Manual or Micromotor Extraction for NW6 (Photos attached)

[DerekDerek]

Hello everyone,

I will be really grateful if I can have some advice from your guys. I received a reply from Dr. Yaman's case manager after sending my photos to them (I am a NW6; 44 year-old asian with a huge recipient area); they have proposed 3 options:

Option 1 - 4000 grafts by micromotor extraction; return 12 months later for second treatment ($3,250).

Option 2 - 3000 grafts by manual extraction; return 12 months later;  ($3,000).

Option 3 - 5500 grafts by manual extraction that will be performed in two-day session ($$ not been advised; but I reckon probably $6000).

When I asked about the difference between motor vs manual; the case manager advised that the manual extraction is more safer and gentle; it will do less harm to the donor area. However I've seen people mentioning the motorised extraction has evolved (improved) a lot since these years; the rotating speed has been tuned down; generated less heat plus other advantages. Some have mentioned there are downsides of manual extraction; i.e. humon errors during extraction due to long hour procedure etc. It seems like there is no conclusive answer on this topic yet. 

I have opted for Option 2; but deep down I prefer Option 1 as I will get more grafts implanted and it will be done quicker (provided there is 4000 grafts available...). I have disregarded Option 3 as I do not believe they will be able to get that amount of grafts from my donor area.  

Can I have your views on this please; i.e. have I made the right decision to go for Option 2? I have attached some photos of my hair. Many thanks in advance. 

Edited April 25, 2023 by DerekDerek

[Al - Moderator]

I don't think manual or motorized matters very much when only looking at that. Both of them can deliver great results. What matters more is what Dr is performing the procedure and which type of punch tool that particular Dr is better with. One Dr can be more skilled  with a manual punch while another Dr would be better with a motorized punch. The feel (for the Dr) is different between manual and motorized and when they do it every day with a certain one they get to know the feel of that tool on your scalp and they can end up preferring one over the other.

As far as which one of your 3 to pick. I agree with you that with your donor area I'd probably stay away from option 3 as you don't want to risk a depleted donor area. Either 1 or 2 would both be fine.... but again what matters more is who is performing the transplant.

 

[NikosHair]

I feel it's unethical for clinics to place the burden on the patient. What next? new paid-for-options for different solutions for preserving grafts between extraction and implantation😒. We already have ridiculous options given by some clinics on methods of implantation.

They are the 'experts' they should provide a service that gives optimum results consistently for all patients. They resolve the technicalities to achieve the BEST possible RESULTS. Let the patient decide which clinic based on the results and let them relax knowing they are in expert hands.

 

[A_4_Archan]

Good that you didnt choose 3rd one as your donor don't seems to be that healthy ....even if its healthy imo 2 phase surgery is a wise decision ...i agree with nikoshair that this options and evrythng sucks...doctors are there to give best results ...we trust them and pay them for that...if manual punch is better thn they should not give the option of motorised one...tht makes no sense...bt imo this days punch don't matter...hands matter more thn such instruments..doctor can choose any punch they feel comfortable with....so i would say ask dr yaman directly about this ..ask him about the specific thing and ask him that which procedure he feels most comfortable with and have confidence in....and you cn go by that...

[duckling]

5 hours ago, NikosHair said:

 What next? new paid-for-options for different solutions for preserving grafts between extraction and implantation😒. 

I believe a clinic near me has beaten you to this idea 😄 .Below are 3 options by them for grafts storage in their packages:

package 1: We store Grafts in RL and use Fridge/Chiller RL to maintain graft temperature during implantation.

package 2: Grafts are stored with RL+PRP and the temperature of graft is maintained by Fridge and Chiller for RL and PRP

package 3: The Hair Graft is stored in Hypothermosol solution and Growth Factor to provide best results. Graft chiller a specific device to keep Hair Grafts at right temperature for Transplantation is used

[duckling]

@DerekDerek Good that you didn't go with option 3. I wouldn't have suggested that even if you had great donor. You should not let so any grafts fight for blood supply. You don't want to lose grafts due to planning phase where you schedule 2 seatings so close. 

The choice between option 1 and 2 depends on the results you have seen from that surgeon using that particular device. In forum you will find the device used during surgery with every thread. So search which device he used in the results you liked most. In italian forum i checked that he mentioned about his micromotor device. Device description sounds good but you will have to dig deep to find out about how much comfortable he is with this device.

Dr. Yaman's "modified micromotor FUE" procedure is minimally invasive and very simple. He uses a slow-spinning motor  with a punch size between 0.7mm and 0.9mm.

[DerekDerek]

Thanks guys, appreciated your advice.

@duckling I am aware of Dr Yaman "modified micromotor FUE", but not sure if it's really that much different than those ordinary versions as everyone can claim theirs are better than others, its hard to verify from our end.

For those who are interested, see below:

 

MODIFIED MICRO MOTOR FUE

Dr. Resul Yaman, has developed a new and exciting surgical instrument for Follicular Unit Excision (formerly known as follicular unit extraction) called the “Modified FUE-Yaman Implanter”. The “Modified FUE-Yaman Implanter” is different than other follicular unit implanters, because the grafts have minimal contact with the patients skin and the surgeons forceps. The “Modified FUE-Yaman Implanter” is an instrument used to transplant follicular units in to the patient’s recipient zone (scalp). This device was designed to reduce physical contact to the patients grafts. By reducing the amount of physical contact, the grafts and the scalp experience less trauma, which lead to a greater graft survival and faster healing.

By Transplanting  many hair follicles, It is possible to get dense and natural results.The serial incision capability of micromotor allows to get more hair follicles.

Taking so many hair follicles  requires a long time to be tranplanted. Thus, hair follicles stay  out for a long time and get damaged. Micromotor  is a devise can reach high speed  so it may damage hair follicles.

Our modification has two main objective:Firstly,by using micromotor at low speed prevents  hair follicles damages arising from  heating  and breaks.Secondly, It aims to reduce the duration of hair follicles staying out.

However, the operation is being performed  by taking 1000 unit hair follicles incrementally. In this modification  after taking and transplanting  1000 hair follicles the operation moves on the other 1000 ones. When the  procedure is repeated  four times a day,4000 hair follicles are transplanted healthily.

By this means, hair follicles staying out duration is from 15 to 45 minutes which  is also the  ideal time  for majör organ transplantations.

[duckling]

9 minutes ago, DerekDerek said:

not sure if it's really that much different than those ordinary versions as everyone can claim theirs are better than others, its hard to verify from our end

very true its tough to know with everyone claiming their method is different. Try to reach out to some past patients of their and only they can inform whether they got any benefit from this method and if they had any prior surgeries with manual punch then more better.

In my opinion , Manual extraction if performed perfectly is going to be better for your donor than micromotor. But that means you need someone like pekiner (there are many surgeons and he is just an example ) who does very less grafts a day and divides surgery into 3 days sometimes. So there is no external factors like fatigue causing issues during extraction.

Yaman's team should be very experienced though and your 3000 grafts should not be causing them any fatigue hopefully. As its a resonable number of grafts for a day. Its 500 grafts more than my liking for a day. But these days it is normal.

[NikosHair]

2 hours ago, duckling said:

I believe a clinic near me has beaten you to this idea 😄 .Below are 3 options by them for grafts storage in their packages:

package 1: We store Grafts in RL and use Fridge/Chiller RL to maintain graft temperature during implantation.

package 2: Grafts are stored with RL+PRP and the temperature of graft is maintained by Fridge and Chiller for RL and PRP

package 3: The Hair Graft is stored in Hypothermosol solution and Growth Factor to provide best results. Graft chiller a specific device to keep Hair Grafts at right temperature for Transplantation is used

Brilliant! Always someone thinking of new ways to upsell in the HT biz.

I

 

[sonofabracherman]

Hello!

Did you go through with the transplant? Any results to share?

[Al - Moderator]

On 4/25/2023 at 3:14 PM, duckling said:

I believe a clinic near me has beaten you to this idea 😄 .Below are 3 options by them for grafts storage in their packages:

package 1: We store Grafts in RL and use Fridge/Chiller RL to maintain graft temperature during implantation.

package 2: Grafts are stored with RL+PRP and the temperature of graft is maintained by Fridge and Chiller for RL and PRP

package 3: The Hair Graft is stored in Hypothermosol solution and Growth Factor to provide best results. Graft chiller a specific device to keep Hair Grafts at right temperature for Transplantation is used

 

This makes absolutely no sense to me. They should always be using whichever one they feel is the best method to preserve the grafts. Why make the patient decide? How is the patient supposed to know what is good and what isn't? That's crazy. It sounds like a way to just blame it on the patient if the transplant doesn't turn out well.