Hey guys, one of the most common questions in regards to FUE is the pros and cons of both the manual and automated/motorized punches used for extractions. In this thread we can discuss both and I will also be listing exact quotes from prominent FUE doc
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Hey guys, one of the most common questions in regards to FUE is the pros and cons of both the manual and automated/motorized punches used for extractions. In this thread we can discuss both and I will also be listing exact quotes from prominent FUE doctors pertaining to their preferences and reasons for and against. Quotes will be in no particular order in regards to whether the Doctor is part of the coalition or not or whether I prefer a certain Doctor's work more or not. Will be totally arbitrary and unbiased. We can also discuss what we think of manual, motorized, ARTAS and Neograft.
Overview:
-Manual punches:
CIT handle with CIT sharp tip punch used by many of the top manual FUE surgeons
Manual punches are operated entirely by hand and contain no moving parts although some have adjustment options for depth. Many surgeons have commented on the manual punches ability to provide tactile feedback as they punch the graft. Avoids the issue associated with motorized punches such as overheating.
Versi handle(no tip shown but usually sharp tip) used by many of the top manual FUE surgeons
Doctors using manual punches:
-Feriduni(CIT handle and punch)(circa 3,000 grafts per session, can split over multi-days)
-Bisanga(Versi handle)(circa 1,500 grafts per day, can do multi-day sessions)
-Mwamba(CIT handle/punch, Versi handle/Super punch, uses motorized LEAD system also)(1,000 grafts a day and can do multi-day sessions)
-Diep(Custom design, uses motorized also)
-Maras(CIT/Ellis handles and punches)(2500 to 3500 grafts over a period of 2 days)
-Reddy(Versi handle and punch)
-Lorenzo(CIT handle and punch, Choi implanter pen)(circa 3,000 grafts per session)
-Erdogan(Versi Handle, sharp and blunt punches)
-De Reys(Versi handle and punch)(circa 1,500-1,800 per day, can do multi-day sessions)
-Dr Keser(Undetermined manual punch and handle)(circa 800 grafts per day, can do multi-day sessions)
-More to be added
Advantages:
-Provides the surgeon with tactile feedback in regards to resistance in tissue and hair shaft
-Impervious to overheating as there are no moving parts.
Disadvantages:
-Can take longer and hence fewer graft in one session
-Fatigue can be more of an issue
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-Motorized punches:
Harris SAFE motorized system with blunt tip punch
Much like the name implies, motorized punches use mechanically and electrical assistance. This allows the device to spin much faster than the manual method which can equate to harvesting more grafts in less time and grafts being out of the body for less time. Issues like overheating and inability to feel when the punch had dulled can occur.
CIT PCID system with sharp tip punch
Doctors using motorized punches:
-Hakan Doganay(Undetermined)
-Ron Shapiro(SAFE system, also use ARTAS)
-Alexander(Undetermined motorized device)
-Cooley(undetermined motorized device and also ARTAS)
-Wesley(SAFE system)(circa 2,000 grafts a day maximum)
-Feller(Feller motorized punch)(circa 800 grafts per session, no split days)
-Umar(Undetermined)
-Paul Shapiro(SAFE system, also uses ARTAS)
-Harris(SAFE system, also uses ARTAS)
-Mwamba(LEAD System, uses manual also)
-Diep(Undetermined, uses manual also)
-Devroye(Custom device with CIT punch, uses manual for beardwork and repair of old plugs/FUE)
-True(CIT motorized device with sharp tip)
-Lindsey(Feller motorized punch)
-Charles(Undetermined, also uses ARTAS)
-Bernstein(SAFE system also uses ARTAS)
-Dorin(CIT motorized device with sharp tip)
-Rahal(SAFE system,also uses ARTAS)(circa 3,000 grafts in one session)
-Bhatti(SAFE system and Kowloon/SAFE punches)
-More to be added
Advantages:
-Can allow for faster extractions and more grafts in one sitting
Disadvantages:
-Can suffer from heat issues in regards to the surgeon not being able to sense when the punch becomes dull
-Does not offer the same feedback as manual
-Often uses more turns/oscillations than needed
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-ARTAS SYSTEM:
A very recent invention which is completely unassisted in the punching process. Can calculate the depth, angle and direction of the graft whilst also determining an entirely random extraction pattern. Transection is said to be very low but results are still rare due to its infancy.
Doctors using ARTAS:
-Cooley(Also uses motorized)
-Ron Shapiro(also use motorized)
-Harris(also uses motorized)
-Bernstein(also uses motorized)
-Arocha(also uses motorized)
-Charles(also uses motorized)
-Rahal(also uses motorized)
-More to be added
Advantages:
-Supposedly can determine the correct angle, depth and direction of grafts
-Fast extraction
-Fatigue not a factor
-Clever extraction pattern
Disadvantages:
-Yield claims currently unsubstantiated
-Currently uses punches larger than desired
-Cost of the machine(circa $200,000US) can inflate the cost of the procedure
-Not currently approved for female patients
-Unknown whether it can alternate between smaller punches for single-hair grafts and larger punches for 2/3/4-hair grafts
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-NeoGraft:
The often controversial NeoGraft system. It operates in a way similar to a motorized punch but has options for extracting the graft via a suction mechanism. The surgeon manually targets grafts(much like a manual/motorized punch) and the Neograft uses suction to transfer the grafts into a small compartment. After a certain amount of grafts are extracted, the surgeon collects the grafts out from the holding compartment and then loads the grafts into the recipient sites.
Doctors using NeoGraft:
-Vories(Choi implanter pen)
-More to be added
Advantages:
-Allows for faster punching and extraction
Disadvantages:
-The suction involved in extraction of grafts can damage the follicle
-The constant flow of air into the graft container can led to the grafts drying out
Topic kindly researchered by Mickey85.
Quotes:
Dr Mwamba
'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.'
http://hairtransplantsforum.com/profile/mywhtc Dr Mwamba was kind enough to offer a very detailed account to his preference. I did naturally assume he used manual exclusively prior to his reply for some reason. Interesting that he also mentions the lack of feeling associated with manual but not to the extent of Lorenzo. He also brings up the heating issue which has seldom been discussed, seems it can affect yield if used for too long due to not being able to feel the punch resisting due to turning dull and heating the tissue and causing torsion... Interesting that he is faster with manual! He does claim that yield is not affected using either providing you know the weaknesses and how to overcome them. Fatigue is mitigated with motorized according to Mwamba.
http://hairtransplantsforum.com/profile/DrHakanDOGANAY Hakan Doganay (Turkey)
'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.'
FUE only surgeon based in Turkey. Works on higher Norwood classes as well as minimal recession. Feels yield is unaffected via motorized method.
I guess the most important part, is the experience and skill of the Doctor? Great read once again.
JamesUK . said:
I guess the most important part, is the experience and skill of the Doctor? Great read once again.
Great point.
