Is a Manual or an Automatic Punch Best for Follicular Unit Extraction Hair Transplantation?

This question, which comes from a member of our Hair Loss Social Community and Discussion Forums, was answered by Coalition hair transplant surgeon Dr. William Lindsey:

I’m considering my options and two hair transplant surgeons are on my list with whom I would like to have follicular unit extraction (FUE). One major difference between the two is that one of them uses a manual punch for making incisions at the donor area. What punch tool (manual or motorized) is considered to be more successful? What are the benefits and drawbacks of each of them?

Dr. Alan Feller, with whom I’m associated, taught me to do FUE’s several years ago. He taught me with his Feller Punches and his fancy machine…actually several prototypes and the real final product. I have used several other machines at meetings and product advertising seminars but never on actual patients. I’ve used a few other hand punches both at seminars and on our own patients.

First of all FUE is more variable in its results than follicular unit transplantation (FUT). I really try to beat this into all potential FUE patients both at our initial consultation and at the pre-op consent process. I think FUE is fine for small areas, ok for medium areas, and potentially a lesser choice for large areas, but an informed patient can weigh these issues and decide the pros and cons of FUE’s possibly lower yield vs. a strip scar.

Second, I think FUE is hard. It’s hard for me and I’ve done a lot and it requires concentration AND it requires a good extraction team who will take the time to try to minimize follicle root damage and yet maximize yield. THAT is why FUE is expensive!

Third, at this point my maximum FUE/day is 1200 and often by 800 or so I’m too tired to keep going OR my transection rate starts to rise.

Fourth, I almost entirely use a Feller Hand Punch because it gives me more control over where the punch is going. When I use the automated punches, the above posters are correct, it’s less fatiguing, but eventually that vibration actually makes my hand tireder than just doing it by hand, and when I go in by hand, I can steer the punch better.

For harder cases and the more recent black guys’ FUE’s that I’ve done, if I have trouble with the Feller Punch I use a different punch. It’s still the same size, but doesn’t have the ventilation hole. I’m not sure why it works better for me in black skin but in the past 3 cases, it has. I bought a bunch at the ISHRS meeting in Boston last year but, for the life of me, I don’t know who sold it. It too is a sharp hand powered punch.

Conversely, I believe Dr. Feller uses the motorized punch, I’m simply not as consistent with it. But he is and many doctors are comfortable with it. But it’s (FUE) still a harder procedure, so make sure that whoever you work with is using what works for him/her.

Don’t go just for some tool or type of device. I got an email yesterday from a patient who appeared ready to sign up for a smallish FUE, but had decided to wait until I, or someone else locally, had purchased ……..such and such new fangled fue automated device…. Rather than wait for some device, he should choose someone whose done some FUE’s successfully.

Dr. William Lindsey

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David (TakingThePlunge) Forum Co-Moderator and Editorial Assistant for the Hair Restoration Forum and Social Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q & A Blog.

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