A Discussion of Current Techniques

[Dr. Tejinder Bhatti]

Hello everyone. I am happy to take part on Bald Truth Talk to engage patients and to provoke healthy discussion with colleagues.

I would like to discuss the opinions that each of you have regarding the merits of different techniques that are currently available to the patient. As we all know follicular unit strip surgery has been the gold standard for many years. However, FUE has been quickly gaining ground and as of the latest reports from the ISHRS FUE is now at parity with strip surgery in that approximatley 1/2 of all procedures performed are FUE. I personally halted all strip surgery in my clinic several years ago and I am performing only FUE surgery exclusively. Strip is quickly moving to the background as some of the last hold outs for strip exclusive offerings have surrendered to the patient demand for FUE. With the number of new clinics opening every day, and they most likely are only offering FUE, the growth will continue to climb and eventually push strip into a niche only corner of the industry.

I would like to hear other opinions about the present state of the industry and where readers and members believe it is headed. Is FUE going to continue to grow? Will strip make some sort of comeback or will an alternative procedure be presented such as Piloscopy or mFUE that will make an impact on the future of surgery?

I look forward to all of your comments and opinions on this subject.

[jamesst11]

I believe FUE will be the new gold standard and advancements in ARTAS will allow it to make it's way into more and more clinics. If piloscopy is truly as fruitful as we expect it to be, this will also be an enormous advancement. I definitely believe within the next 2-5 years strip, as you mentioned, will be less prevalent

[J_B_Davis]

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/threads/21519-FUE-Vs.-FUT-Why-FUE-Alone-Might-Not-Be-The-Perfect-Solution

[arfy]

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.

[Dr. Tejinder Bhatti]

I believe FUE will be the new gold standard and advancements in ARTAS will allow it to make it's way into more and more clinics. If piloscopy is truly as fruitful as we expect it to be, this will also be an enormous advancement. I definitely believe within the next 2-5 years strip, as you mentioned, will be less prevalent

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.

[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"?

[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]

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.

[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.

[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.

[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]

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 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]

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?

[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.