The ultimate manual versus motorized FUE thread

[Mickey85]

Thanks for the article Bill, looks very informative.

[Bill - Seemiller]

Mickey,

 

PupDaddy said:

 

"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"

 

This doesn't sound like he's trying to censor discussion to me. I believe he's suggesting that patient members don't speak on behalf of physicians and their reasons for choosing a particular tool over another. Posts that appear factual, but are yet opinion, can be easily accepted by newbies and thus, I see nothing wrong with the reminders a few have posted that this topic is more about opinion than scientific fact.

 

That said, I strongly believe that patients have every right to speak freely and provide their genuine opinions, input, observations and comments on the efficacy of any treatment, tool, procedure and/or physician. So if PupDaddy is suggesting that patients remain silent, we will not :-).

 

After all, patient demand for only the best results is largely responsible (in collaboration with leading physicians) for revolutionizing the hair restoration profession. That's what makes this community so popular and influential.

 

Ultimately, I hope everyone can respect one another's views and continue discussing this important topic in a civilized and constructive manner.

 

Best,

 

Bill

[Mickey85]

With all due respect Bill, this statement suggested at least some form of censorship to me:

 

"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"

 

Also I took the quote you quoted as:

 

"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"

 

Basically saying all opinions, observations and comments should be left to doctors and reps. Why does he say we should not take about the benefit of one tool or another(that is what this thread is about)? Why does he say we shouldn't talk about why a doctor has chosen a particular method when it's clear from their quotes why(better yield, less fatigue, faster etc)? He suggested limiting discussion to quite some extent. It wasn't like we were putting words in Doctor's mouths regarding their transection rates etc.

 

I do understand that that is his preference though. I was just taken aback by it because this is a discussion forum.

[Bill - Seemiller]

Mickey,

 

I can see why you interpreted it that way, and maybe you're right. If that's so, I stand by what I said in my last post, which I've copied again below.

 

"That said, I strongly believe that patients have every right to speak freely and provide their genuine opinions, input, observations and comments on the efficacy of any treatment, tool, procedure and/or physician. So if PupDaddy is suggesting that patients remain silent, we will not :-).

 

After all, patient demand for only the best results is largely responsible (in collaboration with leading physicians) for revolutionizing the hair restoration profession. That's what makes this community so popular and influential."

 

Best wishes,

 

Bill

[Mickey85]

Mickey,

 

I can see why you interpreted it that way, and maybe you're right. If that's so, I stand by what I said in my last post, which I've copied again below.

 

"That said, I strongly believe that patients have every right to speak freely and provide their genuine opinions, input, observations and comments on the efficacy of any treatment, tool, procedure and/or physician. So if PupDaddy is suggesting that patients remain silent, we will not :-).

 

After all, patient demand for only the best results is largely responsible (in collaboration with leading physicians) for revolutionizing the hair restoration profession. That's what makes this community so popular and influential."

 

Best wishes,

 

Bill

 

Indeed it is

[orlhair1]

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.

 

You obviously misinterpreted my post and I completely disagree with everything you have said in the post quoted above that is critical of me and my opinion. My post did not attack anything you said and I respect your opinion. You have done your research and have your preferences which is great. Neither of us are experts on this topic......that is my point and people reading this should understand that. In fact, your statement that my post is like telling people to go in blind could not be furher from the point I was making.

[Mickey85]

You obviously misinterpreted my post and I completely disagree with everything you have said in the post quoted above that is critical of me and my opinion. My post did not attack anything you said and I respect your opinion. You have done your research and have your preferences which is great. Neither of us are experts on this topic......that is my point and people reading this should understand that. In fact, your statement that my post is like telling people to go in blind could not be furher from the point I was making.

 

didnt mean to offend you champ and while i may have misinterpreted your post, scar5 also took your post as an anti-discussion statement. pupdaddy had already made it abundently clear that i was no expert on the matter, i did not see the reason for you to reiterate it so soon. the wording of your post did sound like it was against us forum members that have been around a bit from expressing a preferance. i say in the first post of this thread 'any conclusions you come to based on the info posted are your own'.

 

apologies if my post was heavy handed. its the internet and things line tone, delivery and intent are easily blurred.

[orlhair1]

didnt mean to offend you champ and while i may have misinterpreted your post, scar5 also took your post as an anti-discussion statement. pupdaddy had already made it abundently clear that i was no expert on the matter, i did not see the reason for you to reiterate it so soon. the wording of your post did sound like it was against us forum members that have been around a bit from expressing a preferance. i say in the first post of this thread 'any conclusions you come to based on the info posted are your own'.

 

apologies if my post was heavy handed. its the internet and things line tone, delivery and intent are easily blurred.

 

Mickey, you are a great contributor to this forum and I truly did not mean anything disrespectful by my post. I had not read Pupdaddy's post when I made my first post and I tried to clarify my intent in response to scar5. The reality of it is that I did not take a position one way or the other on the tools of the trade so to speak. The various types of tools seem to work well for different clinics who use them and produce consistent great outcomes. I love the work of some of the top surgeons that prefer the manual tools and would not hesitate to have FUE done by most of the ones that are mentioned. Sorry that it seemed that I derailed your thread as that was not my intent. All is good my friend.

[Mickey85]

Mickey, you are a great contributor to this forum and I truly did not mean anything disrespectful by my post. I had not read Pupdaddy's post when I made my first post and I tried to clarify my intent in response to scar5. The reality of it is that I did not take a position one way or the other on the tools of the trade so to speak. The various types of tools seem to work well for different clinics who use them and produce consistent great outcomes. I love the work of some of the top surgeons that prefer the manual tools and would not hesitate to have FUE done by most of the ones that are mentioned. Sorry that it seemed that I derailed your thread as that was not my intent. All is good my friend.

 

no problemo champ all water under the bridge hehe. sorry i reacted like an ass, you just looking out for people.

[PupDaddy]

Add Dr. Bhatti to the list of FUE docs who use a motorized punch. According to his posts (reproduced below) he mostly uses Dr. Harris's SAFE motorized hand-held tool, using punch sizes of 0.75 mm and 0.85 mm. He has used the SAFE for four years and says it is a blunt punch, which results in a low transection rate and therefore higher yield. He says that manual FUE is very slow and does not result in better grafts as compared to the grafts he gets with the SAFE. He thinks that some FUE docs still use manual punches because they trained with them and are used to them, especially docs coming from a dermatological background.

 

 

 

02-03-2013

 

Hi Jayukdht,

 

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 is just one of them. I am comfortable using this system since I trained on it 4 years back. The JH 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.

[Raj Jayukdht]

Yep that was his reply to me. Its all good for me.

[Mickey85]

nice addition!

[james84]

Great post.

 

I think the phrase comes to mind....

 

'A workman should never blame he's tools'

[Mickey85]

Great post.

 

I think the phrase comes to mind....

 

'A workman should never blame he's tools'

 

Unfortunately a surgeon never blames his tools, he/she always blames the physiology of the patient. Rarely if ever have I seen a surgeon own up and say his clinic were not up to standard on a particular case. Dr. True(or Dorin) actually gave a very sincere apology on the forum to a patient who had a unsuccessful procedure with them who subsequently went to Feller for repair. That's one of the few times I have seen a doctor 'own up' and not blame the patients physiology or 'x factor'.

[PupDaddy]

According to his web site, Dr. Koray Erdogan (Istanbul) prefers manual punches over motorized punches, or motorized punches with high rotational speeds, anyway -- for two reasons:

 

1. He says he can better sense the change in angle/direction of the hair follicle after it enters the scalp using a lightweight manual punch than he can with a heavier motorized punch.

 

2. He says he has observed that motorized punches with high rotational speeds can damage nearby follicles, create wider scars than manual punches, and cause acne.

 

 

 

From Dr. Erdogan's site:

 

""* What is a micromotor?

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."

[Mickey85]

great edition.

[Mickey85]

I will be reworking this thread very soon. Stay tuned

[michaeljames]

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. I will list each quote in a separate post so it will be easily quotable should anyone want to discuss or elaborate on it. 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 and motorized. I'm leaving ARTAS out due to it's relative infancy.

 

Note: Quotes contained in this thread are the opinions of the Doctors and/or their representatives. Any conclusions you come to based on the information posted here are you own. This thread is not meant to polarize the forum into favoring or denouncing any method used. I am merely posting a collection of opinions on what I view as a very important factor in FUE. I will be adding to this thread as time goes on and Doctor's are free to post their opinions themselves here. I would prefer if representatives post their Doctor's opinions on the matter and not their own simply to keep it keep it level. I'm not being compensated in anyway by anyone, thread is for my enjoyment/interest and yours, should you be interested in such a matter. Peace.

 

Hi Mickey,

 

About two years ago Dr. Mohebi directed and conducted a study regarding FUE, At this time the manual method is the preferred in our centers prior and post the study. There are several premises discussed prior to the study: Hair Restoration Blog » Blog Archive » FUE Transplant – Automated vs. Manual

 

All the Best, Michael

[Mickey85]

The thread has been majorly reworked to include all quotes in one post and an overview of manual, motorized, ARTAS and Neograft with pictures, videos and a list of surgeons who use them. Ongoing alterations and additions will occur, stay tuned.

 

Please let me know what you think!

[Mickey85]

Anyone have any suggestions for what else they want included??

[PupDaddy]

How about listing which doctors do the extractions themselves and which doctors delegate the extractions to their techs or nurses? I think it would be valuable to know who is wielding or operating the clinic's tool of choice for the FUE extractions -- the physician, or his techs. If this thread isn't the best place for that info (your call, Mickey85), then perhaps a separate thread could be started.

[Mickey85]

Im contemplating it PupDaddy.

[PupDaddy]

Also, Mickey, perhaps the clinic's maximum number of extractions per day and maximum total extractions per transplant would be a good fit for this thread?

[Mickey85]

Also, Mickey, perhaps the clinic's maximum number of extractions per day and maximum total extractions per transplant would be a good fit for this thread?

 

Yes! That's actually a good one that I'm willing to include unequivocally People ask me all the time and have reservations about doing multi-day procedures so it would be great to have a database with those details. I will probably do that in conjunction or after I have finished with the list of punches that individual surgeons use.

Edited April 27, 2013 by Mickey85

[TomCruise]

Possibly re-work the title to something broader, as the thread had grown in scope. I could be wrong but it seems like it's than must manual vs. motorized going into basic methodology etc.