The ARTAS Hair Transplantation System For FUE

[Sean]

@Sean, maybe if you go back to Dr. Rahal this year for the guarantee FUE job, then they may use ARTAS robot on you lol :-)

 

@Janna, Is SMG thinking of upgrading to ARTAS robot or still contented with Jamis Harris SAFE system?

 

Hariri I would be wary of any fue with big punch sizes. I don't know if it really is the case here with this machine. Motorized, manual, or robotic fue, punch size is important. To me it would defeat the purpose of fue if done with larger punches, especially, for the hair type I have. Seriously, large punches would make no sense to me and if that was the case, then people getting FUE might as well think strip. I really want representatives to answer questions and concerns here. I hope doctors can chime in and answer concerns in detail.

 

Regarding costs, I don't know if much will change even with this machine. Fue is fue so price per graft will most likely stay the same. On average, by analyzing an average number of grafts harvested by clinics daily and knowing prices of some clinics, I realized most top docs can make at least $16,000 a day 5 days a week which means $80,000 a week. That equates to $320,000 a month or $3,840,000 a year. On average, lets put expenses at $1,040,000 which include consultant salaries, technician salary, marketing, forum fees, medication, supplies, insurance, building expenses, and so forth etc per year. Docs can easily make $2,800,000 a year. Even if a machine like this costs $100,000, the speed and accuracy will enable more grafts in less time equating to more profit. I don't know if yield will be hampered but only time will tell as more and more results are posted. Even though there are depreciation expenses/maintenance expenses for this machine, I am sure it comes with a warranty and to top it off it is covered by insurance as it is FDA regulated piece of equipment. The use of multiple techs for extraction are reduced and so are labor hours. In the end, it will pay itself off quicker than most people think. I should have advised my family members to be hair transplant surgeons rather than cardiologists or neurologists, lol. Experienced neurologists can make like 300,000 yearly, cardiologists make like 400,000 yearly. They got nothing on HT surgeons. Blake, you are on the right track.

[Mickey85]

I think the machine probably cost more than $100,000US though.. If it only cost that much, every clinic on this forum(which make a substantial amount of money) could buy one within a month or two after expenses. But I could be totally wrong.

 

1.6mm or 1.2mm punch gauge is too much. .8 is about the sweet spot. Any less and you risk transection....

[Janna]

Regarding costs, I don't know if much will change even with this machine. Fue is fue so price per graft will most likely stay the same. On average, by analyzing an average number of grafts harvested by clinics daily and knowing prices of some clinics, I realized most top docs can make at least $16,000 a day 5 days a week which means $80,000 a week. That equates to $320,000 a month or $3,840,000 a year. On average, lets put expenses at $1,040,000 which include consultant salaries, technician salary, marketing, forum fees, medication, supplies, insurance, building expenses, and so forth etc per year. Docs can easily make $2,800,000 a year. Even if a machine like this costs $100,000, the speed and accuracy will enable more grafts in less time equating to more profit.

 

Hi Sean,

 

Obviously I cannot speak for other clinics performing FUE and what their income/expenses are from FUE surgeries but I think most would say your figures are OFF the mark. I think a select few will get $16k or higher for their fue procedure but it certainly won't be an every day occurance. Based on what I know from SMG's income/expenses, I can emphatically say the figures you posted are way off.

 

 

there are only a handful of clinics performing fue only and they are based abroad. At least I'm not aware of any FUE only in North America. The clinics abroad charge something like a $1 to $3 a graft/hair just to attract patients to their clinic. But most of these are unknown clinics that often times produce sub-par results.

 

The cost of the Artas is much, much more and there is also an ongoing fee of maintaining the machine and a $1 per graft on top of all the other expenses. It's a big committment to make such a purchase so that's why there is only a handful of clinics who have the machine so far. The speed and accuracy will speed up the extractions but you have to keep in mind that there is only so much donor to harvest in one round and this varies from patient to patient. You also need to allow time to plant the grafts.

 

Hariri,

 

Yes, we are considering it but only if they are able to come up with smaller punch sizes. I believe they are working on .9mm punches at the moment. My understanding of most clinics who have the Artas are using 1mm punches currently.

 

It would be interesting to get some feedback from clinics who have the Artas robot. I know it was recently featured at the FUE workshop in Colorado earlier this month. The consensus is that everyone seemed really impressed with the quality of the grafts extracted by the Artas robot.

[Sean]

Hi Sean,

 

Obviously I cannot speak for other clinics performing FUE and what their income/expenses are from FUE surgeries but I think most would say your figures are OFF the mark. I think a select few will get $16k or higher for their fue procedure but it certainly won't be an every day occurance. Based on what I know from SMG's income/expenses, I can emphatically say the figures you posted are way off.

 

 

there are only a handful of clinics performing fue only and they are based abroad. At least I'm not aware of any FUE only in North America. The clinics abroad charge something like a $1 to $3 a graft/hair just to attract patients to their clinic. But most of these are unknown clinics that often times produce sub-par results.

 

The cost of the Artas is much, much more and there is also an ongoing fee of maintaining the machine and a $1 per graft on top of all the other expenses. It's a big committment to make such a purchase so that's why there is only a handful of clinics who have the machine so far. The speed and accuracy will speed up the extractions but you have to keep in mind that there is only so much donor to harvest in one round and this varies from patient to patient. You also need to allow time to plant the grafts.

 

Hariri,

 

Yes, we are considering it but only if they are able to come up with smaller punch sizes. I believe they are working on .9mm punches at the moment. My understanding of most clinics who have the Artas are using 1mm punches currently.

 

It would be interesting to get some feedback from clinics who have the Artas robot. I know it was recently featured at the FUE workshop in Colorado earlier this month. The consensus is that everyone seemed really impressed with the quality of the grafts extracted by the Artas robot.

 

 

Hi Janna, I agree. I said based on some clinics. I just took random various factors into account including how many grafts posters had in one day and so forth. Some clinics do multiple procedures, whether strip or fue, or both. Some do just one procedure a day, some do more. If they wanted to they can achieve that target and it isn't unrealistic. If it costs $8 grafts by one clinic for 2000 grafts fue in one day then that is $16,000 grand right there for fue. If there are two procedures of 2500 grafts strip and 2000 grafts strip at $4 a graft then that can be $18,000 grand right there. Some clinics may charge $10 a graft and just 1,000 grafts would cost $10,000 and there may be another procedure the same day making more. This probably applies to some clinics and may not be how it is everyday. One day it could be less, the next day more.

 

Even if we take it down to a lower average of $8,000 a day * 5 times a week making $40,000 a week and $160,000 a month, being $1,920,000 yearly. It's still very profitable. I don't think that number is hard to reach. I did remember reading a thread before which has been deleted now. It was where a junior doctor was complaining about a procedure he had with Dr. Farjo and I believe in that thread they disclosed an estimate in response due to back and forth talk and it was in the millions.

 

The doctors abroad do charge low per graft but I think mostly due to their own economies and region. I do agree with you that they can charge low just to attract overseas clients from other countries as well. There are some that even offer $1 dollar grafts here in North America but we don't really see much of their results.

 

Regarding the reference of $100,000 for the machine, I saw it mentioned here.

Source: http://www.hairrestorationnetwork.com/eve/166777-cost-fue-via-artas.html#post2313887

 

Then again, I saw another website that said initial investment of $200,000 . So, the price could have gone up?

Sources: Is Robot FUE Actually Cheaper? - Balding Blog or All I Want for Christmas Is My Robot Hair Transplant - Lauren Goode - Commerce - AllThingsD

[Blake Bloxham]

At least I'm not aware of any FUE only in North America.

 

Technically, I believe Dr. Umar's hair restoration clinic is FUE only (as long as body hair graft extraction via FUE counts).

[Sean]

I just found these two cool news articles showing Dr. Rahal and the ARTAS system along with some Q&A. Hope it helps.

 

Hair Q&A with Dr. Hussain Rahal

 

http://www.canada.com/Life/All/Hair+today+more+tomorrow/7209051/story.html

[PupDaddy]

According to Dr. Robert Bernstein on his site, the ARTAS currently uses "a sharp 1 mm punch" to cut through the upper part of the skin (epidermis and upper dermis), "immediately followed by "a duller, 1.3 mm punch" to "separate the deeper part of the follicular unit from the remainder of the dermis and subcutaneous fat." So the surface punch is 1 mm, which seems an acceptable size in terms of punctate scarring -- maybe not quite so good as the smallest manual punches, but small enough. Plus, I would think you would get a greater number of 2 and 3-hair FU's using a 1 mm surface punch.

 

I spent a couple of hours yesterday watching the various ARTAS videos on YouTube and reading about it on Dr. Bernstein's site. I have to say, it is very, very impressive. Precisely replicating perfect depth and perfect ANGLE of follicular unit scoring, over and over, quickly and efficiently, with computerized mapping to make the most efficient use of the donor, and without the fatigue of manual or hand-held motorized punches, looks to be a game-changer. And according to Dr. Bernstein, who was one of the first adopters, ARTAS beats the transection rate of manual extraction or hand-held motorized extraction -- especially for large sessions -- hands down:

 

“A follicular unit is about a half a millimeter and you have a one millimeter circle that has to go dead center over it to punch this out. So when you’re doing it by eye and you’re doing thousands of them over time you’re missing them over time it’s not exactly precise. The robot is dead center each time and follows the angle of the hair."

 

* * *

 

"There’s always damage to the follicles when you’re doing it [manually] because you’re doing it by hand through these very tiny incisions and so the yield is going to be less and so with a robot if you try to get out 100 follicles you’ll get very close to 100 follicles.”

 

I'm really interested to see yield and density from some of the top docs using ARTAS compared to their FUT or manual/hand-held motorized FUE results, and I'm especially interested to see 3,000+ single-day FUE cases from these docs now that ARTAS should make this more practical and repeatable.

[ej]

how can you put a 1.3 mm punch through a 1.oo mm hole ? ... unless you dont , and the actual wound size is in fact 1.3 mm which is huge !

 

ej

Edited September 10, 2012 by ej

[PupDaddy]

how can you put a 1.3 mm punch through a 1.oo mm hole ? ... unless you dont , and the actual wound size is in fact 1.3 mm which is huge !

 

ej

 

 

Skin is elastic. The perimeter of a 1 mm hole that is cut into the scalp can momentarily be stretched outward. Based on Dr. Bernstein's description and the ARTAS videos, I would surmise that the 1 mm, sharp punch nests inside the 1.3 mm duller punch (the 1.3 mm dull punch is kind of a "sheath" around the 1 mm sharp punch) and that both can extend and retract independently. The 1 mm punch extends, i.e., emerges from within the outer punch, to cut the hole and hold it open momentarily for the 1.3 mm dull punch to slide over the inner punch into the hole. The minutely larger outer punch, having a rounded/tapered outer surface edge, slightly stretches the hole to accommodate it but doesn't cut the hole larger. The sharp inner 1 mm punch then retracts, leaving the duller 1.3 mm punch to extend farther forward into the hole to separate the "root" of the FU from the dermis and subcutaneous fat, and then retract, allowing the hole to snap back to its original size. Or so I would surmise.

 

When you watch the ARTAS videos, you see that all of this happens in an instant.

 

I doubt that the reputable docs who have adopted and/or helped develop the ARTAS (Harris, Bernstein, Rahal, etc.) would lie about the cutting punch size or use the thing on patients if unacceptably large holes were created -- something that would be evident as soon as the patient's donor area heals.

[ej]

sounds very traumatic for the skin and the surrounding follicles if this is indeed what happens .

 

I fail to see how a 1 mm punch can hold open a hole larger than 1mm for a larger punch 1.3 mm to slide into, blunt or sharp its a lot bigger .3mm diameter is a lot bigger than 1.00 mm , unless were talking internal diameter punch , were the outside would be say 1.2 mm , internal 1.00 mm with the outer punch 1.3mm sliding down to extract the graft over the outer 1.2mm punch , either way in my opinion all these punches are way to big and will cause white dot scarring and destroy valuable donor , i have read somewhere the manufactures are working on a smaller punch , however that doesnt help the guys who have allready jumped in the chair !

 

Perhaps some of the patients who won the competition with the Dr in California to have the procedure done could chime in and let us know how there donor area is looking

 

regards

 

ej

[HARIRI]

I think that the super talented FUE surgeons like Lorenzo, Bisanga, Feriduni, Umar and Feller will never fall for this robot. Most of them would even stick to the manual stuff where State of the Art is there. I'm not convinced at all with ARTAS robot until they minimize the incision size. I think its a tool to ease the doctor job and not to maximize results of patients! Who would love to be Guinea Pig and risk his valuable grafts and get big dots at the back of his head!!!

[PupDaddy]

I am not so dismissive of new technology, especially one that has been cleared by the FDA, developed in collaboration with experienced FUE surgeons, and purchased by some of the top names in the business. There have already been numerous "guinea pigs" during the clinical trials, and considering that ARTAS is now being used by Drs. Bernstein, Harris, Rahal, and others for their FUE cases, we should start seeing more and more patient results.

 

As we know, there are three primary challenges with FUE transplants, especially large session FUE transplants: (1) punching around the follicular units without transecting or otherwise damaging them, and doing so repeatedly, thousands of times, being dead center each time and precisely matching the angle of growth, (2) separating the follicular unit from the dermis and subcutaneous fat to enable extraction of the FU without undue torsion, yanking, or other forces that can damage it, and again, doing so repeatedly, thousands of times in a session, and (3) getting "chubby" FU's rather than "lean" FU's -- again, thousands of them so that the FU's that are transplanted will not only survive but mature well and flourish as well as FU's extracted via strip. ARTAS purports to address each of these challenges by perfectly, repetitively, and quickly (making possible mega FUE sessions) excising and separating for extraction healthy, robust follicular units that should yield growth percentages and hair maturity rivaling strip transplants -- something that even the most careful and gifted FUE surgeons using manual punches or hand-held motorized punches have yet to consistently achieve.

 

So I, for one, am optimistic about ARTAS as a game-changing tool for FUE, especially for large cases. I am especially interested to see results (including the appearance of the donor) of the first wave of Rahal patients whose FUE transplants are done with the assistance of the robot and whether his large ARTAS-assisted FUE cases consistently yield results as good as his large FUT cases.

[ej]

very technical and advanced machine , yet it still cant differentiate between light and dark hair ! how can it then ` feel ` an individual`s scalp as im led to believe all are slightly different ! I too would like to see results , especially of the donor , as stated earlier be good if a patient could post some

 

ej

[Sean]

I read that Adamo Papa had 2500 grafts extracted by ARTAS today by Dr. Rahal. Lets see how it looks like in the months ahead. He is willing to do continious updates to show donor and growth from ARTAS.

 

This article just posted and gives more info: Ottawa clinic hosts Canada

 

 

More info about it in this thread as well,

http://www.hairrestorationnetwork.com/eve/167724-september-28th-first-robotic-hair-transplant-canada.html

[Sean]

Video: Ottawa clinic hosts Canada

[PupDaddy]

Thanks, Sean! It was cool to see Dr. Rahal with the ARTAS in action.

 

Matt from Dr. Rahal's office has started a thread about Adamo's case.

[twinspark]

So whats the cost of Artas Compared to neograft if we are talking about 3000 grafts?

[highstream]

Although I wouldn't need anywhere near 3000 grafts (maybe a quarter to third of that), I come to the forum for the first time with a similar question to twinspark's: What is the range of transplant costs for Artas or SAFE vs other FUE or non-FUG surgical methods. I live far enough away from FUE practitioners that travelling blind for even a consult is not an option. I had a couple of experiences with FUG a good while back and know that cheap is generally not good, while expensive is not better and may even be involved with deceptive practices (thinking back on an L.A. area facility). In particular, I am wondering about Dr. Harris's (CO) price structure, since he appears to be one of the two closest to me. Thanks,

 

I assume the research on FUE has been seen, but just in case there is a 2010 review article on the NIH website from the Journal of Cutaneous and Aesthetic Surgery: Follicular Unit Extraction Hair Transplant. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2956961/

[Rachmunas4life]

I just received an e-mail from Shapiro Medical. They are now using the Artas! : )

[Janna]

To clarify - we offer the FUE procedure via Artas as well as our SAFE system technique.

[Dr. Ricardo Mejia]

The ARTAS is a good device. I looked at it for my office, but currently unable to implement it. For one, I would need a dedicated room I currently do not have available. THe traditional FUE technique in my hands Does the job well and very efficient.

[TruthOnly]

It is definitely an interesting machine. One thing that is important to mention that no one has is it is FDA approved. I don't think any surgeons hands are? Definitely a good tool but actually it is not any faster than manual extraction.

 

The most promising thing about it is a reduction in transection rate. It proved in clinical trials to consistently produce a transection rate of < 2%. Compare that to the best surgeon out there in it is unmatchable (realistically 10-12% at best).

 

So just to leave an example, if you are worried about donor availability: If you got 5000 FUE grafts manually, it is safe to assume at least 500 grafts transected. Take the same procedure and it is GUARANTEED that the number drops to a maximum of 100 grafts lost. That is an extra 400 grafts that can be utilized. Then we just rely on the skill of the surgeon to place the lines and angles correctly. However, the price is currently unattainable for the average person.

 

Possibly in the future we can see generic devices produced that could actually reduce the cost compared to manual FUE. Most doctors out there charging 10$ per graft for ARTAS and $8 for FUE. I know Rahals price is 7.50$ for FUE and 8.50$ for ARTAS, but he claims that there is no difference in result with the two procedures. But it may be insignificant to the eye at this point.

[HARIRI]

No matter what machines and robots they invent, Its all for the sake of the surgeon's comfort in order to make his job easier and allow him to get more patients in a week. When it comes to final outcomes and yield, Manual FUE is still the best. Best FUE surgeons in the world are still using it such as Bisanga, Lorenzo and Feriduni (who once used SAFE motorized tools and then went back to manual because of poor yields). Manual FUE requires surgeon's stamina and talent. I would never want to be drilled lol.

[Janna]

Hariri,

 

It's interesting to read your posts because you have strong opinions that they often come across as if they are facts.

 

Sometimes you speak on behalf of physicians as if you know them and have in depth conversations with them on a regular basis. Maybe you do with many of them but I know you haven't done so with Dr. Shapiro, yet you post as if you know why Dr. Shapiro acquired the Artas or why we switched from manual sharp punch to the motorised SAFE system. As I understand it, you don't like any motorised fue tools, and you have every right to your opinion. Are all docs using any type of motorised tool - sharp or dull punches put in the same category? While I believe there is only one dull punch, there are several variations of the sharp motorised punches. Do you remember the much hype about the Feller cordless sharp drill? Is he being lazy using motorised tool or is he innovative?

 

Dr. Lorenzo, God bless him, is about the hardest working man I know who punches and takes all the grafts out himself not to mention planting all the grafts too. He works long hours and is quite passionate about his work. I know he's tried the Feller drill but I wasn't aware he's tried the SAFE system. Did all three purchase the SAFE system, try it for awhile then decided against it or just one of them? That part wasn't clear to me. How many patients did he/they try it on? When I visited all three clinics few years ago, they hadn't tried the SAFE system so it'd be interesting to get their opinion on it. I'm not disputing these top docs's reputation or their work or the fact that you like them. I like all of them too. When you speak to each of them, can you ask them about their yield? What is their percentage of patient satisfaction with their FUE? I know Feriduni has 4-5 techs that are skilled at punch/extracting, just as Dr. Feriduni is but I know yield can be compromised with any FUE procedure regardless of the technique. I'm sure they will tell you that while they strive for 100% yield on 100% of their patients, they don't have it. There's a fundamental difference between dull and sharp punches. You should find out the difference and why some choose dull as oppose to sharp. The top clinics tend to produce the most consistent results, thats why they are considered tops. For consistent results and for best yield at our practice, we converted to the SAFE system and acquired the Artas, not for anything else.

[Mickey85]

I cant speak on behalf of hariri but it is true that dr feriduni once used a motorized punch for some time but switched to manual. He actually told me this in my consult. I wont say exactly what punch it was as im only 80 percent sure but will double check and get back to you.

 

Lorenzo also has used the Devroye punch in the past(there is a video of him using it) but now favors the dr. C(you know who im talking about) manual punch. Same as dr. Feriduni.

 

Not sure if dr bisanga ever tried motorized punches but he does use manual now. Dr de reys also has a dislike for motorized punches as you cannot 'feel' the feedback the punch has on the graft which can prevent transection.