Surgical hair transplant instruments are all small today, they use millimetres (mm) or micrometres (μm) for calibration precisely because they are small. Surgeons use instruments with varying diameters, or size, depending on their standards, ability, and needs.
(taken from a current suppliers website)
The sole use of an implanter takes the doctor skills out of the loop with the punch and place action. This makes the process easier, requires less focus, is less precise, requires less diligence and takes much less time. The entire premise of using the implanter is because it is much faster and easier to use, of course, less skills also equals less wages paid. For the clinic, this allows them to do larger or multiples of sessions daily, weekly, monthly.
Opposed to a more refined approach, not high volume, with attention to micro details, such as hair depth, angle, orientation, density, hair distribution. However, this requires a greater need for competency and skill, diligence, and patience, as much slower to perform. This comes at a price.
For one, precision, quality and refinement is of paramount importance. For another, less refinement, with speed, and ease of use being the primary factors. There is a place for both.