There are three stages to performing FUE. Punch and extraction, then graft checking and separation, and finally, graft placement. All stages are as important as the other, and the best results will be a combination of factors, mainly skill, quality of instruments and standards.
The quality of punching and then extraction is a blend between the instrument used and the expertise and skill of the individual. You can have the best punch but in the wrong hands, cause great damage, transection, over harvesting and more. The most skilled and expert using inferior tools will do a better job but limited how well they can conduct the task, for instance, by slowing down the process or reducing the numbers they can safely reach. Graft extraction while needing to be efficient requires care managing the grafts, appropriate pressure when removed.
Graft care is an often-overlooked area of importance, trimming and cleaning the grafts, keeping them saturated and maintained in an appropriate holding solution. Using stereo microscopes being optimum for this area of the procedure, as grafts are cut and moved multiple times until separated into their relevant sizes, adding to the potential danger of being damaged. The job can be long, requires excellent hand eye coordination, skill, and the ability to sit for extended periods of time in the same position.
Graft placement, methods range for efficiency and ease, others for precision. Changing the accuracy of aspects such as depth control, orientation, and angle of placement, even which direction the arc of the hair lays when placed. As with graft placement it requires an elevated level of concentration and a commitment to consistency, especially when placing into custom-made recipient sites, having to follow the premade sites and size distribution.
Hair transplant results will always vary, a difference in competence, the level of care, the need for speed, preference of doctor or technician FUE. Regardless, there will always be a combination of factors that affect the quality, skill, quality of the instruments, and the level of protocols and standards in place.