A Discussion of Current Techniques

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  • Sean
    Senior Member
    • Jan 2011
    • 262

    #16
    Originally posted by J_B_Davis
    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?

    An updated estimate says it could be at least 210,000 patients a year – more than twice the number in the Institute of Medicine’s frequently quoted report, “To Err is Human.”



    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?

    Comment

    • J_B_Davis
      Senior Member
      • Dec 2008
      • 409

      #17
      Originally posted by Sean
      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.

      Comment

      • Dr. Tejinder Bhatti
        Junior Member
        • Nov 2012
        • 8

        #18
        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.

        Comment

        • arfy
          Senior Member
          • Sep 2015
          • 114

          #19
          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.

          Comment

          • LogicalBald068
            Member
            • Oct 2015
            • 32

            #20
            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.

            Comment

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