The problem with the field of hair transplant (suggestions requested)

[janna]

ejj wrote:

some questions that may be asked could be ....

If you are competent at fue why have you invested in a `robot` to score the grafts ?

Do you think a 1.4 mm robotic  punch will damage the patients donor ?   ejj

Of course, that's a huge punch size. From what I understand, the clinics using the Artas are using 1.0mm punches. You hear the 1.3mm and 1.4mm sizes thrown out there and those sizes are for dilating - not for scoring. Artas is currently testing the .9mm punches. I know one physician who is using the .9mm punches and he likes it. However, it will still have a bigger size dilator that comes with it.

"There's consistency that comes with computerized extraction. There are patients who are easier to extract than others - the robot makes it consistent across the board." This is the the feedback I've heard in regards to Artas robot.

 

[topccat29]

It €™s seems to me it is only patients that have been taken advantage of in the past that even bring up any of these points. What does this say about an industry that remains silent? It says not much has changed, just some of the players and techniques. Are there some really good clinics out there, yes but for most researching they don €™t know what to make of any of what they see and read or whom to believe. It all becomes very confusing.

Many in the industry like to label those that speak up as being bitter a way of trying to discredit them. This is hardly the case and is a misconception. I don €™t get jackshit for spending my time here writing any of this. My own repair can only be taken so far with present technology. This is all to help guys avoid the pitfalls of the way this industry operates, we simply do not want to see this all continue.

Regarding my previous post I would also add a person that is a good judge of character picking up on little things through conversations and interactions would definitely need to be added to the judging panel. Certainly not sexual deviants like some of what current recommended lists offer. Imagine 60+ doctors pay to be judged by such a person a sexual deviant and the industry wonders why patients sound bitter. Maybe they need to get a clue and wake up already or will it be business as usual.

Dr. A even one of your own students thought it was acceptable to start a thread directed at me trying to besmirch my character and why, simply because I asked about several patients who complained about their result and had their posting deleted from the forums. So yes character does matter when trying to figure this all out. And yes I remember how the student treated the teacher on some of the various forums going back a decade ago. Please excuse my French but I like to say an asshole will always be an asshole regardless of how hard he smiles.

 

[topccat29]

Anyone who has not mastered a .8mm punch should not be performing fue in my opinion.

Robots are more about speed, avoiding manual labor resulting in hand fatigue and making more money in the long run. This does not benefit the patient but benefits the bottom line.

My guess is that punch size has not been discussed with even one patient that has undergone an fue procedure with the robot. This is why the industry has not changed it €™s not what they tell you it €™s what they leave out. Any person with common sense would choose someone who has mastered a small punch with high yield over a larger punch. It would be complete idiocy to anything other than this and that is why it €™s not brought up.

 

[ejj]

The punch sizes i quoted were taken from the artas specifications , i find it slightly concerning that " arty " would punch then stretch using a robotic dilator after reading the info below .
Im aware the below refers to implantation , however its interesting re the comment of damage to the scalp

"Dilators
This technique is not performed by NHI.

Dilators were first introduced by Dr. Emanual Marritt of Denver Colorado in 1988. As the surgical sites for smaller grafts became smaller, Dr. Marritt had difficulty locating the holes after he made them. Once he found them, he had difficulty inserting the grafts. He came up with idea that he should use a toothpick-type device, placeing them in the small holes as he made them. By doing this, the holes were stretched and became larger. This made them easier to locate and it also made the grafts easier to place. As he removed each dilator, he kept count and was sure that every hole was filled.

As Dr. Marritt built experience, he found that he did not need the dilators. He was also concerned that the stretching may have caused more damage to the scalp.

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The above photograph shows dilators in use during a hair transplant (from the text "A Color Atlas of Hair
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[janna]

I think how Artas uses the dilator is much different than the doctor you mention. I recall seeing various dilators a long time ago. Currently, instead of using dilators, we use the planting forcep to widen the recipient site just before inserting the graft into the incision to avoid damage to the follicles. This practice has been done for years but it's been especially important for fue grafts because they are more fragile. This practice of dilating incisions have been done for many, many years but I have never noticed any damage to the scalp. You have to keep in mind that back in 1988, the grafts, incisons were all humongous. Despite incisions and grafts being large, it doesn't surprise me that they didn't acquire the skill to plant the grafts appropriately. It's fair to say most of the results I've seen from the 80's were horrendous.

 

[ejj]

below is from restoration robotics on wiki pedia , the transection rates a bit` heavy`

regards

ejj



Benefits

Overall, the ARTAS System enables trained physicians to harvest follicles using FUE more rapidly and with significantly lower transection rates than with traditional methods. Transection rates using ARTAS are reported at 8%, as compared with 20-30% with manual FUE. The ARTAS procedure can be done in half the surgery time compared to manual FUE.[3][/suP] The system harvests follicular units in a random fashion so that any scaring related to the procedure can be well-hidden with the remaining hair. Patients receiving the ARTAS procedure can return to normal activities in one to two days, compared to weeks or months for strip harvesting procedures.[3][/suP]

 

[topccat29]

Yes they certainly were using cutting edge technology. Wonder if they told the patient.

 

[ejj]

i wonder were they get the transection figures from , its like they just ....." pluck " them from thin air , i spoke to a Drs rep the other week who quoted transection being somewhere between 5% and 3% on average, the robot comes in at 8% approx , on selected texture and colour of hair as it cant do all suitable hair types , curly, light hair etc

I wonder if Dr Arvind`s transection is 20 - 30 % ?? hopefully this will lead us back to the thread topic , while pointing out another problem within the industry the constant , marketing and scaremongering of never ending , newer, quicker, better, equipment, products , procedures, that rarely live up to the hype, and rarely benefits the patient

regards

ejj

 

[topccat29]

May those that fail to completely inform the patient of all options and possible consequences suffer the same fate along with their family members when dealing with a medical practitioner. What goes around comes around and when the shoe is on the other foot maybe they will finally understand as of yet them don't seem to get it. To be asking a doctor why didn €™t you tell me there was a superior and safer treatment for my baby boy, baby girl, mom or dad can be quite devastating.

 

[topccat29]

The line below was recently posted by a patient to another forum. He had a 1mm punch used on him by a good ole boy down in the Southland. Does anybody that works in the industry feel what he feels or does it just not matter to you. Just another day on the job I guess. Please tell this patient what he should do or post your answer here and I will send it to him. You that work in the industry you are the expert he has white dotting all over his donor now what?

the yield wasn't so bad from you guys although can't say anything positive about those 1mm punch scars in my donor.

 

[Sparky]

topccat29 wrote:

Yes they certainly were using cutting edge technology. Wonder if they told the patient.

I've seen this on youtube, it's gross

 

[hairtech]

ejj,

Where did you learn that the ARTAS uses a 1.4mm punch? I thought it has a range of punch sizes.

 

[bullitnut]

Sparky wrote:

topccat29 wrote:

Yes they certainly were using cutting edge technology. Wonder if they told the patient.

I've seen this on youtube, it's gross

That's awful and wrong on so many levels.

 

[ejj]

Artas Robotic Hair Transplant

[align=center]
[/align]

Restoration Robotics, a company founded by Dr. Frederick H. Moll, developed the ARTAS System. This completely automated machine is the first robot designed to carry out the scoring aspect of the FUE hair transplant procedure. Once the machine is turned on and initial parameters are set by the physician, and set to start, the machine decides which follicles to score around. It then proceeds from one follicle to the other at preset speeds.

HOW ARTAS WORKS: THE MECHANICS

Cameras, color identification sensors, and 3-D imaging software guide the robotic arm of ARTAS in selecting which follicles to score. To carry out the rest of the FUE process, ARTAS employs:

• A needle punch mechanism[/*]
• Disposable dermal punches[/*]
• Disposable cartridges[/*]
• A video imaging system[/*]
• A user interface

[/*]
This double-punch extraction technique requires an outer 16g (1.65mm) punch with cutting capabilities, along with an inner 18g (1.2 mm) punch with a blunt edge.

ARTAS is only approved for use on patients with straight hair that is dark brown or black in color.

The patient is positioned for the robot to punch out the grafts on a donor area of roughly 5 to 10cm at a time. During this time, the patient must remain absolutely still as the head is restrained by straps. After this, the surgeon removes each graft by hand with a pair of forceps. The patient is then repositioned for ARTAS to work on a new section of donor hair. This process continues until the extraction portion of surgery is complete. The implantation of grafts to the bald area is done using a traditional transplant approach.

ABOUT RESTORATION ROBOTICS

On April 14, 2011 the FDA granted a 510K dollar clearance to the ARTAS System for follicular unit extraction of the scalp on androgenic alopecia patients.

In 2007, the International Society of Hair Restoration Surgery (ISHRS) meeting was presented with the initial test results of ARTAS. At that point, the prototype had an unacceptably high transection rate of 30%. After more research and testing, at the ISHRS meeting of the following year the company reported that the device had decreased transection rates to 6-15%. At the ISHRS meeting in September 2011 the company reported further improvement in the transection rates of 2-7%, but this is subject to verification.


Image created by digitalart.

POTENTIAL PROS OF ARTAS


The prospect of a machine delivering FUE grafts is an attractive one if the machines can replicate the touch of an expert human practitioner. Also, Restoration Robotics intends for the ARTAS System to boost the speed of the extraction process. It is the opinion of Dr .... that these machines are in their early stages of development and limited in their ability to replicate the nuanced and finer touch of a skilled FUE surgeon. For instance, the robot is currently restricted to scoring follicles in the middle areas of the back and sides of the head and not for lower laying hairs of the nape or even beard and body. It obviously has restrictions with regards to the color of hair and curliness of the hair.

CONS OF ARTAS

We believe that no robotic device can replicate the fine touch of a skilled FUE physician using a hand-held extraction device.

Regardless of how sophisticated a 3-D imaging system or color identification sensor may be, no automated device will be able to discern the best follicle for extraction. No robot can select donor hairs with a specific hairline or eyebrow design in mind. Many experienced FUE practitioners may find no reason for using robotics at this stage. However, it is conceivable that novice FUE practitioners lacking a firm grasp of might find robots as a more viable option; a short-cut to the necessary time and learning curve required of advanced FUE. In these instances, sub-par results may be the consequence not only of the possible flaws of a device but the role and judgement of a novice FUE provider. Regardless of the device used, the need for training in the FUE procedure cannot be over-emphasized. Many patients have expressed discomfort at the prospect of a computer-controlled machine drilling hundreds or thousands of holes in their scalps.

Other issues considers to be possible areas for improvement in robotic FUE include the following:

1. While the use of a larger bore punch of 1.65mm in the robotic technique may improve on the transection rate, it also raises the prospect of certain complications or undesirable effects such as:

• The use of larger bore punches in robots, for example 16g (1.65mm in diameter) would create larger wounds. Larger wounds equal larger scars and more healing complication potential. Regular hand directed FUE tools utilize a 0.8-1.2mm punch on average. At these punch sizes, wound size is smaller, thus wounds have less healing complications and less scarring.[/*]
• The use of larger bore punches of 1.65mm in any FUE procedure also increases the chance of damaging the adjacent hair follicles. This raises the prospect of the complication that can sometimes accompany FUE hair transplants, called the halo effect. Each halo consists of a large circular area of loss from the removed grafts and surrounding hair that is damaged by the reach of a large punch. Many of these in a donor area could create a moth-eaten look.

[/*]
2. It has long been known that a technique involving the use of a sharp punch that is followed by a deeper-reaching blunt punch may increase the risk of buried grafts, which may lead to cyst formations, in addition to damaging the selected follicle.

3. If a robotic device set to automatic punches out hundreds of grafts in that 5-10cm section before the surgeon checks for transections, then it would mean the potential loss of several of those grafts before the physician realizes what is going on. A surgeon is thus best advised to constantly check on transection rates in order to minimize follicular genocide.

4. As mentioned before, the Artas robotic system s approval is thus far limited to those with black or brown and straight hair only.

5. After the extraction process comes the implantation portion of surgery, wherein the utmost level of skill is an uncompromising requirement. A novice FUE practitioner using ARTAS must understand that extraction is only the first step to any kind of hair transplant. The provider must be skilled in the art of recipient area designs and principles. This is something no machine can execute on behalf of a surgeon. Replicating nature requires the natural touch of a doctor and an artist.

 

[ejj]

bet the guys who got 30 % transection in 2007 , wish they had waited a year to be with the guys who got 15% transection , and they in turn probably wish they had waited until 2011 to be amongst the ` guinea pigs ` who managed to get somewhere between 2% -7% ( unverified )

what amazes me is the ` lowballing ` (as explained in Dr Rassmans book ) there trying to make out 7% is acceptable !

were has Dr Arvind gone , be good to hear his opinion on this , especially this industries insatiable appetite for , newer , better , faster , tools and equipment that rarely benefit the patient

toodle oooh

ejj

 

[ejj]

ARTAS NEOGRAFT HAIR REPLACEMENT

What: Breakthrough hair transplant robotic technology


Where: Dr. Gregory Turowski office, 9843 Gross Point Road, Skokie


Cost: Varies but typical is $10,000


Time: Six to eight hours


Phone: (847) 674-4646

Website: drturowski.com/hair-transplantation-chicago.html
Article Extras

View Gallery SKOKIE €” Some employees in Dr. Gregory Turowski €™s Skokie office call the new assistant €œHarry € although they admit his €” or more accurately its €” name is a bit cliched.

But what else would one call a breakthrough robot with the potential to revolutionize human hair transplants?

Harry deserves his own name since he has only six siblings in the world and he remains the only such €œHarry € in the Midwest.



I prefer my name " Arty " to " harry " or as the Dr calls it " ARTAS NEOGRAFT "..

Toodle oooh

ejj

 

[topccat29]

*****WARNING*******

This post represents some of my own personal opinions while also using examples from experience in my own life. To many this post would seem negative but its intent is to be educational. Instead of complaining about having to read it please put on your big boy pants and pass it up.

You see Dr A this is why the industry can €™t change. The majority being driven by money and less by ethics.

A good example has been posted to this thread. Many in the industry will justify the use of this robotic system for the simple reason that for some it €™s a foot into the door when it comes to fue, it requires almost zero physical work, and it €™s a way of increasing their income. I €™m sure there are also many that work in the industry that will just have to go along with it regardless of how they really feel about these large punches as they are employees and don €™t have much say. I understand this completely as I have worked for employers who made decisions I didn €™t necessarily agree with and they didn €™t seem very good for the customer. Well I needed the job as I had to pay my bills and these same people need their job and need to pay their bills so it is up to the patient to figure it out.

I even look at the forum that banned me as my postings on FUE seemed to promote the procedure and they considered that very dangerous. They actually now have a subsection on their forum specifically for the promotion of FUE some 2 years later. You see you can only lie for so long before people figure you out so instead of lying maybe those in the industry should start doing the right thing and stop with all the bullshit already.

Although I myself have never performed a FUE procedure using a small manual punch I can relate to the dexterity and stamina that is involved in doing this by hand for a procedure that can last the good part of a day. This is an honest account and not meant to boast in any way but might be easier for others to understand. There is something in my own life that I am constantly complimented on and that is as odd as it may sound my ability to strike a heavy bag. I can easily go 15-20 rounds and that is not a typo with full power combinations without really tiring. Random people will come up to me and ask me how I reached this level, even seasoned martial artists have come up to me and asked how is it I am able to maintain the exact same striking power regardless of its round 1 or 20. Well I have been doing it for 38 years so what seems very easy actually took quite a long time with lots of hard work. Constantly striving to work harder regardless of it was a hand strike to a wooden board or a round kick to a wooden post. Doing it until I felt like my limbs were going to come off and then doing it some more. So here is my point 99.9% of those who ask and really want to reach the same level will not do what it takes as the time required is too long and it €™s too hard. They might last a few weeks or months but then when they realize how much labor is really involved they say screw it and this is when they start looking for an easier way. This mentality is pervasive throughout society just look at what people will spend money on to avoid having to put in effort. How about those electrical stimulating devices to tighten the core muscle or maybe it €™s the cream the lady €™s wipe on their ass to melt away the cellulite, I mean c €™mon doesn €™t anybody see through this crap. Guess what there is no easier way when it come to fue and that has been demonstrated by all the guys who now talk about the power tools that were used on the head in the past with complete disgust some of them as recent as a week ago.

So what are we seeing with FUE? The majority of the doctors not only lack the talent but they lack the mental and physical ability to actually perform the procedure. So instead they are willing to sacrifice more damage to the patient in order for them to compete.

In my opinion the real money with this robot will be made in punch replacement. Who benefits from this recurring stream of income, I will let you do that research for yourself. I would not be surprised if they even give away the robot as long as that punch replacement business is there. The more robots out there the more punches sold and with that the illusion comes the belief that the robot must be better. This is reality guys and it does not benefit the patient. You don €™t have to agree its just food for thought.

 

[topccat29]

My suggestion to those that make a living from this industry is to move towards the light. No one is taking suitcases full of money when they leave this earth. You will be remembered for the good you have done so have something good people can remember you by.