Saturday, 9 January 2016

Robotic FUE v Non-Robotic FUE

There has been much excitement around the world with the development of robotic assisted FUE (follicular unit extraction). Any new developments that may improve outcomes and patient satisfaction are to be commended. A major selling point has been the ability of the robotic FUE machine to extract grafts at faster speed than what can be done manually by the Surgeon. This would naturally equate to larger FUE graft numbers per session and therefore less time in the chair.
However let’s look at these facts:
·         In Australia, the most reputable and experienced FUE hair transplant surgeons have not adopted this technology.
·         Arguably the world’s most famous FUE surgeon Dr John Cole from Atlanta, USA has not adopted the robotic FUE machine either.

So the question is why aren’t all these Doctors eager to make the FUE procedure less demanding on themselves and the patients by taking up the robotic FUE machine?
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 Here a few facts about robotic FUE:
1.       A complete donor shave must be performed. This means you can not isolate the extraction points to a small surface area of the donor.

2.       The robotic machine uses larger (meaning thicker) punches to extract all the grafts. When done manually, the punch size is individualized to the patient and the specific hair grouping. This means 0.8 mm punches can be used for single haired grafts, 1.0 mm grafts for the 2 and possibly 3 haired grafts and the 1.2 mm punch from the 4 haired grafts. An experienced FUE surgeon will typically use the 1.0 mm punch for a high majority of the follicular units extracted.

3.       Using a larger punch results in the FUE scar spots being more visible in some individuals. Slightly thicker grafts also means that less follicular units are planted per square cm, which creates in a thinner coverage than if smaller FUE punches were used.

4.       Transection rates (the percentage of hair follicles damaged during the extraction process) from robotic FUE machines, have been shown in some studies to be higher than compared to manual or motorized FUE in experienced hands. The higher the percentage of damaged hairs, the lower the overall growth rates that are achieved.  

5.       Doctors without any hairtransplant qualifications or experience are using robotic FUE devices around the world.

6.       The outcomes with robotic FUE are no better than manual or motorized FUE (in the hands of experienced FUE hair transplant surgeons).

hair loss treatment7.       The process of manually extracting 1000 grafts or more in a day via FUE is very exhausting to the eyes of the surgeon. This is why hair transplant Doctors in the vicinity of 60 years of age or older, who do not have the healthy eye sight of their younger years, rarely perform the FUE method. This robotic machine allows these same Doctors the ability to now offer FUE to their patients.

So a summary of the benefits/advantages to the Surgeon are:
  • FUE can be performed faster with little involvement of the Doctor.
  • Larger graft numbers are possible but with a higher transaction rates.
  • Robotic FUE can be performed by a Doctor with limited to no hair transplantation experience. They would only need a team of experienced hair transplant technicians to perform the planting.

In Australia, it is interesting that those Doctors who were often the greatest doubters of the benefits of FUE, who had a very limited experience of performing this method, are now the promoters and supporters of robotic FUE! How times change…

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