The ARTAS Hair Restoration System Vs. Other Methods of Follicular Unit Extraction (FUE) Hair Transplantation?

This hair loss question  was answered by Dr. Paul Shapiro of Bloomington, MN who is a member of the Coalition of Independent Hair Restoration Physicians.  

Is there any advantage of ARTAS over manual follicular unit extraction FUE? Is it only for easing the job of the hair restoration surgeon or does it have advantages for the patient himself? Can you explain more? So far it looks to me that it’s a tool designed for the fatigue of the surgeon. Is this it and nothing more?

It is true that by using the ARTAS robot there will be less fatigue of the surgeon and that is a good thing. Even though we all like to think we do our best all the time, we all do a better job if we are less fatigued. But if that was the only reason for using the ARTAS we would not have invested in it.

We are using the robot because we feel it has the potential to be superior to all other methods of follicular unit extraction hair transplantation. The robot has two punches. First, it makes a scoring punch with a sharp punch and then it makes a deeper punch with a dull punch. We believe this method, using the robot to visualize and guide the punch has the potential of yielding superior follicular unit grafts with less transection and more tissue around the grafts.

FUE is still a relatively new process compared to the traditional strip hair transplant. There are many ways the follicles can be extracted and there still is a debate whether any one method is superior. There are sharp punches and dull punches. There are various mechanical assisted devices for both sharp and dull punches. The ARTAS is one of many mechanical assisted devices.

The difference between a sharp and a dull punch is how deep one can go. With a sharp punch the surgeon needs to be very precise with the depth of the punch. If the punch goes lower than the bulge of the hair follicle it is easy to transect the hair. The hair then is harvested by carefully pulling the graft out and this can leave the hair bulb with very little or no extra tissue around it. Also, the graft can be damaged during this pulling process. When using a dull punch, the punch can go all the way down to the hair bulb. Instead of cutting, the dull punch separates the graft from surrounding tissue by bluntly dissecting around the graft while the graft straightens. In theory, using a dull punch allows for more tissue around the grafts and thus better survival. Also the grafts are already separated from the tissue so there is little or no trauma in removing the graft. The disadvantage of a dull punch is the grafts can get buried

Just to be clear, the robot is one of many mechanical assisted devices. All of these make it easier on the surgeon. There is the SAFE system which also uses a dull punch. The NeoGraft machine the powered FUE Isolation Device both use a sharp punch. There are other mechanical devices I have not mentioned. All these machines can yield excellent results when used correctly by an experienced hair transplant surgeon.

At Shapiro Medical Group, we use the SAFE system and the ARTAS. We believe, ultimately, that the robot has the potential to yield superior results. The robot is constantly improving. New hardware is constantly being developed to make the ARTAS more accurate and they have developed a .9mm punch. At present, in most of our FUE cases with the robot, we are also extracting some grafts using the SAFE system. Since we have only been using the robot for 6 months we are just starting to get results in. We want to compare the results to see if there is a difference in graft survival and donor scarring.

Because the robot is a new technology, we are going slow and taking limited cases. We do not have any 6 month follow up cases yet so I cannot give you any information on our results compared to using the SAFE system. I can say that the grafts extracted when using the robot look as good as the SAFE method and I am expecting excellent results.

Dr. Paul Shapiro

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David (TakingThePlunge)
Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q & A Blog.
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