Sapphire FUE vs. the CHOI Pen

When considering a hair transplant, the implantation technique plays a crucial role in the final result. The Sapphire FUE and Choi methods are often compared because both rely on graft harvesting before implantation.

The difference mainly lies in placing grafts into the scalp.

The term DHI is sometimes used for direct implantation with an implanter pen; it does not describe a harvesting method separate from FUE. The ISHRS distinguishes these steps. A Choi implanter and recipient sites prepared with a sapphire blade are two ways to organize implantation after FUE harvesting. Their suitability depends on the patient, the plan, and the team's experience.

At NOVA Capillaire, preparing recipient sites with a sapphire blade remains our team's preferred approach to plan a hairline suited to the face and distribute grafts according to the treatment plan.

Understanding differences between Sapphire FUE and CHOI

Both techniques start similarly: grafts are harvested from the donor area, using a manual, motorized, or technology-assisted method. The real difference comes afterward, during implantation.

With Sapphire FUE, the practitioner first prepares micro-channels. With the Choi method, the graft is loaded into an implanter pen and pushed into the scalp.

This approach prepares recipient sites before placement. Angle, depth, direction, and distribution require careful planning with either approach.

Technique	Principle	Advantages	Limits
Sapphire FUE	FUE extraction followed by micro-incisions using sapphire blades	NOVA's preferred method: recipient sites prepared before graft placement	Requires extensive experience. Not easy to master
CHOI Pen	FUE extraction followed by graft loading into a needle before implantation	Implantation with a pen selected and loaded to suit the grafts	Loading and placement require care to limit stress on grafts

Sapphire FUE

Principle: FUE extraction followed by micro-incisions using sapphire blades
Advantages: NOVA's preferred method: recipient sites prepared before graft placement
Limits: Requires extensive experience. Not easy to master

CHOI Pen

Principle: FUE extraction followed by graft loading into a needle before implantation
Advantages: Implantation with a pen selected and loaded to suit the grafts
Limits: Loading and placement require care to limit stress on grafts

Sapphire FUE: precision and control

Sapphire FUE uses a sapphire blade to create micro-incisions before implantation. This step precisely prepares the site before placing each graft.

Main benefits:

precise control of angle, depth, and direction;
planning graft distribution;
hairline planning;
micro-incisions sized to suit the grafts.

Creation of recipient sites with a sapphire blade during a hair transplant — A close-up of the instrument in contact with the scalp.

Sapphire FUE’s difficulty lies in its precision. It is not automatic but depends on the practitioner’s skill, eye, and experience.

How does the Choi implanter work?

Choi: a direct implantation method

The Choi method uses an implanter pen. The graft is loaded into a needle, then directly inserted into the scalp.

This approach calls for an instrument and loading technique suited to the grafts, as well as a trained team. The tool's name alone does not predict the outcome.

Points to discuss with the team:

careful loading of each graft;
risk of compression inside the needle;
careful control of angle and depth during placement;
reduced visibility of the graft once loaded into the implanter.

Three-hair graft held by micro-forceps at the entry of a Choi pen needle — A close-up of a graft being handled.

Graft too large for the needle

The graft visible in this image contains several hairs and appears too wide to be inserted without constraint into the needle. Forcing its passage increases the risk of trauma or transection.

Points to consider with an implanter pen

Implanter pens involve loading and placement steps that require precision. Grafts are fragile: needle choice, loading technique, and storage conditions matter. These considerations do not establish that one approach systematically causes more injury than another.

A - Risks of graft compression

Loading grafts into the Choi Pen can create compression, especially with grafts containing several hairs.

A graft with three or four hairs, for example, may be too large for the implanter's needle. Forcing it into too narrow a space increases the risk of injury or transection.

The CHOI method uses a cylindrical needle that mechanically pushes grafts into the scalp.
Poor loading or an unsuitable instrument may injure a graft; the actual risk cannot be inferred from the implanter's name alone.
Instrument quality and team training deserve attention without attributing a loss rate to a category of clinics.

Comparison of graft loading in a CHOI needle and cut hairs engaged in the groove lifting a bulb — Two views of the tip of an implantation instrument.

B - Hair orientation and graft visibility

With an implanter pen, part of the graft is less visible after loading. The team must therefore plan its orientation and control placement. However, angle and direction are essential to avoid an artificial result.

On a hairline, a few misplacements are enough to make the transplant visible. Method choice should account for the area, the grafts, and the team's experience.

C - Uneven distribution of grafts

With either method, graft distribution by composition must be planned before placement.

For a natural hairline, single-hair grafts must be placed in the first line. Grafts of two or three hairs should be placed further back to increase density without creating an artificial effect.

Once a graft is loaded into the implanter, prior identification and organization of single-hair grafts remain especially important at the front.

Hairline after hair transplant showing multiple grafts implanted too close to the frontal edge — A close-up of the frontal area with a magnified detail.

D - Snagging and risk of transection

The Choi injector also presents a snag risk. During insertion, part of the graft can protrude from the needle groove and catch on the skin. This can alter the bulb's position, create traction, or cause graft injury. At this stage, the problem is not only aesthetic: it may also affect follicle survival.

ISHRS technical publications describe this type of mechanical limitation, especially when the graft is not perfectly aligned in the needle.

Comparison of an intact graft before implantation and a graft showing proximal snagging after passing through a CHOI injector — Two close-up views of grafts.

Why NOVA prefers sapphire-prepared recipient sites

FUE refers to the harvesting of follicular units. The word 'sapphire' describes the tool used to prepare recipient sites; it is not a separate harvesting method.

Each micro-incision is prepared according to the area, the natural hair orientation, and the desired result. This step helps the team plan the design and distribution; it cannot by itself guarantee density or the final appearance.

Female hairline Sapphire FUE — Work along the frontal hairline.

A - Planning hair direction and design

Sapphire FUE allows respecting the natural angle of the hair. This is crucial, especially on the hairline. A good hairline must not only be dense. It must be naturally irregular, progressive, and adapted to the face.

Sapphire FUE allows this precision work because channels are prepared before implantation. The practitioner prepares the intended direction and depth before placement.

B - Adaptability to all hair types

Sapphire FUE can adapt to fine, thick, curly, or coiled hair,, provided it is performed by an experienced team.

Each hair type requires a different strategy. Angle, density, and graft distribution must be adjusted case by case.

This technique can also be useful to correct certain previous transplants when the donor area permits.

C - Minimizing graft damage

With Sapphire FUE, the graft does not need to be forced into a needle before implantation. Micro-incisions are prepared in advance, limiting mechanical stress on the follicle. With either approach, grafts must be handled and placed with care.

This aspect is essential: a well-extracted graft but poorly handled can lose part of its potential.

Avoid misleading marketing strategies

Marketing labels do not establish that a technique is newer, safer, or more effective for every patient.

NOVA prefers sapphire-prepared recipient sites in its practice. This choice should be explained with its limits and adapted to each person's assessment.

The choice should therefore not be based on the technique's name, but on the quality of the action, graft management, and the ability to create a coherent hairline.

Before-and-after results with Sapphire FUE

The before-and-after results allow concrete assessment of transplant quality. What to observe: the hairline, density, hair orientation, and overall harmony.

Sapphire FUE enables natural results when grafts are well selected, well distributed, and implanted precisely.

Understanding these comparisons

THE RESULTS

Behind every comparison is a starting point, a procedure and a period of regrowth. These details put the images into context.

Look at the hairline and thinning areas in the photograph taken before the procedure.

These cases show transplants performed using the Sapphire FUE technique. The graft count provides context for each patient’s procedure.

The time shown indicates when the photograph was taken after the transplant. Each journey progresses at its own pace.

14months