Punch: the instrument used to extract follicles

In the field of hair transplantation, there are many instruments that the hair restoration specialist uses during the procedure. One of these is the punch, and here we explain what it is and how Dr. Espinosa Custodio uses it.

The punch is a circular surgical blade with a diameter ranging from 0.6 mm to 1.2 mm. It is used in the donor area and allows the doctor to extract the follicular units, or grafts, which are then placed into Petri dishes so that the specialist technicians can classify them.

As mentioned, the punch is available in different sizes. The doctor selects the appropriate diameter based on the patient’s previous assessment and his own clinical experience. The size corresponds to the thickness of the patient’s follicles and, together with Dr. Espinosa Custodio’s expertise, helps ensure that the extracted follicles are not damaged and remain in optimal condition for implantation into the recipient area.

The micromotor and the punch

This instrument may be used with or without external assistance. Depending on the case, the doctor’s expertise may make it preferable to use the punch together with a micromotor, allowing cleaner incisions and minimising scarring in the donor area.

The micromotor rotates the tip of the punch at high speed, facilitating follicle extraction using the FUE technique. However, the doctor’s experience is essential to avoid damaging the donor area.

It also speeds up the procedure, allowing a greater number of grafts to be extracted in less time. As a result, the overall duration of the hair transplant is reduced, benefiting both the patient and the surgeon.

Despite having this technology available, the doctor may decide, depending on the patient, not to use the micromotor in all or part of the donor area. In those cases, the manual punch becomes the doctor’s primary instrument.

Frequently Asked Questions

Can the doctor choose the wrong punch size?

The doctor carries out a personalised assessment of every patient, which may be performed either in person or online. During an in-person consultation, specialised tools such as the HairMetrix by Canfield dermatoscope can be used. This device measures several characteristics of the patient’s hair, including the average number of hairs per follicular unit, the distance between follicles, the anagen-to-telogen hair ratio, hair density, and follicle thickness. Based on this information, the doctor selects the punch sizes that will be required during the procedure.

Will the punch leave noticeable scars?

Scabs are generally more visible in the recipient area, where they heal over the following days. These scabs may fall off naturally or be removed at the clinic, depending on the doctor’s recommendation. The punch, however, is used in the donor area. In this area, scabs are minimal and healing is usually very fast, so there is generally no need to worry about visible scarring.

The donor area will be treated with the necessary care so that, within a few weeks after the procedure, there is little or no visible trace of the intervention.

Are the punch incisions painful?

The patient will not feel pain at any point during the procedure because the doctor administers local anaesthesia before making the incisions. As a result, although the patient remains awake throughout the surgery, they should not experience any discomfort.esar de estar despierto en todo momento, no notará molestias en ningún momento de la cirugía.

Dr. Espinosa Custodio works at Instituto Médico del Prado, his hair clinic in Madrid, and performs hair transplants in Mexico, twice a year. If you would like to make an appointment, you can contact us on +34 912 468 664, on WhatsApp +34 627 396 322 or on the contact page of our website. From Mexico you can contact us at +52 55 4590 9909.