Manual vs Automatic punch for FUE?

[saska1209]

I'm considering my options and two HT surgeons are on my list with whom I would like to have FUE.

 

One major difference between the two is that one of them uses manual punch for making incisions at the donor area.

 

What punch tool (manual or motorized) is considered to be more successful? What are the benefits and drawbacks of each of them?

[Thehairupthere]

Motorized FUE devices tend to make cleaner cuts and have less tissue drag allowing the graft to be removed much easier and intact.

[scar5]

Motorized FUE devices tend to make cleaner cuts and have less tissue drag allowing the graft to be removed much easier and intact.

 

This is HIGHLY disputed by some FUE docs. The more common explanation is that a hand punch allows the doctor to 'feel' around the graft. This too could be complete BS for all I know, but it is easy to see that a lighter punch, whilst more difficult to break the skin, would be more easily maneuvered.

[Levrais]

The advantage to a motorized device is that it causes less fatigue for the doc and more grafts can be harvested in a shorter time. Critics say, as sacr5 said, that the docs can't feel what's going on as well and may end up with more transections. Also that the motorized drill may generate heat which could be bad for the grafts.

[jfables]

I've had both types done. Not so great yield with either. I would go with a FUE doc who does the extractions himself and not more than a 1000 a day.

[saska1209]

I've had both types done. Not so great yield with either. I would go with a FUE doc who does the extractions himself and not more than a 1000 a day.

 

 

Thanks guys for the responses.

 

jfables, where and which doctor did you get your HT done? And how many grafts were transplanted in each session and how much (%age) yield did you get?

 

Thanks

[Dr. William Lindsey]

I'll add my 2 cents here. Take it for what its worth and of course this is free advice so it may be worth little.

 

Dr. Feller, with whom I'm associated, taught me to do FUE's several years ago. He taught me with his Feller punches and his fancy machine...actually several prototypes and the real final product. I have used several other machines at meetings and product advertising seminars but never on actual patients. I've used a few other hand punches both at seminars and on our own patients.

 

First of all FUE is more variable in its results than strip. I really try to beat this into all potential FUE patients both at our initial consultation and at the preop consent process. I think FUE is fine for small areas, ok for medium areas, and potentially a lesser choice for large areas, but an informed patient can weigh these issues and decide the pros and cons of FUE's possibly lower yield vs. a strip scar.

 

Second, I think FUE is hard. Its hard for me and I've done a lot and it requires concentration AND it requires a good extraction team who will take the time to try to minimize follicle root damage and yet maximize yield. THAT is why FUE is expensive!

 

Third, at this point my maximum FUE/day is 1200 and often by 800 or so I'm too tired to keep going OR my transection rate starts to rise.

 

Fourth, I almost entirely use a Feller hand punch because it gives me more control over where the punch is going. When I use the automated punches, the above posters are correct, its less fatiguing, but eventually that vibration actually makes my hand tired-er than just doing it by hand, and when I go in by hand, I can steer the punch better.

 

For harder cases and the more recent black guys' FUE's that I've done, if I have trouble with the Feller punch I use a different punch. Its still the same size, but doesn't have the ventilation hole...I'm not sure why it works better for me in black skin but in the past 3 cases, it has. And I bought a bunch at the Boston meeting last year, but for the life of me I don't know who sold it...so at some point I'm going to be looking harder for the name so I can buy more. But it too is a sharp hand powered punch.

 

Conversely, I believe Dr. Feller uses the motorized punch, I'm simply not as consistent with it. But he is and many doctors are comfortable with it. But its(FUE) still a harder procedure, so make sure that whoever you work with is using what works for him/her.

 

Don't go just for some tool or type of device...I got an email yesterday from a patient who appeared ready to sign up for a smallish FUE, but had decided to wait until I, or someone else locally, had purchased ........such and such new fangled fue automated device.... Rather than wait for some device, he should choose someone whose done some FUE's successfully.

 

I hope this helps.

 

Dr. Lindsey McLean VA

[jfables]

Dr. Lindsey,

Thanks for contributing. Do you find that there is a physiological variable with FUE in that some patients will not get good yield no matter how carefully the extractions are performed because their grafts are I suppose to sensitive to handle the extractions?

Have you had patients like this who then went on to strip, and did you notice that the yield was significantly better? Thank you.

[Dr. Alan Feller]

Patients really shouldn't concern themselves too much with the techniques favored by particular doctors because in the end it's the results that count.

 

No single technique is going to be the best or the worst. If only surgery were that simple and clear cut.

 

In general, there is no right answer to the question. It really depends on the physiology of the patient you're dealing with and the skill level of the doctor and team.

 

 

I like to have multiple tools available when I perform FUE. I usually start with a manual punch and progress my way to motorized if I feel it will improve the yield and minimize follicular trauma. In general, doctors new to FUE should start with a motorized tool as it is actually easier to perform and generally gives higher yields. That said, the amateur should also hon their manual skills because, as stated, there is a better "feel".

 

Sometimes it's better to walk and sometimes it's better to ride a motorized vehicle, it just depends on the terrain. Same thing for FUE.

 

In the end, again, just look at the results from the doctors you are considering. If you see CONSISTENTLY good results then that's the clinic you go for irrespective of HOW they do it.

 

Dr. Feller

[Dr. William Lindsey]

JFABLES

 

I only have one guy who we just couldn't get FUE to work on at all. It was a young man who'd had radiation for a brain cancer. I started out with FUEs and couldn't get anything. We converted to strip, and did 2 strip surgeries which grew faster and better than the typical non irradiated scalp. And on the second case I tried 100 FUEs, all were easy to harvest, and appeared to grow.

 

I have a second young man who we just treated after cancer treatments 2 weeks ago. So I'll post his results when they appear.

 

Our medical student is writing this up for presentation at the Triological Society this winter.

 

Sorry JFables, but this is all I can really say to your question.

 

Dr. Lindsey McLean VA

[jfables]

Thanks for the info, Dr.Lindsey.

It would be interesting to look at the cancer patient's case.