Definition & Overview

A punch graft is one of the different techniques used in hair transplantation. It works by removing a portion of skin that bears hair from a donor area. This graft is then transplanted into the recipient area, which is punched out to accommodate the graft.

A punch graft is one of the older methods of hair transplantation. It was considered as the standard method for more than 20 years and was widely used from 1970 until 1993. However, by late 1980, many doctors were already trying out other techniques due to the drawbacks of the procedure.

Who Should Undergo and Expected Results

A punch graft for hair transplant can be recommended to men and women with bald spots or suffering from hair loss. This can be due to:

  • Disease – Hair loss is sometimes a symptom of an illness, such as liver disease or cancer.
  • Scarring – Severe trauma to the head or scalp can cause scarring that leads to hair loss.
  • Male or female pattern baldness – This is the most common type of hair loss. It affects almost half of all men aged 50 and older.
  • Alopecia – A medical condition that causes severe hair fall resulting in hair loss. It is an autoimmune condition wherein the immune system attacks the hair follicles. This type of balding can affect even young patients, such as teenagers. It comes in two forms, namely alopecia areata or scarring alopecia. It can also cause complete hair loss in the scalp (alopecia totalis) or loss of hair on the scalp and body (alopecia universalis).


A punch graft can be adjusted based on the size of the donor site. As such, the procedure can be used to treat baldness of varying sizes and shapes. Some grafts are round and come in a standard size that can hold around 10 to 15 hairs. But since some of the larger punch grafts cause scarring, doctors sometimes use smaller punches. Thus, some grafts, which are called mini-grafts, are smaller and can only hold up to 4 hairs. A micro-graft, on the other hand, can hold only up to 2 hairs.

A punch graft, also known as a standard graft, is effective in placing hair in bald areas. However, its end results are not always impressive. In fact, most of the patients who underwent the procedure were said to have an unnatural-looking appearance. Their hair was widely likened to that of a doll. Although the technique was used for a long time, it never produced a natural look. This prompted doctors to seek other methods of hair transplantation.

How is the Procedure Performed?

During a punch graft for hair transplant, the following steps are taken:

  • The hair in the donor area is first trimmed short. This allows the graft to become easier to access.
  • Local anaesthesia is then administered onto the donor site.
  • A 4 mm punch is used to remove a cylindrical-shaped portion of skin with hair on it from the donor area. The skin must have around 12 to 30 hairs. The punch refers to a tube-like instrument made of carbon steel. The edges are sharp so that it can punch through the skin in the donor and recipient sites.
  • A cylindrical shape is then also punched out from the recipient area to remove the bald skin. The bald skin is then discarded.
  • The area is then covered with the punch graft.
  • If several grafts are used, they are placed around 1/8 of an inch apart in order to maintain good circulation in the scalp.
  • The scalp is cleaned and covered with a gauze dressing. In some patients, a pressure bandage may also be used for at least 2 days.
  • The donor area is left to heal on its own.


The procedure may need to be performed in two or three more sessions to achieve the patient’s desired look. The surgeon will also make sure that the grafts are placed in the right way so that the hair will grow in the right direction.

Possible Risks and Complications

Patients who undergo a punch graft for hair transplant are at risk of:

  • Having an unnatural look
  • Grafts compression – There is a risk that the graft will compress after the skin has healed, resulting in a "pluggy" look. This problem is more common among patients whose hair is naturally coarse and dark.
  • Abrupt hairline
  • Shotgun scarring in the donor area
  • Depletion of donor hair
  • Large cuts due to the punching procedure


Other problems with this technique are:

  • It destroys a large percentage of hair follicles in the donor site.
  • Since the hair roots are cut off, not enough hair grows back in the recipient site. This makes the bald spot still prominent in some cases.
  • Some of the transplanted follicles do not survive in the long term.

    References:

  • Shiell RC. “A review of modern surgical hair restoration techniques.” J Cutan Aesthet Surg. 2008 Jan; 1(1): 12-16. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2840892/

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