Yes, assuming the surgeon is an expert with years of experience, a manual punch causes less trauma than a powered rotary punch.
The problem is that very few top surgeons will do 100% manual punch procedures because it is slower and more physically taxing on the surgeon. It is a much better use of their time time to use powered tools. In their minds, the net effect is close enough the same so why not make things easier (and more profitable) for themselves.
No…manual tools are becoming a thing of the past. I am only aware of two clinics in the world that do 100% manual and that’s hlc (great clinic) and Jose Lorenzo (sub par doctor that’s gotten surpassed by many other Spanish docs).
for example, the waw system is very good. The hybrid trumpet punch decreases transaction and allows smaller punch sizes to be used. I had manual fue done and my scarring is no better than any other, might be on average a bit worse tbh.