Optimal FUE Punches and Quality Extraction - Dr. Jean Devroye

Sep 14 / Skillmed Institute

FUE Punches

The informative online course featuring Dr. Jean Devroye investigates the world of Optimal Follicular Unit Extraction (FUE) Punches and Quality Extraction. [1] Participants explored the nuances of FUE punches and their role in achieving excellence in the field of hair extraction. An acknowledged expert in the industry, Dr. Jean Devroye, graciously shares his insights on precision cutting and the crucial need for quality extraction in the constantly changing field of hair restoration.

Dr. Devroye's Journey and Expertise

With a doctorate in medicine, surgery, and obstetrics, Dr. Jean Devroye brings to the table an extensive career spanning more than 25 years. He has demonstrated an unwavering commitment to achieving the highest performance standards throughout his journey. This dedication is evident through his mastery of FUE techniques and his collaborations with esteemed professionals worldwide. Dr. Devroye's expertise truly shines in intricate procedures, such as eyebrow, beard, and moustache transplantation. His approach incorporates both FUE and FUT techniques, allowing him to consistently deliver outstanding outcomes.

Core Aspects of FUE Punches

During his presentation, Dr. Devroye examines the fundamental elements of FUE punches, which introduce a distinct challenge in the quest for precision cutting and high-quality extraction. [2] This challenge involves striking a delicate balance among various factors, including scar size, transaction rate, graft count, and ease of extraction. A central element within this delicate interplay is the complex "splay," referring to the conical shape at the base of the follicular unit, which intricately connects different structures.

Understanding "Splay" and Extraction Depth

In the context of hair transplantation, "splay" refers to the conical shape present at the base of a follicular unit within the scalp. [3] This structure's intricate interconnectivity poses challenges during the extraction process. The splay connects hair follicles, sebaceous glands, and other elements, making precise extraction more complex. [4]

Moreover, extraction depth refers to the level at which a hair follicle is removed from the donor area of the scalp during a hair transplantation procedure. [5] The depth affects the survival rate of the graft, scarring, and overall procedure success. Shallow extractions offer minimal scarring but may increase the likelihood of transaction (partial graft removal). Deeper extractions may reduce transaction rates but could result in larger scars.

Achieving an optimal balance in extraction depth is crucial to ensure graft survival while minimizing the negative impact on the donor area.

Evolution of Punch Designs: Sharp, Blunt, and Hybrid Punches

Punches are surgical instruments used to extract follicular units during FUE procedures. Sharp punches were initially popular due to their speed and ease of use. [6]

However, their tendency to cause high transaction rates and compromise graft quality led to the development of alternative punch designs. Blunt punches, introduced by Dr. Jim Harris, aimed to reduce transaction rates and improve graft quality by minimizing tissue trauma. [7]

Hybrid punches combine the advantages of both sharp and blunt punches, highlighting the dynamic evolution of punch designs in the hair transplantation industry.

Historically, sharp punches were the go-to choice due to their swiftness and user-friendliness. However, their application came at a cost, with high transaction rates and compromised extraction quality often arising due to the challenges posed by splay. Dr. Jim Harris introduced a revolutionary shift through the concept of blunt punches.

This alternative approach facilitated a more cautious extraction process, mitigating the impact of splay and leading to lower transaction rates and improved overall extraction quality. Dr. Harris' proposed method entailed using a sharp punch for initial scoring followed by a blunt punch for extraction, a strategy aimed at enhancing the extraction process.

Dr. Devroye underscores the significance of striking a delicate balance between punch geometry and depth. Achieving the ideal combination of low transaction rates, minimal scarring, and abundant graft counts requires meticulous consideration. An intriguing paradox emerges as he highlights that while smaller punches might minimize scarring, they simultaneously increase the risk of higher transaction rates. In contrast, larger punches may decrease transaction rates but come with the drawback of potentially yielding more conspicuous scars.

Another crucial consideration in the extraction process is the curvature of grafts. [8] Mismanagement of graft curvature can significantly complicate the extraction process. Dr. Devroye's meticulous research underscores the multifaceted nature of achieving optimal graft quality, acknowledging the presence of numerous variables at play.

The Movement Technique: Rotation, Oscillation, and Vibration

Extraction: The T-shaped Punch

The T-shaped punch design amalgamates cutting and dissecting into a single step.

Graft Quality and Punch Geometry

Central to Dr. Devroye's presentation is the critical interplay between punch geometry and graft quality. [10] Through a series of punch designs featuring varying diameters, he effectively illustrates punch size's tangible impact on graft dimensions and quality. This in-depth examination yields invaluable insights into maintaining an optimal balance between graft thickness and the surrounding tissue.

Highlighting Graft Chubbiness: A Vital Aspect

Dr. Devroye's research underscores the significance of graft chubbiness, signifying the amount of surrounding tissue encompassing a graft. His findings affirm that grafts with greater chubbiness exhibit enhanced survivability and growth rates. This pivotal observation underscores the pivotal role of graft quality in dictating the triumph of transplantation outcomes.

Insights from Dr. Devroye's Work

Drawing from a recent comparative study by Richard C Shiell, the history of the hair restoration industry has not been smooth. [11] The field has seen a number of significant developments from the era of punch grafting to the present-day methods of follicular unit hair transplantation.

Innovative Progress: A Testament to Dedication

Dr. Devroye's contributions uncover a dominion of innovative progress in hair transplantation. His emphasis on punch geometry, graft chubbiness, and evidence-based research further cements his status as an esteemed leader in advancing the frontiers of hair restoration techniques.


The landscape of hair transplantation remains dynamic, defined by a relentless pursuit of innovation and continual refinement.

Visionaries like Dr. Jean Devroye play a pivotal role in propelling the industry forward by introducing groundbreaking concepts, novel techniques, and ingenious movement strategies. The insights shared by Dr. Jean Devroye during this online course provide a profound understanding of the world of FUE punches and the pursuit of excellence within hair transplantation.

Thank you again Doctor!
Skillmed Team.


  1. Sharma, R., & Ranjan, A. (2019). Follicular Unit Extraction (FUE) Hair Transplant: Curves Ahead. Journal of maxillofacial and oral surgery, 18(4), 509–517. https://doi.org/10.1007/s12663-019-01245-6

  2. Gupta, A. K., Love, R. P., True, R. H., & Harris, J. A. (2020). Follicular Unit Excision Punches and Devices. Dermatologic surgery: official publication for American Society for Dermatologic Surgery [et al.], 46(12), 1705–1711. https://doi.org/10.1097/DSS.0000000000002490

  3. Dua, A., & Dua, K. (2010). Follicular unit extraction hair transplant. Journal of cutaneous and aesthetic surgery, 3(2), 76–81. https://pubmed.ncbi.nlm.nih.gov/21031064/

  4. Trüeb, R. M., Henry, J. P., Davis, M. G., & Schwartz, J. R. (2018). Scalp Condition Impacts Hair Growth and Retention via Oxidative Stress. International journal of trichology, 10(6), 262–270. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6369642/

  5. Garg, A. K., & Garg, S. (2018). Donor Harvesting: Follicular Unit Excision. Journal of cutaneous and aesthetic surgery, 11(4), 195–201. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6371717/

  6. Mohmand, M. H., & Ahmad, M. (2019). Battle of the Punches: Comparison of transection rates of different punches during FUE. Journal of cosmetic dermatology, 18(6), 1837–1840. https://doi.org/10.1111/jocd.12957

  7. Garg, A. K., & Garg, S. (2020). "Combination Grafting" of Scalp and Body Hair to Enhance the Visual Density of Hair Transplant and Coverage of Higher Grade of Baldness. Journal of cutaneous and aesthetic surgery, 13(2), 163–169. https://shorturl.at/ouzMZ

  8. Jimenez, F., Alam, M., Vogel, J. E., & Avram, M. (2021). Hair transplantation: A basic overview. Journal of the American Academy of Dermatology, 85(4), 803–814. https://doi.org/10.1016/j.jaad.2021.03.124

  9. Sethi, P., & Bansal, A. (2013). Direct hair transplantation: a modified follicular unit extraction technique. Journal of cutaneous and aesthetic surgery, 6(2), 100–105. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3764754/

  10. Trivellini, R., & Gupta, A. K. (2020). The edge-out punch: An advancement that reduces follicular unit excision hair transplantation transactions. Journal of cosmetic dermatology, 19(9), 2194–2200. https://doi.org/10.1111/jocd.13532

  11. Shiell R. C. (2008). A review of modern surgical hair restoration techniques. Journal of cutaneous and aesthetic surgery, 1(1), 12–16. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2840892/