Background Early use of follicular unit excision (FUE) as a method of hair transplantation was limited by high rates of hair follicle transection. This hurdle has been overcome by innovative methods, punch shapes, and devices. With the vast array of tools available, it can be difficult for hair transplant surgeons to choose the best option for their practices. Aims To provide an in‐depth review and comparison of currently available FUE methods, punch designs, and motorized devices, and discuss how these tools fit the unique skin and hair characteristics of patients. Methods A review of the literature and available information on FUE methods, punches, and devices, as well as the authors’ experience in this area, is provided. Results Innovative FUE methods, punch shapes, and motorized devices have successfully minimized the rate of hair follicle transection. Methods include the use of sharp punches with depth control, and blunt rotating punches. Punch shapes such as flared, hybrid, and edge out have successfully reduced transections by keeping the cutting edge away from the follicles under the skin. The development of motorized devices using features including rotation, roto‐oscillation, oscillation, vibration, suction, and hydration has also aided in achieving more successful graft excision. Conclusion Follicular unit excision is a widely used technique by hair restoration surgeons. Therefore, it is important for physicians to be aware of the array of punches and devices available and understand how these tools can be used to adapt to the unique skin and hair characteristics of individual patients to optimize successful graft harvesting.

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The follicular unit excision (FUE) technique has taken the hair transplant world by storm. Its popularity has surpassed the traditional strip-harvesting technique (FUT) and is currently the most soughtafter type of hair transplant. 1 Although FUE has many advantages over FUT, limitations still exist. To many patients, the greatest disadvantage of FUE is that the donor area must be shaved prior to surgery, which is a major deterrent to patients wishing to keep their surgery discreet. With longer hair styles becoming more popular, this patient demographic is growing.The issue of shaving the donor area has driven development of the long hair FUE technique, where shaving the donor area is avoided. This technique fosters a fast reintegration into the patient's social, work, and professional activities. Unfortunately, the long hair FUE technique is known to be technically demanding and slow to perform. Thus, most hair restoration surgeons hesitate to adopt this method into their practices. However, the technology and technique involved in long hair FUE have recently advanced to a more user-friendly level allowing this technique to begin populating hair restoration clinics worldwide to meet the patient demand.We discuss the preview long hair FUE technique and review punch designs that have been developed to facilitate this procedure. This information will help inform hair restoration surgeons and aid transition of this technique into their practices.

SUMMARY The technique of follicular unit excision for harvesting grafts for hair transplantation procedures has become very popular. This technique relies on the use of small punches to remove viable grafts. Many different punch shapes have been developed to accommodate the varying nature of skin and hair characteristics, resulting in hair transplant surgeons requiring a variety of punches to suit a wide range of patients, which can be overwhelming to the beginner when trying to decide on the optimal choice of a punch to suit a particular skin characteristic. We describe a novel multipurpose ring punch that can be used on patients with a variety of skin and hair characteristics, as well as for shaved and long hair FUE. Features of this punch include an octagonal ring that protrudes from the outer wall of the punch and functions to control the punch’s trajectory into the deeper dermis during incision. Additionally, this punch has a dull, notched edge which allows for use in long hair and shaved FUE without sacrificing ease of incision through the epidermis. This punch is the first of its kind to have this breadth of versatility with a one‐size‐fits‐all design.

BackgroundThe follicular unit excision (FUE) technique has become the preferred method for hair transplants over the traditional strip harvest technique due to low scar visibility and shorter recovery time for the patient. However, a limitation of the FUE technique is the potential for graft trauma due to the small diameter, sharp punches used to harvest individual follicular units.AimsHere, we introduce the novel edge out FUE punch that is designed with a thicker wall and has an internal bevel. We describe how the dynamics of this punch reduces the risk of follicle transection.MethodsA review of the available literature and information on the edge out punch in comparison with other punch shapes, as well as the authors' experience in this area, is provided.ResultsThe edge out punch is designed with thick walls and an internal bevel, placing the sharp cutting edge on the outer diameter. The dynamics of this punch aid in directing the graft into the center of the punch lumen and keeps the sharp cutting edge away from the hair follicles deeper in the dermis, reducing the risk of follicle transection.ConclusionThe dynamics of the forces generated by the edge out punch aid in minimizing follicular transections during graft harvesting. By understanding the dynamics behind this novel punch, hair restoration surgeons (HRSs) can optimize their surgical technique to obtain consistently high‐quality grafts during FUE.