No single technique, nor device
Let me begin my response by saying that there is no single technique or device that stands out as being the absolute best when in comes to hair restoration, just as there is no single surgeon that is the best in the world. Each surgeon develops his/her skill using his/her instruments of choice for the best possible surgical outcome.
Not that long ago, I collaborated with Hacettepe Medical University in Turkey in a study using an electron microscope to determine the damage caused to graft quality using high rpm’s (30,000) with a motorized system. The results of the study showed that there was no real difference in graft quality between grafts extracted through a motorized system and those of a manual punch.
Though the findings of the study showed no real difference in graft quality between the two techniques, I believe that the manual punch creates less damage to the donor area, thereby increasing the donor capacity in a positive way. In my own personal practice, I have chosen to use the manual punch combined with a technique that I developed, the DES or Sequential Method. In the video below, you can visualize the difference and benefits in extraction using the Sequential Method.
Two of the state-of-the-art concepts in FUE are:
1) how to utilize the donor area in an efficient and effective way, and
2) how to create the best overall homogenization that allows for a natural look.
Essentially, as FUE hair restoration specialists, we have solved the problems surrounding regrowth, density and a natural appearance. However, we are still facing some problems when it comes to donor capacity, especially in patients characterized as Norwood 5-6.
There are many FUE techniques and many doctors developed their own. There are some commercial FUE approaches supplied through Neograft or Restoration Robotics (Artas Robot) that do much of the heavy lifting. Most of the other tecnhiques, require excellent manual skills and there is not substitute for experience in their use, while the Robot, does most of the work putting little work load on the doctor. All of these systems work well in the right hands. .
There are do different instrument available in the market to harvest the grafts for FUE procedure. Each doctor has their own preference on the machines. It is best to trust your doctor then the machine used as it is he that ultimately harvests and. Designs the recipients area and places the grafts.
Best method of FUE is a skilled DOCTOR (not the motorized drill or the NeoGraft)
FUE is just a method of harvesting grafts. FUE is a great surgery but most people who want the FUE is mislead into thinking it is the best surgery. FUE still leaves scars (thousands of dots). I see patients from around the world who want me to fix their FUE scar with SMP.
Many doctors push FUE or Neograft or ARTAS claiming "no scar" or "minimally invasive".
Many doctors dissuade patients from strip surgery asking "why would you want a big scar".
Many patients with strip scars will never notice the linear scar.
I was an engineer working with Dr. Rassman in 1998 (before I became a doctor) . My work involved a concept of a robot which would use a special optical sighting system to align the hairs for an automated FUE. This work became U.S. Patent 6572625 that we licensed to the ARTAS robot. Similar technology from our U.S. Patents are used in the NeoGraft. I perform FUE in my practice with my hybrid FUE instruments, ARTAS, or even NeoGraft. My point is that I am very familiar with the FUE, ARTAS, NeoGraft, and all forms of harvesting hair follicles. I've made and tried ultrasonic FUE, oscillation FUE, two step FUE, etc.
Your focus of surgery should be on RESULTS. Not how a doctor takes out the grafts or the machine they advertise.
The FUE hair transplantation technique has many advantages over the older FUT/Strip technique, mainly the absence of the big post operative scar in the donor area. However, the FUE technique has to be carried out by a very well trained and equipped medical team that has significant experience in FUE procedures in order to harvest an adequate number of hair follicles. Motorised FUE harvesting tends to be faster, but in the hands of inexperienced surgeons may result in increased transection of the hair follicles.
Trust the surgeon, not the method of FUE
The method of FUE for hair transplant is not the most important part, but rather the technique that works best for the surgeon. There are obvious benefits to FUE over the strip procedure, however, due to the absence of the tell tale scar that is placed on the back of the scalp for the strip procedure.
The best FUE method is the one that:
1) has the least damage to the follicle (i.e. the lowest transection rate and the best healing for the donor area)
2) has the highest YIELD (i.e. the number of grafts obtained out of the number of graft harvests attempted)
3) has the best results in the hands of that particular surgeon!! Some surgeons do better with sharp punches, others with dull, and still others with small or large diameter punches.
The bottom line is; Pick your surgeon - and then trust THEM to pick the best technique for your particular case.
What is the Best Method for a Hair Transplant?
We can not make such generalisations but there are two aspects to this question.
The technique that each surgeon has mastered is the best method in his hands.
Sometimes the patients situation dictates a certain technique to be preferred.
the best method depends on the surgeon not the device. There are great surgeons who do manual FUE with little transection and there are great surgeons who do motorized or robotic FUE with little transection. The opposite is also true.
It all comes down to the skill, experience and care of the surgeon - not the method.