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The ultimate manual versus motorized FUE thread


Mickey85

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Will be adding popular tools and devices on the first page very soon including the Versi Handle, CIT hand and punch, Harris SAFE system etc, Feller motorized punch etc.

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This is a very informative. I just wanted to clarify that I have used a combination of 0.75mm, 0.8mm, and 0.9mm punches for my patients (whether its scalp or beard or body FUE). The size depends on the density of donor hair in that region as well as the desired graft type (3-haired FU versus fine 1s or 2s).

 

I use a SAFE scribe and do my own FUE on my patients (rather than outsourcing). All FUE grafts are incubated in chilled PRP prior to transplantation. This helps account for the slightly decrease presence of protective subcutaneous tissue that is inherent with FUE versus strip harvest grafts.

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Hello Dr. Wesley, thanks for chiming in! You are the first surgeon who has personally contributed his details hehe. I will add your details to the thread. Do you use the SAFE scribe with the accompanying blunt punch or do you install a sharp punch instead? What is the maximum graft quantity session in one day? Thanks so much again :)

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You're very welcome. I prefer the blunt 0.8mm punch as, in my hand, I find that it tends to minimize transection (versus sharp punch).

 

My preference is also to limit FUE sessions to <2000 grafts/day. The out-of-body time for these types of grafts that do not possess as much protective surrounding subcutaneous tissue as those from a strip harvest can start to impact their survival after many hours.

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First time I saw this thread and must say I am thrilled! This is an amazing work, Mickey! You are definately a great contribution to this forum. Thank you so much!

An amazing experience (4002 grafts) with Dr. Koray Erdogan (ASMED Clinic).

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Thank you Denny. It is a labor of love and it initially started off very simple by just having quotes from Doctors about their opinions on manual and motorized punches but then I decided to expand on it quite extensively. Hoping Erdogan and De Reys become recommended here so I can add their profiles to the lists hehe.

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I think FUE is the future. I've heard top coalition docs from this forum say to me during a consult " FUE is just old wine being marketed in a new bottle". Well, I understand alot of these FUT docs are unhappy and it seems to me stubborn and unwilling to adopt the time to master FUE. It takes tremendous dexterity and artistry and manual FUE can turn out masterpieces in the right hands. Not so sure about these robotic FUE machines, I have no opinion because I have not seen enough results yet to judge. I think I would go to Dr. Koray in Turkey if I had the money and could do it. Anybody have any thoughts on who in the USA is doing great FUE work? Specifically the Midwest? Thanks this discussion is a tremendous help to us newbies deciding what to do. I have decided though, and have cancelled 3 times, a strip procedure. I am happy for those who got great results from it, but its not for me. My gut really tells me to avoid it. Anytime I do not listen to my gut feeling things turn out bad. I think it is unethical and actually very informercial-sleazy for clinics and surgeons who blame a patients physiology whenever the outcome is less than stellar. During the consult they do not mention that much, do they? But if your scar widens, or you have scalp numbness, they blame you! Thats why I would stick to FUE if I got a HT. It has less risks involved. I'd happily trade in a smaller yield rate than have nerve damage from a strip procedure. Nothing wrong with strip, again it is proven to give great results. But I think there has to be more discussion initially in the consults and before surgery regarding all the risks and possible damage. I am not a fan of patients being blamed because they're bodies do not heal great. That is a load of B.S. BUt to stay on topic great read on all things FUE

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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.

 

Interesting comparison. Personally, every time I shave using a shaving machine I am left amazed that people actually use these devices over manual shavers. My moderately priced shaver (3 rotating blades) always leaves hairs in different areas. It is such a hassle to get a quality shave from one. If the parallel exists to automated hair translant procedures, then I would concur, the manual ones would get you a better quality result the first time, just like a manual shaver.

Paulygon is a former patient of Dr. Parsa Mohebi

 

My regimen includes:

HT #1 2710 grafts at Parsa Mohebi Hair Restoration in Los Angeles in 2012

Rogaine foam 2x daily, since 2012 (stopped ~10/2015)

Finasteride 1.25mg daily, since 2012 (stopped ~12/2015)

 

HT #2 3238 grafts at Parsa Mohebi Hair Restoration in Los Angeles in Jun. 2016

Started Rogaine and Propecia in July. 2016 after being off of them for about a year.

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Lots of folks have asked me about FUE and I think Mickey has done an outstanding job documenting the FUE procedure/process. Folks should read and review Mickey's valuable threads for FUE. He has covered it pretty well.

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+1, Sean! Mickey is a champ!

"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.

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Hahaha. Any time, buddy!

"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.

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Hi all,

I read first post and I noticed that micromotor because of high speed rotation can damage donor area with making larger scars than in manual fue.

 

My question is: Can micromotor damage hair folicle during extraction so after transplant hair won't regrow ?

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Hi all,

I read first post and I noticed that micromotor because of high speed rotation can damage donor area with making larger scars than in manual fue.

 

My question is: Can micromotor damage hair folicle during extraction so after transplant hair won't regrow ?

 

There are a number of hand-held motorized punch systems currently being used for FUE, each differing in punch sharpness, wall thickness, oscillation feature, rotation speed, grabbing/pulling feature, and other aspects. In the U.S., for example, Drs. Harris and Umar each sell their own hand-held motorized punch systems to other ht docs. So it is difficult to generalize when talking about hand-held motorized punch systems. They have evolved along with FUE. A couple of early models fell out of favor for various reasons and are no longer in use. As more was learned about what works and what doesn't, other systems have taken their place in the market.

 

To date, there are no studies establishing that hand-held motorized punch systems in general, or any specific motorized punch system presently on the market, cause more or less damage to hair follicles than do FUE extractions using manual punches -- due to heat or other reasons. Some docs/clinics using a motorized punch system get good FUE yield, some don't. Some docs/clinics using manual punches get good FUE yield, some don't. Ultimately, the extraction of viable grafts comes down to the experience and skill of the surgeon or tech using the tool, be it a motorized punch system or manual punches.

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There are a number of hand-held motorized punch systems currently being used for FUE, each differing in punch sharpness, wall thickness, oscillation feature, rotation speed, grabbing/pulling feature, and other aspects. In the U.S., for example, Drs. Harris and Umar each sell their own hand-held motorized punch systems to other ht docs. So it is difficult to generalize when talking about hand-held motorized punch systems. They have evolved along with FUE. A couple of early models fell out of favor for various reasons and are no longer in use. As more was learned about what works and what doesn't, other systems have taken their place in the market.

 

To date, there are no studies establishing that hand-held motorized punch systems in general, or any specific motorized punch system presently on the market, cause more or less damage to hair follicles than do FUE extractions using manual punches -- due to heat or other reasons. Some docs/clinics using a motorized punch system get good FUE yield, some don't. Some docs/clinics using manual punches get good FUE yield, some don't. Ultimately, the extraction of viable grafts comes down to the experience and skill of the surgeon or tech using the tool, be it a motorized punch system or manual punches.

 

I totally agree with this summary of the current situation about manual vs. motorized FUE.

I would like to add that, despite no scientific evidence has been documented showing an advantage for either method, the manual punch doctors have succeeded in marketing their technique better than the motorized. They have taken advantage of the manual method sounding more 'hand-made' than the motorized, thus creating the illusion that the grafts are handled with better care and with less damage. There might be an indirect truth in this, that the unauthorised technicians who do FUE all use powered devices, leading to hair transplant disasters not because of the instruments they are using but because of the lack of professionalism. I am eager to either participate in or to see scientific studies clarifying this topic in the near future.

Ali Emre Karadeniz, MD (Dr. K)

AEK Hair Institute

Istanbul, Turkey

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I totally agree with this summary of the current situation about manual vs. motorized FUE.

I would like to add that, despite no scientific evidence has been documented showing an advantage for either method, the manual punch doctors have succeeded in marketing their technique better than the motorized. They have taken advantage of the manual method sounding more 'hand-made' than the motorized, thus creating the illusion that the grafts are handled with better care and with less damage. There might be an indirect truth in this, that the unauthorised technicians who do FUE all use powered devices, leading to hair transplant disasters not because of the instruments they are using but because of the lack of professionalism. I am eager to either participate in or to see scientific studies clarifying this topic in the near future.

 

 

I dont think no one has conducted a study to prove this scientifically due to money to be made. However, look at the various clinic photos and you can distinguish manualmvs motorized. True, some inexperienced reps can damage more with motorized due to lack of professionalism, but that goes to show why manual may be a safer process.

 

In any case, I think patients prefer slow and steady vs quick extract and place techniques. Extreme care should be given through extraction, and by logic manual may be the process that provides it more than motorized.

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Dear Sean,

 

The problem with trying to compare results with manual vs. motorised FUE we inevitably compare apples and oranges. The compared groups are not homogenous. 99% of patients want more grafts and more coverage in a single session. These patients will usually be less educated than the other 1% and will usually go to much cheaper FUE clinics who provide motorised FUE done by technicians. So this group of patients are operated by a much lower average quality of surgeons. On the other hand, the 1% who understand how delicate the FUE procedure is, will go to much more expensive and high quality clinics who provide either manual or motorised FUE. These patients will ask for less number of grafts per session for the reasons you mentioned. The manual FUE surgeons will not be forced to do a dangerously high number of grafts per session and will take a safe number having the luxury of taking care of each graft. This is why I think we will be comparing apples and oranges. If the patient asks a motorised FUE surgeon for 1500-2000 good grafts, I believe those grafts will be at the same quality with manual FUE grafts and the results would be the same. As a motorised FUE surgeon, I would like to one day do an FUE procedure half and half with an experienced manual FUE surgeon and have the grafts evaluated by an objective team for graft quality to clarify this issue. I hope to arrange in a future workshop. I would be willing to give up on my technique if the manual FUE happens to come on top. In the end we are scientists and not fans of a sports club; what is better for patients should be preferred by all of us.

 

Regards,

 

Dr. Ali Emre Karadeniz

Ali Emre Karadeniz, MD (Dr. K)

AEK Hair Institute

Istanbul, Turkey

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