Jump to content
Mickey85

The ultimate manual versus motorized FUE thread

Recommended Posts

Hey guys, one of the most common questions in regards to FUE is the pros and cons of both the manual and automated/motorized punches used for extractions. In this thread we can discuss both and I will also be listing exact quotes from prominent FUE doctors pertaining to their preferences and reasons for and against. Quotes will be in no particular order in regards to whether the Doctor is part of the coalition or not or whether I prefer a certain Doctor's work more or not. Will be totally arbitrary and unbiased. We can also discuss what we think of manual, motorized, ARTAS and Neograft.

Overview:

 

-Manual punches:

yv1LtWJ.png

CIT handle with CIT sharp tip punch used by many of the top manual FUE surgeons

 

Manual punches are operated entirely by hand and contain no moving parts although some have adjustment options for depth. Many surgeons have commented on the manual punches ability to provide tactile feedback as they punch the graft. Avoids the issue associated with motorized punches such as overheating.

 

rpVKN3Zl.png

Versi handle(no tip shown but usually sharp tip) used by many of the top manual FUE surgeons

 

Doctors using manual punches:

-Feriduni(CIT handle and punch)(circa 3,000 grafts per session, can split over multi-days)

-Bisanga(Versi handle)(circa 1,500 grafts per day, can do multi-day sessions)

-Mwamba(CIT handle/punch, Versi handle/Super punch, uses motorized LEAD system also)(1,000 grafts a day and can do multi-day sessions)

-Diep(Custom design, uses motorized also)

-Maras(CIT/Ellis handles and punches)(2500 to 3500 grafts over a period of 2 days)

-Reddy(Versi handle and punch)

-Lorenzo(CIT handle and punch, Choi implanter pen)(circa 3,000 grafts per session)

-Erdogan(Versi Handle, sharp and blunt punches)

-De Reys(Versi handle and punch)(circa 1,500-1,800 per day, can do multi-day sessions)

-Dr Keser(Undetermined manual punch and handle)(circa 800 grafts per day, can do multi-day sessions)

-More to be added

 

http://www.youtube.com/watch?v=H5g7pKwR0fQ

 

Advantages:

-Provides the surgeon with tactile feedback in regards to resistance in tissue and hair shaft

-Impervious to overheating as there are no moving parts.

 

 

Disadvantages:

-Can take longer and hence fewer graft in one session

-Fatigue can be more of an issue

___________________________________________________________________________________________________

 

 

-Motorized punches:

PBMmF7el.png

Harris SAFE motorized system with blunt tip punch

 

 

Much like the name implies, motorized punches use mechanically and electrical assistance. This allows the device to spin much faster than the manual method which can equate to harvesting more grafts in less time and grafts being out of the body for less time. Issues like overheating and inability to feel when the punch had dulled can occur.

 

 

4SiIScS.png

CIT PCID system with sharp tip punch

 

Doctors using motorized punches:

-Hakan Doganay(Undetermined)

-Ron Shapiro(SAFE system, also use ARTAS)

-Alexander(Undetermined motorized device)

-Cooley(undetermined motorized device and also ARTAS)

-Wesley(SAFE system)(circa 2,000 grafts a day maximum)

-Feller(Feller motorized punch)(circa 800 grafts per session, no split days)

-Umar(Undetermined)

-Paul Shapiro(SAFE system, also uses ARTAS)

-Harris(SAFE system, also uses ARTAS)

-Mwamba(LEAD System, uses manual also)

-Diep(Undetermined, uses manual also)

-Devroye(Custom device with CIT punch, uses manual for beardwork and repair of old plugs/FUE)

-True(CIT motorized device with sharp tip)

-Lindsey(Feller motorized punch)

-Charles(Undetermined, also uses ARTAS)

-Bernstein(SAFE system also uses ARTAS)

-Dorin(CIT motorized device with sharp tip)

-Rahal(SAFE system,also uses ARTAS)(circa 3,000 grafts in one session)

-Bhatti(SAFE system and Kowloon/SAFE punches)

-More to be added

 

 

 

 

Advantages:

-Can allow for faster extractions and more grafts in one sitting

 

Disadvantages:

-Can suffer from heat issues in regards to the surgeon not being able to sense when the punch becomes dull

-Does not offer the same feedback as manual

-Often uses more turns/oscillations than needed

 

___________________________________________________________________________________________________

 

 

-ARTAS SYSTEM:

OWg44MEl.png

 

A very recent invention which is completely unassisted in the punching process. Can calculate the depth, angle and direction of the graft whilst also determining an entirely random extraction pattern. Transection is said to be very low but results are still rare due to its infancy.

 

Doctors using ARTAS:

-Cooley(Also uses motorized)

-Ron Shapiro(also use motorized)

-Harris(also uses motorized)

-Bernstein(also uses motorized)

-Arocha(also uses motorized)

-Charles(also uses motorized)

-Rahal(also uses motorized)

-More to be added

 

 

 

Advantages:

-Supposedly can determine the correct angle, depth and direction of grafts

-Fast extraction

-Fatigue not a factor

-Clever extraction pattern

 

Disadvantages:

-Yield claims currently unsubstantiated

-Currently uses punches larger than desired

-Cost of the machine(circa $200,000US) can inflate the cost of the procedure

-Not currently approved for female patients

-Unknown whether it can alternate between smaller punches for single-hair grafts and larger punches for 2/3/4-hair grafts

 

______________________________________________________________________________________________________

 

 

-NeoGraft:

ZdAYKiJl.png

 

The often controversial NeoGraft system. It operates in a way similar to a motorized punch but has options for extracting the graft via a suction mechanism. The surgeon manually targets grafts(much like a manual/motorized punch) and the Neograft uses suction to transfer the grafts into a small compartment. After a certain amount of grafts are extracted, the surgeon collects the grafts out from the holding compartment and then loads the grafts into the recipient sites.

 

Doctors using NeoGraft:

-Vories(Choi implanter pen)

-More to be added

 

 

 

Advantages:

-Allows for faster punching and extraction

Disadvantages:

-The suction involved in extraction of grafts can damage the follicle

-The constant flow of air into the graft container can led to the grafts drying out

 

________________________________________________________________________________________

Edited by Mickey85

Share this post


Link to post
Share on other sites

Quotes:

 

-Dr Lorenzo(Spain) quote taken from email

 

"Motorized and robotic never can achieve the precision and feeling of manual"

 

-Dr Lorenzo[/b] posted this in an email to me when I brought up the use of motorized and ARTAS. It should be noted that Lorenzo has used motorized in the past and has a video of myself using it but he clearly prefers manual punches for their tactile feedback and simplicity.

 

_________________________________________________________________________________________________________

 

Dr Mwamba(Belgium) quote taken from this forum and the Q&A Blog Article "Manual vs. Motorized Follicular Unit Extraction (FUE) Hair Transplant Punches"

 

"I used mostly manual FUE but I do have motorized FUE as well ( The FUE extractor from LEAD company with a combination of oscillated mouvements and non oscillated mouvements ).

 

Manual punch allows you to get a feeling of the difference in tissue resistance , especially when you have curve grafts or splay grafts .resistance of the hair shaft is different from the surrounding connective tissue and with a manual punch you will feel it and stop your penetration .With the motorized punch you are loosing a lot of that feeling .But with time , I know you can have some kind of feeling too .

 

Second thing is the heating of tissue from the punch .With motorized FUE , when the punch get dull , you don't feel it necessarely , but the machine will still use it forces to cut .With forces , you can heat or get some torsions of the tissue .

 

One thing also we need to face is hands fatigue with the manual technique .

When I use the motorized FUE , I usually start with the manual punch to get all the characteristics of the patient :skin fragility , grafts angle and splay .And if I feel comfortable and I found out it is an easy case , then I switch to the machine to preserve my hands .And most of the time , I asked the patient if he feels comfortable with it .

 

My transection rate is equal with both techniques .In terms of speed , I am faster with the manual technique as I got much practice with it .I tend to be more cautious and not in rush when I use the motor to overcome the weakness of the latter technique .

 

I am not fan of the speed gain with the motor that everybody seems to voice out .What matters is the quality of grafts you are producing and if you can get it faster , then fine .I do not think that multiple days of surgery will impair the graft yield."

 

 

Dr Mwamba was kind enough to offer a very detailed account to his preference. I did naturally assume he used manual exclusively prior to his reply for some reason. Interesting that he also mentions the lack of feeling associated with manual but not to the extent of Lorenzo. He also brings up the heating issue which has seldom been discussed, seems it can affect yield if used for too long due to not being able to feel the punch resisting due to turning dull and heating the tissue and causing torsion... Interesting that he is faster with manual! He does claim that yield is not affected using either providing you know the weaknesses and how to overcome them. Fatigue is mitigated with motorized according to Mwamba.

 

____________________________________________________________________________________________________

 

Dr De Reys(Belgium) Q&A from Youtube

 

"The feeling is the most important thing to do the extraction. A machine cannot offer you feeling. It is designed to make you work fast. But it takes away all the feeling."

 

De Reys is a FUE-only surgeon. He mentions that manual punches are slower than motorized but give a better result. Quote was taken from a Q&A with De Reys on Youtube. He seems very adamant that manual is superior...

 

_____________________________________________________________________________________________________

 

Dr Hakan Doganay(Turkey) quote taken from this very forum

 

"By using manual punch, you can get 600-700 grafts in 3 hours. With motorized punch, it is possible to get around 2500 grafts in 3 hours. Some people say that motorized punch damages donor areas. If you are not careful, motorized or manual does not matter both of them can damage other hair roots.

 

While doing HT, the time is important to keep hairs safe. For this reason we use motorized punch and we haven't seen any problem."

 

FUE only surgeon based in Turkey. Works on higher Norwood classes as well as minimal recession. Feels yield is unaffected via motorized method. Dr Hakan Doganay was recently inducted onto this fine forum.

 

______________________________________________________________________________________________________

 

Dr Feriduni's(Belgium) representative. Quote taken via email

 

"Dr. Feriduni only tried an automatic device once but it was not a great success since you have much more accuracy with a manual FUE punch."

 

 

Dr Feriduni is a 50/50 FUT and FUE surgeon. I did get a more detailed reply from Feriduni himself through our Skype session but cannot remember the quote verbatim. It did echo the aforementioned quote. Will ask for Feriduni for a reply through email and post it in a new post at a later date.

 

_______________________________________________________________________________________________________

 

Dr Devroye(Belgium) quote taken from this very forum

 

"First, I am going to explain to you which was my approach. A few years ago, I was interested in the motorized systems on the market. I observed for example the work of two devices : the one of Dr Feller and the calvitron (ex neograft). They did not fit perfectly my expectations. Indeed, the basic idea was to realize exactly the same type of work with the engine as with the hand. For that purpose, I needed a system with a very big precision, capable of turning only a bare minimum of tours, just enough to make the cut. I also needed an oscillating system turning alternately to the right and to the left. I needed a mastering of this oscillation and also a fine control of the speed. I wanted also a system working on battery. I thus conceived a system using a hand piece of dentist. An aluminum heavy pedal completes the set. The punches used are the ones of Dr J.C.

I've been using the definitive version of my device for three years and practically found only advantages compared to the manual technique.

 

Indeed, the engine frees one of the hands of the rotation work. The hand so freed focuses much more easily on the orientation of the hand piece and the punch. It also allows to work in normally uncomfortable positions for the hand work. It allows to increase the number of grafts collected in one day. With the hand I reached 1200 grafts a day. With the engine I reach 2000 grafts. It has enabled me to decrease my FUE prices.

 

I do not use any more the manual FUE except in certain particular circumstances as the removal of old punches or the work on the beard."

 

Dr Devroye was kind enough to offer this significant insight on his sentiments regarding manual and motorized punches.

 

______________________________________________________________________________________

 

Dr Erdogan (Turkey) via his website

 

"What is a micromotor(motorized punch)?"

It is an electrical device with high rotational speed, which is also used by dentists.

Recently, micromotor usage has become popular in FUE technique, since they are capable of faster extraction of the hair grafts.

Hair follicles after entering the skin change their direction with a slight angle. It is possible to sense this angle using a light[weight] punch. But it is harder to sense this angle since the micromotor is heavy. Furthermore, I observed that micromotors due to their fast rotation, damage the near by follicles and causes wider scars and acne formation. Therefore; even though it takes less time to finish the work with a micromotor, personally I prefer to use the manual punch method."

 

Dr Erdogan talks about the drawbacks to using an automated/motorized punch and states he prefers the manual method. Special credit to PupDaddy on this forum for bring this quote to my attention.

 

_____________________________________________________________________________________

 

Dr Bisanga(Belgium) taken from his representative 'sl' off this fine forum

 

"Dr.Bisanga believes in using a manual punch, he feels it gives him more control and sensitivity as to what he is doing and is happy with the type of tools he uses and indeed the sizes used.

 

Doctors will have personal preferences and some will prefer motorized punches and are more comfortable with that approach so each to their own really.

 

I can say years of manual punching has given him extremely strong hands though!"

 

Dr Bisanga performs both FUE and FUT and believe in a strict FUE protocol of only extraction 30% of the donor area to avoid a thin appearance.

 

________________________________________________________________________________________

 

Dr Bhatti (India) taken from an email to a patient

 

"This is in regard to your query on the sizes of punches.

Well, I use the Harris dull punch- sizes 8 and 9. The actual cutting diameters of these punches are - 0.75 and 0.85 mm respectively. The other punches available in the market are marked as per internal diameter.

Well, in most cases I use 0.75 mm since it allows me finer grafts which can be packed closer together for greater density in contrast to grafts harvested with the 0.85 mm punch. But it is not that all cases are necessarily candidates for a smaller punch! In around 15% of my clients who have larger follicular groupings, I do use 0.85 mm alone. I mostly first use the 0.75 mm punch avoiding larger follicular groupings and come back again to harvest the latter with 0.85 mm punch. On average 80% and above work can be done in most cases with the smaller punch.

I have never had the occasion to use sizes bigger than 0.85 since the past 4 years after I picked up the wonderful FUE technique.

I hope I have answered what you had asked.

 

 

01-02-2013

 

Wish you a happy new year.

There are so many motors available in the market- JH(Jim Harris SAFE system) is just one of them. I am comfortable using this system since I trained on it 4 years back. The JH((Jim Harris SAFE system) punch is a blunt punch and causes a low transection rates and hence a higher yield of grafts per session.

The Kowloon punch is a semi-sharp punch and I use this too.

Manual FUE is very slow and it is not that it gives better grafts. Doctors use it (esp. dermatologists) since they are used to this technique."

 

Bhatti favors the motorized method. Special thanks to PupDaddy and Jayukdht for this great addition.

 

______________________________________________________________________________________________

Edited by Mickey85

Share this post


Link to post
Share on other sites

Very informative Mickey. Great thread.

Share this post


Link to post
Share on other sites

Lots of good food for thought here. With all of the FUE instruments out there I hope that it just boils down to the doctor's personal preference and that the yields are comparable.

Share this post


Link to post
Share on other sites

What can FUE do??

 

Norwood 1:

 

836 grafts

SSKtAGMl.png

Work of Dr Feriduni. Click to view profile

 

1,441 grafts

n05HAhsl.png

Work of Dr Feriduni. Click to view profile

 

____________________________________________________________________

 

Norwood 2:

 

1,906 grafts

dFFvORgl.png

Work of Dr Feriduni. Click to view profile

 

2,360 grafts

Er94Auzl.png

Work of Dr Feriduni. Click to view profile

_____________________________________________________________________

 

Norwood 3:

 

2,154 grafts

aJxaoCsl.png

Work of Dr Feriduni. Click to view profile

 

2,067 grafts

NMGLmanl.png

Work of Dr Feriduni. Click to view profile

 

2,543 grafts

6EDPvK5l.png

Work of Dr Bisanga. Click to view profile

_____________________________________________________________________

 

Norwood 4:

 

2,533 grafts

QfVisyol.png

Work of Dr Bisanga. Click to view profile

 

2,701 grafts

fstNEN3l.png

Work of Dr Lorenzo. Click to view profile

____________________________________________________________________

 

Norwood 5:

 

5,035 grafts

3NTcJnzl.png

Work of Dr Lorenzo. Click to view profile

 

2,600 grafts

skGW72al.png

Work of Dr Feriduni. Click to view profile

____________________________________________________________________

 

Norwood 6:

 

3,939 grafts

1263IJzl.png

Work of Dr Lorenzo. Click to view profile

 

6,381 grafts

hy0ZVWcl.png

Work of Dr Lorenzo. Click to view profile

____________________________________________________________________

Crown:

 

1,499 grafts

ydeeK4tl.png

Work of Dr Feriduni. Click to view profile

 

____________________________________________________________________

 

Scar repair:

 

278 grafts

ANirllml.png

Work of Dr Feriduni. Click to view profile

 

____________________________________________________________________

 

The following link contains FUE results from physicians recommended by this forum and will be constantly updated:

 

FUE photo gallery

 

______________________________________________________________________

 

2-Step and 3-Step FUE:

 

-2-Step FUE:

2-step FUE can be further understood when compared to its 3-step alternate. Simplified, the 2-step FUE technique is basically the punching of the graft and simultaneous loosening of the graft from surrounding tissue(1st step) and then the gentle removal with forceps(2nd step). Sounds basic enough but there is a 3-step technique which can have its advantages also.... Read on.

 

-3-step FUE:

3-step FUE involves using a sharp edged punch(as opposed to a blunt edge) to score the epidermis(step 1), switching to a blunt edge punch to actually dissect and simultaneously loosen the graft from the tissue(step 2) and finally the removal via forceps(step 3). The advantage of this is that by not using a sharp punch near the root of the graft, transection can be minimized. Of course the trade off is more time needed.

 

-1-step FUE:

Recently invented by Dr. Koray Erdogan. Little is known about this technique but will be discussed as the information becomes public.

 

____________________________________________________________________________________________________

 

Sharp and blunt tips:

 

-Blunt tips:

 

The notion of using blunt tips(usually in conjunction with motorized devices) was derived from the idea that since the tip is not sharp there is a much lower incidence of transection. Now I use the term 'idea' because in reality it is not so simple as using a blunt edge can relate in the need for more oscillations to get to the bottom of the graft which can have an undesirable effect on the tissue and the graft itself. Ideally you want to use the least amount of oscillations whilst getting to the bottom of the graft. More oscillations equates to overheating of the drill and thus heating of the scalp and underlying tissue. All these factors are possible occurrences to keep in mind, they are not unavoidable or set in stone. The commonly used SAFE system comes equipped with blunt tips

 

-Sharp tips:

Sharp tips allow the surgeon to reach to bottom of the graft with fewer turns or oscillations but it poses the risk of transecting some or all of the follicle as it reaches its destination. However with fewer turns there is less strain on the tissue and also less heating issues(on motorized devices). It is a double edged sword and there are trade-offs between the two tip styles.

 

______________________________________________________________________________________

 

-Punch gauges/sizes

Punch gauges can vary. Typical ranges are .75mm to 1.0mm. Small punches are great for minimizing scarring but are not really suitable for larger 2,3 and 4-hair grafts. Using a .75mm punch to extract a triple-hair graft could result in partial or full transection of the graft. Something like a .9mm gauge would be more suited. Respectively, using a larger gauge can preserve yield levels but also create scars larger than desired and damage surrounding follicles. One size does not fit all.

Edited by Mickey85

Share this post


Link to post
Share on other sites

Reproduced below is an informative post of Janna's on the subject of manual punches v. motorized punches for fue. She posted it in response to another member opining that fue using manual punches is universally superior to fue using motorized punches, and that only greedy or lazy docs would use motorized punches for fue.

 

Besides pointing out the fallacy of this unsubstantiated opinion, Janna provided lots of information pertinent to this topic, including the critical functional distinctions among different makes/models/kinds of currently available motorized punches (e.g., sharp v. dull, turning velocity), the sharp v. dull distinction between currently available manual punches, and advances in motorized punch technology. In short, not all motorized punches are created equal. Nor or manual punches.

 

Janna pointed out that a really meaningful assessment of motorized punch v. manual punch use by fue docs would include the make/model and characteristics of the manual or motorized punch used, why they chose that manual or motorized punch, and, in the case of fue docs who have used both, the number of procedures performed using each, and the yield rates achieved by that doc using the particular motorized punch v. the particular manual punch. I know that is way too much to ask of you, Micky85, but that kind of information would really enhance your survey.

 

Anyway, here is Janna's post that I referenced. It was posted on December 8, 2012 and can be found in the thread at this link: http://www.hairrestorationnetwork.com/eve/165305-artas-hair-transplantation-system-fue-post2328021.html#post2328021

 

“It's interesting to read your posts because you have strong opinions that they often come across as if they are facts.

 

Sometimes you speak on behalf of physicians as if you know them and have in depth conversations with them on a regular basis. Maybe you do with many of them but I know you haven't done so with Dr. Shapiro, yet you post as if you know why Dr. Shapiro acquired the Artas or why we switched from manual sharp punch to the motorised SAFE system. As I understand it, you don't like any motorised fue tools, and you have every right to your opinion. Are all docs using any type of motorised tool - sharp or dull punches put in the same category? While I believe there is only one dull punch, there are several variations of the sharp motorised punches. Do you remember the much hype about the Feller cordless sharp drill? Is he being lazy using motorised tool or is he innovative?

 

Dr. Lorenzo, God bless him, is about the hardest working man I know who punches and takes all the grafts out himself not to mention planting all the grafts too. He works long hours and is quite passionate about his work. I know he's tried the Feller drill but I wasn't aware he's tried the SAFE system. Did all three purchase the SAFE system, try it for awhile then decided against it or just one of them? That part wasn't clear to me. How many patients did he/they try it on? When I visited all three clinics few years ago, they hadn't tried the SAFE system so it'd be interesting to get their opinion on it. I'm not disputing these top docs's reputation or their work or the fact that you like them. I like all of them too. When you speak to each of them, can you ask them about their yield? What is their percentage of patient satisfaction with their FUE? I know Feriduni has 4-5 techs that are skilled at punch/extracting, just as Dr. Feriduni is but I know yield can be compromised with any FUE procedure regardless of the technique. I'm sure they will tell you that while they strive for 100% yield on 100% of their patients, they don't have it. There's a fundamental difference between dull and sharp punches. You should find out the difference and why some choose dull as oppose to sharp. The top clinics tend to produce the most consistent results, thats why they are considered tops. For consistent results and for best yield at our practice, we converted to the SAFE system and acquired the Artas, not for anything else.

Share this post


Link to post
Share on other sites

Great thread Mickey85. I strongly believe that manual FUE is the Gold standard for a better yield and that motorized tools and ARTAS robot serves the surgeon rather than the patient. It would make his job easier and reduce his physical stress by allowing him to achieve double number of grafts with same time which means more profits. The surgeons who are using it make it seems that its for the sake of the patient but in reality its for the own. I know that many doctors achieve excellent results with motorized tools but still manual FUE will always remain the best option for us.

 

Think of it as a shaving machine. There are many shaving machines that are claiming to remove every single hair on your cheek with using 3 rotating blades following the contour of the face. However they would never be as effective as manual blades where they allow you to have full control.

 

Judge by your own, look at manual FUE surgeons results and look at motorized or robotic FUE surgeon results. Judge on your own. Its just manual FUE needs a patient doctor with stamina and this is the challenge. This my personal opinion regarding this matter.


Plug removal + Strip scar revision - Dr. Ali Karadeniz (AEK)- May 23, 2015

Plug removal + 250 FUE temple points- Dr. Hakan Doganay (AHD)- July 3, 2013

Scar Tricopigmentation- Dr. Koray Erdogan (ASMED)- May 3, 2013

2500 FUT (Hairline Repair)- Dr. Rahal- July 26, 2011

 

My Hair Treatments:

1- Alpecin Double Effect Shampoo (Daily)

2- Regaine Solution Minoxidil 5% (2 ml once a day)

3- GNC Ultra NourishHair™ (Once a day)

4- GNC Herbal Plus Standardized Saw Palmetto (Once a day)

 

My Rahal HT thread http://www.hairrestorationnetwork.com/eve/164456-2500-fut-dr-rahal-hairline-repair.html[/size]

Share this post


Link to post
Share on other sites

Thanks Hariri. I too follow the same sentiments of preferring the manual punch. I prefer that it retains the tactile feedback and has no moving parts that can create friction and heat.

 

Interesting comparison to electric shaving and blade shaving as I actually use a straight razor and absolutely love it! The straight razor gives you control over the angle of the blade so you can cut very close. Took me a while to learn though and I still nick myself at times lol.

Share this post


Link to post
Share on other sites

Just so readers of this thread will know, neither Hariri nor Mickey85 are ht docs. Nor, to my knowledge, have either undergone a hair transplant via fue. (Nor am I, or have I.) I only say this in case a new member reading this thread as part of their research into fue were to confuse their layman observations and opinions for those of physicians who actually perform fue, have tried both manual punches and motorized punches for extracting the follicular units, and can credibly compare graft survival/yield rates as between these two kinds of extraction tools.

 

If the purpose of this thread is to poll ht physicians to determine which fue extraction tool they use and why (and, ideally, identify the make/model of the tools they have used, the number of procedures performed using each tool, transection rates with each, and the graft survival/yield rates achieved with each), then I submit that the thread is better served by leaving opinions about the comparative efficacy of these tools and ht physicians's reasons for choosing one over the other, to the physicians who have actually used them. That is, so long as the thread is intended as an objective effort to collect and collate this interesting and valuable information as opposed to an effort to push a preconceived notion or agenda. No offense, but why should anyone considering fue and reading this thread care that a non-physican, who has never extracted a graft from someone's donor or even had an fue transplant, "prefers that [a manual punch] retains the tactile feedback and has no moving parts that can create friction and heat," or believes, without evidentiary foundation or objective substantiation and in direct contravention of the statements of one of our Coalition member's representatives, that "manual FUE is the gold standard for a better yield" and that "motorized tools and ARTAS robot serves the surgeon rather than the patient?"

 

When a Coalition physician or his representative says that they experienced no appreciable difference in fue graft survival/yield when using the SAFE motorized punch vs. manual punches, that the SAFE motorized punch in their experienced hands enhanced consistency of extracted graft quality and robustness and was chosen for that reason, or when an experienced fue doc with impressive, documented large-session results says that he prefers a particular motorized punch over manual punches because in his hands, the transection rate is the same (small) but the extra extraction speed offered by his motorized punch pays dividends with graft survival because the grafts are out of the body for a significantly shorter amount of time -- what, are they lying? We must assume so, and we must believe that a member here must have inside information from these clinics for him to nevertheless opine that nah, these reputable physicians with distinguished track records are only interested in "profits" at the expense of their patients if they have elected to use a motorized punch (or ARTAS) to execute their fue extractions. Really?

 

This isn't my thread so I can't very well set the rules. But I think that this thread will be far more valuable if opinions, observations, and comments concerning the relative efficacy of these follicular extraction tools, transection rates, yield rates achieved with each, the benefits of one over the other, if any, and reasons a particular doctor has chosen to employ one or the other, should be left to the doctors and their representatives.

 

Thanks again to Micky85 for starting this interesting and (potentially) valuable physician's fue survey.

Share this post


Link to post
Share on other sites

I agree with your PupDaddy.

 

I feel it would be very beneficial and helpful to potential patients if there was a comprehensive source of information that gave comparison of the positives and negatives of the different harvesting techniques and tools- manual punches,motorised tools, Artas,Neograft, choi implanter etc.

 

Additionally I feel it is wrong for many people to feel the Artas is inferior to manual tools when there are no results yet to compare between the two.

 

I could be wrong with this thought, but maybe one reason why the Artas was created was to help the American clinics perform larger fue sessions on one day. The reason being is the law in some parts of America doesn't allow the technicans to play a more prominent part in the harvesting phase in comparison to the European clinics.

 

Just a thought.


2 poor unsatisfactory hair transplants performed in the UK.

 

Based on vast research and meeting patients, I travelled to see Dr Feller in New York to get repaired.

Share this post


Link to post
Share on other sites

I think there is room for patient discussion, layman pondering, potential customer chit-chat ets., I suppose I assumed that people these days are far more skeptical. I guess as many newbies looked at a high post number and think, 'casualty, gone nuts' as they do 'fountain of wisdom' but maybe Pup has a point about newbies being vulnerable, I don't know.

 

But what I do think I know is this..

Leaving the discussion to the clinics and reps??? That is far-and-away more misleading and distorted way of presenting a full picture. There is no doubt that clinics and reps know far, far more than we will ever know...but why would they tell us? Reps are valuable, docs are gold, but we need the resident nut-cases like myself (before we inevitably expire) to add a little heat.

 

I remember reading on another board some people were bashing HTN as a bunch little pusssies pandering to the strip reps and docs and that there was no room over there for even discussing FUE innovation because the posters were just clapping their hands and patting each other's backs.

 

Just yesterday I saw Dr. Feller's FUE spin video...and what spin it was. (usual crap about FUE limited to augmenting the 'modern method' =strip) Complete rubbish. No diss, on Dr. Feller cause he legit and a great doc, but that is reality of a slice-of-life on the information stream a newbie would be digesting wholesale without people like us chipping in and saying, "hey...wait up!"

 

Very pleased Mickey put this up. Here is another point a rep or doc will rarely discuss...and I give Dr. Feller the credit for bringing it up once or twice, the fatigue effect of manual punching.

 

There are two styles for manual punching I can see. One a toggle and steady push and two, more of a direct punch, maybe with a slight twist in it. I have seen both styles. Which is better? I have no idea, but I could speculate the punch is easier on the docs wrist, hand and fingers.

 

So if we found out, or discussing the pros and cons of manual punching and concluded that manual punching, using a toggle motion, seems likely to be the best method because plausible reasons were brainstormed, refuted etc., and then concluded that it had a limited shelf-life because of doctor fatigue, and then concluded that this might impact on the overall product strategy for FUE - say by delimiting to 'small jobs' ..then I think it is a plausible, logical and useful. Yes, we have to qualify it. Ultimately, we will follow the trends set by the clinics, but in little ways, our input is essential for progress to.

 

I hope newbies don't rely on us so called 'vets' but on the other hand, I hope they don't swallow that video I just saw from Dr. Feller without a grain of salt either.

Share this post


Link to post
Share on other sites

I don't know what was said about this community on another forum. But we have never rejected innovation nor have we hindered discussion about FUE or any hair restoration related topic. While there will always be dissenting opinions, this community encourages it's members to openly discuss and share their input.

 

Personally, I think this is a great topic. In fact, I posted a link to this topic in the ISHRS Facebook page to garner se physician input as well.

 

In my opinion, a physician should use the tool they produce the best results with. Some prefer manual and some prefer motorized FUE. Each individual tool (not just whether it's motorized or not) has it's own unique advantages and disadvantages. I've seen some excellent results with many tools.

 

I do think it's beneficial to discuss the pros and cons of all available tools. However, I'm also a firm believer that a tool is only as good as the person behind it. If you give a fool a hammer, he'll break his thumb. But a skilled contractor can build a well designed home.

 

Best wishes,

 

Bill


I am the managing publisher of the Hair Transplant Network, the Hair Loss Learning Center, the Hair Loss Q&A Blog and this Hair Loss Forum. I am also a 4 time hair transplant patient. View my patient hair loss website to view my entire hair restoration journey with photos.

Remember, true beauty radiates from within, not from the skin.

I am not a medical professional and my words should not be taken as medical advice. All opinions and views shared are my own.

Share this post


Link to post
Share on other sites
Just so readers of this thread will know, neither Hariri nor Mickey85 are ht docs. Nor, to my knowledge, have either undergone a hair transplant via fue. (Nor am I, or have I.) I only say this in case a new member reading this thread as part of their research into fue were to confuse their layman observations and opinions for those of physicians who actually perform fue, have tried both manual punches and motorized punches for extracting the follicular units, and can credibly compare graft survival/yield rates as between these two kinds of extraction tools.

 

If the purpose of this thread is to poll ht physicians to determine which fue extraction tool they use and why (and, ideally, identify the make/model of the tools they have used, the number of procedures performed using each tool, transection rates with each, and the graft survival/yield rates achieved with each), then I submit that the thread is better served by leaving opinions about the comparative efficacy of these tools and ht physicians's reasons for choosing one over the other, to the physicians who have actually used them. That is, so long as the thread is intended as an objective effort to collect and collate this interesting and valuable information as opposed to an effort to push a preconceived notion or agenda. No offense, but why should anyone considering fue and reading this thread care that a non-physican, who has never extracted a graft from someone's donor or even had an fue transplant, "prefers that [a manual punch] retains the tactile feedback and has no moving parts that can create friction and heat," or believes, without evidentiary foundation or objective substantiation and in direct contravention of the statements of one of our Coalition member's representatives, that "manual FUE is the gold standard for a better yield" and that "motorized tools and ARTAS robot serves the surgeon rather than the patient?"

 

When a Coalition physician or his representative says that they experienced no appreciable difference in fue graft survival/yield when using the SAFE motorized punch vs. manual punches, that the SAFE motorized punch in their experienced hands enhanced consistency of extracted graft quality and robustness and was chosen for that reason, or when an experienced fue doc with impressive, documented large-session results says that he prefers a particular motorized punch over manual punches because in his hands, the transection rate is the same (small) but the extra extraction speed offered by his motorized punch pays dividends with graft survival because the grafts are out of the body for a significantly shorter amount of time -- what, are they lying? We must assume so, and we must believe that a member here must have inside information from these clinics for him to nevertheless opine that nah, these reputable physicians with distinguished track records are only interested in "profits" at the expense of their patients if they have elected to use a motorized punch (or ARTAS) to execute their fue extractions. Really?

 

This isn't my thread so I can't very well set the rules. But I think that this thread will be far more valuable if opinions, observations, and comments concerning the relative efficacy of these follicular extraction tools, transection rates, yield rates achieved with each, the benefits of one over the other, if any, and reasons a particular doctor has chosen to employ one or the other, should be left to the doctors and their representatives.

 

Thanks again to Micky85 for starting this interesting and (potentially) valuable physician's fue survey.

 

i don't even know where to start.

 

this forum is predicated on being transparent. that works both ways, patient and doctor. i am not going to silence others or be silenced one iota providing it stays on topic. this is a discussion forum. while this thread is for informational purposes it is also for discussion. you see i say 'i prefer' manual, prefer meaning that is MY choice. when someone makes a thread asking the community about their situation, should no one but reps reply then? given your notion, no one but doctors and reps should reply to any thread pertaining to any hair transplant options.

 

im quite offended in the tone and wording used against me and hariri. to berate(ok maybe wrong word) us but liberate reps WHO DO have an agenda to their doctors is very contradictive. both hariri and i have not had fue but we are also not paid by any doctor. we are unbiased and orientated only by our own experiences, not by monetary gain.

 

 

i will not discourage discussion of the topic. i could have taken a much more agressive approach. if potential patients come.to the conclusions that one way is better than the other, that is up to their discretion. but at least they will be more informed. before my research i knew nothing about fue, punch sizes, blunt or sharp, manual, motorized or artas etc. this is a thread pertaining to a very important factor that i feel should be made aware to potential patients. the doctor's quotes are there to SUPPORT but not dictate a viewpoint.

 

i appreciate your opinion, even though you may not appreciate ours. in future please do not derail my thread, the private messaging system is there for a reason. im more than happy for you to contribute your opinion ON TOPIC.

Edited by Mickey85

Share this post


Link to post
Share on other sites
I think there is room for patient discussion, layman pondering, potential customer chit-chat ets., I suppose I assumed that people these days are far more skeptical. I guess as many newbies looked at a high post number and think, 'casualty, gone nuts' as they do 'fountain of wisdom' but maybe Pup has a point about newbies being vulnerable, I don't know.

 

But what I do think I know is this..

Leaving the discussion to the clinics and reps??? That is far-and-away more misleading and distorted way of presenting a full picture. There is no doubt that clinics and reps know far, far more than we will ever know...but why would they tell us? Reps are valuable, docs are gold, but we need the resident nut-cases like myself (before we inevitably expire) to add a little heat.

 

I remember reading on another board some people were bashing HTN as a bunch little pusssies pandering to the strip reps and docs and that there was nyo room over there for even discussing FUE innovation because the posters were just clapping their hands and patting each other's backs.

 

Just yesterday I saw Dr. Feller's FUE spin video...and what spin it was. (usual crap about FUE limited to augmenting the 'modern method' =strip) Complete rubbish. No diss, on Dr. Feller cause he legit and a great doc, but that is reality of a slice-of-life on the information stream a newbie would be digesting wholesale without people like us chipping in and saying, "hey...wait up!"

 

Very pleased Mickey put this up. Here is another point a rep or doc will rarely discuss...and I give Dr. Feller the credit for bringing it up once or twice, the fatigue effect of manual punching.

 

There are two styles for manual punching I can see. One a toggle and steady push and two, more of a direct punch, maybe with a slight twist in it. I have seen both styles. Which is better? I have no idea, but I could speculate the punch is easier on the docs wrist, hand and fingers.

 

So if we found out, or discussing the pros and cons of manual punching and concluded that manual punching, using a toggle motion, seems likely to be the best method because plausible reasons were brainstormed, refuted etc., and then concluded that it had a limited shelf-life because of doctor fatigue, and then concluded that this might impact on the overall product strategy for FUE - say by delimiting to 'small jobs' ..then I think it is a plausible, logical and useful. Yes, we have to qualify it. Ultimately, we will follow the trends set by the clinics, but in little ways, our input is essential for progress to.

 

I hope newbies don't rely on us so called 'vets' but on the other hand, I hope they don't swallow that video I just saw from Dr. Feller without a grain of salt either.

 

could not agree more. i would trust the word of a veteran like you over any rep anyday of the week. some of the spin i have heard publicly and privately via reps has had me laughing in chair. and thats beig as respectful as i can be to reps.

 

 

the fatique issue has been seldomly spoken about. it affects doctors in different ways. some can handle 3000 grafts while others only 800...

Share this post


Link to post
Share on other sites

Altogether, I think results are what matter in the end. If a physician is comfortable with a tool and is able to minimize transection and scarring, and maximize yield, then I think the type of tool used is almost a moot point.

 

In the end, it will always be the skill of the physician, not the tool used, that creates excellent results. What's more, these ethical, talented FUE physicians will only utilize tools that they are comfortable using and produce solid results.

 

Having said that, I really don't take issue with motorized FUE tools in the hands of an experienced physician. However, I do think it's dangerous when some of the highly automated tools are marketed toward neophyte physicians.


"Doc" Blake Bloxham - formerly "Future_HT_Doc"

 

Forum Co-Moderator and Editorial Assistant for the Hair Transplant Network, the Hair Loss Learning Center, the Hair Loss Q&A Blog, and the Hair Restoration Forum

 

All opinions are my own and my advice does not constitute as medical advice. All medical questions and concerns should be addressed by a personal physician.

Share this post


Link to post
Share on other sites
Altogether, I think results are what matter in the end. If a physician is comfortable with a tool and is able to minimize transection and scarring, and maximize yield, then I think the type of tool used is almost a moot point.

 

In the end, it will always be the skill of the physician, not the tool used, that creates excellent results. What's more, these ethical, talented FUE physicians will only utilize tools that they are comfortable using and produce solid results.

 

Having said that, I really don't take issue with motorized FUE tools in the hands of an experienced physician. However, I do think it's dangerous when some of the highly automated tools are marketed toward neophyte physicians.

 

I can understand those sentiments Blake. However, from the research I have gathered, there are pros and cons to using both manual and motorized, Dr. Mwamba's account was probably the most telling and lends some credence to why some choose not to use manual(fatique and time) or motorized(heat affecting the ability to feel when the punch is blunt etc).

 

It is very telling to me that some prominent FUE physicians(who practice FUE 40-50% of the time or more) trialed a variant of motorized punch and then choose to revert back to the slower manual technique. This tells me that the results(at least in their hands) suffered under motorized.

 

This of course does not mean motorized is rendered unreliable as great FUE doctors like Hakan and Devroye use motorized exclusively and churn out very nice results. But to me, I would prefer the use of a manual punch. Anything that gives the physician more response and alerts him to possible transection is a big advantage for me.

Share this post


Link to post
Share on other sites

It is very important for all readers to realize that this thread is about opinions of posters who are HT patients or people interested in the process. I do not mean that as critical in any way, but patients, including myself, are not experts. There are a lot of outstanding doctors using both methods getting excellent results. Do your own research and come to your own conclusions about what is right for you.


Surgery - Dr. Ron Shapiro FUT 6/14/11 - 3048 grafts

 

Surgery - Dr. Ron Shapiro FUE 1/28/13 & 1/29/13 - 1513 grafts

 

http://www.hairrestorationnetwork.com/orlhair1

Share this post


Link to post
Share on other sites
Do your own research and come to your own conclusions about what is right for you.

 

Why stop there? Why not just ban all discussion. Instead of calling a 'Discussion Board' just call it a 'Non-Discussion Board'

 

Really Orhair,

 

Why the sensitivity about this particular thread? I don't hear these kinds of disclaimers in other threads? Is there something you know, that we don't? Why not tell us?

Share this post


Link to post
Share on other sites
Why stop there? Why not just ban all discussion. Instead of calling a 'Discussion Board' just call it a 'Non-Discussion Board'

 

Really Orhair,

 

Why the sensitivity about this particular thread? I don't hear these kinds of disclaimers in other threads? Is there something you know, that we don't? Why not tell us?

 

I have said this in other threads on other topics also. I like the discussions, but someone new doing their research might look at some of these discussions differently than people who have been around looking at this and other topics and doing research for a long time. The information is good, but people could read these opinions as fact vs. peoples own personal opinions and preferences. It is not a disclaimer, but in my opinion a good word of caution for people when reading this and other threads on this or any forum.


Surgery - Dr. Ron Shapiro FUT 6/14/11 - 3048 grafts

 

Surgery - Dr. Ron Shapiro FUE 1/28/13 & 1/29/13 - 1513 grafts

 

http://www.hairrestorationnetwork.com/orlhair1

Share this post


Link to post
Share on other sites
I have said this in other threads on other topics also. I like the discussions, but someone new doing their research might look at some of these discussions differently than people who have been around looking at this and other topics and doing research for a long time. The information is good, but people could read these opinions as fact vs. peoples own personal opinions and preferences. It is not a disclaimer, but in my opinion a good word of caution for people when reading this and other threads on this or any forum.

 

Thank you for your disclaimer, it has been echoed by Pupdaddy prior. To anyone else, please DO NOT derail my thread by going off topic. If you have nothing to add and/or are not interested in discussing the actual topic than please refrain.

 

God forbid any of us have a preference and/or opinion on one method or the other. Seriously, I don't understand why some people can't accept the fact that maybe all tools are not created equal. Just because certain Doctor's perform FUE does not mean they are all as equally skilled or that the tools are just a means to an end. That is ridiculous. Simply saying "There are a lot of outstanding doctors using both methods getting excellent results" is like saying "just end this thread and let potential patients go in blind". Absolutely ridiculous. I tried being passive about this by not including my opinions on the Doctor's in the actual quotes, I kept it very unbiased but the moment I said "I prefer manual" I get a bunch of guys whose Doctor's conveniently use motorized methods jumping on mine and Hariri's back. We never said we were experts, we never said this was gospel. I never said "Manual is the end all, be all". I said in the opening statement "Any conclusions you come to based on the information posted here are you own" yet you and others are acting like forum police while reps are allowed to run rampant spreading their agenda with no disproval.

Edited by Mickey85

Share this post


Link to post
Share on other sites
To anyone else, please DO NOT derail my thread by going off topic.

 

Mickey,

 

I appreciate that you started this discussion, and I encourage you and other members to continue discussing it. But please remember that all members are invited to voice their opinion, including those who disagree with you.

 

Personally, I don't think there's anything wrong with members trying to remind visitors that this discussion is more about opinion than scientific fact. While such a disclaimer may not be necessary, there's certainly no harm in it.

 

In my opinion, these posts don't take away from, but only add to the discussion. Furthermore, every post has been on topic. It's not like someone decided to derail this topic by asking members' opinions on laser therapy or something :-).

 

Best wishes,

 

Bill


I am the managing publisher of the Hair Transplant Network, the Hair Loss Learning Center, the Hair Loss Q&A Blog and this Hair Loss Forum. I am also a 4 time hair transplant patient. View my patient hair loss website to view my entire hair restoration journey with photos.

Remember, true beauty radiates from within, not from the skin.

I am not a medical professional and my words should not be taken as medical advice. All opinions and views shared are my own.

Share this post


Link to post
Share on other sites
Mickey,

 

I appreciate that you started this discussion, and I encourage you and other members to continue discussing it. But please remember that all members are invited to voice their opinion, including those who disagree with you.

 

Personally, I don't think there's anything wrong with members trying to remind visitors that this discussion is more about opinion than scientific fact. While such a disclaimer may not be necessary, there's certainly no harm in it.

 

In my opinion, these posts don't take away from, but only add to the discussion. Furthermore, every post has been on topic. It's not like someone decided to derail this topic by asking members' opinions on laser therapy or something :-).

 

Best wishes,

 

Bill

 

I can understand that Bill, there certainly is no harm in members reminding visitors that this discussion is about opinion than scientific fact. I'm ALL for people disagreeing with me and saying motorized is better, I don't mind that at all. However neither Hariri nor myself claimed that we were the end all or be all, some of these members are making something out of nothing. Pupdaddy suggested we remove all discussion of the subject, voicing his opinion that we should not have opinions. Then Orhair reiterated what Pupdaddy suggested which was not needed. So i lashed out at Pupdaddy for suggesting censorship/silencing members and myself basically and lashed out at Orhair repeating that Hariri and I were not experts.

 

Doesn't really bother me anyway, I will continue to discuss this topic with those who can handle constructive conversation. People can continue to bring up that Hariri and myself are not hair transplant deities, it bumps up the thread :)

Share this post


Link to post
Share on other sites

Mickey,

 

I agree that some tools are more advantageous than others. Microscopes have been universally accepted and considered superior in dissecting follicular units via FUT by leading hair restoration physicians in order to minimize transection during the slivering and cutting process.

 

To date however, there doesn't appear to be a unanimous decision that one extraction tool is better than the other. Experienced FUE surgeons have their preferences and not all of them agree on the advantages and disadvantages of each tool.

 

While it isn't comprehensive, the below article contains some valuable information regarding manual versus motorized punches and advantages and disadvantages of several popular extraction tools.

 

"The Evolution of Follicular Unit Extraction, its Physicians and its Tools".

 

We certainly encourage discussion and do our best to provide our readers with as much information as possible.

 

Best wishes,

 

Bill


I am the managing publisher of the Hair Transplant Network, the Hair Loss Learning Center, the Hair Loss Q&A Blog and this Hair Loss Forum. I am also a 4 time hair transplant patient. View my patient hair loss website to view my entire hair restoration journey with photos.

Remember, true beauty radiates from within, not from the skin.

I am not a medical professional and my words should not be taken as medical advice. All opinions and views shared are my own.

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now

×