what is currently considered the best FUE extraction tool?

[recedingboy]

In terms of maintaining the integrity of the graft, while also taking into account scar size?

 

Does anyone know what tool Dr. Bisanga uses?

[Levrais]

Do you mean which type or which size? I know he uses a manual punch and not the powered one.

[recedingboy]

Do you mean which type or which size? I know he uses a manual punch and not the powered one.

 

balance between size and maintaining the integrity of the graft.

[Levrais]

Well as far as the size, he uses between .75 and .8 depending on the hairs per graft and characteristics, etc

[Dr. Glenn Charles]

The best FUE devise available is the one that any particualr Hair Restoration physician uses well and is very successful in producing quality grafts with minimal transsection. I have tried several FUE devices. I prefer and currently use the Harris SAFE system.

[recedingboy]

Dr. Charles/Others:

 

Is there a benefit in using a manual tool vs. motorized in terms of re-growth rate?

[superice]

what is the ideal punch size ?

[Dr. William Lindsey]

Dr. Charles and I have the same idea. I was going to post a line that said "the one that works best for your doctor". But he beat me to it.

 

I use Feller hand punches 90% of the time. I'm inconsistent with the motorized punches except in really straight haired guys.

 

For really curly roots I use a different hand punch, but off hand I can't recall the maker.

 

More important the the punch name however it that your doctor feel comfortable with it AND the extracting technicians be skillful. There is a HUGE learning curve with FUE. And even in the most experienced of hands, its a harder procedure than strip, with more variable results.

 

Dr. Lindsey McLean VA

[recedingboy]

With complete respect to all other surgeons on here, when it comes to FUE, most posters seem to feel that Dr. Bisanga from the BHR clinic produces the most consistent, natural, and productive results.

 

Dr. Bisanga uses a manual punch extraction tool. I believe many other European clinics do as well, such as Prohairclinic. Most North American surgeons seem to use a motorized punch tool.

 

Is use of a motorized punch done so that it is less time consuming/fatiguing to a surgeon, or that it is truly what they get better results with?

 

Here are two videos of the extraction process, one with a motorized tool, one with a manual tool. Both are by respectable clinics.

 

I have my opinion on which looks like less invasive/cleaner procedure, I'll let you guys form your own opinions.

 

(Link removed by moderator - See Terms of Service)

 

Follicular Unit Extraction Video - True & Dorin - True & Dorin Medical Group, PC Video Website

Edited July 20, 2011 by TakingThePlunge

[scar5]

The docs are going to drive us around the bend with this one (a circular argument);

 

a: Which way is the fastest to town?

b: It depends, each has his own way, his own preferred route.

a: Well then, which way is generally considered to be the fastest, hands down?

b: The way which is fastest, of course!

a: Look, Damn it, just tell me straight, what is the most popular way?

b: Well, personally, I like 'this' way, but hey, that's just me...but as I said, each to his own

a: Wow

b: Yes, it's a highly refined art and its a personal choice. Do you feel better now?

a: Yes..how much for one graft?

 

We have to use some deductive and inductive logic here, but truth be told, I wonder if we'll ever get around to it. I wonder how much an instrument would cost, the one method that is patently the best - could it ever be established? Would it it be wise? economic for clinics to disclose? Whatever, it holds FUE back. (We never here about strip scalpels being discussed)

 

We have four classes

 

1) Simple sharp punch,

a) that the doc twists with him fingers or b) punches straight down

2) Rotary mechanized punch that

a) Spin in one direction b) Toggle like a washing machine

3) Complex sharp/blunt punch

a) Where a sharp edge breaks the skin and a blunt edge takes over deeper

4) Hand held hose attached to a machine, a.k.a. 'Neograft' machine and its predecessor, the '(just forgot the name)

a) Where the instrument is not fixed to the machine

b) and the graft is sucked up a hose

5) Mystery instrument classes

a) Several docs/clinic have instruments they won't tell us about.

 

Obviously, transection and scarring are the only two worries. But also, we must consider the prospect that one method may have indirect effects on graft survival too. and even the way each method effects the logistics of a clinics operation

a) Like which method will encourage a doc to do less FUE,

b) Encourage them to let techs do extractions

c) Mean that a higher number of grafts will be out of your head for longer

d) Mean that the doc had access to the numbers of grafts likely to be obtained at different stages of the procedure so you don't end up with a 'weak side' simply due to the fact that they ran out of grafts and it was six o'clock.

 

1) Repetitive Strain is a real worry for docs

2) Initial costs of instruments vary dramatically

3) Patents apply

4) Prestige and 'Brand' are important for some instruments/Docs

5) Conversely, secrets are also important

 

So say we could establish the ideal instrument for 50 grafts, but is it the ideal instrument for 5000? Strictly, it should be, because transection and scarring should be the only issue, but because of the above (and more) it isn't. Damn.

 

Of hand I like the hand punch, but each doc will get tired quickly and most likely injured because how many times can a docs fingers spin over that little punch before he says, damn it, I'm getting RSI, why didn't I tell this dude to get strip?

Then Neograft is a good idea, because the weight of the device is not in the hands of the operator - it's just the end bit. But I hear the hose dries out the graft - on the other hand, who says so? Oh..that guy with a patented punch. duh..makes sense. What about several unmentionable clinics/docs? Aren't they are getting some good damn results recently - even the one large evil one. Mnn, but they are secret. One of them was a pioneer of FUE and he STILL won't tell the others what he does, how he does it. Can't blame him I guess...but hell. Those rotary punches, the unidirectional ones run by techs look bad.. They look relatively heavy, top heavy, so whilst the tech can easily change the angle, he/she can easily 'mis-change' the angle too. Mnn. One famous doc using them doesn't seem to show FUE results much these days. Now for the SAFE and Feller punches. What can we say about them? I just don't know. They are patented. They are brands! They are brands with doctors names on them. Damn..I'm scared to even question them. Feller's punch was designed to make it easier and reduce the cost. So have the costs come down? Speaking of costs, I remember when the Axis of EVIL cooperation charged $12 a graft, then went to $7 overnight. Did they change punches? Did they go rotary? The RSI strain thing is real. Whilst I think the hand punch, simply twisted, back and forth, by an experienced doc might be best, it is a limited way of thinking because that experience obtained by a doc comes at a cost. He/She will do less FUE because of it and he/she will discourage you from FUE because of it. So, I go back to the Harris/Feller type things and wonder about the Neograft. Is it as notorious as it is made out to be?

What a rant. Damn it.

[Levrais]

From the stand point of the Doctor the powered punch would certainly be less fatiguing. For the patient as well since they can probably get more grafts in a shorter time. The argument against the powered drill is that it produces heat which can be harmful to the grafts. I liked that video with Dr True.

[mattj]

The argument against the powered drill is that it produces heat which can be harmful to the grafts.

 

It seems to me that a powered instrument wouldn't produce enough heat that couldn't be cooled frequently through immersing the tip in water after every X amount of extractions. I don't know if this is practical or not but it seems reasonable that if a powered tool has benefits then the heat drawback could be overcome in this way.

 

I'm just thinking out loud really...

[recedingboy]

It seems to me that a powered instrument wouldn't produce enough heat that couldn't be cooled frequently through immersing the tip in water after every X amount of extractions. I don't know if this is practical or not but it seems reasonable that if a powered tool has benefits then the heat drawback could be overcome in this way.

 

I'm just thinking out loud really...

 

I believe Dr. Rahal uses a powered tool. Does he find heat to be a concern, and if so what is done to address it (if anything).

[Blake Bloxham]

I've always appreciated the presentation Dr. Feller shared when he began using the powered extraction tool he designed. A lot of thought went into neutralizing some of the negative, destructive forces (heat, friction, tension, torsion) associated with traditional powered devices.