Dr. Mwamba, do you use a manual follicular unit extraction (FUE) punch or motorized? What are your views on both?
A manual punch allows you to get a feeling of the difference in tissue resistance, especially when you have curved grafts or splayed 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 losing 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 gets dull, you don’t feel it necessarily, but the machine will still use its forces to cut. With forces, you can heat or get some torsion of the tissue.
One thing also we need to face is hand 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’s skin fragility, graft angle and splay and, if I feel comfortable and I find out it is an easy case, then I switch to the machine to preserve my hands. Most of the time, I ask 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 a fan of the speed gain with the motor that other hair restoration surgeons tout. 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. Patrick Mwamba
Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q & A Blog.
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