The ultimate manual versus motorized FUE thread

[Ali Emre Karadeniz]

I would like to make a comment about a topic that I see is repeated on many posts.

 

I see that the preference of a 'motorised or manual punch' is mentioned as 'motorised or manual work'. I don't agree with the latter phrasing, as in reality both methods are manual. This means that in both techniques the surgeon uses his own hand movements to do graft extractions. The only difference is that the rotation force is created by the motor in the motorised FUE. All other variables are controlled with the hand. In fact, as a result of not having to use hand force to rotate the punch, the surgeon using the motorised punch has the luxury to use his strength and fine tuning on other variables such as depth control, angle and speed, which is more difficult when using significant force to penetrate the skin. Whether these gains I mentioned give an advantage to the motorised punch or not could be discussed for a long time, but my point is not to claim an advantage over one method. It is to clarify the misconception of the motorised punch FUE being perceived as motorised work, which should be used to define robotic FUE instead.

[Blake Bloxham]

Zyzz,

 

They are very similar devices. The lion implanter simply features a few upgrades actually designed - in part- by Dr. Lorenzo himself.

[Mickey85]

Zyzz,

 

They are very similar devices. The lion implanter simply features a few upgrades actually designed - in part- by Dr. Lorenzo himself.

 

Always so knowledgeable and informative Blake

[Ali Emre Karadeniz]

I suggest a change in the terms used for FUE techniques:

 

1. The two types of FUE are robotic FUE and manual FUE

 

2. Manual FUE can be either done using a manual punch or a motorised punch.

 

The important nuance is that when we say motorised FUE, this makes it sound as if using a motorised punch, is FUE done by a machine, whereas it is actually done by the surgeons hand, just like when using a manual punch. Instead of saying motorised FUE, we should say manual FUE using a motorised punch and manual FUE using a manual punch. Shortening this, we should say motorised punch or manual punch, not motorised FUE or manual FUE.

 

This correction that accepts both types of punches are actually used for manual FUE, may lead us back to the discussion of whether using a manual punch or a motorised punch allows the surgeon to control better the important parameters such as vibration, alignment, angle, direction, depth and speed.

[fueguy]

1. The two types of FUE are robotic FUE and manual FUE

 

2. Manual FUE can be either done using a manual punch or a motorised punch.

 

I think we should breakdown like below. Much more clear. There is more to it like technician vs doctors extractions, dull versus sharp punch. But it's a great start for newbies.

 

Hand-held

Neograft

Manual

Motorized

 

Robotic

Artas

 

Amature

Artas

Neograft

 

Professional

Manual

Motorized

[fueguy]

I would also add a third:

 

Amature

Dull punch (most start with Harris safe)

 

Professional

Sharp punch (more skill needed)

[Sean]

From experience, I now believe that surgery that is completely manual is the only way to go for FUE.  

[Bill - Seemiller]

Sean,

While I don’t entirely disagree, I’m afraid that when we base things slowly on our experiences, we have tunnel vision.   Regrettably, that prevents us from seeing the facts and how other people experience things.   The reality is, Motorized FUE is a slight bit easier but as a result, it’s easy or at least easier for hair restoration surgeons or their technicians to get a little lazy. This is amplified even more with devices like the Neograft and maybe even the Artas Hair Restoration System.   Surgeons who work manual FUE equipment have to stay on their toes and work harder and no doubt it takes more time, skill and experience to get it right. 

Personally, I truly admire those hair transplant surgeons who perform FUE with manual devices and constantly get superior results. It shows how skilled experience they really are.   That said, as long as hair transplant surgeons to use powered or automated FUE devices to extract follicular units don’t get lazy or sloppy, they too can produce superior results.  

 The end of the day, it always does come down to the surgeon, their skill and experience. The tool or device a surgeon uses should assist in making the job a bit easier, but it should never make a surgeon lazy because it will affect the results.  

 I just thought I would add my two cents on this. 

Best wishes, 

Bill

[HairShadows]

This was an interesting read. Dr. Ali Emre Karadeniz gave a very compelling answer regarding the benefits of the motorised punches.

My take away is that the best tool is the one the surgeon is most comfortable with. To those that compared manual v motorised with a manual razors and electric razors, seriously - don't be ridiculous, find a better analogy.

I would be VERY interested to see how things stand in 2018.

[Sean]

On 7/12/2018 at 12:15 PM, Bill - Managing Publisher said:

Sean,

While I don’t entirely disagree, I’m afraid that when we base things slowly on our experiences, we have tunnel vision.   Regrettably, that prevents us from seeing the facts and how other people experience things.   The reality is, Motorized FUE is a slight bit easier but as a result, it’s easy or at least easier for hair restoration surgeons or their technicians to get a little lazy. This is amplified even more with devices like the Neograft and maybe even the Artas Hair Restoration System.   Surgeons who work manual FUE equipment have to stay on their toes and work harder and no doubt it takes more time, skill and experience to get it right. 

Personally, I truly admire those hair transplant surgeons who perform FUE with manual devices and constantly get superior results. It shows how skilled experience they really are.   That said, as long as hair transplant surgeons to use powered or automated FUE devices to extract follicular units don’t get lazy or sloppy, they too can produce superior results.  

 The end of the day, it always does come down to the surgeon, their skill and experience. The tool or device a surgeon uses should assist in making the job a bit easier, but it should never make a surgeon lazy because it will affect the results.  

 I just thought I would add my two cents on this. 

Best wishes, 

Bill

Bill,  i hear what your saying, but just stated opinion based on talking to lots of doctors offline, a few top docs told me manual is probably the safer approach.  Device heat, fast extractions with vibrations, higher mm punch sizes on most motorized devices, suction methods (both air and saline), depth controls, not safe for certain caliber hairs and etc are some factors that can be detrimental with motorized.  Downside with manual is that it is slower, some docs have to break up large scale surgery into multiple days, there is still risk of transections but lower rate as other variables of motorized are minimized.  

I have heard Dr Devroy’s motorized punch is the safer punch most doctors prefer, variable speed and less harsh extractions.  Quite a few docs Seem to be using that device now.  That is probably a safer tool overall when it comes to motorized.  In fact, some docs raved about it in my discussions.

Whether manual or motorized, both surgeries can cause fatigue so it amazes me how some docs that do these fatigue inducing surgeries still work on multiple patients same day.

Id rather consider one patient of the day approach vs multiple.  I dont want a doc overwhelmed and working with someone elses scalp fatigue on my scalp.  

Very few surgeons can nail FUE, this is true for any surgeon from any online list.  Not all are superior in this method even if they offer it or are recommended.  Very few understand how to do fue safely and efficiently and in the best interest of patients by safely harvesting.  Many can be good in FUT but very few can be superior in FUE.  Look at the docs that are booked out 3 years vs those that have availability within 6 months.  That alone speaks volumes. 

It’s not easy to face in person criticism of the way your hair is every other day or have eyes wander towards your scalp.  Many people do not deserve that and want to live in peace.  Ive been supportive of a lot of repair folks and provided my time talking to many.  Ive spoken to FUT cases as well, but  Out of all the fue repairs ive spoken to, so far I don’t think any of them were manual FUE.  That kind of speaks volumes too.  

I am hoping there is a regulatory body that forms and analyzes these surgeries more. Regulation is needed for sure and more monitoring.  

 

[MohanSingh]

tHANKS FOR SHARING SUCH A USEFUL INFORMATION ABOUT FUE HAIR TRANSPLANT SURGERY.

[HairFunk]

Interesting topic this! 

[Raphael84]

Fascinating. Would be interesting to get some updated opinions and preferences of several Drs with the evolution of both manual and motorised punches?