Having the ability to correct punch misalignment, on the fly, which would overcome angulation issues during the dissection of hair grafts, would be an incredible advancement in the field of surgical hair restoration. Essentially "dummy proofing" the dissection and extraction process, allowing practitioners to remove intact, non-transected or damaged hair hair follicles every time would be a game changer. IAHRS accepted member Sanusi Umar, M.D. discusses his new FUE punch and how he believes it will help to overcome many of the issues being seen with more traditional punches.

Spencer Kobren: The point is you're not actually having to go in there and twist that punch. You're able to just plunge the punch into the scalp, into the tissue. The punch, essentially does the work because of the threading.

Dr. Sanusi Umar: Right. The punch does that. It pulls the graft, it cuts around it and releases it. It avoids the transsection. It overcomes the issue of splay. It overcomes the issue of impaction. The issue of torsion is completely solved because of another aspect of the punch where you have an expanding volume. So as the graft goes into the punch, it has more space to expand.

Spencer Kobren: And you're not dealing with any possible heating issues?

Dr. Sanusi Umar: No. No heating.

Spencer Kobren: Right.

Dr. Sanusi Umar: In addition to that because this punch is attached to the Ugraft machine, which hydrates the graft as you go on. So there is a steady drip of fluid that lubricates the grafts-

Spencer Kobren: So there's not desiccation. You're not getting denuded grafts. 

Dr. Sanusi Umar: Not at all. The grafts are being healthy and at the end of each core, there's a drop of fluid deposited into the hole where the graft is. When you do FUE, you score several grafts and then you pull them out.

Spencer Kobren: Right.

Dr. Sanusi Umar:  That time it takes for you to do the scoring and then pull them out, some grafts will get compromised. 

Spencer Kobren: You know what I noticed, and this is something you brought up the fact that you provided video and animation, you guys were able to actually, essentially just extract grafts by rubbing your thumb over the top of the graft without any pulling action.

Dr. Sanusi Umar:  Exactly.  

Spencer Kobren: You know-

Dr. Sanusi Umar: I call that the FUE Swipe Maneuver.  This FUE Swipe Maneuver really will not be the case if you're not using an intelligent punch. 

Spencer Kobren: Well, normally, forceps have to be used and there is a degree of ... You have to separate the tissue with pulling. 

Dr. Sanusi Umar: Yes. So with this technology, the way it works is, by the time you finish scoring almost half of the graft's already free and ready to come out.

Dr. Sanusi Umar:  So we do that by simply swiping the area. By so doing, you find that a lot of the grafts are degraded in that way. So there are many aspects of this technology that's quite novel to what has been practiced today as a state of the art. With the integration to the Ugraft revolution machine that does the hydration, hydrating the graft as you go and when your grafts come out with the punch, what happens with all FUE, you simply just use your foot pedal to eject the graft using pulse fluid ejection. That, again, the only type of technology that does that in the FUE field today. We don't use suction to pull the grafts out. We do not use forceps, or anything manual, to remove grafts that are impacted in the punch.

Spencer Kobren: That's extremely unique. Here's the thing, the suction aspect of things is, it's such a ... there's so many variables when you're using, even different degrees of suction, and there is a school of thought that suction absolutely causes grafts, even if it's just minimal, it causes the desiccation and drying of grafts. There are companies that have tried to work through that by kind of using a ... what is it called, I want to call it reverse osmosis, but that's probably the wrong term, but there are essentially using fluid to create suction, so that there's no airflow coming through the tube. That was a smart, I think, move forward. But, this ... just from the way that it appeared, and just the way that you describe it, seems like it's kind of a simpler solution. Even though it may be more complicated to develop, it seems like the logical endpoint.

Dr. Sanusi Umar: Yes. The idea of having, what I call and intelligent punch, is the concept of a hybrid punch with a thread in that pulls grafts on its own. That gives the punch an intelligent attribute. Now, the question is, well, if it's just a matter of pulling the graft, as you score around it, why don't you just add suction? The problem with that is that if you are doing that that extraneous or external suction, it's not as coordinated as if, what you have with the punch doing it on its own. Because your suction can be too much, in which case what happens is you have a plucking action-

Spencer Kobren: Which can cause tearing, and just the air being sucked through is going to cause drying. 

Dr. Sanusi Umar: Or you end up with just some hair shaft with very little texture around them. That's the effect of plucking. So that's when the suction now is more than you need, right? So you have that. You're going to have a lot of diluted grafts that are not likely to do us well. It doesn't matter how the suction comes, whether the suction comes with fluid, or with air because the plucking effect is still there. We're aware of that, and that's what we avoided in this situation. 

When you have a punch that has intelligent properties, it overcomes that. That's not an issue because the punch doesn't rely on any external source of suction, or pulling action, to do what it does. It just does it on its own. It does it just at the right time.