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Until recently, implanter pens were the Sleeping Beauty of hair restoration surgery. After Choi introduced the placing devices more than 25 years ago, only a few trod the thorny path toward using them.1,2 Not only is placing grafts with implanters trickier than with forceps, but it also increases the workload for the surgeon. The drawbacks of implanters seemed to offset their supposed beauty—that is, causing less graft damage during placing than forceps. In many clinics, the pens landed in the famous “closet for useless surgical gadgets,” waiting there for years to be awakened. Nevertheless, with the portion of FUE procedures growing, the interest in implanters has surged. Because FUE grafts are more frail and smaller than FUT grafts, even seasoned teams struggle with placing them. Many surgeons have therefore turned to implanters to prevent the frequent crushing and hooking of FUE grafts.3-6 The option to pre-make the incision and delegate placing with flexible3,7 or dull needle4 implanters to technicians has further increased the popularity of the device. Amid the new hype, however, concern is growing that implanters cause their own set of complications.8 The allegations vary, but they mostly fall into two broad categories: 1. Loading issues: damage caused by inserting the grafts into the pen. A typical worry is that grafts suffer “needle squeezing,” a crushing injury that occurs when grafts are pressed into the groove of the implanter needle. Another concern is that teams encounter difficulties with loading and can injure the grafts. 2. Placing issues: growth failures caused by planting grafts with the device due to, for example, implanters causing grafts to hook or break on a regular basis.

Does the use of implanters affect the quality of FUE grafts?