enough to excise the unit. This small size would then heal easily, quickly without a significant scar.
Common punch sizes used by hair transplant surgeons range from 0.75mm-1.0mm. Recent evidence on the use of larger punch tools has shown that they increase the risk for scarring.
One of the great things about the FUE method of hair transplant surgery is that it has minimal risk for scarring. Using a larger punch size negates this benefit. Most experienced hair transplant surgeons agree the smaller the punch size the better.
Some doctors who still use the larger punch size claim that the larger punch allows them to extract follicles containing 2, 3, and 4 hairs. The truth is, punch size has little to do with what type of hair follicles that can be extracted. What plays a bigger role, is skill and experience. More often than not, these doctors lack the expertise needed to extract follicles containing multiple hairs using a smaller tool.
The other scenario where we still see larger punch sizes being used, is with
robotic devices. Robots and automated tools can’t be as precise as a tool operated by a human hand. Therefore, they utilize a larger punch size in an attempt to increase extraction results. The problem with this is that the risk for scarring increases dramatically. Further, the success rate for transplanted follicles decreases dramatically due to the trauma induced by the large punch.
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Αν τα Αγγλικά σου δεν είναι καλά, χρησιμοποίησε το google translate.