What is the DHI Technique?

In everyday language, DHI (Direct Hair Implantation) is often marketed as a standalone “different hair transplant method,” but the definition by international authorities is clearer: the DHI Technique means creating the recipient site incision and placing the graft simultaneously using a sharp-tipped implanter pen. This is not a donor harvesting method like FUT (strip) or FUE (individual graft harvesting); it is a placement technique. The ISHRS clearly states that some centers use the term “DHI” both to describe an immediate-implantation workflow and the use of a sharp implanter; however, DHI should not be marketed as a separate “method” on its own. It also emphasizes as an advantage of implanters that the follicular bulb is not grasped directly with forceps, thereby potentially reducing trauma. ISHRS

Brief history: The idea of a sharp implanter was described in Korea in the 1990s by Prof. Choi and his team. Using the Choi hair transplanter, single-hair grafts were reported to be placed with more controlled angle and depth into areas such as the hairline, eyebrows, and eyelashes. This approach was adopted early especially for straight-thick Asian hair; with the widespread adoption of FUE in the 2000s, implanter-based implantation also gained broader use in the West.

How is the DHI Technique performed? Steps and critical nuances

In the DHI Technique, the surgeon (and team) uses a sharp implanter (Choi-type or equivalent) of appropriate diameter. The assisting team loads the grafts (follicular units) into the implanter’s lumen before they dry out and without applying pressure to the follicular bulb. The surgeon enters the recipient area in a single motion, releases the graft at the planned angle–direction–depth, and withdraws the needle. In experienced teams, a 2-1-1 or 3-1-1 circulation (loading–placing–checking) maintains rhythm and speed. The short-acting vasoconstrictive effect of epinephrine combined with local anesthesia is paired with a segmented placement plan and bleeding control. With proper tip selection and depth control, dense packing and natural orientation can be achieved together.

Implanter vs. forceps: ISHRS technical assessments report that high-quality comparative evidence is limited to support the claim that implanters reduce trauma or significantly increase survival compared to forceps. Although the biological rationale is strong, more comparative studies are needed before stating “an implanter is definitely superior.” (ISHRS HT Forum)

Graft trauma reduces survival: Experimental and clinical data have shown that even minor injuries such as partial paring, graft fracture, or damage to the follicular bulb (and dermal papilla region) can significantly reduce survival. Therefore, regardless of the instrument, atraumatic graft handling is essential. (PubMed)

Clinical evidence: an overview of data on the DHI Technique / implanter technique

– KNU implanter (early data in Asian hair): In a 2001 study, follicular unit transplantation with the KNU implanter reported hair-count-based survival of about ~92% at 6 months and ~90% at 12 months, indicating that implanter placement can yield satisfactory mid-to-long-term growth.
– Immediate implantation (DHT/DHI Technique workflow): A 2013 DHT series noted that immediate implantation with FUE is feasible in practice and aims biologically to reduce out-of-body time and prevent drying. However, in today’s slit and sapphire approaches, out-of-body times are also minimized.
– Practical guide with sharp implanter: A 2023 peer-reviewed how-to article emphasized that with correct tip diameter–depth–angle control and good team organization, high-density placement can be performed safely; however, effective management of bleeding and graft popping requires experience.
– Recipient site techniques (hole vs. slit; coronal vs. sagittal): A 2023 prospective split-scalp comparison showed that the hole technique can shorten recipient-site preparation time versus the slit technique, without claiming a clear superiority in growth/survival. Theoretical work on slit design suggests that coronal orientation may, in some cases, reduce vascular injury and facilitate direction control; yet comparative clinical data remain limited.
– Graft trauma and survival: A 2021 comparative study demonstrated that survival is significantly reduced in grafts with paring damage, fracture, or follicular bulb injury compared with intact grafts. This reinforces the message that gentle tissue handling is critical regardless of the placement instrument.

Potential advantages of the DHI Technique

1. Respecting existing hair: In cases requiring densification among existing hairs, single-step placement rather than incision + forceps can make the field more predictable and atraumatic. This may particularly enhance naturalness in the crown.
2. Angle–direction–depth control: With an implanter, these three parameters are managed in the same maneuver; since the follicular bulb is not compressed by forceps, the potential for mechanical trauma is reduced.

Limitations and learning curve

– Bleeding and “popping”: Because incision and placement occur simultaneously with a sharp implanter, field management can be challenging in bleed-prone skin; with inexperienced use, popping (neighboring grafts being displaced) may increase. This can negatively affect density and survival.
– Speed/logistics in large areas: For very wide areas with high graft counts in a single session, some teams may find pre-made incisions + rapid placement protocols more efficient. The choice depends on the surgeon’s experience and team organization.
– Evidence-based claims of superiority: As of today, there is limited high-level evidence to conclude “implanter = meaningfully higher survival.” Technique selection is mostly determined by case characteristics and surgeon preference.

Small areas and density increase

In narrow areas especially when “dense packing” among existing hair is targeted single-step placement with a sharp implanter can offer practical advantages in terms of respecting neighboring follicles and controlling direction. When combined with tip diameter–graft thickness matching, depth control, and bleeding management, this approach minimizes complications.

Recovery, side effects, and safety

After the DHI Technique, edema, scabbing, temporary erythema/itching, and mild pain may be expected; folliculitis, prolonged bleeding, infection, or shock loss may rarely occur. The risk profile follows principles similar to FUE or FUT; well-planned anesthesia, controlled hemostasis with epinephrine, proper washing/care protocols, and the patient’s medication management (especially anticoagulants/antiplatelets) reduce complication rates. Reviews on FUE also report that careful planning and atraumatic technique help keep complications low.

Team standardization

Tip diameter graft thickness matching, depth stoppers, a clear understanding of the superficial–deep plane difference, the loading–placing circulation, and bleeding control are key elements of success in the DHI Technique. Sharp-implanter guides note that when these details are managed correctly, a balance of speed + density + direction control can be achieved; otherwise, popping and bleeding issues may become prominent.

Frequently Asked Questions

Is the DHI Technique better than FUE?

The DHI Technique is a placement technique, whereas FUE is a harvesting method. High-quality comparative data clearly proving the DHI Technique’s superiority over FUE are limited; outcomes are mostly determined by the surgeon’s mastery of the technique, atraumatic handling, and planning.

Is higher density possible with the DHI Technique?

Experienced teams can achieve high-density placement with correct tip and depth control; bleeding management and team synchrony are critical. However, similar density can be achieved with all implantation approaches. At this stage, the team’s experience matters more than the tool.

Does the DHI Technique reduce bleeding?

Because incision and placement are simultaneous with a sharp implanter, hemostasis requires careful management; anesthesia-epinephrine planning and segmentation can keep this under control, but reduced bleeding is not guaranteed in every case.

What proportion of grafts will grow?

Depending on the center and technique, studies with implanters have reported hair-count-based growth rates of around ~90% at 6–12 months. That said, different hair types, skin biomechanics, and surgical protocols influence results. There is no definitive evidence isolating technique as the determining success factor. When performed correctly by experienced professionals and in the absence of complications, overall success typically exceeds 90%.

Does it matter how you prepare the recipient area?

Each option hole vs. slit, or coronal vs. sagittal has pros and cons. A 2023 prospective split-scalp study showed a time advantage for the DHI Technique; stronger evidence is still needed for a clear superiority in growth. Theoretical work on slit design suggests that coronal orientation may reduce vascular injury in some scenarios.

Conclusion: DHI Technique

The DHI Technique is an implantation approach in which follicular units harvested with FUE are placed in a single motion via a sharp implanter, aiming to optimize time, minimize mechanical trauma, and control angle/depth. The biological rationale (short out-of-body time + minimal manipulation) is strong, and practice guides and clinical series show that, with proper protocols, high growth and natural density can be achieved. Nevertheless, current literature does not support a definitive claim of superiority; experience, team standardization, and individualized planning remain the strongest determinants. When planning, hair type, target density, area size, vascular anatomy, and comorbid medical factors should be assessed; the surgeon’s command of the technique and atraumatic tissue management come first.

Note: This content is for informational purposes and is not a substitute for medical advice. Diagnosis, indications, and treatment decisions require evaluation by a qualified physician. At Hair of Istanbul, the choice of technique is individualized by jointly assessing hair type, pattern of loss, target density, and expectations.

The pen used in the DHI Technique (Image 1)