Published On November 6, 2018. Last Updated on December 10, 2021.

Punch misalignment is a major nemesis to a successful of the hair transplant procedure popularly called follicular unit extraction (FUE). In this minimally invasive hair surgery procedure, the punch tool must score around the follicle by dissecting around the hair follicle. The score must be deep enough to separate it from all anchoring tissue attaching it to the skin in which it is contained. The operating surgeon must exactly predict the alignment of the graft inside the skin that renders it invisible using a punch tool.Punches are typically between 0.65 and 1.2mm in diameter. Using conventional punches, any slight deviation would result in transection of the graft. Dr.UGraft™ hair transplant technology features rotary punches that have largely minimized the danger of poor hair transplant growth from graft misalignment injuries.

A combination of features which render the punches and the UGraft™ system smart, to enable them to intelligently track the course of the follicles into its invisible depth of the skin in spite of misalignment from:

  1. Surgeon error
  2. Moving donor areas (eg moving abdomen during extraction of abdominal hair or a patient who cannot keep very still
  3. Unpredictable hair angulation inside of the skin

Image illustrates how basic punches may incur poor hair transplant growth from graft misalignment injuries

Image illustrates how basic punches may incur poor hair transplant growth from graft misalignment injuries

Overcoming Misalignment in Linear Scar Free Hair Transplant with Dr.UGraft™

The ability to overcome misalignment problems in linear scar free hair transplant is a big boon to both patients and surgeons. To the patient, it translates to many more surviving grafts and many more accessible grafts. To the surgeon, it means a less steep learning curve and an easier, faster, more efficient procedure that is also more ergonomically friendly.

The features of Dr.UGraft™ technology that makes this possible include these patented features:

  1. Patented flaring of the punch tip
  2. Patented and patent pending graft gripping and pulling (Graft control)features
  3. Other proprietary features
Dr.UGraft® Zeus FUE Hair Transplant System complete fluid enabled handpiece

Dr.UGraft® Zeus FUE Hair Transplant System handpiece with all accessories

The Dr.UGraft flared hybrid punch avoids graft injuries due to misalignment

Mechanism of Graft Injuries Due to Misaligned Punches

When performing non-linear scar free procedures practitioners rely on the outer hair shaft as their primary visual cue for determining the angle that should be used to align the punch device.

However, relying on the visible hair angle may not always lead to the accurate determination of where the hair follicle is positioned. Here are several types of situations that give rise to poor hair transplant growth from graft misalignment injuries.

Follicular Damage In Curly, Wavy or Sharply Angled Hair

When hair is curled, wavy or has a sharp angle, a typical follicular graft extraction punch will not have a mechanism for tracking changes in hair direction. The punch may follow a certain angled trajectory along a straight path. But if the actual follicle is situated at a different positioning or angle, whether acute, tortuous or unknown, the conventional punch will continue to descend along a straight trajectory and incur a high likelihood of severing the graft.

Graft Injury From Human Hair Transplant Error During Surgery

Poor hair transplant growth from graft misalignment injuries may also result when human hair transplant error causes the punch to inadvertently move away from the intended trajectory. Further advancement of the instrument into the skin then results in injuring the actual graft. This could be from:

  • Misjudgment of hair orientation by the surgeon
  • Shaky hands
  • Patients variation whereby the hair curvature /orientation above the skin usually used by the surgeon to guess the follicle orientation deep within the skin) does not predict the hair orientation deep within the skin. This is a very common scenario in patients with Afro-textured hair but is found in other demographics as well.

Moving Donor Areas and Wounded Follicles

Additionally, poor hair transplant growth from graft misalignment injuries may also occur when the surface of the donor region is moving. This can happen with restless patients or body regions such as the abdomen which is soft, not firm, moving as the patient breathes. The motion of body parts can easily skew the practitioner’s intended trajectory for the punch.

Dr.UGraft™ Features For Avoiding Poor Hair Transplant Growth from Graft Misalignment Injuries

The Dr. UPunch i ™ device of Dr.UGraft’s hair transplant technologies has been designed with several unique features that help prevent graft injuries due to misaligned punches.

Dr.UGraft devices are built with cutting-edge features to overcome issues of poor hair transplant growth from graft misalignment injuries.

Dr.UGraft devices are built with cutting-edge features to overcome issues of poor hair transplant growth from graft misalignment injuries.

Patented Dr.UPunch Graft Control Design Minimizes Misalignment And Hair Angulation Problems In Linear Scar Free Hair Transplantation.

DrUPunch™ collection of rotary punches are imbued with a remarkable inventive twist by way of patented combination of patent pending features that works to generate a graft pulling mini vortices that serve to drive the punch forward with minimal guidance from the surgeon. These patented features allow the device to exert a corkscrew-like grip on the tissue surrounding the hair follicle unit. With this type of hold in place, body motion, hair curvature or angle becomes a non-issue. The punch is able to maintain it’s grip as it progresses down the course of the hair deep into the skin with little or no guidance from the operator.

The graft pulling effect is delicately balanced by the punch cutting action that is pointed away from the follicle it is harboring within its lumen as the follicle it contains. The follicle advances upwards ever so slightly ahead of the cutting tip. The result is that even wildly angulated follicles would have negotiated their problematic angle points into the protective punch lumen ahead of the advancing cutting tip. This phenomenon is well illustrated in the following live video supported by a self-explanatory animation.

Patented Flared Hair Transplant Punch Tip and Hybrid Hair Transplant Punch Phenomenon Minimizes Misalignment Problems In Linear Scar Free Hair Transplantation

The most obvious way to damage a graft is to accidentally cut into it. This is what happens when misalignment occurs from any number of reasons mentioned above. Dr.UGraft™ suite of rotary punches come with a patented flaring of the tips to minimize this problem. The edging out of the tip means the cutting tip axis is substantially directed away from the follicle. The result of this flaring is that the portion of the punch that abuts the follicle is the concave portion of the punch end. By this feature, the patented feature imbues the Dr.UGraft™ rotary punches with a hybrid character which combines both sharp and dull punch features in one. This is a radical departure from traditional punches which have been traditionally classified as either sharp (eg the Cole punches) and dull/flat punches (eg Harris’s SAFE punches).

With conventional rotary Follicular Unit Extraction punches, the cutting vector points inward, towards the follicle, exposing it to a high risk of contact with the sharp edge.

Taking this into account, the rotary Dr.UPunch™ is designed to make the exact opposite scenario a reality. Instead of cutting into the follicle, it’s flared edge is able to cut away from the graft. What faces the follicle is not a sharp edge, but rather a dull, non-threatening surface. The actual cutting edge on the flare is directed away from the graft.

Video: Dr.UGraft Overcomes Misalignment Issues

Watch this video to see how general hair transplant punches require an exact alignment and are otherwise prone to severing the graft. Achieving accuracy is often a hit-or-miss situation, as the second extraction to the right shows.

By contrast, this video illustrates how the Dr.UGraft device allows for a much wider margin of error. Even with slight misalignments, the punch is still able to safely score around the follicle and separate it from it’s tissue attachments.

Due to its patented grip, pull and score features, Dr.UGraft's rotary punch is able to overcome hair transplant error from slight misalignments, while being able to safely remove the graft from the donor area

Due to its patented grip, pull and score features, Dr.UGraft’s rotary punch is able to overcome hair transplant error from slight misalignments, while being able to safely remove the graft from the donor area

Video: Dr.UGraft Technology Overcomes Misalignment Risks in Moveable Donor Areas

Some patient cases may require grafts taken from soft, moveable donor surfaces where it is very easy for punches to become misaligned due to breathing and the general softness of these areas. Watch this animated video to see how the Dr.UGraft hybrid punch is able to overcome the high potential for graft injuries in such regions.

Poor hair transplant growth from graft misalignment injuries is very likely due to extractions in highly moveable regions like the abdomen. Dr. UGraft punches is able to prevent these types of damage on softer, mobile body surfaces.

Poor hair transplant growth from graft misalignment injuries is very likely due to extractions in highly moveable regions such as the abdomen. Dr. UGraft punches is able to prevent these types of damage on softer, mobile body surfaces.

Video: Dr.UGraft Demonstrates Ease of Extraction in Stomach Donor Area

Watch this video of Dr.UGraft being used in live surgery to safely and expertly harvest stomach hair, where the donor region is prone to movement due to its softness. Despite the challenge of angulation and the lack of firmness inherent within this area, Dr.UGraft succeeds in overcoming misalignment issues.

The Dr.UGraft hybrid hair transplant punch succeeds on the mobile stomach abdominal region where other hair transplant punches fail. Even with a moving surface, this technology is still able to overcome the potential for graft misalignment errors.

The Dr.UGraft™ Zeus sends a continuous drip of fluid to the punch opening through its patented Dr.UGraft™ Nurture Hand-piece to endow Dr.UPunch tools with a unique liquid irrigation system. This fluid irrigation process creates a plane of fluid around the follicle ahead of the advancing punch tip. A tight water seal ensues upon contact and cupping with the skin. The punch’s rotation create a vortex. This vortex then enhances the graft pulling effect of the graft pulling effect of the patented graft control design of the punch. As mentioned previously, this improves the ability of Dr.UGraft™ system to auto-navigate the course of the hair under the skin with minimal operator guidance.

In cases where the donor surface is in motion, this water seal helps minimize alignment errors to minimize graft damage.

The ability for practitioners to make accurate punch alignments in minimally invasive hair transplant surgery is a skill that requires a significant learning curve. However, due to the innately intelligent features of Dr.UGraft™ suite of punches, it is possible to quickly overcome many types of common issues such as poor hair transplant growth from graft misalignment injuries.

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Video: Dr.UGraft Rotary Punch Used to Safely Harvest Chest Hair

This video demonstrates the use of the Dr.UGraft rotary instrument to successfully remove sharply angled chest hair, despite its high degree of angulation which would otherwise cause misalignment injuries with general hair transplant punches.

Dr.UGraft's flared hair transplant punch corrects for misalignment issues with sharply angled chest hair, which is otherwise highly susceptible to damage with regular hair transplant punches.

Nurture Fluid System Creates a Water Seal To Enhance Dr.UPunch

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Dr.UGraft’s flared hair transplant punch corrects for misalignment issues with sharply angled chest hair, which is otherwise highly susceptible to damage with regular hair transplant punches.

Frequently Asked Questions – Poor Hair Transplant Growth from Graft Misalignment Injuries

Which types of hair on the body tend to grow at the sharpest angles? Are these more subject to human hair transplant error?

Sharper hair angulation becomes a more serious consideration with donor regions that are further away from the head and central column of the body. Hair that grows on the scalp typically grows at about ninety degrees. The angulation of nape hair is acuter. Hair angles become sharper on the beard regions, increasingly more acute on the trunk and finally the extremities.

Additionally, people of African descent have Afro-textured hair which is curlier than the hair found in other demographic groups.

This revolutionary system solves the problem of hair angulation.