ARTAS Donor Destruction? You have to see this!

[ArochaHair]

Dr. Arocha feels that there is some negative information regarding the use of the ARTAS hair restoration robot. Some have said that the ARTAS system causes excessive donor scarring and damage due to unnecessarily large punches as well as having a reduced area of donor hair that the robot can harvest from which can contribute to the patient having a "moth eaten" donor zone. These are not concerns that are currently valid due to how the system operates and any tangible cosmetic downsides really come down to user judgement.

 

The ARTAS system is unique in that it is continuously updated with new information to make it better. There is a steady stream of system updates that include, among other things, the control algorithm, the punch sizes and the dexterity of the robotic arm itself. These improvements are obvious and dramatic even when compared to what was being done only two short years ago. Dr. Arocha feels that these advancements to the ARTAS system warrant a second look.

 

The case below is one that was performed six months ago where approximately 1800 grafts were harvested. The photos were taken during surgery so there is no post-operative power washing to clean the donor area. The ARTAS system is not perfect and Dr. Arocha feels that if one is to use the ARTAS in their practice the clinic should be in a position to take over with manual extraction if necessary but in general the benefits of the ARTAS system in it's current iteration are clear. When compared to any clinic using manual extraction it would be extremely difficult for even a trained eye to confidently say which extraction technique was used in these photos, manual punch extraction or extraction using the ARTAS robotic system.

 

 

 

 

Edited June 20, 2016 by ArochaHair

[Bill - Seemiller]

Dr. Arocha,

 

Thanks for sharing. I think like any other extraction device, the ARTAS can be misused and as a result, in some cases, it may cause donor area issues. At the end of the day, nothing replaces a skilled and experienced surgeon and it takes a skilled and experienced surgeon to use and operate the ARTAS.

 

What do you think?

 

Best wishes,

 

Bill

[pidda]

Dr. Arocha,

 

Thanks for sharing. I think like any other extraction device, the ARTAS can be misused and as a result, in some cases, it may cause donor area issues. At the end of the day, nothing replaces a skilled and experienced surgeon and it takes a skilled and experienced surgeon to use and operate the ARTAS.

 

What do you think?

 

Best wishes,

 

Bill

I agree.

[wylie]

The problem isn't ARTAS, it's who is using it.

[pidda]

For example, this is probably a bad idea: http://www.hairsite.com/hair-loss/board_entry-id-124213.html

[ArochaHair]

Hello Bill,

 

Yes, this has been our message. The ARTAS is a tool and it is best used by experienced hair restoration clinics. The impression I get from the responses in this thread is that the readers recognize that ARTAS is just that, a tool, and it is all dependent on the user.

 

Pidda references an image that is a prime example of how not to use ARTAS but this image could have been an image of any extraction tool in use today. I did a search and there are some images online that are similar but were from manual hand held extraction techniques. The point is that no matter how good a tool may be it is only as good as the user and his or her judgement to use it.

 

The problem that we see sometimes is when patients come in and repeat to us what they have heard from others. The ARTAS robot causes excessive scarring. The ARTAS robot uses punches that are too big. The ARTAS robot cannot cherry pick grafts. This thread intends to address these issues and others if anyone wants to present questions.

 

1. "The ARTAS robot causes excessive scarring." When the ARTAS robot first came out it was using punches that were too large. We don't dispute this and we don't think Restoration Robotics would dispute this either. The improvements have been coming just as they have been for every other form of FUE surgery. In the beginning of FUE before ARTAS there were only manual punches but the early debates discussed the benefits, if any, of going below 1mm in diameter. Then there were debates about the use of motorized punches and so on and so forth. The point is that they have all improved as has ARTAS.

 

For instance, here are two photos of this same patient after the donor area healed.

 

 

 

There is no massive scarring on this patient and it is very difficult to see any indicators that FUE was performed. When you compare the extractions of this latest ARTAS patient to the patient below which was done with handheld manual the difference is obvious.

 

 

ARTAS extraction zone during surgery.

 

 

Handheld manual extraction from a random clinic found online in Spain.

 

 

 

2. "The ARTAS robot uses punches that are too big."

 

As I said, in the beginning this was the case and it was even using punches that Dr. Arocha felt were too big in general leading in to 2015 but this past 18 months has shown some real progress. The current standard is .9mm but .85mm is rolling out now and .8mm is expected by the end of the year.

 

3. "The ARTAS robot cannot cherry pick grafts."

 

The ARTAS can now differentiate the number of hairs in each follicular unit and can be told which size groupings to target. This is the standard for how all top FUE clinics operate in that they will take the larger bundles and leave smaller one hair grafts behind to help prevent the moth-eaten effect. We can also set the parameters affecting extraction density.

 

4. "No top tier FUE clinics use ARTAS" Respectfully, we think this is inaccurate too. Some other well known clinics have tried ARTAS and decided to no longer continue with it's use but we feel they may have given up prematurely. We almost did as well and we are not new to the use of FUE. In fact. Dr. Arocha enjoys using manual hand held FUE tools but he decided to give ARTAS a second chance and he has learned that it is far better than it was when he first purchased the robot three years ago.

 

One thing needs to be made clear. We do not feel that the robot is "better" than manual hand held extractions that we and other top FUE experts offer. ARTAS is a supplementary and where it excels above and beyond what any human can do is in it's consistency and lack of fatigue. Every top doc experiences this and it is unavoidable. Wear and tear can take it's toll on the human wrist and it is when fatigue sets in that mistakes can and do occur. With the improvements that have occurred (and are coming) to the robot the baseline standard of care and results are being elevated. In an age where unlicensed technicians are starting to dominate the hair restoration landscape we feel that the ARTAS, guided by an experienced hair restoration surgeon, is a safer option. ARTAS does not get tired. ARTAS does not come in hung over. ARTAS will never ever be a rookie that needs to be trained because every new ARTAS that comes off the assembly line has the cumulative knowledge and experience in it's learning algorithm (that is also pushed out to older machines as an update) from each and every one of the millions of extractions it has performed since the beginning which means it is getting "smarter" and more experienced every day.

[Shampoo]

Bill or Dr. Arocha....

 

I know it's apples to oranges but....

 

If you are going to be in the surgery chair say 8 hours how

does during procedure discomfort compare for FUE vs FUT?

[pidda]

Well, as for me personally, I would never trust the ARTAS robot ever again no matter how many "updates" or "upgrades" it has in the future. I would only trust manual punches in the right hands from now on.

[ArochaHair]

Shampoo, I think that strip is probably more comfortable during the procedure because the patient is in the harvesting position for a shorter period of time compared to FUE but the longer face down time of FUE is more than made up for by the quicker healing and less post operative discomfort.

 

Pidda, your position on ARTAS makes sense if you had an unfavorable experience with it but this happens for patients that have strip and other forms of FUE as well. What you said about only having manual punches "in the right hands" is the entire point of this thread however in that ARTAS is a tool, just like a manual punch is a tool, and the tool is controlled by the doctor (or should be controlled by a doctor). The judgment of the doctor and how to use the tool determines (for the most part) the outcome of the procedure. For instance, the image you linked to is a clear indicator of poor judgement and then there is this image I posted of a recent manual punch extraction case:

 

Manual extraction FUE immediate post-surgery.

 

Compare the above manual extraction case to the ARTAS case I presented and the difference in judgement (and punch size of course) is clear.

 

ARTAS extraction during surgery.

 

The current state of ARTAS is not just about how the donor looks during surgery of course. The healed result is what matters as seen in this four month photo of the same patient:

 

 

The message we wish to convey is that in any procedure the tools that are used are not determining the outcome of the surgery, the doctor and the staff are, because they are the ones controlling these tools. Just like two clinics that use manual can be different, two clinics that use ARTAS can be different as well. In fact, Arocha Hair Restoration is recognized by Restoration Robotics (the manufacturer of ARTAS) as an "ARTAS Center of Clinical Excellence" due to Dr. Arocha's experience in the field and how he applies this experience to using the robot as well as the feedback and suggestions he gives on it's use and how it can be improved. Only 10% of all clinics using ARTAS have this designation.

 

We hope this clears up some of the confusion about ARTAS and dispels the myth that donor zones are automatically destroyed just because an ARTAS system was used. In our opinion, compared to many surgeries being performed today, some patients would be lucky to have an ARTAS system participating in their surgery.

[lorenzo]

Look good.

Dr. Arocha are you convinced that the ARTAS works better than manual FUE?

If so why don't the top FUE clinics in the world use it?

[ArochaHair]

Hello Lorenzo,

 

I already addressed those questions in point #4 in an earlier post in this thread. Thank you.

[lorenzo]

I already addressed those questions in point #4 in an earlier post in this thread. Thank you.

 

Thanks I missed that. Good explanation.

[ArochaHair]

Hi 911fan,

 

Yes, here is a before/after that we can share.

 

 

[Dr. Bernardino Arocha]

Hello HTN community,

Happy July 4th to all! God Bless America, we are still young, the best is yet to come! We can do it!!

The bottom line, you cannot rely on one procedure or one tool to create Hair Restoration Excellence! During the donor harvest we obtain the raw material to perform our hair restoration art works! Have fun, be safe!!!

[hairthere]

Hi Dr.Arocha,

Happy July 4th to you as well! This work looks very refined! Very much looking forward to my September trip to your clinic!

Erik

[Dr. Bernardino Arocha]

hairthere (Erik):

 

Thank you for your kind words! Had a wonderful Independence day. Such a nice kudos from an experienced member of the HTN community is much appreciated! We look forward to your upcoming visit in September!!

[Pete-from-Farjo]

Interesting topic. And excellent result posted also.

[ArochaHair]

Thanks, Pete! Your comments are appreciated.