Regular Member bruce90 Posted February 3, 2019 Regular Member Share Posted February 3, 2019 Hi everyone, Just wondering what your opinion is regarding these two different techniques for extracting grafts? Which one produces better results in the hands of an experienced surgeon and which one is best for reducing scarring and trauma to the donor area? I am very conscious of having a donor area with very limited scarring so wondering if one would work better for my situation? Link to comment Share on other sites More sharing options...
Senior Member Legend007 Posted February 3, 2019 Senior Member Share Posted February 3, 2019 It’s not the technique , but the clinic and the results u should be concerned about .. 1 Link to comment Share on other sites More sharing options...
Raker Posted February 3, 2019 Share Posted February 3, 2019 Either way it’s down to the skill of the surgeon, focus on the services the clinic provide and the end result. 1 Link to comment Share on other sites More sharing options...
Senior Member LordBaldwin Posted February 4, 2019 Senior Member Share Posted February 4, 2019 As the other posters mentioned, the skill of the surgeon is definitely the most important factor when it comes to your results. However, all things being equal, my impression is that motorized FUE is significantly faster and cheaper, but manual punch yields higher graft survival rates and less scarring in the donor area (which I think is what you're looking for). Link to comment Share on other sites More sharing options...
Regular Member jim009 Posted February 4, 2019 Regular Member Share Posted February 4, 2019 most off the top clinics juse WAW system http://www.devroyeinstruments.com Link to comment Share on other sites More sharing options...
Senior Member Markee Posted February 9, 2019 Senior Member Share Posted February 9, 2019 On 2/4/2019 at 9:42 AM, jim009 said: most off the top clinics juse WAW system http://www.devroyeinstruments.com Who uses that ? Link to comment Share on other sites More sharing options...
Regular Member jim009 Posted February 9, 2019 Regular Member Share Posted February 9, 2019 dr Devroye,feriduni,...... Link to comment Share on other sites More sharing options...
Senior Member 1978matt Posted February 9, 2019 Senior Member Share Posted February 9, 2019 3 hours ago, jim009 said: dr Devroye,feriduni,...... ..konior, nadimi, gabel, Shapiro... 4,312 FUT grafts (7,676 hairs) with Ray Konior, MD - August 2013 1,145 FUE grafts (3,152 hairs) with Ray Konior, MD - August 2018 763 FUE grafts (2,094 hairs) with Ray Konior, MD - January 2020 Proscar 1.25mg every 3rd day Link to comment Share on other sites More sharing options...
Senior Member VicTNYC Posted February 9, 2019 Senior Member Share Posted February 9, 2019 On 2/4/2019 at 9:42 AM, jim009 said: most off the top clinics juse WAW system http://www.devroyeinstruments.com Thanks! Added-to-cart! Guess What all my balding friends and family are getting next Xmas! “YOU get an FUE and YOU get an FUE...EVERYONE gets an FUE!” 😂😂 1 Link to comment Share on other sites More sharing options...
LonelyGraft Posted February 9, 2019 Share Posted February 9, 2019 6 hours ago, 1978matt said: ..konior, nadimi, gabel, Shapiro... I thought konior and Nadimi use perform manual fue? Link to comment Share on other sites More sharing options...
Administrators Melvin- Admin Posted February 10, 2019 Administrators Share Posted February 10, 2019 On 2/3/2019 at 8:20 AM, Legend007 said: It’s not the technique , but the clinic and the results u should be concerned about .. ^this I remember this whole “manual” FUE craze started a few years ago. Simply because some top clinics were performing successful FUE manually. All of the sudden the community thought it was the gold standard. However, several top notch clinics perform micromotor FUE with fantastic results and pristine donor sites. I’m a paid admin for Hair Transplant Network. I do not receive any compensation from any clinic. My comments are not medical advice. Check out my final hair transplant and topical dutasteride journey: View my thread Topical dutasteride journey Melvin- Managing Publisher and Forum Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q&A Blog. Follow our Social Media: Facebook, Instagram, Linkedin, and YouTube. Link to comment Share on other sites More sharing options...
Senior Member Spaceman Posted February 10, 2019 Senior Member Share Posted February 10, 2019 (edited) On 2/4/2019 at 6:42 AM, jim009 said: most off the top clinics juse WAW system http://www.devroyeinstruments.com IDK if Hasson & Wong use WAW in their clinic, but Dr. Wong has demonstrated it along side Devroye and raved about it on the H&W blog. Also agree with Legend and Melvin that consistency and quality of results is most important. OP, if your goal is to minimize trauma and scarring in donor then look for clinics that consistently show the least signs of surgery in the fully healed donor area in patient posted results. New tools/techniques are continually developed and top surgeons employ different tools/techniques depending on the case. Edited February 10, 2019 by Spaceman Formatting Link to comment Share on other sites More sharing options...
Dr. Raymond Konior Posted February 10, 2019 Share Posted February 10, 2019 (edited) The mostly useless topic of manual versus motorized should be relegated to the trash heap. It may have held relevance at some point in time, but it means little today. Patients should also be leery of dogmatic statements made about how an individual conducts his or her practice as the only person who can provide definitive detail as to what is done and how it’s done is the surgeon himself. The fact is that I use multiple devices for extracting grafts, with the device of choice depending on the situation at hand. There are days when a motorized technique is best and days when a manual technique is best. There are days when a straight-wall trephine is best and days when a flared-wall trephine is best. There are days when a straight-edge trephine is best and days when a serrated-edge trephine is best. This argument reminds me of guys arguing which is better, a straight-edge screwdriver or a Phillips screwdriver. Of course the answer is that it depends on the situation at hand. Also remember, there are some talented surgeons who can use every technology effectively and some who, despite having the best of the best instruments, can’t extract quality grafts on a consistent basis. When it’s all said and done, it’s not the instrument that matters as much as the surgeon choosing the instrument to use for the situation at hand. If you place the world’s finest and most expensive Steinway piano in front of most people, very few would be able to generate a beautiful song. On the other hand, place one of the world’s top five pianists in front of a Walmart special keyboard and you will probably hear some darn good tunes. Edited February 10, 2019 by Dr. Raymond Konior 7 2 Dr. Ray Konior is a highly esteemed member of the Coalition of Independent Hair Restoration Physicians. Link to comment Share on other sites More sharing options...
Administrators Melvin- Admin Posted February 10, 2019 Administrators Share Posted February 10, 2019 4 hours ago, Dr. Raymond Konior said: The mostly useless topic of manual versus motorized should be relegated to the trash heap. It may have held relevance at some point in time, but it means little today. Patients should also be leery of dogmatic statements made about how an individual conducts his or her practice as the only person who can provide definitive detail as to what is done and how it’s done is the surgeon himself. The fact is that I use multiple devices for extracting grafts, with the device of choice depending on the situation at hand. There are days when a motorized technique is best and days when a manual technique is best. There are days when a straight-wall trephine is best and days when a flared-wall trephine is best. There are days when a straight-edge trephine is best and days when a serrated-edge trephine is best. This argument reminds me of guys arguing which is better, a straight-edge screwdriver or a Phillips screwdriver. Of course the answer is that it depends on the situation at hand. Also remember, there are some talented surgeons who can use every technology effectively and some who, despite having the best of the best instruments, can’t extract quality grafts on a consistent basis. When it’s all said and done, it’s not the instrument that matters as much as the surgeon choosing the instrument to use for the situation at hand. If you place the world’s finest and most expensive Steinway piano in front of most people, very few would be able to generate a beautiful song. On the other hand, place one of the world’s top five pianists in front of a Walmart special keyboard and you will probably hear some darn good tunes. Very well said and great analogies. I agree 100%. I’m a paid admin for Hair Transplant Network. I do not receive any compensation from any clinic. My comments are not medical advice. Check out my final hair transplant and topical dutasteride journey: View my thread Topical dutasteride journey Melvin- Managing Publisher and Forum Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q&A Blog. Follow our Social Media: Facebook, Instagram, Linkedin, and YouTube. Link to comment Share on other sites More sharing options...
LonelyGraft Posted February 11, 2019 Share Posted February 11, 2019 13 hours ago, Dr. Raymond Konior said: The mostly useless topic of manual versus motorized should be relegated to the trash heap. It may have held relevance at some point in time, but it means little today. Patients should also be leery of dogmatic statements made about how an individual conducts his or her practice as the only person who can provide definitive detail as to what is done and how it’s done is the surgeon himself. The fact is that I use multiple devices for extracting grafts, with the device of choice depending on the situation at hand. There are days when a motorized technique is best and days when a manual technique is best. There are days when a straight-wall trephine is best and days when a flared-wall trephine is best. There are days when a straight-edge trephine is best and days when a serrated-edge trephine is best. This argument reminds me of guys arguing which is better, a straight-edge screwdriver or a Phillips screwdriver. Of course the answer is that it depends on the situation at hand. Also remember, there are some talented surgeons who can use every technology effectively and some who, despite having the best of the best instruments, can’t extract quality grafts on a consistent basis. When it’s all said and done, it’s not the instrument that matters as much as the surgeon choosing the instrument to use for the situation at hand. If you place the world’s finest and most expensive Steinway piano in front of most people, very few would be able to generate a beautiful song. On the other hand, place one of the world’s top five pianists in front of a Walmart special keyboard and you will probably hear some darn good tunes. Dr. Konior what is your opinion on clinics that utilize technicians for extractions? Link to comment Share on other sites More sharing options...
Senior Member Sean Posted February 11, 2019 Senior Member Share Posted February 11, 2019 On 2/10/2019 at 7:59 AM, Dr. Raymond Konior said: The mostly useless topic of manual versus motorized should be relegated to the trash heap. It may have held relevance at some point in time, but it means little today. Patients should also be leery of dogmatic statements made about how an individual conducts his or her practice as the only person who can provide definitive detail as to what is done and how it’s done is the surgeon himself. The fact is that I use multiple devices for extracting grafts, with the device of choice depending on the situation at hand. There are days when a motorized technique is best and days when a manual technique is best. There are days when a straight-wall trephine is best and days when a flared-wall trephine is best. There are days when a straight-edge trephine is best and days when a serrated-edge trephine is best. This argument reminds me of guys arguing which is better, a straight-edge screwdriver or a Phillips screwdriver. Of course the answer is that it depends on the situation at hand. Also remember, there are some talented surgeons who can use every technology effectively and some who, despite having the best of the best instruments, can’t extract quality grafts on a consistent basis. When it’s all said and done, it’s not the instrument that matters as much as the surgeon choosing the instrument to use for the situation at hand. If you place the world’s finest and most expensive Steinway piano in front of most people, very few would be able to generate a beautiful song. On the other hand, place one of the world’s top five pianists in front of a Walmart special keyboard and you will probably hear some darn good tunes. Hi Dr Konior, When you decide what tool to use, what hair type determines that? Is Manual or Motorized better for? Thin hair Medium hair Thick hair or is manual or motorized FUE better for one ethnic group vs others? Asian, Arab, Mid Eastern, Indian, Caucasian, Black, etc Thank you. Link to comment Share on other sites More sharing options...
Dr. Raymond Konior Posted February 11, 2019 Share Posted February 11, 2019 What is my opinion on clinics that utilize technicians for extracting grafts? Hmm… Answer these three questions: 1) Would you allow a tech to remove a brain aneurysm on your mother? 2) Would you allow a tech to perform coronary artery bypass on your father? 3) Would you allow a tech to remove a testicular cancer on you? If the answer is “yes” to any of these questions, you should do nicely in a tech-driven hair restoration facility. If, on the other hand, you answered “no” to all questions, then ask yourself why you would allow a technician to perform a surgical procedure on your scalp. Also, if you answered “no” to all questions, and you decide to use a facility that uses technicians for graft extraction – without direct supervision by the operating doctor – ask your doctor why he or she is not performing the procedure, but rather uses the service of a technician to perform what I deem to be a surgical procedure. Questions I would direct to the physician if he or she uses technicians for graft extraction without direct doctor supervision: 1) Do you use a technician because you have poor eyesight? 2) Do you use a technician because you have a tremor? 3) Do you use a technician because you will be in another room maximizing your profit for the day? 4) Do you use a technician because you don’t believe patient care and supervision is important? 5) Do you use a technician because you are lazy and prefer to surf the web or check your stock portfolio? 6) Do you use a technician because you lack surgical skills and believe the technician is capable of delivering a better quality graft than you would be capable of delivering? 7) Do you believe harvesting grafts is a “simple” component of the surgical procedure or that harvesting grafts is “no big deal” such that it can readily be delegated to a technician? The bottom line is that I believe hair restoration is a surgical procedure that should be performed by a doctor. It is not a mundane and simplistic task that is capable of being delegated to the technician level. Face it, most technicians have little to no formal education, i.e. they receive “on the job” training. Who is training them and who is supervising them? We in this practice respect the doctor-patient relationship and feel that the patient is entitled to the doctor’s presence in the operating room from beginning to end. 6 Dr. Ray Konior is a highly esteemed member of the Coalition of Independent Hair Restoration Physicians. Link to comment Share on other sites More sharing options...
Senior Member Gasthoerer Posted August 11, 2019 Senior Member Share Posted August 11, 2019 Want to bump this old thread as recently many top clinic switched (partly) to WAW system of Devroye. Clinics I am aware using WAW now are: - Devroye (obviously) - Feriduni - PHC - Konior (at least sometimes) I discussed +/- with several clinics and the feedback was: 1. trumpet punch Pro: Great and allows smaller punch diameter with less transection Contra: Higher cost 2. Motor Pro: Allows hand to focus on graft curvature as rotation (oscillation) is performed by the motor Pro: Faster ( shorter duration of surgery and grafts out of body time) Contra: Knowledge of motor speed etc required = retraining for staff required Contra: Weight of the tool reduces the feeling for the graft The last argument was so big for one clinic, which led to their decision to remain manual. There was no negative comment on the new punch besides cost and patent issues. 400+ grafts in 2018 and 2900 grafts in 2020 via FUE with Feriduni Link to comment Share on other sites More sharing options...
LonelyGraft Posted August 11, 2019 Share Posted August 11, 2019 9 hours ago, Gasthoerer said: Want to bump this old thread as recently many top clinic switched (partly) to WAW system of Devroye. Clinics I am aware using WAW now are: - Devroye (obviously) - Feriduni - PHC - Konior (at least sometimes) I discussed +/- with several clinics and the feedback was: 1. trumpet punch Pro: Great and allows smaller punch diameter with less transection Contra: Higher cost 2. Motor Pro: Allows hand to focus on graft curvature as rotation (oscillation) is performed by the motor Pro: Faster ( shorter duration of surgery and grafts out of body time) Contra: Knowledge of motor speed etc required = retraining for staff required Contra: Weight of the tool reduces the feeling for the graft The last argument was so big for one clinic, which led to their decision to remain manual. There was no negative comment on the new punch besides cost and patent issues. Which clinic decided to stay with manual fue? Link to comment Share on other sites More sharing options...
Senior Member CosmoKramer Posted August 11, 2019 Senior Member Share Posted August 11, 2019 9 hours ago, Gasthoerer said: Want to bump this old thread as recently many top clinic switched (partly) to WAW system of Devroye. Clinics I am aware using WAW now are: - Devroye (obviously) - Feriduni - PHC - Konior (at least sometimes) I discussed +/- with several clinics and the feedback was: 1. trumpet punch Pro: Great and allows smaller punch diameter with less transection Contra: Higher cost 2. Motor Pro: Allows hand to focus on graft curvature as rotation (oscillation) is performed by the motor Pro: Faster ( shorter duration of surgery and grafts out of body time) Contra: Knowledge of motor speed etc required = retraining for staff required Contra: Weight of the tool reduces the feeling for the graft The last argument was so big for one clinic, which led to their decision to remain manual. There was no negative comment on the new punch besides cost and patent issues. Interesting... Was the clinic that decided to remain manual Dr Dieps clinic? Link to comment Share on other sites More sharing options...
Senior Member Gasthoerer Posted August 11, 2019 Senior Member Share Posted August 11, 2019 15 minutes ago, CosmoKramer said: Interesting... Was the clinic that decided to remain manual Dr Dieps clinic? No, (even though many clinic still do manual and maybe also Dieps), this comment came from Hattingen. But they did not try Devroye's WAW system but some other tools including self made ones. 400+ grafts in 2018 and 2900 grafts in 2020 via FUE with Feriduni Link to comment Share on other sites More sharing options...
Senior Member CosmoKramer Posted August 11, 2019 Senior Member Share Posted August 11, 2019 11 minutes ago, Gasthoerer said: No, (even though many clinic still do manual and maybe also Dieps), this comment came from Hattingen. But they did not try Devroye's WAW system but some other tools including self made ones. Gotchya, thanks for the info. Link to comment Share on other sites More sharing options...
Administrators Melvin- Admin Posted August 12, 2019 Administrators Share Posted August 12, 2019 8 hours ago, CosmoKramer said: Interesting... Was the clinic that decided to remain manual Dr Dieps clinic? Dr. Diep uses motorized, the reason why most felt that motorized was the best was because of Dr. Lorenzo, but I believe the mystique is beginning to die down, as top clinics reveal that they use motorized tools as well. I’m a paid admin for Hair Transplant Network. I do not receive any compensation from any clinic. My comments are not medical advice. Check out my final hair transplant and topical dutasteride journey: View my thread Topical dutasteride journey Melvin- Managing Publisher and Forum Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q&A Blog. Follow our Social Media: Facebook, Instagram, Linkedin, and YouTube. Link to comment Share on other sites More sharing options...
Senior Member CosmoKramer Posted August 12, 2019 Senior Member Share Posted August 12, 2019 23 minutes ago, Melvin-Moderator said: Dr. Diep uses motorized, the reason why most felt that motorized was the best was because of Dr. Lorenzo, but I believe the mystique is beginning to die down, as top clinics reveal that they use motorized tools as well. I agree, in the right professional hands, the motorized vs Manuel debate seems to be waning. I just assumed Diep as in his recent patient YouTube videos he’s been mentioning doing the extractions manually. Correct me if I’m wrong but I believe he mentioned manual also in your interview videos with him?....either way it’s interesting...to me at least. Link to comment Share on other sites More sharing options...
LonelyGraft Posted August 12, 2019 Share Posted August 12, 2019 2 hours ago, Melvin-Moderator said: Dr. Diep uses motorized, the reason why most felt that motorized was the best was because of Dr. Lorenzo, but I believe the mystique is beginning to die down, as top clinics reveal that they use motorized tools as well. Lorenzo only utilizes manual punches.... Link to comment Share on other sites More sharing options...
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