A question for the experts: FUE extraction

[FUE2014]

All,

 

If the doctor who was going to operate on you (in my case Dr Doganay - in June) documented in their website that they preferred to do motorised extraction over manual; claimed no noticeable difference between the two methods of extraction; and charged less for motorised, is there anyone here who would still elect to go for manual and if so why?

 

I obviously want to maximise my result and am still on the fence about manual vs motorised. I am happy to pay more for manual but if the tech doing the extraction is more proficient with the motorised extraction, then who I am to argue?

 

However, there is a part of me that thinks motorised extraction only really serves the doctor in terms of increased turnover of patients and profit, or is this overly cynical?

[Mickey85]

I would GLADLY pay extra for manual FUE over motorized. Any day of the week. Manual gives the surgeon feedback on how it is interacting with the graft. This can be imperative to graft survival. Sharp manual punches also allows the surgeon to punch the graft with as few oscillations as possible, preventing shearing of the protective tissue of the graft. Motorized has its advantages such as less hand fatigue and quicker extraction time but I feel the majority of good to excellent FUE results are manual. Just my opinion.

 

Some quotes from surgeons/clinics in regards to manual:

 

 

 

"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's(Belgium) representative. Quote taken via email

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"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." Dr De Reys taken from Youtube Q&A

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

 

"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

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"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

 

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"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

 

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Taken from my thread(citations provided):

 

http://www.hairrestorationnetwork.com/eve/169281-ultimate-manual-versus-motorized-fue-thread.html#post2334960

[FUE2014]

Thanks Mickey, you have helped me make my mind up. Manual it is :-)

[Mickey85]

Here are the opinions of surgeons who use motorized:

 

"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." Hakan

 

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"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." Devroye

 

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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

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Most choose the motorized method because they can extract faster.

[Mickey85]

Thanks Mickey, you have helped me make my mind up. Manual it is :-)

 

Remember however, it is YOUR scalp. I don't suggest rushing into any procedure just because I state my opinion and surgeon's quotes. Look at the individual surgeon's work. Compare them to others who use manual/motorized. Who has the best results? Who has the most results? Who has quite a few poor results? What device do they use? This will ultimately give you a better idea

[Mickey85]

I just want to clarify that I prefer manual over motorized in general. However your opening post sounds like you are debating whether Dr Hakan to operates on you via manual or motorized method? Or if you should go to a manual FUE surgeon like Lorenzo? I have not seen any manual results from Hakan so I cannot advocate the manual method through him. I can only advocate manual extraction with guys like Lorenzo, Bisanga, Erdogan, Maras etc who use manual method exclusively and have produced many great results over the years using manual. I have not seen any manual results from Hakan though.... His motorized results are very good mind you, but I do prefer manual surgeons.

[FUE2014]

I just want to clarify that I prefer manual over motorized in general. However your opening post sounds like you are debating whether Dr Hakan to operates on you via manual or motorized method? Or if you should go to a manual FUE surgeon like Lorenzo? I have not seen any manual results from Hakan so I cannot advocate the manual method through him. I can only advocate manual extraction with guys like Lorenzo, Bisanga, Erdogan, Maras etc who use manual method exclusively and have produced many great results over the years using manual. I have not seen any manual results from Hakan though.... His motorized results are very good mind you, but I do prefer manual surgeons.

 

Yes, that it is a good point. I will contact him and ask if he could post some results where he has used manual results.....goodness having an HT is definitely not straight forward

[jbrant]

I just want to clarify that I prefer manual over motorized in general. However your opening post sounds like you are debating whether Dr Hakan to operates on you via manual or motorized method? Or if you should go to a manual FUE surgeon like Lorenzo? I have not seen any manual results from Hakan so I cannot advocate the manual method through him. I can only advocate manual extraction with guys like Lorenzo, Bisanga, Erdogan, Maras etc who use manual method exclusively and have produced many great results over the years using manual. I have not seen any manual results from Hakan though.... His motorized results are very good mind you, but I do prefer manual surgeons.

 

This is the heart of the matter. The punch is a tool. Manual or motorized, it is a tool. And a tool is only as good as the operator behind it. Some operators have more experience and proficiency with one type of a tool than others, and their results will be best with their preferred tool that they have the most proficiency and experience with. Look at the results. Once you are comfortable with the surgeon and their clinic's results, then go with their recommendation for the tool.

[FUE2014]

Thanks jbrant, Doganay's results are generally great and he is a recommended surgeon here, however so many doctors seem to prefer manual and as Mickey says the results tend to be better. Another thing worth noting is (unless I am wrong here) it is not Doganay doing the extractions with the motorised tool but his tech....and I have no idea how experienced he/she is.....I have also made enquiries with Dr Erdogan who is a bit more expensive, but he does only manual extraction (again I am not sure if it is him or one of his techs who performs the extractions)......anyway food for thought

[Mickey85]

Thanks jbrant, Doganay's results are generally great and he is a recommended surgeon here, however so many doctors seem to prefer manual and as Mickey says the results tend to be better. Another thing worth noting is (unless I am wrong here) it is not Doganay doing the extractions with the motorised tool but his tech....and I have no idea how experienced he/she is.....I have also made enquiries with Dr Erdogan who is a bit more expensive, but he does only manual extraction (again I am not sure if it is him or one of his techs who performs the extractions)......anyway food for thought

 

Erdogan shares punching and extraction duties with his tech, mainly a woman called Delek(forgive me if my spelling is incorrect here). She is very skilled....

[FUE2014]

Great post from 3 years ago from a doctor on this forum - highlights the motorised/manual debate is actually a lot more nuanced than I thought:

 

I'll add my 2 cents here. Take it for what its worth and of course this is free advice so it may be worth little.

 

Dr. Feller, with whom I'm associated, taught me to do FUE's several years ago. He taught me with his Feller punches and his fancy machine...actually several prototypes and the real final product. I have used several other machines at meetings and product advertising seminars but never on actual patients. I've used a few other hand punches both at seminars and on our own patients.

 

First of all FUE is more variable in its results than strip. I really try to beat this into all potential FUE patients both at our initial consultation and at the preop consent process. I think FUE is fine for small areas, ok for medium areas, and potentially a lesser choice for large areas, but an informed patient can weigh these issues and decide the pros and cons of FUE's possibly lower yield vs. a strip scar.

 

Second, I think FUE is hard. Its hard for me and I've done a lot and it requires concentration AND it requires a good extraction team who will take the time to try to minimize follicle root damage and yet maximize yield. THAT is why FUE is expensive!

 

Third, at this point my maximum FUE/day is 1200 and often by 800 or so I'm too tired to keep going OR my transection rate starts to rise.

 

Fourth, I almost entirely use a Feller hand punch because it gives me more control over where the punch is going. When I use the automated punches, the above posters are correct, its less fatiguing, but eventually that vibration actually makes my hand tired-er than just doing it by hand, and when I go in by hand, I can steer the punch better.

 

For harder cases and the more recent black guys' FUE's that I've done, if I have trouble with the Feller punch I use a different punch. Its still the same size, but doesn't have the ventilation hole...I'm not sure why it works better for me in black skin but in the past 3 cases, it has. And I bought a bunch at the Boston meeting last year, but for the life of me I don't know who sold it...so at some point I'm going to be looking harder for the name so I can buy more. But it too is a sharp hand powered punch.

 

Conversely, I believe Dr. Feller uses the motorized punch, I'm simply not as consistent with it. But he is and many doctors are comfortable with it. But its(FUE) still a harder procedure, so make sure that whoever you work with is using what works for him/her.

 

Don't go just for some tool or type of device...I got an email yesterday from a patient who appeared ready to sign up for a smallish FUE, but had decided to wait until I, or someone else locally, had purchased ........such and such new fangled fue automated device.... Rather than wait for some device, he should choose someone whose done some FUE's successfully.

 

I hope this helps.

 

Dr. Lindsey McLean VA

 

http://www.hairrestorationnetwork.com/eve/162180-manual-vs-automatic-punch-fue.html

[JohnGage]

The doctor performing the procedure is much more important than the tools he uses.