Fue scarring - punch sizes

[JimD]

I've been reading quite a bit about the varying size of Fue punches, the donor area and scarring.... I have a quick question which I hope someone can shed some light on.
If a 1mm punch is used a certain number of grafts will be removed from a certain area, for example say 10 grafts could be extracted from 1cm sq using 1mm punch leaving 10 holes, now if a smaller 0.7 punch is used you may be able to extract 16 grafts from the same area as the extractions can be closer, thus leaving 16 holes.... The more holes equals more chance of scar tissue amalgamating.
My question is which punch will leave the most scarring?

 

[topccat29]

This picture represents the difference in punch sizes. When one simply looks at the numbers 1.0 compared to .7 it seems in inconsequential. But when you do the math and figure out the square area of the circle and then understand the percentage difference in the size of the wound then you will better understand why the larger punch leaves a much larger wound and the potential for visible scarring can be much higher.

If less holes were the answer we could go back to the very old procedure where the 4mm punch was used and you had these very robust grafts. The term robust graft is often used in a way where one takes a negative and makes it appear positive, very deceptive and basically just telling a lie. People that don €™t know much can be told anything about anything and they would believe it. You know kind of like bigger is better very easy for the brain to comprehend.

When we tattoo we try to make the dot as small as possible €¦ €¦ €¦ €¦ €¦ €¦.when we do fue we like the really robust grafts €¦ €¦ €¦ €¦ €¦ €¦.it all becomes laughable at some point of unless of course you are the patient that doesn €™t know.

Does this mean you will end up with no visible scarring with the smaller punch €¦ €¦ €¦ €¦ €¦ €¦ €¦ €¦no €¦ €¦ €¦ €¦ €¦ €¦better to have the smallest procedure possible and evaluate how your own body heals taking as little risk as possible. But if I was a betting man and through my own experience of having very large punches used on my head and very small punches used on my head I would bet on the smaller punch.

 

[JimD]

With the smaller punch will they not extract more grafts thus increasing the scar tissue in that area and creating a thinner look.

 

[topccat29]

Over harvesting is a separate issue. Ethical clinics have protocols in place and they will stick with a certain percentage when harvesting with fue and they rarely go past that percentage. Some guys don €™t seem to understand why one doctor will state that a donor region will be able to withstand a greater percentage of harvesting while another will not. The ethical doctor understands it is not a short term issue but a long term issue and because he has the patient €™s long term welfare in mind he does not go above that number regardless of if he loses a customer.


Often times it is the larger punch that gives the donor the moth eaten look as it creeps over to adjacent follicles and transects them (kills them off).

 

[JimD]

Thanks Topcat, the picture makes it easier to understand. Hopefully there aren't too many clinics around who over harvest the donor areas.

 

[Sparky]

I like Dr Cole's approach to harvesting, he grids off the back of the head too make sure he harvests equally, and he only goes 2mm deep in most cases, only taking out what is needed and leaving the adipose tissue behind where it should be.

 

[bullitnut]

Sparky wrote:

I like Dr Cole's approach to harvesting, he grids off the back of the head too make sure he harvests equally, and he only goes 2mm deep in most cases, only taking out what is needed and leaving the adipose tissue behind where it should be.

How exactly does he grid of the donor area Sparky do you know?...sounds like a good idea and i'm intrigued, but ive never seen it*nl

 

[Sparky]

https://www.youtube.com/watch?v=khVm4wSpzjo

Skip over all the acell stuff if you like and you can see it.

it's at 3:30

 

[topccat29]

Sparky you might be mistaken, the grid and markings are being made to keep track of extractions sites to access donor regeneration and not as a means of determining the extraction pattern as it €™s all Acell related.

I have seen this video before and what he says about Acell does not appear to be true in my opinion as time seems to have proven. But what he does say about the robust graft is absolutely true as I have an elevated rim across the entire front of my head, not complaining maybe one day I will do something about it but the point is that is what robust grafts do. They leave the recipient area elevated and lumpy. The skin is not smooth no different then someone that has liposuction or fat injections................looks terrible.


So if someone wants to sell you a robust graft I €™m telling you from my own actual experience €¦ €¦ €¦ €¦ €¦..real world experience and not simply something I read on some message forum that large robust grafts are not a good idea. Yeah sure it sounds good.............I drink a nice 5 country coffee blend...............it's strong, creamy, well balanced and robust in flavor which is good but the term robust can also be bad.


In my opinion and from my own experience robustness has absolutely nothing to do with viability. Viability is about skill.

As for myself I had no idea what a robust graft was years ago when I had those procedures. This is what I don't think many get...............how was I suppose to know to even ask..............lol.............excuse me doctor will you be giving me the robust grafts today or the not so robust grafts that will leave me with a more pleasing to the eye result.................lol...............I can laugh about not knowing much at one time......that's life it and never stopped me from moving forward.

 

[Sparky]

To be honest I wasn't interested in the acell part, I personally don't believe in donor regeneration, I don't think it's possible at the moment.

I would imagine that he is still taking an even amount from each section, rather than randomly punching 100 out of one section and 50 out of another, if he isn't then I think he should be.