Manual FUE is the traditional method of follicular unit extraction. In this technique, the surgeon uses a handheld punch tool to individually extract hair follicles from the donor area. The success of this method depends heavily on the surgeon’s skill, as they control the depth, angle, and force applied during the extraction process. 

Advantages 

• Personalization and Accuracy: The manual method allows the surgeon to adjust their technique as needed, tailoring it to individual hair types and scalp conditions. This flexibility often results in more natural-looking outcomes [5]. 

• Reduced Transection Rates: Research shows that experienced surgeons using manual FUE can achieve lower follicle transection rates (damage to follicles), which is essential for a successful transplant [2][6]. 

• Less Equipment Dependence: Unlike motorized methods, manual FUE does not require complex machinery, making it viable in various clinical environments [10]. 

Disadvantages 

• Time-Intensive: Manual FUE is labour-heavy and slower compared to motorized approaches. Surgeons typically extract between 1,500 and 2,000 grafts per session, which often means multiple sessions for those with significant hair loss [1][4]. 

• Surgeon Fatigue: The prolonged nature of manual FUE can lead to hand strain, potentially reducing precision during longer procedures [6]. 

• Larger Punch Diameter: Manual punches tend to have slightly larger diameters than motorized ones, which may result in more noticeable scarring in the donor area[1].