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Fred88

Have to make a choice in a few days

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Just now, Fred88 said:

That kinda scares me a bit. Is that a proven statement? I don't know many who are doing manual; just Pekiner and Keser. But I kinda guess the also huge price different is coming from there.

Do a systematic comparison of before/afters and you will see it very quickly. I was honestly quite shocked at how apparent it was. I'm considering doing a separate thread on it. When you think about it it is quite logical why it is the case: Grafts are fragile things. Motorized punch submits them to additional heat and torque, and the doc or the tech doing the extraction loses the fine sense of control during the extractions. Motorized users also seem to have more patients suffering permanent damage or shock loss to the donor.

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27 minutes ago, Szotz_257 said:

If he is using motorized now I would strongly suggest you reconsider your choice, or at least think deeply about your decision. The average rates of graft survival between manual and motorized are not comparable. If you do a comparison of docs doing manual FUE and motorized, you will be shocked by how inconsistent and often outright poor the motorized results are.

That's not how you compare "survival rate". Take one doctor and make him master manual and motorised punches and then ask to perform extractions with both tools one after another. That's how you can compare and know for sure if it's true or not.

So many doctors are using micro motor with excellent results and vise versa.

Don't focus on tool, focus on result. After 20 years you will not care what tool doc used, you will care how you look.

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@Rolandas Agreed

@Szotz_257 I would have to disagree with your above statements regarding manual v motorised punch. Transition and graft survival is down to the skill of the user. Motorised punches are still manually controlled by the Doctor. I am not endorsing the Doctors discussed within this thread and do not their approach or preferred tools. The manual being superior is such an outdated argument. As Rolandas said, a great Doctor with good control of both manual and motorised will achieved great results and choose his preference. A poor/average Doctor with little/intermediate control of either manual or motorised, will achieve poor/intermediate results and choose his preference. Many of the worlds leading surgeons use a motorised punch.

This topic has understandably been discussed at length on many occasions. I reiterate what I have previously posted.

Many Drs/Clinics try selling themselves as only manual harvesters and claim it is superior. It’s a sales tool. The other thing they talk about is small punches. But small punches are great for the right patient in the right situation. However, there is much more follicle injury with small punches used in the wrong patient and in the wrong situation. The main thing is to avoid very large punches. Manual and punch size are sales tactics that a lot of clinics use to scare patients and encourage them to schedule with them. In reality, anytime a clinic pitch all manual punch or only small punch sizes, it is a clinic that you should probably avoid.  

One has to correctly match the equipment and procedure to the patient. No two patients are exactly alike so it is important to have a selection of tools and a variety of methods to succeed in ALL patients. Therefore if a clinic "sells" one method and one punch, they are going to fail a lot of the time. Every aspect of your procedure has to be individualised to your needs.

 

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Patient Advisor for BHR Clinic Athens - Greece

ian@drchristianbisanga.com  -  WhatsApp - + 34 642 37 03 83

I am not a medical professional and my words should not be taken as medical advice. All opinions and views shared are my own.

My Hair Loss Website - Hair Transplant with Dr. Rahal

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1 minute ago, Rolandas said:

That's not how you compare "survival rate". Take one doctor and make him master manual and motorised punches and then ask to perform extractions with both tools one after another. That's how you can compare and know for sure if it's true or not.

So many doctors are using micro motor with excellent results and vise versa.

Don't focus on tool, focus on result. After 20 years you will not care what tool doc used, you will care how you look.

Of course, results are what matter. And in my opinion, micromotor on average will always give worse results (measured in graft survival) than using manual punch. This means lower density at the 12-month mark and lower chance of long-term graft survival. Doesn't mean the result cannot be aesthetic despite the lower density. But that's really the wrong way to think of it. As Melvin said in another thread, while money comes and goes, grafts are finite. When they are gone, they are gone.

Motorized punch mainly serves to reduce stress for the doctor or lead hand doing the extractions, and for more grafts to be extracted in a shorter time. This lets the doc inflate the graft count and make more $$$. For docs with low per graft quotes it makes total economic sense to use it. But it has zero benefits to the patient.

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3 minutes ago, Raphael84 said:

@Rolandas Agreed

@Szotz_257 I would have to disagree with your above statements regarding manual v motorised punch. Transition and graft survival is down to the skill of the user. Motorised punches are still manually controlled by the Doctor. I am not endorsing the Doctors discussed within this thread and do not their approach or preferred tools. The manual being superior is such an outdated argument. As Rolandas said, a great Doctor with good control of both manual and motorised will achieved great results and choose his preference. A poor/average Doctor with little/intermediate control of either manual or motorised, will achieve poor/intermediate results and choose his preference. Many of the worlds leading surgeons use a motorised punch.

This topic has understandably been discussed at length on many occasions. I reiterate what I have previously posted.

Many Drs/Clinics try selling themselves as only manual harvesters and claim it is superior. It’s a sales tool. The other thing they talk about is small punches. But small punches are great for the right patient in the right situation. However, there is much more follicle injury with small punches used in the wrong patient and in the wrong situation. The main thing is to avoid very large punches. Manual and punch size are sales tactics that a lot of clinics use to scare patients and encourage them to schedule with them. In reality, anytime a clinic pitch all manual punch or only small punch sizes, it is a clinic that you should probably avoid.  

One has to correctly match the equipment and procedure to the patient. No two patients are exactly alike so it is important to have a selection of tools and a variety of methods to succeed in ALL patients. Therefore if a clinic "sells" one method and one punch, they are going to fail a lot of the time. Every aspect of your procedure has to be individualised to your needs.

 

Of course, the skill of the user is a very important in determining transection (I assume this is what you meant) and graft survival in any extraction, whether that is done through motorized or manual. However, given equal skill the graft survival will be lower with motorized, since the graft will be subjected to more damage. At  this point I must have compared thousands of before/afters of motorized and manual FUE users, and whether it's the doctor or anyone else using it, the final density is always worse when motorized tools are used. You do not have to trust me on this. Do a systematic before/after comp and judge for yourself. Or even better, find some examples of doctors that have made the switch from manual to motorized and see how things have panned out. Lupanzula being a recent example IIRC.

Docs will tell you that there is no difference is skilled hands. But they have a strong motivation to say this, because the tool is a quality of life improvement for them and lets them make more money per procedure.

Other than that, I agree with your general point that no patient is alike and that no procedure fits all patients.

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16 minutes ago, Szotz_257 said:

Motorized punch mainly serves to reduce stress for the doctor or lead hand doing the extractions, and for more grafts to be extracted in a shorter time. This lets the doc inflate the graft count and make more $$$. For docs with low per graft quotes it makes total economic sense to use it. But it has zero benefits to the patient.

But drs can regulate the price they want to charge!? Isn't it the case? If you notice among the well known drs (at least in Turkey) there is a price difference and this is coming from the amount of work that dr is involved in personally. Although, can't deny some of the expensive ones are making money just from their popularity while techs do their mega sessions (you know who I mean). 

Your argument about manual punch over motorized still makes sense to me. I can't find any reason about invention of motorized rather than doing more and more grafts. Can't argue how a motorized could improve results more than manual.

Edited by Fred88

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Juts listened to Karadeniz explanation in regards to manual vs motorized. Interesting! He makes 3 reasons that say exactly other way round that motorized is theoretically better than manual. These are the reasons;

1. "In manual rotation of hand cause fatigue hence might reduce efficiency of extraction with doing it faster."

2. "when rotating the pen in the manual technique, your rotation angle is not straight and is wobbling as a natural consequence of your arm movement which if not done by a expertise could damage the follicles. Motorized doesn't lack there."

3."Needing to have more pressure on the pen via manual might change the direction of hair when extracting. Sharp pen in motorized need less pressure if no."

He mentions one advantage of manual however:

1. "manual need an experienced Doc who knows. So techs cannot do that and HT business can not cancer-ly grow". Totally agree, makes a lot of sense.

 

But when a Doc who is able to do both uses motorized your're not talking about technicians anymore, then what's wrong with that? Let's not forget that some drs don't do dense packing so maybe that's why result doesn't look that full. Price wise, a Doc using motorized with less price could do manual, be exhausted more and charge more like others, I don't see the point.

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41 minutes ago, Fred88 said:

But drs can regulate the price they want to charge!? Isn't it the case? If you notice among the well known drs (at least in Turkey) there is a price difference and this is coming from the amount of work that dr is involved in personally. Although, can't deny some of the expensive ones are making money just from their popularity while techs do their mega sessions (you know who I mean). 

Your argument about manual punch over motorized still makes sense to me. I can't find any reason about invention of motorized rather than doing more and more grafts. Can't argue how a motorized could improve results more than manual.

I think I know which surgeon you are talking about, hehe.

And yes, logically there’s no upside to motorized for the patient. All else equal, the graft will have a lower chance of surviving, much lower in some cases. Hair loss is progressive and grafts are finite, meaning graft survival should be one of your highest priorities. This was a bitter and hard-earned lesson for myself personally.

No one can make the choice for you and for all I know it might turn out well with Demirsoy anyway. But you at least have my two cents here.

Edit: the reasons given for motorized being superior sound pretty weak to me. Of course, expertise and experience are important in order to compensate for fatigue and control things like rotational angle when performing manual FUE. None of this changes the fact that the graft is exposed to more heat, torque and force with motorized than with manual, and that this lowers graft survival.

Keep in mind, motorized is very good for docs. They therefore have a powerful motivation to use it, and to convince you that it’s no different from manual, or even superior. 

Edited by Szotz_257

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12 minutes ago, Szotz_257 said:

I think I know which surgeon you are talking about, hehe.

And yes, logically there’s no upside to motorized for the patient. All else equal, the graft will have a lower chance of surviving, much lower in some cases. Hair loss is progressive and grafts are finite, meaning graft survival should be one of your highest priorities. This was a bitter and hard-earned lesson for myself personally.

No one can make the choice for you and for all I know it might turn out well with Demirsoy anyway. But you at least have my two cents here.

Edit: the reasons given for motorized being superior sound pretty weak to me. Of course, expertise and experience are important in order to compensate for fatigue and control things like rotational angle when performing manual FUE. None of this changes the fact that the graft is exposed to more heat, torque and force with motorized than with manual, and that this lowers graft survival.

Keep in mind, motorized is very good for docs. They therefore have a powerful motivation to use it, and to convince you that it’s no different from manual, or even superior. 

Find a doctor, who does motorised extractions but not doing 3000-4000 a day and can focus on extractions and you are good to go 👌

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2 hours ago, Szotz_257 said:

If he is using motorized now I would strongly suggest you reconsider your choice, or at least think deeply about your decision. The average rates of graft survival between manual and motorized are not comparable.

Sorry, I do not think this is still the case or it is mixing up correlation and causality (there might be more destroyed donors from motorized punches as many hair mills using unexperienced staff with cheap micro motors). 

Of course a fully rotating motorized punch is bad. But lately many top clinic using WAW from Devroye (just out of the top of my head: Konior, Feriduni, PHC,...) and having excellent and consistent results. All your arguments (torque, heat,...) do not apply in that case (if you can control oscillation and speed). Only disadvantage remaining is weight of the device but on the other hand it is easier to follow the direction of the graft as the hand does not need to rotate. 

 

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@Szotz_257 Thanks for pointing that out. I did indeed mean transection.

@Fred88 The reasons that you have listed from Dr Karadeniz do not sound weak to me. They sound sensible and logical. I do not know this Doctor or his work.

1 hour ago, Szotz_257 said:

Docs will tell you that there is no difference is skilled hands. But they have a strong motivation to say this, because the tool is a quality of life improvement for them and lets them make more money per procedure.

This was clearly answered in Freds post. One reason was that manual punching can cause fatigue. As with all individuals in any line of work, fatigue is a real thing. When fatigued your performance in any industry, will drop significantly. Therefore when you state that -

50 minutes ago, Szotz_257 said:

And yes, logically there’s no upside to motorized for the patient

This is the upside. If a Doctor can avoid fatigue, his performance will be better.

There is one thing being a patient and having good knowledge of the industry and procedure, there is another being a respected ethical surgeon who understands the intricacies of performing surgery first hand. Are such things as the toughness of patients skin taken into account with such an argument?

Obviously everybody has their own view on this. I would also feel very confident that two leading physicians with a preference for differing tools would not necessarily agree on this.

I do however feel that in this discussion Doctors have been portrayed as choosing tools for profit. Im sure in many cases this is accurate. But I can also guarantee in many cases, this couldn't be further from the truth. Physicians offer patients in particular cases pro bono surgery, they discount prices to make them affordable, they often decline an individual as an unacceptable candidate and explain other non surgical and non profitable (for himself) options. They could have easily have accepted such a patient and earned €10k - €20k. It is unfair to portray that the decision on a Doctors tools are made purely for financial motivations.

I have never met Dr Lupanzula and am not associated with him in any way. But in my opinion, his work is excellent. @Szotz_257 To have used him as an example after studying some of his results. Let me ask a question. How many results have you studied? How many patients per week does Dr Lupanzula schedule? 5 - 8? (He may have 2 patients per day, but many patients will be scheduled over 2 days) Thats 20 - 32 each month, 240 - 384 each year. Lets go straight down the middle and use the average, 312 patients per year. Again, how many results may you have viewed to come to this conclusion? 10 results would represent 3.12% of his cases. 20 results - 6.24%. 30 results - 9.36%. I dont imagine you have made your hypothesis on more than 30 results. That represents less than 10% of his patients/results. For arguments sake, lets say that your hypothesis on the results that you have seen is correct, it still represents less than 10% of his patients/results. This is information bias. Therefore it is subject to large margin of error.

If your hypothesis is correct regarding lower density, have other parts of the procedure also been considered. How are the grafts placed into the recipient sites? Forceps, implanter pens?

My aim is not be confrontational in any way. Forums are amazing for community, education, debate and opportunity. But it is important to present things correctly otherwise it can mislead others or unfairly single particular physicians out. If things are point of view, then that is absolutely fine, and discussion, debate and opinion drive any industry forward and aid evolution. But they should then be explained as point of view. 

How I see it, Dr Lupanzula is definitely one of the good guys in an industry with so many sharks. We should respect that.

Interesting conversation. @Szotz_257 Thanks for the debate brother.

@Fred88I wish you the best of luck with your decision.


Patient Advisor for BHR Clinic Athens - Greece

ian@drchristianbisanga.com  -  WhatsApp - + 34 642 37 03 83

I am not a medical professional and my words should not be taken as medical advice. All opinions and views shared are my own.

My Hair Loss Website - Hair Transplant with Dr. Rahal

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7 hours ago, Gasthoerer said:

Sorry, I do not think this is still the case or it is mixing up correlation and causality (there might be more destroyed donors from motorized punches as many hair mills using unexperienced staff with cheap micro motors). 

Of course a fully rotating motorized punch is bad. But lately many top clinic using WAW from Devroye (just out of the top of my head: Konior, Feriduni, PHC,...) and having excellent and consistent results. All your arguments (torque, heat,...) do not apply in that case (if you can control oscillation and speed). Only disadvantage remaining is weight of the device but on the other hand it is easier to follow the direction of the graft as the hand does not need to rotate. 

 

When did Konior and Feriduni make the switch? I'll try compiling a side-by-side of results. Regarding this tool in particular, I would suggest everyone PM me. Not that this necessarily correlates with the quality of his tool, but I would encourage everyone to read transplantedphil's thread. One feature of Devroye's results that I've noted, even those posted on his website, is low growth, though this cannot necessarily be pinned down to the extraction tool (see my comments below).

Though less severe in their effects, the arguments about torque, heat and force do apply here as well. And you still suffer from the lack of feedback compared to manual. I address some of the deeper substance in your comments in my reply to Raphael, below.

7 hours ago, Raphael84 said:

 

I do however feel that in this discussion Doctors have been portrayed as choosing tools for profit. Im sure in many cases this is accurate. But I can also guarantee in many cases, this couldn't be further from the truth. Physicians offer patients in particular cases pro bono surgery, they discount prices to make them affordable, they often decline an individual as an unacceptable candidate and explain other non surgical and non profitable (for himself) options. They could have easily have accepted such a patient and earned €10k - €20k. It is unfair to portray that the decision on a Doctors tools are made purely for financial motivations.

I have never met Dr Lupanzula and am not associated with him in any way. But in my opinion, his work is excellent. @Szotz_257 To have used him as an example after studying some of his results. Let me ask a question. How many results have you studied? How many patients per week does Dr Lupanzula schedule? 5 - 8? (He may have 2 patients per day, but many patients will be scheduled over 2 days) Thats 20 - 32 each month, 240 - 384 each year. Lets go straight down the middle and use the average, 312 patients per year. Again, how many results may you have viewed to come to this conclusion? 10 results would represent 3.12% of his cases. 20 results - 6.24%. 30 results - 9.36%. I dont imagine you have made your hypothesis on more than 30 results. That represents less than 10% of his patients/results. For arguments sake, lets say that your hypothesis on the results that you have seen is correct, it still represents less than 10% of his patients/results. This is information bias. Therefore it is subject to large margin of error.

If your hypothesis is correct regarding lower density, have other parts of the procedure also been considered. How are the grafts placed into the recipient sites? Forceps, implanter pens?

My aim is not be confrontational in any way. Forums are amazing for community, education, debate and opportunity. But it is important to present things correctly otherwise it can mislead others or unfairly single particular physicians out. If things are point of view, then that is absolutely fine, and discussion, debate and opinion drive any industry forward and aid evolution. But they should then be explained as point of view. 

How I see it, Dr Lupanzula is definitely one of the good guys in an industry with so many sharks. We should respect that.

Interesting conversation. @Szotz_257 Thanks for the debate brother.

@Fred88I wish you the best of luck with your decision.

Good, I will take the last word here, then. 

In general, the causality chain of a hair transplant result is dense and hard to unwind. As you say, it is unfair to pin everything on the extraction tool to being used. A ton of factors come into play, from tools, patient physiology, management of time out of body, discipline in following post-op instructions, to the skill of the surgeon/technicians during extraction/incision/implanting.

Of course, a more advanced extraction tool in the hands of an experienced surgeon will produce better results than a cheap tool in the hands of an inexperienced technician. All I'm arguing is that with all other variables held equal, the rates of graft survival will be lower with a motorized tool, and I have yet to see a convincing argument against that. The aforementioned factors (quality of tool and skill of extractor) will reduce the difference but not close it entirely. Therefore, as a doctor, you are, on average, increasing the risk of a poor result rather than containing it, by using motorized tools. I find it hard to believe, given years of experience using manual punch, that the element of fatigue will be so compromising to the physician or technician's performance that there is a tangible positive delta from using a motorized tool.

You may be inferring too much from my post. I'm not calling doctors in general greedy, or purely motivated by money. Every doctor will have a variety of considerations when taking on a patient, based mainly (as far as I can see) on reputation risk, academic interest, personal ethics and financial gain. Usually, all will be present to some extent, but the distribution of these four will vary from doc to doc, and even change throughout a doctor's career. 

What I'm saying is that using motorized tools makes a lot of sense for the doctor, both financially and in terms of quality of life. Therefore they will be naturally motivated to use them. What may discourage them from using motorized tools is if the motorized tools produce poor results, to the extent that patients complain and post negative reviews online, leading the business to suffer. If the motorized punch produces results that are "good enough" (but not as good as manual), the risk/reward balances out and the doctor can make the switch.

Manually punching thousands of grafts every day is really hard, thankless work and I don't begrudge anyone for wanting to reduce stress on their hands and wrists. But as a patient, my instinct is to de-risk, even if I sympathize with the doctor's motivations. When making a choice as a patient, you do not have the luxury to know the outcome ahead of time. All you can do is to make a sober assessment of the various factors that play into the quality of the final result, and (ideally) choose the ones that maximize the possibility of a good outcome. Motorized will never win out here, for simple, logical reasons.

I was not calling out Lupanzula, simply pointing out that he is a recent example of a doctor that has made the switch to motorized, and exhorting Fred88 to check out some before/afters to compare the rate of growth. He has produced very good results in the past, though all using manual FUE, and seems like a good guy. Here is a recent thread from someone who had a FUE with Lupanzula where he apparently used motorized.

Edited by Szotz_257

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3 hours ago, Szotz_257 said:

1. When did Konior and Feriduni make the switch?

2. ...but I would encourage everyone to read transplantedphil's thread. One feature of Devroye's results that I've noted, even those posted on his website, is low growth, though this cannot necessarily be pinned down to the extraction tool (see my comments below).

3. Though less severe in their effects, the arguments about torque, heat and force do apply here as well. And you still suffer from the lack of feedback compared to manual. I address some of the deeper substance in your comments in my reply to Raphael, below.

I appreciate the work you want to put in. A forum needs people with passion. But I do not like that you take your arguments as facts: There are not.

Step by Step through it:

1a. Feriduni timeline can be best seen in this thread with half manual, half WAW and an explanation from his representative. By the way: He is using techs for extraction: More convenient does not apply to him, and WAW is much more expensive than CIT.

1b. Konior's timeline I do not know, but here is a comment of him. "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.  ". If you continue your work, you might update the list in there. 

2. I have read the thread of transplantedphil and even discussed with him. But his issue is not (!) lack of growth, but the clinic did not plant grafts in the first inch of the hairline. You can take this maybe as a donor issue, but also here it is clearly stated that (most likely) it is not an issue of the tool but an unexperienced person using it. 

3. You have got a point in the weight/lack of feedback argument, but all other are not true in general (but of course they can be in particular cases). A motorized punch with an optimized speed/angle, would create much less (!) torque on the grafts than a manual one typically does and theoretically the device could even be cooled and cause less thermal stress on the grafts. And if you have to follow the curve of a graft with a long stick like instrument, this is of course much easier if you do not have to rotate your hand simultaneous. 

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3 hours ago, Gasthoerer said:

I appreciate the work you want to put in. A forum needs people with passion. But I do not like that you take your arguments as facts: There are not.

Step by Step through it:

1a. Feriduni timeline can be best seen in this thread with half manual, half WAW and an explanation from his representative. By the way: He is using techs for extraction: More convenient does not apply to him, and WAW is much more expensive than CIT.

1b. Konior's timeline I do not know, but here is a comment of him. "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.  ". If you continue your work, you might update the list in there. 

2. I have read the thread of transplantedphil and even discussed with him. But his issue is not (!) lack of growth, but the clinic did not plant grafts in the first inch of the hairline. You can take this maybe as a donor issue, but also here it is clearly stated that (most likely) it is not an issue of the tool but an unexperienced person using it. 

3. You have got a point in the weight/lack of feedback argument, but all other are not true in general (but of course they can be in particular cases). A motorized punch with an optimized speed/angle, would create much less (!) torque on the grafts than a manual one typically does and theoretically the device could even be cooled and cause less thermal stress on the grafts. And if you have to follow the curve of a graft with a long stick like instrument, this is of course much easier if you do not have to rotate your hand simultaneous. 

Okay, let's have a look at these. First, based on the comments, both Feriduni and Konior seem until recently to have used motorized on a special, case-by-case basis. Per Feriduni's representative: "The WAW-system with trumpet punch we use especially in cases with curly or frizzy hair". The patient you linked to had two FUE procedures, one with manual and one with WAW.  As far as I can tell, the hairline was reconstructed using grafts extracted with manual FUE, whereas the crown work was done with WAW-extracted grafts. Please correct me if I'm wrong here.

If Feriduni has made a switch to full motorized, this would be quite recent and there would not be that many patient-posted results on file, if any. Do we have any new hairline results from Feriduni, preferably posted by patients, using only grafts extracted with WAW? As I have written above, I'm not saying that it is impossible to get a decent result with motorized FUE, or that there are no cases where using it is proper, rather that the results will tend to be worse on average, all else being equal. Nothing in your post directly contradicts this. 

On that same note, do we have any results, whether posted by patients or the clinic themselves, of hairline reconstructions by Konior using motorized FUE?

The doctor leads a team, and the desire for convenience and quality-of-life extends to even cases where technicians are doing the extractions. There is no doubt that in the working reality of performing hair transplants every weekday, it is much more comfortable to do extractions using a motorized tool than a manual one. Hence, it is not infeasible that the technicians would be pushing for the use of motorized tools as well. The problems with motorized will not be evident to the team, only to the patient representatives and those who have to live with the final results. The problems become apparent only much later on, months or years after the surgery has been completed. 

Furthermore, motorized lowers the barriers to entry and the skill floor of a technician. A motorized extraction tool can reduce the time needed to train a replacement, thereby reducing the technician's bargaining power in salary negotiations. 

As for Devroye, you are correct in pointing out that the case of transplantedphil does not relate directly to the quality of the tool; I even said as much in my post. However, looking at even the results the clinic has posted, where at least some of the extractions have ostensibly been performed by the maker of the tool himself, there is the recurring issue of poor growth. Personally, I would not be comfortable being operated on with a tool from such a clinic.

Edited by Szotz_257

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5 minutes ago, Szotz_257 said:

The problems with motorized will not be evident to the team, only to the patient representatives and those who have to live with the final results. The problems become apparent only much later on, months or years after the surgery has been completed. 

I fully agree with this thought.

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3 hours ago, Szotz_257 said:

If Feriduni has made a switch to full motorized, this would be quite recent and there would not be that many patient-posted results on file, if any. Do we have any new hairline results from Feriduni, preferably posted by patients, using only grafts extracted with WAW? As I have written above, I'm not saying that it is impossible to get a decent result with motorized FUE, or that there are no cases where using it is proper, rather that the results will tend to be worse on average, all else being equal. Nothing in your post directly contradicts this. 

On that same note, do we have any results, whether posted by patients or the clinic themselves, of hairline reconstructions by Konior using motorized FUE?

You made a hypothesis that motorized (in the same experienced hands) is worse than manual. It would be your duty to proof it is true by some sort of statistic. If I link know a case with a great result of Feriduni with WAW what does this proof? Nothing! It would be one random good case. Our mind always fools us: If you think that the results with motorized punch are worse, that is what you mind makes you believe. It does not mean it has to be true at all. 

What we can see, even the best and most ethical clinics of this forum switch more and more to motorized (Konior, Feriduni, Lupanzula, ...). So either they are all unethical and short sighted (if the results drop, we will learn this earlier or later) or they really believe the results are equal or even better. I hope they are not. 

By the way: Here are some recent Feriduni results with WAW for the hairline but you need to register. They look great even though 12 month are not reached yet:

https://www.alopezie.de/foren/transplant/index.php?t=msg&th=12650&start=0&

https://www.alopezie.de/foren/transplant/index.php/mv/msg/12347/0/40/

 

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1 hour ago, Gasthoerer said:

You made a hypothesis that motorized (in the same experienced hands) is worse than manual. It would be your duty to proof it is true by some sort of statistic. If I link know a case with a great result of Feriduni with WAW what does this proof? Nothing! It would be one random good case. Our mind always fools us: If you think that the results with motorized punch are worse, that is what you mind makes you believe. It does not mean it has to be true at all. 

What we can see, even the best and most ethical clinics of this forum switch more and more to motorized (Konior, Feriduni, Lupanzula, ...). So either they are all unethical and short sighted (if the results drop, we will learn this earlier or later) or they really believe the results are equal or even better. I hope they are not. 

By the way: Here are some recent Feriduni results with WAW for the hairline but you need to register. They look great even though 12 month are not reached yet:

https://www.alopezie.de/foren/transplant/index.php?t=msg&th=12650&start=0&

https://www.alopezie.de/foren/transplant/index.php/mv/msg/12347/0/40/

 

Providing such statistics is very hard, as you very well know. All I can do right now is relay soft information imparted through reviewing hundreds  of before and afters, tempered by personal experience as I told you over PM. That personal experience also translates to a bias, which I'm aware of and hope I am able to correct for. But longer term, I do intend on compiling a data set of before/afters with manual and motorized to make a systematic comparison. You will be happy to contribute a data point to that, I'm sure.

The docs don't need to be unethical or short-sighted to adopt a tool that gives poor results. They may be on the receiving end of sales and marketing efforts, or maybe they are trusting feedback from other doctors which later turns out to be flawed. A few years back, ARTAS was all the rage with many reputable docs investing in machines, which were later left idle as the results were not good. This is all part of the ebb and flow of technological progress in the hair transplant industry, which is still maturing and developing.

I will check out the results. Thanks for providing them. 

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New day in my path towards choosing a doctor:

I've now leaned back for a while, contemplating a bit more on my decision.

Was suggested by a famous guy on the net who helps poor people like us with his advices (guess who ;)) to think about HLC as well. Dr Ozgur is working there. Their results look very good (specifically the hairline doesn't look very round!). They're doing manual and 1500 grafts per dar (ethical). 2.43€ per graft. Everything seems at its highest. However don't know yet how much of the work is done by whom. Seems a place full of different unfamous doctors plus Ozgur.

I've come to the point to say the huge price gap between HT places is just about the extraction method (makes the major difference) and the amount of work Dr is involved in. 

Was quoted by Dr Demirsoy between 3500-4000 grafts in one day via micromotor. Yet, I've not got recovered from the fear of "what the heck?!, 4000 grafts, micromotor, all in one day, front, top, crown?! Seriously?! Kidding or killing my grafts intentionally or being interested in permanent shock loss in my crown area?!". If I could just trust this doctor and his new trend of only-motorized method a bit more, I wouldn't hesitate (no one wants to pay 4000€ more for the same result).

Still running like a headless chicken welcoming your thoughts...

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I had really good growth from Konior using WAW and no doubt he will use it again for my crown.  He even showed me the follicles near the end of the procedure.  They were small as hell but all in one piece.  He made the comment that they often come out better than strip grafts using this tool.

There are too many half decent micromotor results from shoddy doctors which disprove that motorised is 'bad'.  Plenty of bad ones too, which is perhaps when manual or another method (FUT) all together would have been a better choice.

 


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

500 FUE grafts (TBC) with Ray Konior, MD - 2020

My HT results thread from 1st procedure.

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21 hours ago, Fred88 said:

New day in my path towards choosing a doctor:

I've now leaned back for a while, contemplating a bit more on my decision.

Was suggested by a famous guy on the net who helps poor people like us with his advices (guess who ;)) to think about HLC as well. Dr Ozgur is working there. Their results look very good (specifically the hairline doesn't look very round!). They're doing manual and 1500 grafts per dar (ethical). 2.43€ per graft. Everything seems at its highest. However don't know yet how much of the work is done by whom. Seems a place full of different unfamous doctors plus Ozgur.

I've come to the point to say the huge price gap between HT places is just about the extraction method (makes the major difference) and the amount of work Dr is involved in. 

Was quoted by Dr Demirsoy between 3500-4000 grafts in one day via micromotor. Yet, I've not got recovered from the fear of "what the heck?!, 4000 grafts, micromotor, all in one day, front, top, crown?! Seriously?! Kidding or killing my grafts intentionally or being interested in permanent shock loss in my crown area?!". If I could just trust this doctor and his new trend of only-motorized method a bit more, I wouldn't hesitate (no one wants to pay 4000€ more for the same result).

Still running like a headless chicken welcoming your thoughts...

I hope it's not a YouTuber who charges for his "consulting" services and who had bad work from Turkey. I wouldn't waste your time choosing a clinic based on whether they do "manual" or "micromotor" FUE. The only thing you should focus on are the results. Expand your search to places other than Turkey. Honestly, I wouldn't trust most of the clinics in Turkey. 


I do not provide medical advice, recommendations, all responses are my opinion.

My Hair Transplant Journey

Melvin- Associate Publisher and Forum Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q&A Blog.

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