HomeMedicalSurgical SolutionsInnovations in Robotic Hair Restoration

Innovations in Robotic Hair Restoration

By Martain Pierre Jean Loonen, Consultant Plastic Surgeon, The American Academy of Aesthetic Medicine

Alopecia is a chronic hair loss condition characterized by active hair loss, affecting 80 % of men and 40 % of women during their lifetime.

The global alopecia treatment market size was valued at USD 8.2 billion in 2022 and is expected to grow at a compound annual growth rate (CAGR) of 9.0% from 2023 to 2030.

The global hair transplant market is expected to grow from $5.94 billion in 2022 to $7.24 billion in 2023 at a CAGR of 21.9%.

In 2021, 703,183 people had hair transplant surgeries globally.

A hair transplant is the surgical procedure in which hair follicles are extracted from one part of the head known as the “donor site” and implanted into the balding area of the head known as the “recipient site.” It is considered an effective technique to treat male and female pattern baldness. The donor site is mainly the area that is resistant to baldness and has a significant amount of donor hair e.g. back or sides of the head.

There are two different ways of extracting the donor’s hair. One is Follicular Unit Transplantation (FUT) also known as strip harvesting and the other is Follicular Unit Extraction .

FUT involves a technique where a thin strip of healthy hair bearing skin, from a ‘permanent’ area of the scalp (where hair is genetically programmed to continue growing for life) is harvested and transplanted to the recipient site.

FUE hair transplant is a surgical procedure in which hair follicular units  are extracted one by one from the donor site and implanted into the recipient site. One follicular unit extracted contains 1 to 4 hairs or more in exceptional cases.

Both techniques are considered effective to treat male and female pattern baldness. A hair transplant procedure can be used to restore the scalp, eyebrows, eyelashes  and the beard hair.

The ARTAS Robotic hair transplant was the first  robotic follicular unit extraction system.

ARTAS Restoration Robotics, was created by the American company Restoration Robotics in 2008.

ARTAS robotic hair transplant system received its marketing approval in 2011. It is now the most widely used robot in the world in the field of hair transplantation.

The first generation robots were only able to perform follicular unit extractions .

In 2018, Restoration Robotics (the company has since merged with Venus Concept) launched a version of the ARTAS robot that not only harvests the follicular units but also provides  recipient site making and follicular unit implantation options.

The system includes a multi-camera stereoscopic vision system with a 44-micron resolution. This system, combined with the seven-axis robot arm of the device, enables physicians to conduct automated procedures with  high precision.

The robotic hair transplantation has certain advantages. The use of algorithms by the robotic grafting system makes it easier to select patients whose hair is best suited to automated extraction, by analysing the nature of the hair, its angle of growth and its density. It iIdentifies the most suitable hair follicles for harvesting and protects the existing hair follicles. It calculates the precise depths and angles of the hair follicle units. This identification facilitates the surgeon’s work. Precision robotics is used, which gives speed, accuracy, and consistency to the procedure.

The speed of robotic extraction reduces the intervention time of a hair transplant and reduces the fatigue of the medical team, which can better focus on the implantation of the grafts extracted by the robot. The robot leaves no room for human error and works with extreme precision. It can harvest over 1500 grafts per hour .Automated extraction is more precise than manual extraction and reduces trauma to the capillary dermis with early return of the patient to his or her normal life.

There are certain limitations in robotic hair transplant. Robotic extraction is not suitable for very fine or frizzy hair. The ARTAS robot is easily used on the side of the skull or on the occiput, the most common donor area. However, it does not allow grafts to be harvested elsewhere, such as the neck, face or torso, whereas manual extraction can be performed anywhere, especially in the case of a patient suffering from complete alopecia, where grafts will have to be harvested elsewhere than on the skull. The punched follicular units need to be manually extracted and individually loaded into the implantation system with relative slow robotic implantation speed compared to manual implantation. These processes increase the procedure time substantially.

The robot programming and frequent patient installation are time consuming as well and may further increase the procedure time especially when a surgical team is using the robot during the first cases . The purchase price of the robot and the single use consumables are substantial and increase the procedure price for the patient.

Semi-automated robots,like the Neograft SAFER Robot and the SmartGraft transplant device, were developed as an alternative and cheaper option for the ARTAS system.

These systems use a compressed air punch (or micro-punch) connected to the system and equipped with a rotating micromotor that will extract and suck out the follicles into a collection container and can automatically count the amount of extracted follicular units. To harvest the grafts, the surgeon will take the punch in hand, adjust the speed of the rotary motor according to the nature and quality of the hair, and puncture the grafts one by one. After extraction, follicular units must be manually placed into recipient sites that are created in the balding areas. These systems reduce the procedure time  but the purchase cost is substantial higher compared to standard manual systems.

The ideal future robotic hair restoration systems could be  a combined  ARTAS and  semi-automated device with automatic suction, collection and implantation preparation of the extracted follicular units during a robotic procedure and further development of artificial intelligence technology to reduce the necessary manual programming and frequent patient installation during the procedure .

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