Sharp Punch and Dull Punch

Hair alignment is different in and out of the scalp.

Using FUE procedure to punch the grafts is a blind procedure.

There is no way to see through the skin. Therefore, two types of punch (sharp and dull punch) are used to reduce the transection rate.

	Deep Level	Advantage	Disadvantage
Sharp Punch	shallow, only cut through skin	less transection	bare graft caping
Dull Punch	deep to whole follicle	punch out whole follicle	more transection

* Sharp punch only punch through skin, need to use two forceps to pull out the grafts.Because the tissue around the follicles didn’t separate, a lot of time follicle come out without any surroundings tissue,that we call bare grafts. Sometimes during pulling, only skin pull out,follicle still stay in the scalp, that we call capping.*Dull punch method,use blunt dissection to isolate the follicular units from the surrounding tissue.Require more experience and skill to perform, even the speed of punch is very important.

FUE and Me

In my 18 year hair transplant career, I have been seeing numerous old 4mm Punch grafts.

It was rare to see any grafts without transection. There are times I even see the graft without any hair.

Initially I believed using the new FUE 1mm punch would yield a much higher transection rate, but after I visited Dr.James Harris at Denver last year, I completely changed my mind.

Seven hair transplant physicians attended the workshop. Dr.Harris taught us how to align the angle, where the scalp entry point is, how to tighten the scalp and how to control the punch speed. He watched us perform the procedure and corrected our mistakes one by one. He was such a good teacher, he could tell us how the grafts would turn out before we did it, by observe our alignment. By the end of the workshop, everyone had reduced the transection rate dramatically.

Now I changed my attitude toward FUE. I recognized it as a completely different method now, even though it is still a blind procedure but the transection rate might be reduced dramatically via adequate training and practice.