A Discussion of Current Techniques

[LogicalBald068]

Hi, HT (Hair Transplantation) is the fastest surgical technique that moves individual hair follicles from body part. Before knowing the techniques basic for HT is Kind of Surgeries lies for HT as it subscribed below in short There
Types of Surgeries:
•Androgenetic Alopecia
•Eyebrow transplant
•Frontal hair line lowering or Reconstruction
There several techniques preciously done for the HT as mentioned below:
Harvesting Methods
Strip harvesting
Follicular Unit Extraction (FUE)
This information just signifies only the type of techniques and methods involving in Hair transplantation.

[arfy]

When Dr Woods first attempted to bring FUE to America, he warned that FUE in the wrong hands would damage patients, and he said that was why he wouldn't share his knowledge with the hair transplant industry. Of course, everyone jeered him, and called him greedy and paranoid.

Well it turns out that Dr Woods might have had a good point. The same clinics who do sub-standard work with strip surgery, the same clinics who refused to update their old "minigraft" procedures to "follicular unit" procedures, are now able to buy the tools to perform FUE. FUE is just the harvesting technique, and it's not a "game changer" in regards to all the other problems in the hair transplant field, such as greed, dishonesty, disregard for the needs of patients, incompetence, the "factory" approach to surgery, and so on.

[Dr. Tejinder Bhatti]

Thank you everyone for your valuable opinions and input on this subject. The issues regarding the robot are complex however I believe that any art form may be quantified by mathematical models if one digs deep enough Regardless, the human hand is at this time superior to any machine due to the mind that controls it. This is assuming enough experience has been gained through years of trial and error.

Regarding the comments about mFUE, I agree that the punch is very large. Based on rough estimates from the information available online I conclude that the surface area of the punch must me nearly 1.5cm overall. I believe it has been said that the punch can be round or eliptical depending on the case but I believe we all know that hair does not grow in organized elipses or circles in the donor scalp so it is virtually impossible for there to NOT be transection of hairs that remain in the donor zone as well as transection of hairs in the target punch area. The hairs internal to the extracted punch graft are certainly safe and sound but it is the hairs on the perihery of the punch and along the periphery of the punch "hole" in the donor zone that are certainly transected due to the nature of large punches in general.

The market in general will continue to move foward with FUE gaining more and more ground. Unfortunately much of this will in fact be due to new clinics adopting FUE as well as existing clinics that have traditionally only performed other cosmetic procedures also adopting FUE as an adjunct to their existing offerings. These types of clinics will be doing the most damage and will be their results will be the results shared by non-FUE advocates that wish to discredit the technique in general.

[J_B_Davis]

You are right. Human error is possible. Depending on what a real patient reveals, such examples are showcased by patients who went to certain docs and revealed the poor outcomes online. This is indeed true for regular surgeries and etc where various tools, machines, and robots are used. Some surgeries are under the shirt or in the bone and etc. however, this form of surgery is cosmetic in nature where perfection and art is key and the area involved is highly visible. One screw up and it is all eyes on you. What if the Artas extraction and buttons go haywire and the machine keeps drilling automatically, it cant even distinguish light colored or blonde hairs, and, indicates uses for darker hair types. How would it extract African American curly hairs or those with different diameters and textures? I mean there is clearly a reason why certain ISHRS clinics publically announced they stopped using it. A car is like this robot, an underexperienced user can drive it, and fatal cosmetic accidents may happen. For me, as a patient, It is hard to see a major plus point utilizing it for my own surgery. There are folks that had extractions done by it, it was revealed on some other forums, that they had low yield. I spoke with few folks who are planning to get hair restoration and they want to make 100% sure it isn't the robot. Aside from that, they also mentioned they'd prefer surgical extractions and incisions done by the doctor and that the doc be only dedicated to them, as the sole patient, on the day of the procedure. Even now, some docs have 2 patients or more per day depending on their teams and surgical protocols. Some docs have more than 2 patients a day and this robot is excellent for docs that would like to save time on extractions, thus, enabling them to do more than the typical surgical FUE procedure they normally do. It speeds up the process, so that i think is a major plus point for them. Team members can utilize it for extractions. In some cases, it acts as a loophole where a tech can use the machine like a surgeon, as legally techs can't do surgical extractions themselves in almost every state.

You got valid points, but again, if machine arm, software, electrical malfunction or anything happens at a clinic where some doc may not know how to do manual FUE as backup or is not as proficient in FUE overall as they relied heavily on this robot, then the patient is at a higher risk. I see a model developing where docs may not be proficient and rely heavily on this machine for fue, and that can be scary. There are docs that go to FUE conventions and learn extraction techniques by hand on patients and there are docs that may rely on this machine. It is like any general plastic surgeon, who may not be a hair expert, will be able to capitalize on this machine, but it may create further risk for a patient with limited donor trying to obtain high level of cosmetic change. You should read some of the debates and concerns presented across forums. It's got a lot of hair loss sufferrers and docs concerned.


Not to take away from the doctor's thread. I think very few docs, who perform FUE, follow Dr. Bhatti's type of surgical protocol. He does his own extractions and incisions and focuses on that one patient at a time. That is ideal trait many patients are looking for when it comes to FUE hair restoration. FUE has come a long way and doctors have perfected their methods. There where days where bigger than 1 mm punches were used, creating dot patterns in the back of the head. Now, docs have learned the art of extraction using smaller punches where applicable.

Dr. Bhatti, do you see presentations and successes with FUE more often? I mean at the events/conferences you might attend? Do surgeons talk about techniques and tools they use and how FUE has changed?

I would say that since the robot is relatively new, 99.9% of all disasters we see on the internet are hair transplants that have been performed by conventional methods and that includes all the bad FUE that we see. So to throw robots into that mix is probably a bit premature. I read other forums and the bad robot results have not really surfaced yet. I recently read one thread on another forum and from what I can see, the issue was with insufficient number of grafts. hairline design and graft placement, which would be considered human error.

I agree 100% with you that this type of surgery has to be undetectable and that has always been one of the biggest issues with bad hair transplants. “Art” is in the eye of the beholder and there are many doctors who do hair transplants who preach that they are “artists”, but as we all know art is subjective. Remember, Picasso was an artist, but I doubt you would want him to perform your hair transplant. Judging from all the disasters we see online, it looks like there are a lot of Picassos doing hair transplants.

I also agree that a machine like this has to be used by people who know what they are doing. If for some reason the robot does fail, the doctor has to know how to take over. I am sure there are safeguards to avoid the machine going haywire. It’s not like the patient walks into a box and they press a button and the machine just goes to town. If the robot malfunctions the operator will most likely have many safeguards as well as just stopping the thing or pulling it away from the persons head, so this does not seem like a legitimate concern.

I’m sure there are a lot of people who would prefer their doctor to do all the work, as long as they are good, but that’s just not the reality of what is happening. I agree about the model that you are seeing where less proficient surgeons are getting into hair transplants, but they are relying more on techs than on robots right now and I believe that in order to compete even the few who are claiming to do all the extractions, will eventually either use techs or some sort of machine to be more efficient. Most of the really “great’ clinics in Brussels and other parts of Europe for example rely heavily a techs to do their extractions, yet patients go to these doctors based on their reputation. Same goes for North America. So we can all be idealists or we can be realists. These clinics have already figured out the “loopholes”, they don’t need a buy a $300,000 robot to circumvent things.

[Sean]

That’s an important article, So is this statement, "Dr. Martin A. Makary, an associate professor of surgery and health policy and management at John Hopkins University and one of the study’s authors, said that, while the future for robotic surgery is promising, there is a gray area when it comes to assessing the difference between doctor and device error. "

Tell me, do we know what percentage of mishaps were caused by human error and what percentage were cause by machine malfunction? Do you know how many people are killed every year in hospitals due to human error?

http://www.propublica.org/article/how-many-die-from-medical-mistakes-in-us-hospitals

And how many hair transplant patients are harmed by the hands of unethical or undertrained human hands every year?

You are right. Human error is possible. Depending on what a real patient reveals, such examples are showcased by patients who went to certain docs and revealed the poor outcomes online. This is indeed true for regular surgeries and etc where various tools, machines, and robots are used. Some surgeries are under the shirt or in the bone and etc. however, this form of surgery is cosmetic in nature where perfection and art is key and the area involved is highly visible. One screw up and it is all eyes on you. What if the Artas extraction and buttons go haywire and the machine keeps drilling automatically, it cant even distinguish light colored or blonde hairs, and, indicates uses for darker hair types. How would it extract African American curly hairs or those with different diameters and textures? I mean there is clearly a reason why certain ISHRS clinics publically announced they stopped using it. A car is like this robot, an underexperienced user can drive it, and fatal cosmetic accidents may happen. For me, as a patient, It is hard to see a major plus point utilizing it for my own surgery. There are folks that had extractions done by it, it was revealed on some other forums, that they had low yield. I spoke with few folks who are planning to get hair restoration and they want to make 100% sure it isn't the robot. Aside from that, they also mentioned they'd prefer surgical extractions and incisions done by the doctor and that the doc be only dedicated to them, as the sole patient, on the day of the procedure. Even now, some docs have 2 patients or more per day depending on their teams and surgical protocols. Some docs have more than 2 patients a day and this robot is excellent for docs that would like to save time on extractions, thus, enabling them to do more than the typical surgical FUE procedure they normally do. It speeds up the process, so that i think is a major plus point for them. Team members can utilize it for extractions. In some cases, it acts as a loophole where a tech can use the machine like a surgeon, as legally techs can't do surgical extractions themselves in almost every state.

You got valid points, but again, if machine arm, software, electrical malfunction or anything happens at a clinic where some doc may not know how to do manual FUE as backup or is not as proficient in FUE overall as they relied heavily on this robot, then the patient is at a higher risk. I see a model developing where docs may not be proficient and rely heavily on this machine for fue, and that can be scary. There are docs that go to FUE conventions and learn extraction techniques by hand on patients and there are docs that may rely on this machine. It is like any general plastic surgeon, who may not be a hair expert, will be able to capitalize on this machine, but it may create further risk for a patient with limited donor trying to obtain high level of cosmetic change. You should read some of the debates and concerns presented across forums. It's got a lot of hair loss sufferrers and docs concerned.


Not to take away from the doctor's thread. I think very few docs, who perform FUE, follow Dr. Bhatti's type of surgical protocol. He does his own extractions and incisions and focuses on that one patient at a time. That is ideal trait many patients are looking for when it comes to FUE hair restoration. FUE has come a long way and doctors have perfected their methods. There where days where bigger than 1 mm punches were used, creating dot patterns in the back of the head. Now, docs have learned the art of extraction using smaller punches where applicable.

Dr. Bhatti, do you see presentations and successes with FUE more often? I mean at the events/conferences you might attend? Do surgeons talk about techniques and tools they use and how FUE has changed?

[arfy]

FUE grafts should be surgically extracted and incisions should be created by a doctor only.

When it comes to techs doing surgical extractions or a robot like this, it is not what the patient should pay for. A patient should pay for the work done by the doctor that has marketed their name and to be worked on with doctor focus 100% the day of surgery.

I agree with this completely. I wasted $36,000 on surgery where virtually all of the grafts were harvested by techs. The doctor only spent about half the time in the room. I have to wonder if this is why none of my grafts grew. Just because grafts are harvested by a human being, is no assurance of quality. Beware of low-paid medical techs doing most of your surgery, and not the doctor who advertised his own personal experience and skill.

[J_B_Davis]

No, i dont believe machines can outperform humans.

http://www.pbs.org/newshour/rundown/mishaps-and-deaths-caused-by-surgical-robots-going-underreported-to-fda/

Not only that, robots and machines can easily be hacked and etc, a human cant. Artificial Intelligence is different and can also be hacked and modified and a virus or bug can be attached.

Would you want to own a surgical machine with such risks to patients? In the medical world, such a risk can mean the downfall of yoir career if something goes terriblely wrong. If it is a risk your willing to take on your patient, then by all means it is the willing ethical behavior you adhere to and the outcome is whatever that happens to your patient.

That’s an important article, So is this statement, "Dr. Martin A. Makary, an associate professor of surgery and health policy and management at John Hopkins University and one of the study’s authors, said that, while the future for robotic surgery is promising, there is a gray area when it comes to assessing the difference between doctor and device error. "

Tell me, do we know what percentage of mishaps were caused by human error and what percentage were cause by machine malfunction? Do you know how many people are killed every year in hospitals due to human error?

http://www.propublica.org/article/how-many-die-from-medical-mistakes-in-us-hospitals

And how many hair transplant patients are harmed by the hands of unethical or undertrained human hands every year?

[Sean]

I believe that we have been sold on the idea that hair transplantation is an “art” as opposed to a surgical procedure that when performed correctly and within specific guidelines is based on math, science and balance. This is the “art” of hair transplantation. It’s a learned skill as opposed to a real “art.” If a skilled doctor has the ability to set the parameters of this important balance, then this type of surgery will eventually lend itself to robotics like no other. No set of hands or human eyes will be able to match it. It’s only a matter of time.

FUE was marketed heavily way before it was perfected and very few who are now marketing it have perfected their techniques either. If a robot can eventually accomplish this, and it seems like its getting closer, hair transplantation as we know it will be archaic. As artificial intelligence continues to develop, no man or team of technicians will be able to complete.

If you really believe that machines can’t out perform humans in tasks like this, you should take a look at this video.

https://www.youtube.com/watch?v=w8Nvq7aGqoA

No, i dont believe machines can outperform humans.

http://www.pbs.org/newshour/rundown/mishaps-and-deaths-caused-by-surgical-robots-going-underreported-to-fda/

Not only that, robots and machines can easily be hacked and etc, a human cant. Artificial Intelligence is different and can also be hacked and modified and a virus or bug can be attached.

Would you want to own a surgical machine with such risks to patients? In the medical world, such a risk can mean the downfall of yoir career if something goes terriblely wrong. If it is a risk your willing to take on your patient, then by all means it is the willing ethical behavior you adhere to and the outcome is whatever that happens to your patient.

[J_B_Davis]

I do believe FUE is now the gold standard based on the hype and requests online and the number of FUE procedures increased. BUT when it comes to ARTAS, a robot is a robot, nothing comes close to the perfection of the human hand. Art has always been done by hand and machines will never master the complex labor performed by the human hand. The pyramids were built by people, where it marvels scientists. The Mona Lisa was drawn by a man where no machine could replicate and perfect the level of artistry involved. An expensive ARTAS machine will not give you better and safer extraction. Yes, it will increase the level of work output because a machine is extracting at a steady speed. Where a surgeon can maximize number of extractions, but there is no gaurantee the machine nails 100% extraction yueld. Machines will always have recalls and changes, where the human skill would remain constant. By the way read up on some ARTAS fda filings.

This robot is a push by some in the industry due to the level of marketing involved by the makers if it. I know a few clinics who have stopped using it after 100s of surgeries due to it not working out for them. Those clinics have disclosed this across some online forums.

FUE grafts should be surgically extracted and incisions should be created by a doctor only.

When it comes to techs doing surgical extractions or a robot like this, it is not what the patient should pay for. A patient should pay for the work done by the doctor that has marketed their name and to be worked on with doctor focus 100% the day of surgery.

I believe that we have been sold on the idea that hair transplantation is an “art” as opposed to a surgical procedure that when performed correctly and within specific guidelines is based on math, science and balance. This is the “art” of hair transplantation. It’s a learned skill as opposed to a real “art.” If a skilled doctor has the ability to set the parameters of this important balance, then this type of surgery will eventually lend itself to robotics like no other. No set of hands or human eyes will be able to match it. It’s only a matter of time.

FUE was marketed heavily way before it was perfected and very few who are now marketing it have perfected their techniques either. If a robot can eventually accomplish this, and it seems like its getting closer, hair transplantation as we know it will be archaic. As artificial intelligence continues to develop, no man or team of technicians will be able to complete.

If you really believe that machines can’t out perform humans in tasks like this, you should take a look at this video.

https://www.youtube.com/watch?v=w8Nvq7aGqoA

[Sean]

I do believe FUE is now the gold standard based on the hype and requests online and the number of FUE procedures increased. BUT when it comes to ARTAS, a robot is a robot, nothing comes close to the perfection of the human hand. Art has always been done by hand and machines will never master the complex labor performed by the human hand. The pyramids were built by people, where it marvels scientists. The Mona Lisa was drawn by a man where no machine could replicate and perfect the level of artistry involved. An expensive ARTAS machine will not give you better and safer extraction. Yes, it will increase the level of work output because a machine is extracting at a steady speed. Where a surgeon can maximize number of extractions, but there is no gaurantee the machine nails 100% extraction yueld. Machines will always have recalls and changes, where the human skill would remain constant. By the way read up on some ARTAS fda filings.

This robot is a push by some in the industry due to the level of marketing involved by the makers if it. I know a few clinics who have stopped using it after 100s of surgeries due to it not working out for them. Those clinics have disclosed this across some online forums.

FUE grafts should be surgically extracted and incisions should be created by a doctor only.

When it comes to techs doing surgical extractions or a robot like this, it is not what the patient should pay for. A patient should pay for the work done by the doctor that has marketed their name and to be worked on with doctor focus 100% the day of surgery.

[J_B_Davis]

Thank you Mr. J_B_Davis for your opinion. I agree that some of the stigma regarding strip scarring is warranted simply due to the undpredicatable nature of patient healing. No matter how skilled a surgeon may be there can always be factors at play that we cannot anticipate that may be unique to a patient, or type of patient. These factors can be impossible to identify visually. "Chop shops" is a good way of describing how any clinic, FUT or FUE, can cause harm. That is why it is difficult for me when clinics present cases of bad or isolated cases of FUE and claim that all FUE is similar. It is unfortunate but is the way of the online market. I understand your position on Piloscopy but I am not sure what kind of "reach" it will have. Why do you believe that mFUE is "pointless"?

Hello Dr. Bhatti,

Let me first answer your question on why I believe mFUE is pointless, at least in the way that I have seen it performed in this video posted by Dr. Lindsey

https://www.baldtruthtalk.com/threads/21483-Dr.-Lindsey-MFUE-technique-in-a-patient-with-previous-FUE-and-strip-McLean-VA

It appears that the punch being used is not only huge, but can transect a lot of hair around the edges of each punched out piece of tissue. Since it also appears that the procedure was performed in a linear fashion, leaving only a very minuscule amount of hair bearing tissue between each punch, the patent will still be left with what can only be described as a “modified” linear scar. He will basically be left with dashes across his head.

Now I can see the advantage of there being less tension on each wound, but if you include the possible transection and the fact that there is valuable donor being left behind, it would probably be in the best interest of this patient to have had another strip since he already has a linear scar from his first hair transplant. mFUE seems like the wrong name for this procedure, perhaps mStrip would be more appropriate? This is course is just my observation based on that video, and I am in no way questioning Dr. Linsey’s skill or the fact that he seems like a very caring doctor.

Concerning your response to Jamess11 about the ARTAS robot, to be honest, I would be more concerned about a scalpel or punches getting in to the hands of novices, which apparently happens every day judging from some of the horror stories on the internet. These novices don’t understand the challenges that various patients present either, yet they are carving these poor guys up and hoping for the best. At least with the robot these patients have a chance.

[Dr. Tejinder Bhatti]

My concern with CURRENT techniques is that they are placed in the hands of novices. As with anything, despite the technique utilized, there will always be unexperienced, unethical HT surgeons engaging in them. Unfortunately, I am a product of such callous abuse in the field, as are many others.

Mr. Jamesst11,

As mentioned to Mr. Arfy I agree with your point. I am sorry to know of the abuse you have been subjected to. I hope you find a solution that gives you peace. If I can be of any service with regards to your case I am happy to provide, with no obligations on your part whatsoever.

[Dr. Tejinder Bhatti]

FUE will gain in popularity. However, just because a clinic does FUE doesn't mean the results will be good. FUE is the harvesting method only, and patients can still have bad yields or unnatural looking results with FUE. Whether FUE continues to grow depends on the competence of the clinics who do it. The public usually doesn't want strip surgery, once they understand what it is. With the rapid expansion and aggressive marketing of FUE, if there are incompetent clinics doing the procedure (and not all clinics can perform surgery at an equally high level) it could negatively impact the hair transplant business overall.

Thank you, Mr. Arfy for your participation. I agree 100% with your comments. I believe it is easy to say that no patients come into a clinic asking for strip surgery but they all come in asking for FUE. Unfortunately there are many many clinics that have picked up on the desire for FUE and this is one reason why we see so much growth in the field overall. There are opportunists in every aspect of life and it is no different with hair restoration surgery, more so now with FUE. It is up to those that are ethical with their practice to stand up and educate patients about the pitfalls that await them without their due diligence but even then problems can arise. By being educators as well as physicians we can help to limit the fall out from such practices.

[jamesst11]

Thank you to the esteemed forum members that have participated thus far.

Mr. Jamesst11,

You have an interesting view about FUE being the new gold standard. I do agree with you and the point about ARTAS is valid. My concern with the robot is that it will be placed into the hands of novices that do not understand the challenges that various patients can present. Piloscopy is an interesting development as well and I am anxious to see how it unfolds over time.

My concern with CURRENT techniques is that they are placed in the hands of novices. As with anything, despite the technique utilized, there will always be unexperienced, unethical HT surgeons engaging in them. Unfortunately, I am a product of such callous abuse in the field, as are many others.

[Dr. Tejinder Bhatti]

I believe that FUE will be perceived as the “gold standard” and eventually dominate the market based on consumer demand and the stigma that has been created of having a strip scar. Some of this stigma is warranted, because there are so many chop shops doing very poor work, but I personally do not believe that FUE is always in the best interest of the person and that strip will be indicated for those who are either not candidates for FUE or for those who have a very limited donor supply and every graft counts.

I agree with Jamesst11 as far as the advancement of robotics but I think that Piliscopy will have a very limited reach and that mFUE, just judging from a video posted on this site, is kind of pointless.

This is best video I’ve ever seen on the topic. To me this makes sense, but I know that most clinics will eventually become FUE only.

https://www.baldtruthtalk.com/thread...rfect-Solution

Thank you Mr. J_B_Davis for your opinion. I agree that some of the stigma regarding strip scarring is warranted simply due to the undpredicatable nature of patient healing. No matter how skilled a surgeon may be there can always be factors at play that we cannot anticipate that may be unique to a patient, or type of patient. These factors can be impossible to identify visually. "Chop shops" is a good way of describing how any clinic, FUT or FUE, can cause harm. That is why it is difficult for me when clinics present cases of bad or isolated cases of FUE and claim that all FUE is similar. It is unfortunate but is the way of the online market. I understand your position on Piloscopy but I am not sure what kind of "reach" it will have. Why do you believe that mFUE is "pointless"?