This question, asked by a member of our hair loss social community and discussion forums, was answered by Coalition hair transplant surgeon Dr. Carlos Wesley:
I’m looking to undergo Follicular Unit Extraction (FUE), but I was wondering what sort of follicular unit graft transection rates are associated with the procedure? Does it matter what size extraction punch is used? Will a bigger punch decrease transection, but increase FUE scarring?
Dr. Carlos Wesley:
Among the field’s most experienced practitioners of FUE, transection rates range from 2% to 8.5% for the 1-mm punch and from 3% to 10% using the 0.75-mm punch. A 1-mm punch can exact an average graft of 2.5 hairs/graft, while a 0.75-mm punch yields approximately 2.1 hairs per graft.
I think most of us in the fied agree that punches of 1mm or larger can result in visually unacceptable donor area scarring.
______________
Blake – aka Future_HT_Doc
Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Hair Loss Learning Center, the Hair Loss Q&A Blog, and the Hair Restoration Forum
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Transection rate could vary by FUE surgery quite widely. I would say though transection rate depends on several factors of scalp characteristics ( skin thickness,softness-hardness, elasticity or rigidity of the subcutaneous tissues, hair shaft diameter, texture,lenght, diversity of follicular units /narrow or wide units/etc.)and some technical details (etc. manual -power assisted, punch material, method of pulling after graft separation) but surgeon's overall experience counts the best. According to the given circumstances the technique which fits perfect to the particular case shall be choosen at the beginning of the surgery. It means that we need to find out which size of punch is suitable (I use not less than 0.8 and not more than 0.9) do we need sharp or duller punch, what is the speed of the motor, what power do we need to apply and last but not least what is the depth we should work with. If our decision is right ,transection rate will remain under 5%, most of the cases less than 3%. This number can be kept even with 2500-3000 grafts in 3 hours. Please keep in mind that transection rate is a figure of what percentage of grafts (which were targeted) are not extracted succesfully and not the number of grafts transplanted in vain. In normal cases all the extracted and transplanted grafts are viable.
Scar formation at the donor site is known to be very similar by all type of punches unless it is less that 1 mm in inner diameter.
dr.Geza Sikos,
Sikos Hair Transplant Clinic Budapest, Hungary