Hi Bverotti
Thanks for the photos.
We would be of the same persuasion, I know clinics all have different protocols for tools, size and type of punch, how many grafts a day to do etc but with regards to punch size and type we would agree with you.
Too small and there is a danger of not having enough protective tissue on the graft or as you say will not be able to extract intact the whole follicular unit, more so for the larger groupings in the occipital area. Too large then arguably more damage and possible damage to surrounding follicular units also, more visible scarring etc.
Manual is not only about less heat and trauma generated etc but also for the doctor to feel more what he is doing, more direct connection with the patient, more feel for what is happening under the skin as he punches.
I've only had a small manual punch used on me and after many surgeries and 7,000 scalp FUE and 1,400 beard I have a good donor and wear my hair at 2.5mm with no surgery signs, this is attested to by many who have met and examined me in the flesh. I do not personally think I would have the same donor if I had been operated on with larger motorised punches. Personal opinion only of course but after 7 surgeries an opinion that I am entitled to.