Follicular Unit Excision Punches and Devices

Abstract

BACKGROUND Follicular unit excision (FUE) is used to harvest follicular units for hair transplantation using trephine punches. The characteristics of FUE punches can impact the success of this technique; thus, many innovative punch designs and devices have been developed. With many options available, it can be difficult for the hair restoration surgeon to know which punch best suits the needs of their patients. OBJECTIVE To provide a comprehensive review of punch shapes and devices available. METHODS Search of PubMed, reference mining of relevant publications, and hand searching trade publications. RESULTS We examined FUE punches and devices and consolidated descriptive information for each to create textual and visual guides. No single punch shape or device may suit all cases; thus, it is important to know the best uses and limitations of each. CONCLUSION The surgeon should have a comprehensive knowledge base of available punch shapes and devices and understand the advantages and disadvantages of each. It is also beneficial to have an in-depth knowledge of skin properties and follicular unit structure. Ultimately, understanding the dynamics behind punch excision will enhance the FUE technique.

A Novel Follicular Unit Excision Device for All-Purpose Hair Graft Harvesting

“…Most FUE devices are designed to score around a straight hair graft axis. 9 Consequently, these devices are challenged by hair grafts with an angular or tortuous subsurface course. 4 We report an all-purpose FUE device that corrects for both the subsurface course taken by the hair follicle and changing skin characteristics.…”

“…Overall, the all-purpose FUE device incorporates torque such that, at the appropriate torque and speed settings, the punch stops after separating the graft from its lateral attachments ( Supplementary Video 3 ). Thus, instead of relying on the practitioner’s experience of knowing when to pull out the punch or using mechanical guards 5 , 9 or an automatic timeout mechanism of depth control, 24 the all-purpose FUE device intuitively takes its cue mainly from the resistance of the tissue to determine the appropriate depth. 17…”

“…In previous FUE devices, the operator must align the punch’s long axis to precisely align with the long axis of the hair exit angles on the skin or risk graft loss. 4 , 5 , 9 In contrast, the novel device corrects for roughly 20–40 degrees of misalignment through its MAN feature. Thus, the practitioner does not need to be exact in punch-hair-axis alignments.…”

“… 7 , 8 Therefore, practitioners often acquire various devices hoping that one of these might suit the variety of patients they encounter since no single device suits all situations. 9 Other practitioners seek to develop specialized skills in using conventional FUE tools to address challenging FUE scenarios. 10…”

Hair transplantation Follicular Unit Excision (FUE): Introducing the multipurpose octagonal ring punch

“…To perform the FUE technique, the surgeon uses small diameter (generally 0.8‐1.0 mm) punches to remove individual follicular unit grafts from the patient's donor area for implantation in the recipient area. These punches are the backbone of this technique, and their shape and geometry can have a great impact on the success of the hair transplant 2–4 .…”