The ultimate manual versus motorized FUE thread

[hairweare]

Dr Emre, as a doc who does interventional angiographic procedures, despite having equal visual guidance I prefer instruments that give me the most tactile response. Being a trained plastic surgeon I would have thought that you too would have preferred manual over motorized extraction.

[Ali Emre Karadeniz]

Dr hairweare (sorry, but you haven't mentioned your name),

 

I too prefer instruments that give me the most tactile response as a surgeon who does microsurgical vessel anastomosis, but I don't agree that the manual punch gives me this. On the contrary, the need to use hand force for drilling into the skin when using a manual punch prevents me form getting a perfect feel for the angle and depth. As you know, in microsurgical procedures there should not be significant force in the hand for the maximum sensitivity and accuracy of the movements. I believe that the hand work to rotate the punch thousands of times is a waste of energy. The second thing is that the force to penetrate the skin with a manual punch causes a depression at the skin surface, altering the natural direction of the follicle and making it more difficult to control the angle. The third thing is that when the fingers rotate the punch holder, there is an oscillating movement with every rotation being at a slightly different angle to the skin, whereas when the motor rotates the punch the hand can stabilise the hand-piece so that all rotations are kept at the same angle. And fourth, when doing high graft numbers, fatigue while using the manual punch can cause the accuracy to deteriorate at later stages of the procedure. For all these reasons I also disagree with people who claim that the transection rate with the manual punch should be lower; I think it could be higher. Once the sharp edge of the punch touches the side of a follicle, it inevitably will cause a transection, no matter if the punch is manual or motorised. The angle should theoretically be the deciding factor in transections. All of these of course should be proven by studies. I don't criticise manual punch users but I will not surrender to claims that are derived from marketing strategies and accept the inferiority of the motorised punch, until I see convincing data.

 

Regards,

 

Dr. Ali Emre Karadeniz

[hairweare]

Thanks for the reasonable and detailed explanation. I still wonder then why Dr. Lorenzo who obviously could take advantage of a motorized device still favors manual. It would be an interesting debate to listen in on!

 

From a personal perspective, I had a total of 1500 scalp and 300 beard grafts in one session punctuated by a 40 min lunch break. I was quite impressed with Dr. Lorenzo's stamina and recognize his performance may be the exception rather than the rule when it comes to dealing with fatigue. I of course have no direct experience in doing the procedure myself but I assume that the operator has multiple tools i.e. sharp v. dull and varying mm size punches at his disposal and can choose during the first few extractions which is best suited for the task.

 

While I don't know to what degree if any the follicles in the donor area were transected, it appears to the naked eye that all of the implanted grafts grew including the beard ones that went into a fibrotic scar.

I doubt Lorenzo could be achieving the density results he consistently shows if the transection rate was of any significance.

[MikroFUE]

http://www.hairrestorationnetwork.com/eve/177381-dr-doganay-1075-grafts-4-11-14-a.html

Originally Posted by spitfire: Hi , he (Dr. Hakan) does both but i requested punch as i felt a bit more confident that way .

If i go back and now i have a feel for the Dr i could be tempted by motorized , he was clear with me there is no difference in results in his opinion.

 

That's the end.

 

FUE (manual) introduced, FUT doers blamed FUE (manual) doers for high transsection rates, LATER, ............

 

FUE (mikromotor) introduced, both FUT and manual FUE doers blamed mikromotor powered FUE doers for lack of hand precision and higher transection rates. LATER........

 

While you insert a screw to the wall or wood, which provides easiness and precision? Screwdriver with hand power, or (pneumatic) power drill??

 

At the beginning of micromotor powered FUE, physicians were afraid of heat production with high rotating speed of Mikromotor may cause more follicle damage. But, since a great amount of fluid is injected into the tissue (tumescent solution) to make the tissues firm and consistent; so, because microtips works under water, this heat production is so trivial and later turned out to be there was no heat effect with micromotor use and the survival/growth rates are the same as with manual FUE.

 

So, what are the advantages of manual FUE now?,

 

Future_Doc; as a fan of manual FUE, can you add your reasons for that?

[Blake Bloxham]

Mirko,

 

Torsion, tension, friction, and heat - to quote the great Dr. Feller - are the enemy of the FUE extracted follicular unit graft. Per your own explanation, adding tumescent solution - which, by the way, can actually increase transection by distorting the follicles and increase tension during follicle delivery by creating firmer tissues - may slightly decrease the heat function and MAYBE the friction, but it doesn't reduce the tension or torsion.

 

The advantages of manual FUE, in my opinion, are intuitive - the hair follicle is a tiny, fragile organoid; what is the best way to remove, preserve, and transplant an organ? With a power tool or with the simple, gentle motions from the hands of a trained surgeon? Would a heart transplant specialist sever tiny blood vessels and precious muscle fibers with a sharp scalpel or a power saw? Follicular unit grafting isn't akin to screwing a metal screw into a piece of wood - as you described above; it's transplantation of very fragile living tissue.

 

Manual FUE provides the most gentle, atraumatic approach while also allowing the surgeon to feel important physiological feedback. Unfortunately, I do not believe motorized FUE provides these luxuries. Again, I would never say good results can't be achieved by motorized tools in the right hands. However, I still think manual is the most precise, technical, non-traumatic approach.

 

Most of the "advantages" of the motorized tools seem to be geared toward the team performing the procedure - less training/practice, increased speed, and decreased fatigue - and not the patient.

 

Again, just my "two cents." But I've said it before and I'll say it again: FUE tools are just that - inanimate objects used to perform a procedure. The results lay in the skill of the physician.

[TakingThePlunge]

I get a fair number of emails from people asking me if they should choose a doctor that uses manual punches or one that uses motorized punches. I do enjoy these discussions and I appreciate the information that Dr. Emre shared above regarding why he prefers a motorized punch but, when it comes to questioning why one physician uses manual and another chooses motorized, I'm really not that concerned. What I look at is the final results that these doctors produce. Does anyone care what kind of paint brush da Vinci used or whether or not Rembrandt's tools where superior? Nah, we just enjoy the masterpieces they created.

 

I consider world-class hair transplant surgeons to be artists in their own right. Yes, surgery is a science but it takes that artistic flair to mimic nature as closely as possible and create those undetectable results.

 

My advice is to look at the results first. Let the doctor worry about the tools he uses to obtain those results.

[KO]

This is a nice video, very informative. The speaker (Dr. Ximena Vila?) has a very cool-sounding accent.

 

 

 

 

 

How do I paste a video directly onto a post?

Edited November 23, 2014 by KO

[Sean]

What is crazy is doctors and clinics admit that even tools like Artas are not achieving satisfactory results. SMG clinic gave up on Artas, Dr. Umar writes about Artas on his website, other doctors revealing not so great results. it looks like the end of the road for that machine. Patients who had Artas on forums posting negatively.

 

Even motorized Fue is being put into question. This is even more dangerous as inexperienced technicians/non surgeons are allowed to extract with such tools.

[hairweare]

"Does anyone care what kind of paint brush da Vinci used or whether or not Rembrandt's tools where superior? Nah, we just enjoy the masterpieces they created."

 

David, having just visited the Prado in Madrid where I viewed the masterpieces of Rembrandt, Goya and

Valasquez, I strongly suspect that they all used natural brushes as opposed to a Wagner power painter. I concur completely with the sentiments of Future_HT_Doc and during my own vascular procedures always prefer the instruments that give the best tactile feel allowing for fine adjustments. The high tech "power" tools in our box now that the initial excitement has waned, have for the most part become orphan technologies relegated only to niche situations.

 

I had a good discussion with Dr. Lorenzo who shared with me what all good surgeons know so well in that cases may start out routinely with an initial plan but one never knows what you are really dealing with until the procedure is in progress. Even after performing thousands of procedures I always felt that even with the simplest ones there was always something new to learn or improve upon. Lorenzo seems to share that same approach and along with his obvious hand skills makes him an even more impressive physician.

[fisher4man]

This is a nice video, very informative. The speaker (Dr. Ximena Vila?) has a very cool-sounding accent.

 

 

 

 

 

How do I paste a video directly onto a post?

 

Great surgical technique and informative video indeed. Is this guy Lorenzo, who is pushing the pen with lightning speed?

 

And, what is your opinion for dense packaging as shown at the last part of video?

 

http://www.hairrestorationnetwork.com/eve/177566-hair-transplant-slow-growers-really-thing-3.html

Quote:

Originally Posted by Loags79 View Post

high density packing as this runs the risk of graft necrosis.

[Lateatnight]

This is a nice video, very informative. The speaker (Dr. Ximena Vila?) has a very cool-sounding accent.

 

 

 

 

 

How do I paste a video directly onto a post?

 

Yeah, she is!

I spoke with her in person 4 days ago, it's definitely her voice. Super cute woman:D

[KO]

Nice, you get operated on or a consult?

[Sean]

Considering that giving extended timeframes to patients with subpar results can be part of deceptive marketing and questionable physician ethics/practices, or possible fraud, i will forward this and comments to federal and gov doctors to find out if such statements made herein and by doctors herein are true or false. Most docs have worked with skin grafts and burns and hair replacement for some soldiers in battle. So, i am sure they would know the answer how long it takes to normally grow or they may have had studies done. Once i get some sort of answer then, i will send it out to surgeon generals offices and health and safety med boards for further clarifications based highlighting advice based on what i am reading on these forums and doctors part of these forums. It's really important to get the feds involved when there is questionable medical knowledge that is pushed on as fact.

[Blake Bloxham]

Hairweave,

 

Thanks for sharing! I think your experience definitely provides a unique perspective, and I agree with your point of view!

[Lateatnight]

Nice, you get operated on or a consult?

 

Operated. Lorenzo.

[KO]

Congrats, look forward to your results, if you are comfortable posting your experience. I am considering him as well...

[Lateatnight]

I will post my results. In form of a photo album. Sharing my experience, i don't know, and not because i'm not comfortable with it.

Btw, thanks!

[Lateatnight]

After seeing your postoperative pictures, I do understand why you are not comfortable to start a new thread for yourself. How many grafts was that, and where is your preoperative pictures.

 

I bet KO will not be comfortable also and will not open his thread after Lorenzo. We all need to endure him until than his operation and disappear.

 

Lateatnight; you have seen Lorenzo, is this guy, in the middle part of the video who is pushing the pen is Lorenzo? or one of his students?

 

Be more specific!!!

I'm not opening a thread for reasons that have nothing to do with the results.

A little too early to jump to conclusions after few days postoperative.

I had 3600 grafts implanted. Lorenzo is the guy that pushes the pen in the video. No one else except Vila is allowed to do implants with the pen.

 

Don' t know about the issue you're having with KO and the other Lorenzo cheerleaders or whatever you are doing on here, but don't speculate on my surgery to your advantage. My prep pics are somewhere in my hard drive.

 

Regards

[fisher4man]

Thank you for the information you provided, You replied me all.

 

And, you are one of Lorenzo's patients now, and I respect that. You are not a cherleader (this is not my word.)

 

Hope you will change your mind and open a thread from the beginning and telling your full experience with Lorenzo. This will be more sincere and genuine than posting results pictures after the result is evident.

 

I wish you the best result and very good growing sincerely.

[Bill - Seemiller]

Fisher4man,

 

I have removed your last post because for no reason, you are continually harassing forum member KO. I know you may have previously gotten in a debate with him. But that's over now. Thus, please stick to providing your opinion on topics and stop badgering other forum members.

 

Thanks,

 

Bill

[Lateatnight]

Thank you for the information you provided, You replied me all.

 

And, you are one of Lorenzo's patients now, and I respect that. You are not a cherleader (this is not my word.)

 

Hope you will change your mind and open a thread from the beginning and telling your full experience with Lorenzo. This will be more sincere and genuine than posting results pictures after the result is evident.

 

I wish you the best result and very good growing sincerely.

 

I don't even know you, and honestly i don't give a shit, so don't you dare to teach me lesson about genuine and sincere referring to me. I post whatever i want. Picture speaks the truth themselves, words are tools to mislead people.

From now on we avoid each other.

Passo e chiudo!

[fisher4man]

buona fortuna

[Lateatnight]

Ti possa cadere l' uccello per terra e rimbalzare nel didietro

[fisher4man]

MODERATORS, (Blake)

http://www.hairrestorationnetwork.com/eve/177637-dr-lorenzo-no-longer-posting-results-3.html

 

Originally Posted By Future_Doc_: We discussed continuing his (Lorenzo's) recommendation after his return to Spain. Thus far, however, communication has been difficult and we haven't received a conclusive answer.

 

 

If Lorenzo is not a recommended doctor here (not listed in the recommended/coalition members list) then isn't unfair to the recommended physicians that Lorenzo's cheerleaders, KO and Lateatnight, still post his advertorial videos to this sticky thread(s)?

[zyzz]

Has someone answered the difference between the Choi vs Lion implanter pen?