Important question!

[Bobjoe]

If you do a fue transplant of 3000 grafts, should you actually see/get 3000 small extraction dots in the back of your neck?

What I mean is if one graft is equal to one extraction? Or do you get several grafts from one extraction?

Great if anybody could answer this question.

 

[Bigmac]

You can have a graft extracted containing more than one hair follicle, this graft can then be split into individual follicles, therefor you will have less extraction holes than grafts.

 

[sl]

Hi Bobjoe,

As BM said it is possible to have less extraction holes compared to "graft" numbers. What is important here is what the definition of a graft is, some doctors deal in grafts, other follicular units and others hairs, so there can be a wide range of answers, and for that matter hair numbers; and hair numbers fundamentally make a result.

A follicular unit can be made up of 1-4 hairs normally and they grow in little bunches and normally this is considered a "graft" when removed from the scalp with the FUE punch and then placed back into the head in the same state. With FUE much relies on the size of the punch tool, obviously the larger the diameter of the punch the more chance there is of taking more hairs in a graft, for example you may take an intact follicular (for example a 4 hair FU) unit but also an adjacent unit in full or partially, (for example another 2 hairs from a 4 hair FU), so in total that punch has taken 6 hairs in one graft. This could potentially mean less punches but the trauma to the scalp can be much higher, potential for more visible scarring, transection of follicular units and trauma to the surrounding hair causing miniaturisation.

In it's purest forum FUE is about taking a single intact follicular unit, be it 1,2,3 or 4 hairs within the unit, and not overlapping to take more hairs per graft; this can be quicker to perform but is not always in the best interests of donor management and can leave a very uneven pattern of growth in the donor making it harder to go back into and harvest more at a later date. Also it could mean you end up paying more for less hair than your donor could have given if the follicular units were taken individually, especially if you are paying per graft and the average number of hairs drops below the average number you have in your donor.

 

[Prohairclinic]

Taking 3000 grafts using a 1 mm punch will have the donor area look much different when comparing the same number of grafts using a 0.7 mm punch.
Its logical, the smaller the less visible scarring.

However there is 1 catch : as the punches get smaller it will no longer be possible to harvest the 'fat' grafts (3-4 hairs or more).
We find that using punches with 0.7-0.8 mm give us the ability to harvest even the fat grafts. Going much smaller would mean that only a part of a fat graft can be harvested. This is called vertical splitting. Most clinics try not to split vertically because the patient pays to move hairs to bald or balding areas.

 

[Bigmac]

Maybe some clinics can post pictures of different size punch holes to compare.

 

[topccat29]

It might also be helpful to know the exact measurement of the square area of tissue being removed. For instance a 1.0 mm punch would be .78 sq mm where a .75 mm punch would only be .42 sq mm which is a very big difference being almost half the size. But this does not account for the wall of the punch itself. I €™m not sure if the dimension for the punch is the outside or inside dimension. If it is the inside dimension then knowing the dimension of the wall would also be helpful and is this dimension always standard?

 

[Prohairclinic]

Here is a picture of a 23G needle compared with a 0.60 mm titanium coated punch used for FUE hair restoration.

Please note : this was taken with a 130 times magnification!

 

[Bigmac]

Hi Bart, thanks for posting the pictures, could you explain what that needle would be used for.

 

[Bobjoe]

Thanks everybody for great answers, very informative.

From my earlier research I understand that according to certain doctors, should be higher potential of growth if they use a wider instrument, of course this could be a highly subjective opinion so I don't know the facts behind a statement like that.

My doctor where using a 1mm tool as the smallest and I also think he went up to 1.1 or even more for some grafts.

What would be really interesting is to get a graft count at this moment. I wonder if I have more than 1500 grafts that actually survived and started to grow but of course it is very hard for me to tell just to look at it. What I do know is that its far from 3000 so a roughly estimation would be between 1500 and 1800.

Based on this I am highly sceptical to the claim of bigger tools make a big difference for the actual growth of the graft but then of course it could be many other factors playing a part making half of the grafts die.

The only thing that I am certain of after all this is that appearances can be deceptive, what looks like highly professional doctors/teams can be the complete opposite.

 

[Prohairclinic]

Hi BM,

I just used the needle for comparison reasons, in fact we don't use this needle during the treatment.
The 23 g needles are given to patients as part of their after care package. They are to be used if there are bumps in either the donor area or the implant area. These bumps need to be cleared, best with sterile needles and desinfection afterwards.
Greetz,

 

[Bigmac]

Thanks Bart.