Why Robotic FUE is bad for the HT industry.

[topccat29]

I think promoting the ARTAS on the forums is kind of a hard sell at this point as the knowledge level of the average reader is probably higher than the general public. If you look at most of the PR so far with the robotic system it has just been general pieces in various publications and other media outlets, nothing really targeted.

Anyone who bought one of these in hopes of increasing their business will have to wait for the targeted marketing to start if in fact that is the plan once a footprint has been established at least on a national basis if not worldwide. Then look for those $100K ads in various fitness and men €™s magazines where the target market is between 20-30 age group, kind of the sweet spot for the industry. That is when you can see an uptick in inquires if you own the device but then the issue I would imagine would be competing with anyone else who has one and of course still staying true to one €™s ethics which gets kind of hairy when market share starts to come into play. Will the company sell you out along the way with too many machines in too many hands, I don €™t know you tell me. I €™m sure that the temptation to make a deal is hard to resist.

What will the rest of the industry do when this happens and that marketing machine starts to roll. I €™m sure many already know this but just can €™t say it. It will be sad to watch if in fact it does happen. If those in the industry were to do the right thing they would send anyone who specifically requested fue to a place where they know they would be in safe hands and the work is of a higher standard, several to choose from. I mean if you can €™t do it would that not be the right thing to do. But that is not in their heart, to do the right thing as they only can think about more market share.

These guys that run this company are direct to consumer marketers and if you look at all the crap out there that is being sold it certainly might have a chance as numbers are about marketing not about being something better. How disgraceful when you really think about it. The direct to consumer marketing has just not started. As I wrote in the first post regarding Arthur Jones he knew it was easier to convince the masses and have them request it as opposed to dealing with those who had actual knowledge.

Anyway just a thought and will be interesting to watch. Some of the strip only clinics are on the fence because they know these guys are going to destroy their business it €™s only a matter of when. I €™m sure some of the sh*t forums will consider going all robotic results because the person that does that will be the next guy that makes the really big money. In fact there is your million dollar idea in case you have not thought of it yet. Some of these guys can only think about money 24/7 and you are the pawn.

A real man is competitive by nature so those that cave to something inferior can only be described as weasels in my book it also tells you a little something about their ethics.

All these PR pieces you are seeing have been done before 30 years ago. A book I am currently reading had an interesting quote and I must say that I agree and I will paraphrase.

As people we are too lazy to learn and too arrogant to think we need to learn. We feel that whatever way we happen to perceive things is the right way without further study and not consider we could be wrong. With our laziness and narcissism feeding each other we march off believing.

Here is a PR piece from 1993 but reading it just as a consumer most really do not understand what they are reading sure in hindsight you could say you do but not in real time. Most believe they are reading news and information because well it €™s in a news paper or magazine. Of course it does not work that way, some know this but many simply do not and the easiest to fool are the young inexperienced consumers.

 

[Dr Arvind]

2 quick inputs -
a) FDA approval : FDA has approved the use of ARTAS for only fine calibre, straight, brown hair
b) Does the robot make the efficiency better when being performed by an already experienced and good HT doctor? - No, was what the rep of the ARTAS company said.
So, why not learn the entire HT from a good HT doctor for let us say USD 1,00,000/- for a period of 1 year or till he feels you are good enough?

The rep didnt talk to me for the rest of the ESHRS meeting for the next 2 days.

 

[topccat29]

Doesn't sound like he was too friendly. Everyone knows you have to be friendly and put on the happy face in sales, maybe he had a bee in his bonnet.......lol......... I wouldn't sweat it though..............nobody needs friends like that.
I would have gone up to him and asked him what his problem was and you know I never used to be like that before. Just kind of went along with what people told me if it t seemed like they knew what they are talking about. Now I find out for myself and if someone is talking bullsh*t to me I point it out to them right away and I'm seldom quiet about it.

 

[topccat29]

Dr. Arvind I do have to give you a pat on the back for having the courage to ask the question and bring up the point with the rep. Not easy to do most especially when you work in the industry. I can just imagine the pressure to conform most especially when in a large group of peers.

I have learned over time that psychopathic behavior often involves the person exhibiting the behavior becoming extremely angry when questions are asked. The person asking the questions is made to feel guilty or to be a bad person simply for asking. This is a very common strategy. I €™m not talking about asking neurotic questions out of a sense of insecurity. But good common sense questions that just require a logical answer. What one finds is they often just go unanswered or are met with an angry response.

Over the years during my research there was one doctor in particular here in the US that seemed to flip out when I asked specific questions. That of course was a huge warning flag and I also grew to dislike what I was seeing this same doctor do over time. I pointed this out over the years and of course I was brutally attacked for it but good for me because I didn €™t not become another victim like many others.

Keeping oneself and others safe is infinitely more important than the risk of offending another.

 

[topccat29]

When I look at the promotional material for the recent UK robotic workshop it does raise my eyebrow. Just trying to figure it out what it all means. Looking at the bullet points what stands out for me would be a couple of lines.

Learn how to turn this into a $1 million dollar a year procedure.

It doesn €™t say learn how to turn this into a procedure where you patient benefits greatly from an aesthetic result which is superior to every other procedure, its focus seems to be on making more money. Well as a patient that does not mean much too mean in fact it kind of scares me to even be reading it. I want something better for the patient and not the clinic.

The next bullet point that cause me some distress is

Learn from the experts the most successful patient consultations.

I find the line particularly disturbing. Caring for someone and giving them good advice does not require any learning at least for those that have integrity. I certainly would not be trying to sell some young naïve patient something if I don €™t think he has the right mindset. In fact if I were in this business and I had a really young person come in thinking hair is going to help him build his confidence or somehow women were magically going to appear I would have him read from a list of books and have him involve himself in activities that would give him confidence without the procedure first, then come back a year or so later. With older guys it usually is not as much of an issue as they have a better understanding that people will screw you over for money, it €™s just part of life. Just learn to look for the signs and make better decisions.

 

[topccat29]

I don €™t think most understand my passion when it comes to this whole subject, they just don €™t get it. They probably think I have nothing better to do and just like to ramble on.

There was a guy doing state of the art hair transplantation in the late 80 €™s. Probably the best in the world at that time along with being a decent human being and educating the patient completely. But you see I didn €™t know about Bobby Limmer, how would I the information simply was not available. There was no internet and even with the internet you could still have been easily fooled by others. How does one sort through all this horseshit.

So what did I get, I got the state of the art work at that time as it was being presented in various publications such as that news piece posted above. Mind you this is an article no different than a press release represented as news. In the minds of most, important information you need to know. So how did this happen how did that information that was published become the truth. You tell me after you figure it out and it €™s not very hard to do. Who determines what is newsworthy and why? If you see a big write up ask yourself who wrote this and what is their angle.

So here I am in the early 90 €™s getting what I think is the state of the art procedure which will help to repair what was previously done to me. It €™s easy to judge but with limited information and not many choices coupled with some desperation to fix this, it €™s easy to see how it can happen.

Meanwhile hundreds of miles away unbeknownst to me some guy has got a .357 magnum pointed at his chest and blows a hole in himself because he is so distraught after having this same procedure. Now did this same doctor know what had happened as he was prepared to do the same to me €¦ €¦ €¦ €¦ €¦I don €™t know but it would not shock me one bit if he did as my procedure happened after the incident. Do you see what we are dealing with here €¦ €¦ €¦ €¦ €¦who does this €¦ €¦ €¦ €¦ €¦what kind of twisted logic does one drum up in their pea sized brain that the guy with the hole in his chest was just a blip on screen.

This guy with the hole in his chest survived and several years later went on to win a lawsuit for about $500,000 and that state of the art procedure the hairlift was no more. Was he alone €¦ €¦ €¦ €¦no as many others have come forward. This same patient felt so much shame that he could not even take the wig off in court to help make his case. He just couldn €™t get past what had happened to him.

Doctors and those that work for them have an ethical obligation to advise their patients of superior methods that are available regardless of if they offer them or not. If you truly do offer a superior procedure than great all we ask for is a logical explanation.

That could have easily been me with the hole in my chest or maybe my head but for whatever reason it never affected that way. I always thought I will figure this out in time. It €™s like I have this driving force inside that €™s wants to find the solution and not give up. I found the solution for me I just found it a little too late but I €™m still grateful that I didn €™t give up. I do not easily forget that someone could care so much for money and so little for a human life that they are willing to do and say anything.

 

[topccat29]

A recent book I read €œRobotic Hair Restoration Advance Follicular Unit Extraction € by Rashid M. Rashid. Not something I can recommend but one interesting quote worth repeating.

€œ Currently, no robotic device can do the skilled work that a qualified doctor can do with a handheld extraction device €

Interesting quote as it is coming from a book based on a robotic system.

 

[topccat29]

What I find most telling about the quote from the book I posted above is why would it be in there. Why would this doctor/Phd feel obligated to include that particular line in his book which speaks of all of the advantages of a robotic procedure.

Would anyone dare to put in writing before performing a procedure that in fact the robotic procedure you are about to undergo is superior to that of fue by hand?...........................hmmmmm.............

 

[topccat29]

FUE by manual extraction I would imagine has to incredibly hard to do, at least in the beginning when one is learning developing their skill along with the hand strength and endurance it takes to keep performing it hour after hour. Most doctors give up because in fact most doctors are wimps judging from what I have seen over the years. Hard work is not in their vocabulary except for a very few and I believe their backgrounds and life experiences are the determining factor.

I can easily relate although I have never performed a procedure in my life. I have countless numbers of people come up to me and ask me how they should start training to develop strength and endurance and the answer is always the same. You need to start deadlifing for high reps 20-50 reps for at 30 minutes 3 days a week. Doing approximately one set every 3 minutes. I have gone as high as 25 reps with 405 lbs starting from a dead stop depending on my bodyweight. This can only be described as incredibly hard work but over the years it becomes second nature and very easy to do. Most that try it last one day in fact 99.9% fail and then start looking for another way no different then what I see with fue. The fact is sometimes in life the best result does not come from the easy way but it comes from the hard way and not everyone has what it takes to travel that road.

Robotic systems can €™t compare to the results of fue by manual extraction in my opinion. I would also add that any technology that generates revenue from recurring income directly related to the number of procedures being performed and is paid back to the creator of the technology outside of the cost of the technology itself is creating a monster where if other examples of different industries are any indication it will swallow up this industry whole in due time. Just do the math and in the end that becomes very bad for the patient as industries that become dominated reduce choices for consumers plain and simple.

I suppose if one has little to no talent it does become an option but then it becomes a race to make as much money as possible for those that adopt it as those that sell it are interested in getting it into as many hands as possible in the least amount of time. Eventually it might be worth it just to give it away like a cell phone and those that bought that $1200 cell phone back in the early 80 €™s were the real suckers.

Why do I care about all of this €¦ €¦ €¦ €¦ €¦ €¦I don €™t know it just gnaws at my insides sometimes and the information needs to be put out there.

 

[topccat29]

One thing most repair guys agree on is that we are all nice, honest, respectable people and that is partly what led to our situations. We didn €™t want to offend anyone, be disrespectful and question too much, and basically thought others were just as honest as we were €¦ €¦ €¦ €¦..we were all wrong and we all can admit it.

I cannot go back in time and tell guys like Puig, Brandy and others you little bastard you are just a liar much too late for any of that but want I can do is say that anyone that tells you patients from 10 years ago who were not candidates for fue but suddenly now they are because of some machine are liars. Plain and simple they are liars and my suggestion is to stay away from liars when it comes to medical procedures.

They will put on a happy face and a big smile but they are liars.

 

[topccat29]

We can also add these guys that run seminars on how clinics can turn themselves into million dollar operations by purchasing some new machine. They are not here to help patients they are here to help themselves make a million dollars so that would make them an a-hole in my book. They can pretend all they want but I don €™t buy the bullshit.

 

[topccat29]

I love a recent quote by one doctor that the larger robust grafts are better because they can then dissect that same fue graft to obtain some single hairs. Logically it makes absolutely no sense when a skilled doctor can leaving a smaller hole in your head using a smaller punch to extract that same single hair graft. If having less holes in your head that were larger made any sense then you might as well use the 4 mm punch.

I read an interesting article on the morcillator, a device used to remove fibroid from the lining of a women €™s unterus. The problem is when the grind it all up and growth is malignant you now are very likely to be exposed to having stage IV cancer €¦ €¦ €¦ €¦ €¦ €¦ €¦but they don €™t tell you that €¦ €¦ €¦ €¦.always the same just leave out some of the information. The point here being is the quote in the same article.

Why this all happens €œGlossy ads appear in trade journals read by doctors touting the device €™s safety, control and simplicity. Saying it €™s an efficient time saving alternative compared to other techniques and describing the simple, fast, and safe morcellation of even large amounts of tissue.
Note: most of the concerns in these promotional materials focus on the doctor and not the patient. They have more to do with efficiency and speed then they do with patient outcomes.

If you are female and reading this, research before having morcellation. If you are researching hairloss investigate better options.

 

[topccat29]

Hair transplant patients need to understand something. This example of the morcillator which is on ly one of perhaps thousands €¦ €¦ €¦ €¦.the doctor using it is not going to tell you that there is a safer procedure with a better outcome €¦ €¦ €¦he using the morcillator so why would he do that. Those that work in the industry that use the safer procedure with a better outcome are not going to invest time into warning too many about the morcillator guy €¦ €¦ €¦ €¦ €¦.it €™s really not in their interest and can only bring them grief €¦ €¦ €¦.they just keep doing the right thing and if the patient gets lucky or is wise enough then they end up with the safer procedure and better outcome. Not only that, the industry needs to stay within the lines and not upset the system be it removing fibroids or doing hair transplants.

Those that work in the industry in any form cannot tell you much of what you really need to know you have to speak with patients because those that work in the industry also need to just go along with much of what can only be described as crap.

But here is the thing with the ht industry €¦ €¦ €¦ €¦ €¦..when their mother or wife is on the table and the morcillator guy assures them everything will be fine and it turns out it is not fine €¦ €¦ €¦ €¦ €¦ €¦ €¦ €¦.and then they realize they didn €™t have all the information €¦ €¦ €¦ €¦ €¦they will just sit there in their grief trying to figure out why no one told them there was something better. This is in fact why we need to keep passing on good information regardless of if it ruffles somebody €™s feather.

If they would have only spoken to the person who had a loved one that died from the morcillatiion they might have had a chance. Because that person may very well now have all the information after the fact and he will tell you what not to do because he is so outraged by what he sees.

 

[topccat29]

The Robotic ticker is up to just under 9 million grafts extracted €¦ €¦ €¦ €¦ €¦ €¦quite an increase from the last time I looked which was not long ago when it was only 1 million. Most of the outfits offering the procedure seem to show the same 2 stock photos and some of those that did have additional pictures the pictures can only be described as interesting.

One youtue video I watched did not have an update and the patient specifically states updates will be presented. From what I viewed it didn €™t look quite right but just my opinion. I did note one of the comments stated the hairline was f***** up, can €™t say I disagree. This is an just an update to the thread. It will be interesting to watch as the ball starts to roll. Kind of makes me laugh in a way €¦ €¦ €¦ €¦.I think if I was 23 I might sign up without giving it much thought €¦ €¦ €¦ €¦ €¦.looks easy €¦ €¦ €¦ €¦ €¦..boom, boom, boom in and out €¦ €¦ €¦ €¦ €¦.piece of cake. We really can €™t blame young guys when things go wrong, walking in it all seems so harmless.

If you look at some of the clinics that have this device it is very scary in my eyes.

I spoke to a couple of patients recently that had the Acell injected into their skull and they lost massive amounts of hair. I am now trying to figure out what is worse the Acell injections to the head, the ink dots to the head or this device....................what a crazy business all because some guys wants some strands of hair on his head.

The last 2 books I read really hit home when it comes to this device, "Decoding the new Consumer Mind" and "Marketing to Millennials"...................the Millenials in my opinion are easy bait with this technology...............they just can't seem to get enough of the tech and it seems to me that for them it's all good...............I would disagree.

 

[topccat29]

I read quite a few books on Epigenetics over the summer, most of them were terrible except for one. € Epigenetics The Death of the Genetic Theory of Disease Transmission € Here is an interesting blurb.

Many individuals diagnosed with MS, ALS, Alzhiemer €™s, Korsakoff €™s syndrome and Crueutzfel-Jakob Disease share the broad symptom list and brain lesion list with Huttington €™s disease.

These diseases traditionally have affected middle aged people starting at about 35 years of age. Starting in the year 2000, the demographics changed with the fastest growing age group diagnosed with MS, ALS, etc being children under the age of 12. In the author €™s opinion all are caused by high intakes of trans fatty acids, heterocyclic amines and acrylamides.

Point being is chances are you would never hear something like this from organizations that raise money for ALS, they would rather have bucket challenges and make others feel guilty for not going along and supporting that effort. But where does that money go and to who €™s effort does it support most will not look deeper.

And that is the problem with something like this robotic procedure. People will just follow along with what everyone else is doing without looking too much deeper. Once you can control the information stream then everything else just becomes noise. If one is able to increase something 10 fold in such a short period of time what happens when it increase 10 fold again and you are looking at 100 million €¦ €¦ €¦ €¦..etc. Then who controls the information €¦ €¦..certainly not small clinics or hair loss forums.

Anyway it €™s all interesting to watch as one can only learn which is most definitely helpful in other areas outside of HT. Just because someone is in a position of being able to control the information with diseases as only one example, it does not mean they have your best interest in their heart.

 

[battlingbill]

This is such an interesting topic. Im hearing alot of marketing behind the new robotic hair transplants like Neograft but from talking to some doctors i get a sense that the steady hand of a good doctor trumps a machine all day long. Is that the case for most members here?

 

[topccat29]

I would say if you look at the evidence over a very long period of time then the truth can more easily be seen. It €™s kind of like evaluating people €¦ €¦..friends, relatives, business associates, etc. One can only determine what is true and not true over an extended period of time. Sure we all know Mr/Mrs wonderful because they say so but only time is the true test otherwise they are merely words.

Yes in my opinion a small manual punch in the right hands is hands down superior to anything else. Keep in mind hair transplantation is art and not medicine. Who is your favorite musician for instance? Who leaves you speechless when they perform? Now compare that to maybe one of the local guys or someone not at the level of your favorite. Does this matter €¦ €¦ €¦ €¦..yes €¦ €¦ €¦ €¦ €¦ €¦..is everybody of equal skill and talent €¦ €¦ €¦ €¦ €¦ €¦.no €¦ €¦ €¦..

 

[topccat29]

So here €™s the deal. There are only a handful of doctors that have the skill to wield the small hand punch €¦ €¦ €¦..handful is about 5 when you start adding ethics and patience to the list the list gets smaller. You see I don €™t have very much patience I guess that €™s why I €™m not a doctor €¦ €¦ €¦..no patients get it €¦ €¦ €¦ €¦..lol €¦ €¦ €¦ €¦ €¦..but here is the thing those that do have the patience also make wonderful teachers because patience is a wonderful trait to have when you are teaching others but I'm digressing.

So those that don €™t have the skill to wield the small hand punch have other offerings. We want to make everyone feel good so if let €™s say maybe it €™s tattooing then we comment wow that a wonderful hair tattoo, looks very nice and natural. Or maybe they offer Acell so we might so wow I think I see hair regeneration, amazing what pig bladder does €¦ €¦ €¦ €¦congratulations, everyone feels good and everyone is happy.



Between me and you look for someone that can work a small punch with skill. They are not usually going on news programs or constantly releasing PR pieces in the Daily Mail but they are out there.



Read the forums daily as a starting point.

 

[topccat29]

If anyone in the industry tells you that the transaction rates rise for all doctors performing fue with small hand punches and the yields diminish due to hand fatigue then what they are asking you to believe is that which has been presented by highly skilled fue over the years is in fact not real. They are asking you to not believe what you are seeing. To believe their words €¦ €¦ €¦ €¦ €¦ €¦over actual proof shown through real results. Do not believe what you see or what a patient may say but believe what they have to say, believe their words.

When anyone in the industry tells you that a 1mm or a .9 punch is the same as something smaller they are in fact asking you dismiss the logic of basic math. They are trying to convince you that the math doesn €™t matter. The fact is a .9 has a surface area that results in a wound size that is about 40% larger. They are asking you to believe that 40% does not matter. Below is a picture that represents the difference between the square area of a circle using a larger example but the ratio is similar comparing 1 to .75 €¦ €¦ €¦ €¦ €¦it matters.

When they realize that the patient understands the logic behind basic math they then move on to the robust graft theory claiming higher growth rates. What they fail to mention is that robust grafts often result in recipient areas that appear to look like the landscape of the moon. They also fail to mention that they cite a study done by someone who was actually trimming fue grafts in the past to provide the patient with a more pleasing aesthetic result so exactly which is the truth here. It €™s always easy to say that which is convenient but sometimes being truthful is better for the patient.

Robust grafts are extracted by those have neither the skill nor the patience to do otherwise.

I can also tell you about hand fatigue. It does not become a factor once one has been performing something for years and that is the difference and an absolute fact. Fatigue is a factor for only those that have given up as they have never been able to conquer it as their minds were not strong enough to get past it. They chose the easy way and the easy money.

I will give you a real world life example of skill. I am very good at rough carpentry. Working fast and putting it all together quickly. Trim carpentry is much more difficult for me as one needs a great deal of patience and must have the ability to really slow down in their work. An angle might need to be 43 degrees as opposed to 44 degrees. Doesn €™t sound like much but if you want the end result to look aesthetically pleasing then that one degree makes a huge difference. That .15 difference in a fue hand punch is going to matter when you are looking in the mirror.

Many in the industry should spend less time trying to put their words together so that it all looks very polished, creating an aura of professionalism and expertise. That effort should be focused more towards providing the patient with the best available option when it comes to surgery.

Look less for the polished image and look more for the polished result. The results and experiences are what matters not the words.

 

[topccat29]

It €™s probably safe to assume that many of the reps, forums and clinics that took somewhat of an anti fue stance over the years but now seem to be singing a different tune were probably less than honest with consumers and prospective patients.

Did they convince you to go somewhere else if it was in your best interest or did they do something else? If you were given advice that in hindsight might not have been the best do you feel that you may been victimized?

Now that the story has changed does this now make them honest? Does milking something for as long as possible until another option comes around make one honest and does it matter?

The small manual hand punch is still the best the industry has to offer in my opinion and if someone tells you something different I think maybe they are still not being truthful.


Is it possible that those that were less than truthful in the past might still be less than truthful in the present? These are all critical questions one must ask themselves when researching.

Many in the industry will continue to promote what is best for them, what helps them and if pushing robotics is where the money and numbers are to be made than that is what they will do. They never really cared too much about the patients so why would they care about a handful performing superior work?

I can tell you this from my own experience watching and participating in this all. Having had about 1000 fue extracted from my face from a very small area can only be done by a skilled surgeon using a small hand punch and the reasons are very well known to those that work in this industry. Those reasons also apply to the back and sides of the head.

Yes many young guys will say it does not matter but it does and as you get older and the hair styles need to become shorter for both men and women you will better understand why. And yes for most the hair style will be shorter as the hair starts to thin for both sexes it tends to lay better on the head with a shorter cut just look around at the majority. You also have the issue of the skin and hair complimenting each other and this would also be a reason for a shorter style.

Listen I understand we do not want to hurt anyone feelings and we don €™t want to leave anyone out. Maybe the tattoo guy is a good guy and maybe the person offering the robot is good too and I can understand that, we don €™t want to leave anyone sitting out in the cold. We want to be kind to are neighbor. But the facts the way I see them are sometimes you just have to go with the best players.

I can say this for certain. If it were possible for robotics to extract fu €™s from the face in it €™s present form no one working in this industry would ever opt for the procedure themselves. Those same reasons why apply to the back of some young guys head.