Why Robotic FUE is bad for the HT industry.

[topccat29]

What I find interesting about robotics is that they actively market against strip and describe it as a regret. Yet they do not actively market against the small hand punch. The fue counter as I have stated in the past is interesting as in my opinion it €™s meaning seems to be targeted towards doctors and clinics.

I interpret the meaning as hop on board before it €™s too late at least the projected meaning. But in reality I believe it means you work for me now. I have an army 100 strong which soon be 1000 strong and only get bigger. You are simply a soldier and your pay scale will be determined by how many soldiers I have in my army. The guy at the top of the pyramid always makes the real money but many that have signed on don €™t know that which is kind of humorous.

It €™s interesting that honest people were doing the right thing years ago honing their skills and offering many something better, the small hand punch fue. While the dishonest people seemed to just be bad mouthing the work of the honest people. Seems like many are getting their just rewards while some will listen to the music and claim the ship is not sinking the rats will simply desert the ship.

This is just a microcosm of the world we live in and the best philosophy is just to stay away from dishonest people. Nothing good can come of it but one can certainly learn from watching it all.

What €™s even more interesting is that you can read books that were published decades ago and even longer and they can tell you about what is happening in the world today. One must then consider that maybe it €™s a plan €¦ €¦ €¦ €¦ €¦ €¦or at least be open to the idea.

So maybe the same applies here and there was a plan to get some key doctors to sign up and then many would follow. Maybe there is someone out there smarter than many that work in the ht industry €¦ €¦ €¦ €¦..is it possible?

I guess some can always fall back on hair tattooing.

 

[topccat29]

One must research forum history to understand the many who lie and I highly suggest you do the same and not do business with someone that lies. In fact it should be the foundation of your research on which everything else is built. I actually have quotes in my paperwork from those that work in the field of developing robotics for ht that state the same. Just need to go through it all.

2008
One of the things that disgust me is when experienced FUE docs use 1mm plus size punches "on every patient" for the sake of speed and profit in the procedure.


2004
I agree. Having seen the difference between a large 1.00 mm FUE donor site and a 0.75mm donor extraction it really is night and day.
But I've already said this a thousand times.

2004
My response: I discussed earlier that mathematically a 1.0 mm punch has 1.8 times the surface area of a 0.75 mm punch, but I've noticed that the smaller extraction sites heal at least 4 times faster. This is just my anecdotal observation so far, but in time I hope to have more concrete study results.
Some may disagree, but I strongly feel the size of the extraction tool makes a significant difference. If the entire procedure can be done with 0.75 mm or smaller extraction tools it should be. Keep in mind that going smaller than 0.5 mm usually offers very little benefit. We need a certain amount of sebaceous material to protect the follicle and to ensure the entire follicle is extracted. If we go less than 0.5 mm chances are we chop off too much sebaceous material or damage the graft too much. Also, a .5 mm extraction can't usually harvest 3 or 4 hair FU's without increasing the risk of transection. You need a 0.75 for those. the 0.5 is good for 1 hair grafts for hairline work.

2004
I think you are missing a subtle point here.I perform FUE and am demonstrating my technique on these forums so that doctors may use it instead of hiding it from one another AND subject it to open verification of their peers as well as future patients.
Now coming to the issue of which punch to use.I generally prefer the smaller punch 0.5mm to0.75mm.But often the diameter of the punch to be used is also determined by the area over which the FU is spread as it emerges from the skin e.g.in one of our patients the 0.5 mm punch could simply not encompass all the hair as they emerged so we had to use 0.75mm punch.

2003
At first glance it would SEEM that you are correct in limiting the size of the punch for the reasons you mentioned. However, there is much more to Follicular Transfer (FUE) than meets the eye. I have successfully harvested grafts with a .6mm custom punch with NO transection.

2007
I am so sorry... I just had to get this one out. Groups of 2'3, 3's, and 4's...and a freakon 5 haired graft from a 0.75mm punch. Look at these beautiful grafts.



This extraction pattern was posted about 8 years ago and it represents a sensible pattern to minimize the moth eaten look. Would you use a 1 mm punch on each of those areas or would you assess the hair grouping and adjust as necessary? Is doing what is easier better for the patient or better for the extractor?

 

[topccat29]

Maybe there is a better way for me to explain this the way I see it. Of course the truth is always important to me as my values are simply different. Money is nice if you are going to do something good with it but for me personally excessive greed to participate in excessive consumerism not only brings one a false sense of happiness it also seems foolish. Just want others to understand where I am coming from. These are all my own personal thoughts that hopefully will help other make a better decision when deciding on a hair transplant. Eventually I will start blogging because I feel that strongly about it all and maybe some of my postings are off topic.

If you look at the history of fue most doctors found that they needed a range of sizes in their punches. If they were too large major white dotting occurred that was visible even with a short hair style. Too small and grafts were transected and simply had to be thrown away. Now I will concede sometimes larger punches are needed within reason to extract a hair grouping that is larger but the problem with using a one punch size fits all is that hair groupings vary. You need 1 hair, 2 hair, and 3 hair grafts etc in order to have an aesthetically pleasing result with enough density while still maintaining a natural look.

Of course one can simply extract larger multi hair grafts and then dissect them but that is not the true nature of fue. Excessive tissue is being unnecessarily extracted increasing the risk of substantial white dotting. You also risk establishing an extraction pattern that would not be good for the patient in the long run as you hunt down only those multi hair grafts.

This is in fact why some of the best work out there is being performed by those using a range of punches.

In my younger years I had the opportunity to set up and program CNC machinery. On the rotating turret sat the tool holder with a wide array of tools which would simply rotate into position and then move towards the material that was being worked. Each tool had a specific purpose and each tool was a different size because one simply cannot use one tool for every job. I always thought this was a good example for others and maybe it could help them visualize the process .

Hopefully this point is helpful for others in understanding why you need a range of tools for the best possible outcome and that is what we are all here for to help each with the best possible outcome. Maybe one day robotics will have such a turret but right now it my opinion it is not the best of what the industry has to offer and their is a moral obligation to inform the patient fully of all options regardless, as the patient's welfare should always be top priority.

If you are researching you don €™t need to necessarily be an expert but you do need to approach it with common sense. Some might like this post while other may not but I have always found that the truth comes out in the long run.

 

[topccat29]

I would like to make a prediction for 2015. I think some of the forums out there will start heavily pushing the robotic procedure simply because that is where the numbers will be so that is where the money is to be made. Consumer advocacy is great and all but this is a business.


Can one punch size that is larger than the variety of small hand punches a handful of highly skilled fue doctors are using possibly be better €¦ €¦ €¦ €¦ €¦ €¦ €¦not in my opinion. But they will push very hard to have many believe what they are saying.

These are the same people that pushed many young guys away from fue in the past.when it was the better option. Low yield, white dotting, blah, blah, blah.

Do they have any credibility €¦ €¦ €¦ €¦ €¦I would be hard pressed to think so. But is will be interesting to watch what they do. Which forum will jump first to get their piece of the pie is anybody's guess.


Robotics might be a good second choice and many guys will be okay with that option. As long as they are aware and the information has been fully disclosed when marketing then it becomes a personal choice.............good for them.

 

[janna]

topccat29 wrote:

I would like to make a prediction for 2015. I think some of the forums out there will start heavily pushing the robotic procedure simply because that is where the numbers will be so that is where the money is to be made. Consumer advocacy is great and all but this is a business.

I'd have to disagree with your prediction... I don't believe the forums will push the robotic procedures, certainly not in 2015. It's still an unproven technique with not enough results shown by any clinic for forum owners to pursue.

We tried out the robotic procedure for about a year. Ultimately, we didn't feel it was superior over human hands at our practice. We discontinued using it in March of 2014.

 

[topccat29]

Janna maybe you are right and it €™s just a guess on my part from observation. I think not only will the pressure be there but more so the opportunity for a forum to cater more robotic procedures seems like a no brainer for those strictly in it for the money. Doesn €™t mean it €™s the right thing to do but I believe some just will not be able to contain themselves.

I also base it on what I have seen on the forums in general over a very long time. Some seem happy to dilute the quality of doctors for quantity of doctors and I think that would be hard for most to deny. They also did their best to suppress techniques that might have been better options for guys over the last few years. I know because I was in fact told that they were dangerous those exact words by some of these forums.

My opinion in real life is that people that do not care about others certainly will not care about me. So those forums that gave me the impression of not caring too much about the patients do not surprise me when they seem not to care about the quality doctors by diluting them, just my opinion. I also understand maybe most would not want to comment.

In the end it becomes very confusing for new patients and almost as bad as having no information at all.

I distinctly remember a post by a doctor with pictures showing the difference in wound size between a 1.0 mm punch and a .75 mm punch yet years later it no longer matters and he says what it convenient and what benefits him. That is about money and nothing more certainly not what is best for the patient.



He is in fact a liar and that sad part is no one can say anything or tell anyone and patients are just kept in the dark.

 

[topccat29]

Here is good example of how a forum operator can mislead young guys and how anything is possible.

There was one operator back in 2001 that had a small ht session overseas then subsequently the same clinic started promoting hair multiplication on the same forum. What was being promoted didn €™t make sense logically and when several posters including myself started asking questions and presenting some logic the postings were deleted and several members were banned.

How long did that last €¦ €¦ €¦ €¦ €¦ €¦ €¦..a good 12-13 years. How many guys experienced full restoration through this hair multiplication €¦ €¦ €¦ €¦ €¦ €¦.zero. How much money was made is anybody €™s guess. Personally I took what one could consider a lot of abuse over the years for pointing out just that one truth with nothing to gain either way €¦ €¦ €¦ €¦ €¦..but I find it entertaining in a way and maybe I will do something will all this information that I have gathered over the years.

Something does not necessarily have to be better you only need to get people to believe it €™s better and it happens each and every day. It really does come down to coming across the right information and taking a moment for many to just listen and maybe consider it. The problem is the majority regardless of the subject will not listen they will just go with the flow and follow the direction of the herd.

All they need to do is get the herd moving in the right direction. They know that it €™s only the herd that is unaware. It applies to many things in life and medicine in general is a very good example.

I have watched this all for a very, very long time. In fact longer than most who actually work in the industry. I base most of what I say from actual experience and observation.

BTW that same forum owner was able to get guys to contribute to sending a large gift basket to that same clinic for answering some questions. So imagine having that kind of power over a desperate group of individuals. I €™m sure he was laughing at the thought that people would actually send him money..............he probably said to himself this is too easy.


Not everyone is going to do the right thing. They get a little sway or power and it becomes simply about making money as they get caught up in it all.

 

[topccat29]

The biggest mistake the clinics doing some quality work years ago did was to think that they could get someone else to promote them. When you see these whiny little guys on the forums you know those impossible to please insecure little boys. Those guys you gave the power to promote for you, they are those same guys. But they found a way to define themselves and separate from that same group as they had nothing else going on for themselves. This is in fact the same reason many are driven by money €¦ €¦ €¦ €¦.it €™s all they got or could hope for.

Now they can €™t let go even though many are starting to figure them out. They will do whatever it takes as without it they become what they always were to begin with which probably scares them. If they have to lie they will lie and it will just be a new lie. It's no longer about money as money loses it's appeal at a certain point...............it's about being somebody.


The small group of quality clinics should have formed their own group a long time ago but I guess egos just get in the way and eventually they all will pay a price as those whiny insecure guys will reign over you €¦ €¦ €¦ €¦ €¦..just my opinion and thought I would share it.

 

[topccat29]

Robotic systems do not have to be better they only need to have the market perception of being better. Getting them into well known clinics is a good first step strategy and it gives one a leg up in mass acceptance. They don €™t have to be used they just need those clinics to purchase a system to create demand in the second phase. One can also easily outspend in marketing dollars by 10 fold the nearest competition once recurring revenue starts to increase. Finally once you can start to show some numbers take it all public or possibly sell to the highest bidder. Private investors look for a return on these types of deals and they don €™t get into because they want to be in the hair transplant business. This is fairly common knowledge in the business world with private funding.
And all this before the decimated donor areas start appearing as every Joe Blow becomes a ht candidate regardless of what their future holds. Others see this coming too in my opinion €¦ €¦ €¦ €¦.it €™s inevitable so they might as well cash in on a good payday while it lasts €¦ €¦ €¦ €¦ €¦ €¦ €¦.maybe others see something different.

Will any of these clinics that have a robotic system be telling patients there is a better technique out there but sorry I don €™t offer it €¦ €¦ €¦ €¦ €¦ €¦ €¦ €¦ €¦.I €™m going guess €¦ €¦ €¦ €¦ €¦ €¦.no €¦ €¦ €¦ €¦maybe I €™m just a pessimist and should try being more positive.

They just announced the 10 millionth harvested hair €¦ €¦ €¦ €¦ €¦ €¦.woo hoo............how's that for positive.

 

[topccat29]

I asked a recent patient of the robotic system if he was advised on punch sizes. His response is listed below and it does point out that most would probably not even know to ask the question. If you don €™t ask chances are it will not be offered. Almost similar to guys in the past that didn €™t know which questions to ask €¦ €¦ €¦ €¦ €¦ €¦ €¦ €¦..how would they? Same applies to those that go to a hospital for issues €¦ €¦ €¦ €¦..do you know what questions to ask €¦ €¦ €¦ €¦ €¦ €¦.of course you don €™t €¦ €¦ €¦ €¦ €¦ €¦..just pray that you get lucky.


I think many in the industry probably don't feel bad for most of these young guys. They are very brash and don't listen anyway..................so it's there problem. But they do present social proof for other young guys that don't know which questions to ask either so they just follow along...................history repeating itself.



Yeah, the procedure involved the use of that ARTAS robot. The hair was extracted via robot and then plugged in the front by hand

 

[Coopman]

Topcat

I consider myself a reasonably educated guy. But when i started researching HT's, i never really understood FUE punch sizes until at least a year into my research.

I was led to believe by various forum posters (other sites) that FUE was scarless. The logical view i took was that the larger the FUE punch, the lesser chance of graft transection.
It was very difficult to find information on this subject.

What im trying to say is that i never initially understood the importance ofsmaller FUE punch size.

And like you have already shown in your example. There are countless other individuals who dont understand either.

Maybe some of these Clinics that use the inferior Artas machine will start offering SMP to hide the FUE scars, when a patient complains that he cant buzz down to a No.1 without his FUE scarring being on display.

 

[topccat29]

This is a 5000 graft robotic procedure posted to another forum. Most ethical doctors would say that harvesting close to 60% of donor supply by way of fue would probably not be a good idea long term and I would agree and to have this large punch extracting each and every graft does not seem to be a good idea either.

Will this patient be okay short term €¦ €¦ €¦ €¦ €¦probably €¦ €¦ €¦ €¦.but long term I believe there will be a price to pay and yes maybe SMP might be the only option regardless of the negative that can be associated with it.

 

[topccat29]

This is a very recent shot of a donor area from a clinic using the robot. I think the extractions are too high but this 25 year old will be fine for the time being. By the time it becomes a problem it will be too late. I think these guys are licking their chops at being able to offer a second rate procedure.

 

[pidda]

You know, I'd like to think that people mean well in general and that people care about my well being. The nice thing about these forums is that it is here to keep us well informed so that we make the right decisions that give us a positive long term outcome. I think topcat represents someone that is most likely just trying to help people make an informed decision when information tends to get censored or hidden. Knowledge is one of the greatest gifts to mankind and it is important to take advantage of that whenever possible. I am not going to tell people to stay away from the robot, but do the proper research before you do anything permanent.

 

[pidda]

To build on what topcat said earlier, the guy with the robot might actually be a really cool guy. He probably has a lot of charisma and admirable personality traits. There is nothing wrong with that, I like it when people seem nice. High five, nice job, cool robot, neato, more hair!

 

[topccat29]

Pidda young males use the amygdala deep inside their brain which is more reactionary and as the brain matures they tend to start using the frontal cortex more and more which involves rational thought. The older we become the more rational we tend to think. So for young guys their own physiology is working against them and good marketers know this even though they may not understand the process they understand the connection between youth and impulsive choices and they use that to their advantage.

This is the difference between having ethics and not having ethics. As an older person I use this to help younger people regardless of the subject and not to my benefit by taking advantage of them. Some people are driven strictly by money so it tends to skew their thought process it helps to understand all this when making a decision.

In hindsight I never blamed myself for my own decision 30 years ago. It was very normal and someone just used what they knew about me which I didn't know about myself to their advantage. I look at it as a lesson to be learned from as I moved forward in life. Not something to hold me back but something to use to my advantage and make me better.

 

[pidda]

An objective thought that a perspective patient should understand is that a 0.9mm and a 0.7mm-0.8mm punch seem close enough but that is far from the truth. 0.7mm punches especially heal very fast and is the least likely to visibly scar. It might not be the best for 3-4 hair grafts, but if a doctor tells you that anything under 0.9mm transects too often, they are most likely not being truthful. It is pretty much reiterating what topcat is saying.

 

[pidda]

Something slightly off-topic, but if you goto a clinic where the large majority of the staff are female, and the select few, maybe one member of the staff is male. Chances are, the male staff member has had at least one hair transplant. I think some clinics do this to give male patients the idea that they need to get a hair transplant in order to be attractive to the opposite sex. I think is a form of manipulation to reinforce the patient's mind that they are making a good decision. It could be pessimism and paranoia on my part, but it is something to take in consideration about when you judge the quality level of a clinic. It is not always the case of course.

 

[pidda]

If you goto a robotic fue clinic and the doctor tells you sales pitches such as "I don't need to take your money" while at the same time saying "half-price" while rushing you into a surgery very quickly, I would run far, far away from there and never come back.

 

[pidda]

Another thing on my mind is this: How hard is it to use the artas robot? I mean, you have a remote control that you hold in your hand that seems to almost automatically extract grafts from a patient. I have no real experience on how this thing works, but it makes me curious as a naive 25 year old such as myself, how successfully could I operate this robot on another person. It just seems like "oh this graft looks good", mouseclick, "oh this also looks good", mouseclick, "oh hey what about this", mouseclick. Boom boom boom, done. Nice job, lets play golf.