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.