Direct Hair Transplantation: A Modified Follicular Unit Extraction Technique

  • Direct Hair Transplantation: A Modified Follicular Unit Extraction Technique

    DHI refers to a different implantation technique during the FUE transplantation.

  • The grafts are extracted at first using the micromotor assisted punches just as it is done during a FUE transplant. With this technique, there is no need to make incisions in the recipient area.
  • The grafts are first placed into specific implanter pens with a hollow needle connected to a tube and plunger device. These implanter pens are also known as Choi implanters.
  • The grafts are inserted gently within the hollow needle, which is positioned at the tip of the implanter pen.
  • Subsequently, the needle is inserted at an accurate angle of 40-45 degrees into the scalp, thus making the incision site then the graft is implanted by pressing down on the plunger.



During a DHI procedure, an usual amount varying from 2 to 6 Choi implanters and approximately 15-16 needles are concurrently used, with the device coming in a variety of needle sizes to fit the follicular unit grafts.


To evaluate the efficacy and feasibility of direct hair transplantation.

Subjects and Methods:

The patients willing to undergo hair transplantation by the technique of follicular unit extraction were enrolled for the surgery. After administration of local anaesthesia, the recipient sites were created. Thereafter, the processes of scoring the skin with a motorized punch, graft extraction and implantation were performed simultaneously. These patients were followed up to look for the time period of initiation of hair growth, the growth achieved at the end of 6–8 months and any adverse events. The results of patients with noticeable improvement in the photographs and reduction in baldness grade were taken as ‘good’, whereas, in other patients, it was classified as ‘poor’.

  • The main advantage of the implanter is that more grafts can be embeddded in a cm2 of recipient area thus providing a denser transplantation of FUs. This trait is especially advantageous for the front hairline.
  • The major disadvantage of the DHI technique is; it is generally much more costly procedure when compared to the other hair transplantation methods. Furthermore, incorrect graft placement into the implanter pens and inappropriate bending of the grafts during implantation may cause excessive trauma to the delicate hair follicles resulting in death of the follicles.

Sapphire FUE or DHI-FUE ?

  • Because both Sapphire FUE and DHI-FUE have almost the same advantages; opening more channels and implanting more grafts in a given cm2 of the recipient area, both provide denser and smoother front hairline plus a dense transplant for mild forms of hair loss, grade 1 through grade 3.
  • In our clinic, Sapphire FUE does not add any cost to the standard FUE. We use it routinely in appropriate candidates without extra charges.
  • The Sapphire FUE also provides one more advantage over DHI. There is no risk of damaging the delicate hair follicles unlike the DHI implanters which possess this risk during both the graft placement into the implanter and during the placement of the graft  from the implanter to the recipient area.


Sapphire-tip FUE provides the same dense implantation as the DHI does.


  • The Sapphire tip has proved its efficiency to provide a maximally dense transplant over the front hairline and even creating a dense vertex whirl, and its results are very comparable with those of the DHI implanters. Considering that there is no extra cost to the Sapphire FUE, whereas there is too much extra cost for the DHI procedure to get the same result; we do not see much reason to get a DHI procedure. Anyway we provide DHI-FUE in patients who opt for it.

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