Robot-assisted hair restoration LA Times Article

[John P. Cole, MD]

if you have poor hands, you should use a robot or just not do surgery. if you have great hands, this robot cannot match the results of that physician. One day, they may improve it so that it meets the quality of care that i would expect from FUE, but today, it is far below the capacity of a quality FUE surgeon.

This robot is cutting grafts with a 1.2 mm punch.

There are very few results with this robot.

The robot has a transection rate of 8% probably from the sweet spot of the donor area.

In general, the IAHRS is supposed to recommend only the best physicians. This robot is far below the quality of work you can expect from a top notch physician with far better equipment.

[gillenator]

Guys, trust me, the difference between 1 mm and .95 mm is not that much in the right hands. A manual extraction with a .95 mm punch however can potentially show more scarring, and do more collateral damage than a 1mm robotic punch precisely placed.

The real issue IMHO is that the potential collateral damage done with manual extractions far exceed the potential damage of robotic extractions which IMHO are today now far more accurate. Why? You have more control over the torsion, traction, and compression issues that vary quite a bit between the proficiencies of various docs' skill levels when they manually extract.

Yet I do still agree that more refinements and experience have a ways to go and yet we must not forget the element of potential transection of the grafts and why the open-ended risk of manual extraction skills varies throughout the industry between the doctors.

That is why the yields with manual FUE still vary to this day.

[RichardDawkins]

I am serious topcat, i dont care what you hink or why you think i was banned. I was banned because i was stupid enough to get into fights with insane people because they provoked me and i made the mistake to get into this.

But i said this numerous times before. I was never banned because of "hijacking" which in the case of HM is simply untrue because to poiint out possibilities to people is not a crime nor is it highjacking, its only highjacking for people ho live in their dreamworld and dont wanna get woken up.

Why do you attack me when i clearly stand on toppic here by saying that if done correct automatic devices could be used as HST automatisms? This doesnt hurt anyone it keeps people on the run to look into options so that they ont fall for

"Robot FUE without donor regeneration"

Right now people have the choice to say "Hey clinics you could get a robot and we like it, but if you are only offering FUE without looking into donor regeneration, we say you can suck your robots wiener"

Do you undertand this topcat.

Why i havent had it done yet? I sid it numerous times that i wanna save up some money. With all seriousness you are starting to become another SpanishDude

[Follicle Death Row]

Those numbers in my opinion are complete horseshit. An ethical clinic would advise you that it is best not to harvest more than 30% or so of the donor area by way of FUE 10,000 sounds insane to me. But I’m sure there are plenty of clinics that are willing to harvest that many grafts as long as you are paying them. They will just leave the part out about the see through donor area you are going to be left with in the end.

It’s amazing to listen to some of these doctors as for them anything seems to be possible. Anything new that comes out and they are like a kid with a new toy and they can’t wait to give it a whirl. Funny how you never hear these same doctors speaking about proceeding with caution, maybe because caution does not make them any money.

RD one of the reasons you were banned from the other forum I would guess would be that you feel it is okay to hijack every thread on the forums and talk about HM. I don’t see anyone trying to limit your speech. Just start a thread about HM and those that are interested in what you have to say will respond. In fact you can start that thread off with why you are such a strong supporter yet you yourself have not had a procedure performed. Now that would be interesting to read.

Yeah I don't think it's done in practice by most ethical docs. I should think 7000 tops by FUE before it looks patchy for nw 6 donor. That's around 35-40% donor thinning. If they could thin it uniformly they maybe could push the number a little bit but they don't thin it uniformly even though they try.

Dr. Rahal said around 8000 for a patient recently which seems the upper limit for a denser than normal donor. I've seen others say no more than 6500.

Dr. Bauman surprised me with that. He'll be getting into Dr. AA ravaged donor area territory if he goes that far with it.

[topcat]

Those numbers in my opinion are complete horseshit. An ethical clinic would advise you that it is best not to harvest more than 30% or so of the donor area by way of FUE 10,000 sounds insane to me. But I’m sure there are plenty of clinics that are willing to harvest that many grafts as long as you are paying them. They will just leave the part out about the see through donor area you are going to be left with in the end.

It’s amazing to listen to some of these doctors as for them anything seems to be possible. Anything new that comes out and they are like a kid with a new toy and they can’t wait to give it a whirl. Funny how you never hear these same doctors speaking about proceeding with caution, maybe because caution does not make them any money.

RD one of the reasons you were banned from the other forum I would guess would be that you feel it is okay to hijack every thread on the forums and talk about HM. I don’t see anyone trying to limit your speech. Just start a thread about HM and those that are interested in what you have to say will respond. In fact you can start that thread off with why you are such a strong supporter yet you yourself have not had a procedure performed. Now that would be interesting to read.

[Juldsc]

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[RichardDawkins]

If they would use smaller diameter needley and the correct storage solution they could copy HST, just a sidenote from me to maybe put things into perspective.

This would be the first automated hair multiplication device if done correctly

[Follicle Death Row]

Just as an aside here's a FUE related tidbit to ponder. One thing that astounded me recently was the live HT that Dr. Bauman performed on Nalts. They asked how many FUE grafts in total did Nalts have available. Dr. Bauman estimated his total donor FUE reserves at 8000-10000! So after the 3500ish he's had already he may have 4500-6500 remaining! That seems a little crazy to me. It would be great if FUE reserves really did equal strip reserves but I'm still not completely convinced.

Those numbers sound incredible. If I thought I could get strip numbers by FUE I would pursue surgical hair restoration for sure.

[Follicle Death Row]

FDR I would agree .95 is a step in the right direction but there is no need to use a punch much larger than .85 even for multiple hair units. When you start doing the math and measuring the square surface area of the extraction site you realize that a 1mm punch starts to approach double the surface area of a .75mm punch. That does help one to realize why it matters.

Yeah I know. A slightly smaller diameter makes a big difference area wise. Whatever the case is with HST, it is unquestionable that the extraction sites are so clean and hardly noticeable. Punch size makes a big difference despite what so docs will say. If you want to be using FUE and in the IAHRS they should have to use at largest 0.9mm diameter I think. Completely agree with you mate.

[topcat]

FDR I would agree .95 is a step in the right direction but there is no need to use a punch much larger than .85 even for multiple hair units. When you start doing the math and measuring the square surface area of the extraction site you realize that a 1mm punch starts to approach double the surface area of a .75mm punch. That does help one to realize why it matters.

[Follicle Death Row]

I’m all for advancements but I’m more for absolute complete honesty for the patient’s benefit. In its present form the punches on this robot are too large. Patients need to be advised that there are smaller punches being used which will be less apt to cause visible scarring. Because that is informing the patient and it’s only with information that a patient can make an intelligent and responsible decision.

The reality of this industry is that too many clinics like to tell prospective patients only what they want them to know. So yes I agree let the patients know that one day this robot will be using an assortment of extremely small punches and software will be loaded that will optimize the extraction pattern but it’s just not there yet, would you still like to get into the chair.

I agree 1mm is too big. Dr. Feriduni thinks that the biggest punch that should be used is 0.95mm for multiple hair FUs but smaller punches such 0.85mm can be used for singles and doubles.

[topcat]

I’m all for advancements but I’m more for absolute complete honesty for the patient’s benefit. In its present form the punches on this robot are too large. Patients need to be advised that there are smaller punches being used which will be less apt to cause visible scarring. Because that is informing the patient and it’s only with information that a patient can make an intelligent and responsible decision.

The reality of this industry is that too many clinics like to tell prospective patients only what they want them to know. So yes I agree let the patients know that one day this robot will be using an assortment of extremely small punches and software will be loaded that will optimize the extraction pattern but it’s just not there yet, would you still like to get into the chair.

[gillenator]

Hmmm. Watch this space. I'll thorw out a wild optimistic guess but I think in 3 years this system will be using multiple size extraction punches, 0.75mm, 0.85mm, 0.95mm, will be perfectly identifying the number of hairs per FU and will be operating at 1500FU/hour.

It could create extraction maps so that after extracting say 3000 FU it knows how to best extract extract another 2000 on a second pass years down the line.

Perhaps scanning and mapping the recipient could be used in conjunction with ARTAS and some software to layout a plan to optimise the use of extracted hair in the recipient. I'd love to see such software. A laser overlay that tracks even minute movements of the patient's recipient could show where to make incisions for certain densities etc. That would be pretty cool. Maybe wishful thinking on my part but that would be my vision for FUE.

Actually FDR, I don't think your optimism is wild nor a guess but rather educated observations and conclusions to date. I think vascular surgeons are working on similiar software. Watch this technology really take off in the next several years just as you stated.

[Follicle Death Row]

Hmmm. Watch this space. I'll thorw out a wild optimistic guess but I think in 3 years this system will be using multiple size extraction punches, 0.75mm, 0.85mm, 0.95mm, will be perfectly identifying the number of hairs per FU and will be operating at 1500FU/hour.

It could create extraction maps so that after extracting say 3000 FU it knows how to best extract extract another 2000 on a second pass years down the line.

Perhaps scanning and mapping the recipient could be used in conjunction with ARTAS and some software to layout a plan to optimise the use of extracted hair in the recipient. I'd love to see such software. A laser overlay that tracks even minute movements of the patient's recipient could show where to make incisions for certain densities etc. That would be pretty cool. Maybe wishful thinking on my part but that would be my vision for FUE.

[topcat]

I’m not sure if I would agree with you view on my reasoning being skewed. I have seen plenty of white dot scarring from FUE and I have spoken to numerous patients that never expected nor were they told about it before having surgery. I knew at least 5 years ago that I would only accept a punch that was .75 or something very close to it. This is why I was able to have 500 fue’s extracted from my face within a very small area.

I would also disagree with what you wrote about the 1mm punch that is only scoring the area not being a problem. It is drastically larger than a .75mm punch when the surface area is calculated. But that is the whole idea of the posting. Ask the right questions before having any procedure. Ask to see the donor area shaved after it has completely healed and evaluate the result for yourself.

I have had my share of scarring over the last 25 years no need for others to have to have the same experience. You will not see any ethical clinics using a 1mm punch on someone’s face for obvious reasons. The scalp is no different. Is that smaller punch slow, tedious and not as profitable, absolutely. But some things are more important like what is best for the patient. I know for many this will not be a popular opinion but I’m not trying to be popular. These same issues were being discussed back in 2004 yet too many patients were still in the dark and have paid the price. Anyway I like a healthy civil debate and anyone that thinks because a person is a doctor that they have all the answers they would be wrong. They are here to make money and there is nothing wrong with that just do it ethically.