This is the original FUE method where the process of extraction of individual follicular units was carried out with a manual hand held device. Manual FUE punch is simple, metal structure which has handled on one end and a hollow cylinder shaped needle (also called a ‘punch’) on the other end. In this process, the surgeon places the hollow needle around the follicular unit and pushes the tool into the scalp by slow rotatory motion of the fingers. Once the graft is punctured (scored), further separation of the tissue surrounding the graft is done with a sharp tipped or blunt tipped tool. Once completely separated from the surrounding tissue, the grafts are then pulled from the scalp with forceps and stored in apt solution. Once the desired number of grafts is achieved, it is implanted either by needle, forceps or implanted.
Better understanding of patients skin resistance and angle of follicular units.
Greater level of control during extraction (like pressure and force or number of rotation).
No follicular damage due to heat.
No damage of follicular units by torsion and friction (common with motored FUE).
Better quality of grafts with surrounding tissue (thus better chance of survival).
More fatigue to surgeon.
Enhanced chances of human error.
A very slow and cumbersome process (number of graft extracted per hour is less).
It is perhaps one of the best FUE method.