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The History of Surgical Hair Restoration.pptx

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Abhishek Chauhan
Abhishek Chauhan

This document summarizes the history of surgical hair restoration from ancient times to modern developments. It discusses early attempts using animal products in ancient Egypt and pigeon poo by Hippocrates. The first modern techniques were developed in the early 20th century by doctors like Orentreich, Okuda, and Tamura, pioneering smaller grafts and follicular unit transplantation. Developments in the 1970s included the Norwood scale for classification and alternative procedures like scalp flaps and reductions. The 1980s saw the rise of multi-blade harvesting and mini-micro grafts, though these had disadvantages like shock loss.

1 of 44
The History of Surgical Hair Restoration
There are many stages of hair loss that occupy so many of our scalps worldwide. It has been a problem that men have tried to deal with in many ways for thousands of years. The oldest known prescription for hair loss is from Egypt and is 3500 years old. It consisted of hippopotamus fat, crocodile, cat, and porcupine hair boiled in water. Thankfully, no one tried to invent hair transplant technology back then!
Hippocrates, the father of western medicine, use pigeon poo to fight hair loss!
Hippocrates also suffered from hair loss 2500 years ago and he used a mixture of pigeon poo, horseradish, opium and spices. However, Hippocrates also noticed and recorded that eunuchs never seem to lose their hair and suggested castration would be the answer to the problem. Yeah, thats a bit rough but he was actually correct in his assumption as confirmed by researchers at Duke University in the mid 1990s.
Dr. Orentreich, the father of the "plug".
But it wasn't until the middle of the twentieth century that something started to take shape that could be called real progress, more or less. Dr. Normal Orentreich performed hair transplant surgery in his New York office in 1952 and this was the beginning of what we know today as surgical hair restoration. He published a paper in 1959 where he introduced the "theory of donor and recipient dominance" where he described how the transplantation of androgen insensitive hairs could successfully allow hair to grow in previously bald areas. This laid the foundation for surgical hair restoration as we know it today.
Early Hair Transplant Technology
Hair transplant machine used in 1921.
Let's back up for a moment Dr. Orentreich was not the first person to transplant hair. No, this was done in experiments as early as the late 1800's, with some success too. In 1921 there was Dr. J. S. Parsegan who had this crazy idea that if you transplant a woman's hair onto a balding man's scalp it would reactivate dormant follicles.
Anyway, it was Dr. Orentreich who was the first in North America to successfully transplant hair for the cosmetic benefit of men with male patterned hair loss (the term had not been used yet) and it was his work that opened the gates to hair restoration being a cosmetic procedure to "cure" baldness. Before Dr. Orentreich there was work being performed in other parts of the world, most notably in Japan.
Dr. Shojui Okuda (1886- 1962) is the unsung hero of hair restoration.
Dr. Okuda, however, built upon Sasagawa's work and was transplanting anything and everything he could think of. He transplanted hair from the scalp to the arm for experimentation. He rebuilt eyebrows, pubic regions, and even eyelashes. His tools included surgical punches up to 4mm in diameter (a true punch plug) and as small as 1mm in diameter. He noted that the smaller punches were much more difficult to get viable hair so he usually stuck with 2mm to 2.5mm incisions but the point is that he used 1mm punches on many occasions and noted in his journal how the cosmetic effect was superior to that of the larger punches he used.
The "Okuda papers" were published in 1939 and at this point he had already been performing surgeries for ten years. Dr. Okuda never wrote about using his hair transplantation methods for treating male patterned hair loss. However, in 2009, Dr. Okuda's grandsons opened up a room that had been storing their grandfather's equipment and it had previously remained undisturbed for at least 30 years. Among the items in storage were before and after photographs of successful hair transplant procedures that were undocumented in his papers thus indicating that Dr. Shojui Okuda is the true pioneer and father of punch grafting. Atlas Oral Maxillofac Surg Clin North Sep; 6(2):39-53.
About four years after Dr. Okuda's papers were published there was a second Japanese doctor that started to improve on Okuda's hair transplant technology by using smaller punches on a regular basis. Dr.Tamura used smaller punches of roughly 1mm more frequently than Dr. Okuda and even went so far as to refine the grafts that were harvested by trimming and dissecting them before implantation. He published his papers in 1943 in the Japanese Dermatological Journal during the height of the Pacific campaign ofWWII.
Dr.Tamura's refinement of Dr. Okuda's work is a more direct fore bearer to the modern FUE procedure we have today and in effect it renders any recent claims of being "the first" null and void.The first was Dr. Okuda and subsequently Dr.Tamura. It would be a long time before western medicine would learn of these two true pioneers as the information they documented was inaccessible due to WWII and it's aftermath.(Credit: American Hair LossAssociation). It wasn't until 1959 with Dr. Norman Orentreich, mentioned at the top of this page, that western medicine caught on but unfortunately it was not in the form of refinement that one would expect with time.
Fast forward to 1975. Disco was king and so was polyester and crazy hair. Lots of great things came out of the 70's including Dr. O'tar Norwood and his classification system known as the Norwood Hair Loss Chart. this was fairly important as it helped to standardize how hair loss was measured and this allowed for easier diagnosis and treatment recommendations by hair restoration clinics.
It isn't entirely accurate however as there are several patterns found in nature on a regular basis that are not represented on the NW chart but it gets the basics down well enough. Dr. Norwood's classification system also gave the public a way of understanding their own hair loss. They could simply look in the mirror then look at the chart.
Once a balding man knew where he was on the chart it would psychologically give them a solid base to associate themselves so they could take action to actually do something about their problem.
Hair Flap Surgery
The 1970s also introduced a few alternatives to plug hair transplant technology but mainly they were adjuncts to the procedure overall. First you have the scalp flap. The scalp flap was first performed in the 1930s but it never caught on till Dr. Jose Juri ofArgentina introduced the Juri Flap in 1969. A scalp flap is an extremely invasive procedure that requires a high degree general and plastics surgical skill to perform successfully and even then the outcome is questionable. Basically this involves removing a large piece of tissue from one area of the scalp and rotating it to another area in need of hair.
Various forms of scalp reduction surgery.
Scalp reduction Another hair transplant technology alternative is the scalp reduction. Scalp reductions were procedures that literally remove the area of scalp that had hair loss and then pull the edges of the wound together so that the areas of still strong growing hair would be much closer to each other thus you have a reduction of hair loss from this reduction of scalp. It made sense at first glance because youre just cutting out the problem and throwing it away but the problems emerged when arteries would be cut thereby inducing nearly uncontrollable bleeding or when the final result matured the patient would have difficulty styling their hair. This was due to the natural hair geometry being completely distorted from the procedure. Both scalp flaps and scalp reductions have thankfully had their short time in the history
Punch grafting survived the 1970s and continued to thrive into the 1980s.There were some doctors that had tried to use punches significantly smaller than 4mm but none were successful, or at least not enough to warrant creating change, but there was something different that started to push the industry forward. It was the pattern of plug extractions that helped to usher in the next big change.The way that doctors would traditionally remove punch grafts is that they would take their plugs from random areas of the scalp.
Sometimes in close knit groupings and other times spread out over the entire safe donor zone and sometimes well outside of the safe donor zone. But some doctors started to see that when the plugs were extracted close enough together, and in a pattern that formed something similar to a rectangle, they would see that they were creating one large wound that forced them to suture the wound closed. EUREKA!!! No more punch scars!
Eventually someone got the bright idea that a scalpel might be a better way to get out this new rectangular pattern of hair bearing scalp so that patients wouldn't have the buckshot scarring from surgery any more. It kind of makes sense, right? Well, the problem is that someone still decided that it should be easier, not better, so now we have the multi-blade scalpel.
Typical multi-blade scalpels. The multi-blade scalpel is a medieval looking piece of hair transplant technology that takes two to four scalpel blades and puts them in one handle.This means that the doctor can just make one swipe of the scalpel(s) and you've pretty much got up to four narrow strips to dissect hairs from for placement into the recipient scalp. Don't worry about follicular transection because there's plenty of that to go around. Enter the age of the mini-micro graft.This is where the experience of yours truly comes into the picture, as this is the procedure I had performed in the early 90's.
The History of Surgical Hair Restoration.pptx
Mini-micro grafting is not such a bad procedure if performed by someone that gives a damn. No, it can work well but there are several disadvantages to the method. If a multi-blade scalpel is used to harvest the donor hair then many of the grafts in the donor zone, both in the strip removed and the adjacent areas of the donor zone left behind, will be transected and rendered useless. This leads to permanent shock loss in the donor zone and less growth of transplanted hairs for the final result months later. It was a step in the right direction but not quite there.
Current HairTransplantTechnology
In 1994 there was a good ole boy in SanAntonio,Texas by the name of Limmer, Dr. Bobby Limmer, and we have him to thank for the common sense approach of actually caring about how hair transplants look.What Dr. Limmer did was basically take the industry of hair restoration, shove it down a cannon tube and fire it forward into the age of common sense. Dr. Limmer presented the world with the idea that using stereoscopic dissecting microscopes for the dissection of follicular units would provide for a more natural result and a higher yield (growth rate) of transplanted hair
As it turns out he was right and with that he ushered in the age of the follicular unit transplant. Follicular unit grafting via stereoscopic microscopes allows for 30% higher yield of the transplanted grafts and it allowed for refinement that was much more difficult to detect. Finally, it only took about sixty years after Dr.Tamura for the western world to finally get it.
Follicular unit grafting did not actually take off quickly from the start. As with any new development, when it comes to hair transplantation, it was met with massive resistance but eventually it became the gold standard in the field and this is still the case today (2015) where approximately 67% (as of 2014) of all hair restoration surgeries are carried out via FUT
. In the beginning of FUT the biggest procedures were in the range of 800 grafts to 1200 grafts but with time there were improvements to follicular unit grafting and the donor harvesting process as well.Yields continued to climb and harvests of hair continued to grow to the point that today there are many clinics that routinely harvest up to 4000 grafts in a single procedure.There have been many cases of clinics going larger but going beyond the 4000 to 4500 graft range is considered by many to be pushing the envelope just a little too much.
. A lot of people call themselves pioneers but the true, original pioneers of FUE were Okuda andTamura.When you're using 1mm punches for moving hair, you're performing FUE. But, the modern pioneer of FUE is Dr. RayWoods. No one else can make this claim simply because no one else can back up their claims with solid and unquestionable proof. Dr. Woods can and anyone that says otherwise is simply lying. So FUE got its start in North America with Dr. Rob Jones ofToronto and Dr. Alan Feller of NewYork. Both of these doctors saw the merits of the procedure and Dr. Feller in particular, who is kind of a gadget geek to begin with, started working on his own tools and he was the first in North America to create his own FUE hair transplant technology
The hair restoration industry has slowly but surely started to transition away from strip toward FUE but the real push began around 2008 with the introduction of Neograft速 hair transplant technology. Neograft速 is a motorized, hand held FUE device that has a rotating punch that scores the follicular unit.
The History of Surgical Hair Restoration.pptx
This is nothing new as there were other motorized punches being developed and introduced around the same time but the Neograft was different in that it offered extraction AND implantation. It was a novel and unique idea.The way that it works is that once the graft is scored a high powered vacuum attached to the end of the hand held wand would suck the graft out of the donor scalp, through a tube, and into a reservoir filled with chilled saline as a storage medium. Once the grafts were extracted the user would make some adjustments to the machine and then the system would push the grafts back through the tubing to be inserted into the recipient sites made by the wand.
First, it introduced an opportunity for the industry to gain more main stream appeal as Neograft created a massive media and advertising push that had one simple but very effective message.There is no strip scar from the procedure. People that took the time to investigate and research hair restoration techniques knew about FUE in general but the lay public had no idea what was involved and they only knew that strip surgery meant a strip scar and the Neograft technique as many later referred to it, offered no strip scar.The company focused on this message and completely avoided the issue of quality of growth and let the public assume that all results would be the same.
The second reason that Neograft made an impact on the industry is because they introduced what was essentially the first turn key hair transplant clinic in the world. For a fairly nominal fee one could purchase a Neograft machine, rent a small office and maybe hire a receptionist and they could start offering surgery after taking a single weekend training course. Neograft has a team of traveling technicians that would also travel to new clinics to help get them up and running but the formula was simple. Sell as many machines as possible for a decent price. It worked and now Neograft is one of the more recognized names to anyone researching hair restoration. Any doctor or clinic that has the slightest interest in offering hair restoration alongside tummy tucks and Botox injections can now do so.
The Future of HairTransplant Technology The ARTAS robotic surgical hair transplant system
In 2011 the potential future of hair transplant technology received 510K clearance by the United States FDA.The ARTAS速 system by Restoration Robotics was introduced shortly thereafter.This is the first and currently the only robotic hair restoration system. It is exactly as it sounds. A robotic arm with a punch tipped apparatus makes incisions and scores grafts for extraction.The system is actually fairly limited in that it does not remove grafts on its own and it does not place any grafts.Trials are currently underway however to allow the system to make incisions for placement
The idea behind the ARTAS速 system is that it takes the element of fatigue away from the procedure and introduces the use of highly developed algorithms that supposedly offer faster and more reliable scoring of grafts. One unique aspect of the system is that it is constantly being updated based on regular system feedback from each individual machine in use. This means that with every software update that the system goes through it is bringing the lessons learned from the cumulative number of surgeries performed prior to the update.
This has the potential of offering exponential improvements for the accuracy and reliability of the system. Currently the system is using punch sizes of .9mm to 1.1mm but in the early days of its use it was using punches as large as 1.6 and 1.7mm respectively.The progress has been steady and currently Restoration Robotics is working on improving the system to allow for .825mm punches.
Current limitations of the ARTAS速 hair transplant technology include the ability to only work on darker, straighter hair. It has trouble removing grafts from certain areas of the scalp on even the best candidates so supervising doctors must have the ability to compensate by offering alternative means of extraction with either hand held motorized punches or manual punches.

More Related Content

The History of Surgical Hair Restoration.pptx

  • 1. The History of Surgical Hair Restoration
  • 2. There are many stages of hair loss that occupy so many of our scalps worldwide. It has been a problem that men have tried to deal with in many ways for thousands of years. The oldest known prescription for hair loss is from Egypt and is 3500 years old. It consisted of hippopotamus fat, crocodile, cat, and porcupine hair boiled in water. Thankfully, no one tried to invent hair transplant technology back then!
  • 3. Hippocrates, the father of western medicine, use pigeon poo to fight hair loss!
  • 4. Hippocrates also suffered from hair loss 2500 years ago and he used a mixture of pigeon poo, horseradish, opium and spices. However, Hippocrates also noticed and recorded that eunuchs never seem to lose their hair and suggested castration would be the answer to the problem. Yeah, thats a bit rough but he was actually correct in his assumption as confirmed by researchers at Duke University in the mid 1990s.
  • 5. Dr. Orentreich, the father of the "plug".
  • 6. But it wasn't until the middle of the twentieth century that something started to take shape that could be called real progress, more or less. Dr. Normal Orentreich performed hair transplant surgery in his New York office in 1952 and this was the beginning of what we know today as surgical hair restoration. He published a paper in 1959 where he introduced the "theory of donor and recipient dominance" where he described how the transplantation of androgen insensitive hairs could successfully allow hair to grow in previously bald areas. This laid the foundation for surgical hair restoration as we know it today.
  • 8. Hair transplant machine used in 1921.
  • 9. Let's back up for a moment Dr. Orentreich was not the first person to transplant hair. No, this was done in experiments as early as the late 1800's, with some success too. In 1921 there was Dr. J. S. Parsegan who had this crazy idea that if you transplant a woman's hair onto a balding man's scalp it would reactivate dormant follicles.
  • 10. Anyway, it was Dr. Orentreich who was the first in North America to successfully transplant hair for the cosmetic benefit of men with male patterned hair loss (the term had not been used yet) and it was his work that opened the gates to hair restoration being a cosmetic procedure to "cure" baldness. Before Dr. Orentreich there was work being performed in other parts of the world, most notably in Japan.
  • 11. Dr. Shojui Okuda (1886- 1962) is the unsung hero of hair restoration.
  • 12. Dr. Okuda, however, built upon Sasagawa's work and was transplanting anything and everything he could think of. He transplanted hair from the scalp to the arm for experimentation. He rebuilt eyebrows, pubic regions, and even eyelashes. His tools included surgical punches up to 4mm in diameter (a true punch plug) and as small as 1mm in diameter. He noted that the smaller punches were much more difficult to get viable hair so he usually stuck with 2mm to 2.5mm incisions but the point is that he used 1mm punches on many occasions and noted in his journal how the cosmetic effect was superior to that of the larger punches he used.
  • 13. The "Okuda papers" were published in 1939 and at this point he had already been performing surgeries for ten years. Dr. Okuda never wrote about using his hair transplantation methods for treating male patterned hair loss. However, in 2009, Dr. Okuda's grandsons opened up a room that had been storing their grandfather's equipment and it had previously remained undisturbed for at least 30 years. Among the items in storage were before and after photographs of successful hair transplant procedures that were undocumented in his papers thus indicating that Dr. Shojui Okuda is the true pioneer and father of punch grafting. Atlas Oral Maxillofac Surg Clin North Sep; 6(2):39-53.
  • 14. About four years after Dr. Okuda's papers were published there was a second Japanese doctor that started to improve on Okuda's hair transplant technology by using smaller punches on a regular basis. Dr.Tamura used smaller punches of roughly 1mm more frequently than Dr. Okuda and even went so far as to refine the grafts that were harvested by trimming and dissecting them before implantation. He published his papers in 1943 in the Japanese Dermatological Journal during the height of the Pacific campaign ofWWII.
  • 15. Dr.Tamura's refinement of Dr. Okuda's work is a more direct fore bearer to the modern FUE procedure we have today and in effect it renders any recent claims of being "the first" null and void.The first was Dr. Okuda and subsequently Dr.Tamura. It would be a long time before western medicine would learn of these two true pioneers as the information they documented was inaccessible due to WWII and it's aftermath.(Credit: American Hair LossAssociation). It wasn't until 1959 with Dr. Norman Orentreich, mentioned at the top of this page, that western medicine caught on but unfortunately it was not in the form of refinement that one would expect with time.
  • 16. Fast forward to 1975. Disco was king and so was polyester and crazy hair. Lots of great things came out of the 70's including Dr. O'tar Norwood and his classification system known as the Norwood Hair Loss Chart. this was fairly important as it helped to standardize how hair loss was measured and this allowed for easier diagnosis and treatment recommendations by hair restoration clinics.
  • 17. It isn't entirely accurate however as there are several patterns found in nature on a regular basis that are not represented on the NW chart but it gets the basics down well enough. Dr. Norwood's classification system also gave the public a way of understanding their own hair loss. They could simply look in the mirror then look at the chart.
  • 18. Once a balding man knew where he was on the chart it would psychologically give them a solid base to associate themselves so they could take action to actually do something about their problem.
  • 20. The 1970s also introduced a few alternatives to plug hair transplant technology but mainly they were adjuncts to the procedure overall. First you have the scalp flap. The scalp flap was first performed in the 1930s but it never caught on till Dr. Jose Juri ofArgentina introduced the Juri Flap in 1969. A scalp flap is an extremely invasive procedure that requires a high degree general and plastics surgical skill to perform successfully and even then the outcome is questionable. Basically this involves removing a large piece of tissue from one area of the scalp and rotating it to another area in need of hair.
  • 21. Various forms of scalp reduction surgery.
  • 22. Scalp reduction Another hair transplant technology alternative is the scalp reduction. Scalp reductions were procedures that literally remove the area of scalp that had hair loss and then pull the edges of the wound together so that the areas of still strong growing hair would be much closer to each other thus you have a reduction of hair loss from this reduction of scalp. It made sense at first glance because youre just cutting out the problem and throwing it away but the problems emerged when arteries would be cut thereby inducing nearly uncontrollable bleeding or when the final result matured the patient would have difficulty styling their hair. This was due to the natural hair geometry being completely distorted from the procedure. Both scalp flaps and scalp reductions have thankfully had their short time in the history
  • 23. Punch grafting survived the 1970s and continued to thrive into the 1980s.There were some doctors that had tried to use punches significantly smaller than 4mm but none were successful, or at least not enough to warrant creating change, but there was something different that started to push the industry forward. It was the pattern of plug extractions that helped to usher in the next big change.The way that doctors would traditionally remove punch grafts is that they would take their plugs from random areas of the scalp.
  • 24. Sometimes in close knit groupings and other times spread out over the entire safe donor zone and sometimes well outside of the safe donor zone. But some doctors started to see that when the plugs were extracted close enough together, and in a pattern that formed something similar to a rectangle, they would see that they were creating one large wound that forced them to suture the wound closed. EUREKA!!! No more punch scars!
  • 25. Eventually someone got the bright idea that a scalpel might be a better way to get out this new rectangular pattern of hair bearing scalp so that patients wouldn't have the buckshot scarring from surgery any more. It kind of makes sense, right? Well, the problem is that someone still decided that it should be easier, not better, so now we have the multi-blade scalpel.
  • 26. Typical multi-blade scalpels. The multi-blade scalpel is a medieval looking piece of hair transplant technology that takes two to four scalpel blades and puts them in one handle.This means that the doctor can just make one swipe of the scalpel(s) and you've pretty much got up to four narrow strips to dissect hairs from for placement into the recipient scalp. Don't worry about follicular transection because there's plenty of that to go around. Enter the age of the mini-micro graft.This is where the experience of yours truly comes into the picture, as this is the procedure I had performed in the early 90's.
  • 28. Mini-micro grafting is not such a bad procedure if performed by someone that gives a damn. No, it can work well but there are several disadvantages to the method. If a multi-blade scalpel is used to harvest the donor hair then many of the grafts in the donor zone, both in the strip removed and the adjacent areas of the donor zone left behind, will be transected and rendered useless. This leads to permanent shock loss in the donor zone and less growth of transplanted hairs for the final result months later. It was a step in the right direction but not quite there.
  • 30. In 1994 there was a good ole boy in SanAntonio,Texas by the name of Limmer, Dr. Bobby Limmer, and we have him to thank for the common sense approach of actually caring about how hair transplants look.What Dr. Limmer did was basically take the industry of hair restoration, shove it down a cannon tube and fire it forward into the age of common sense. Dr. Limmer presented the world with the idea that using stereoscopic dissecting microscopes for the dissection of follicular units would provide for a more natural result and a higher yield (growth rate) of transplanted hair
  • 31. As it turns out he was right and with that he ushered in the age of the follicular unit transplant. Follicular unit grafting via stereoscopic microscopes allows for 30% higher yield of the transplanted grafts and it allowed for refinement that was much more difficult to detect. Finally, it only took about sixty years after Dr.Tamura for the western world to finally get it.
  • 32. Follicular unit grafting did not actually take off quickly from the start. As with any new development, when it comes to hair transplantation, it was met with massive resistance but eventually it became the gold standard in the field and this is still the case today (2015) where approximately 67% (as of 2014) of all hair restoration surgeries are carried out via FUT
  • 33. . In the beginning of FUT the biggest procedures were in the range of 800 grafts to 1200 grafts but with time there were improvements to follicular unit grafting and the donor harvesting process as well.Yields continued to climb and harvests of hair continued to grow to the point that today there are many clinics that routinely harvest up to 4000 grafts in a single procedure.There have been many cases of clinics going larger but going beyond the 4000 to 4500 graft range is considered by many to be pushing the envelope just a little too much.
  • 34. . A lot of people call themselves pioneers but the true, original pioneers of FUE were Okuda andTamura.When you're using 1mm punches for moving hair, you're performing FUE. But, the modern pioneer of FUE is Dr. RayWoods. No one else can make this claim simply because no one else can back up their claims with solid and unquestionable proof. Dr. Woods can and anyone that says otherwise is simply lying. So FUE got its start in North America with Dr. Rob Jones ofToronto and Dr. Alan Feller of NewYork. Both of these doctors saw the merits of the procedure and Dr. Feller in particular, who is kind of a gadget geek to begin with, started working on his own tools and he was the first in North America to create his own FUE hair transplant technology
  • 35. The hair restoration industry has slowly but surely started to transition away from strip toward FUE but the real push began around 2008 with the introduction of Neograft速 hair transplant technology. Neograft速 is a motorized, hand held FUE device that has a rotating punch that scores the follicular unit.
  • 37. This is nothing new as there were other motorized punches being developed and introduced around the same time but the Neograft was different in that it offered extraction AND implantation. It was a novel and unique idea.The way that it works is that once the graft is scored a high powered vacuum attached to the end of the hand held wand would suck the graft out of the donor scalp, through a tube, and into a reservoir filled with chilled saline as a storage medium. Once the grafts were extracted the user would make some adjustments to the machine and then the system would push the grafts back through the tubing to be inserted into the recipient sites made by the wand.
  • 38. First, it introduced an opportunity for the industry to gain more main stream appeal as Neograft created a massive media and advertising push that had one simple but very effective message.There is no strip scar from the procedure. People that took the time to investigate and research hair restoration techniques knew about FUE in general but the lay public had no idea what was involved and they only knew that strip surgery meant a strip scar and the Neograft technique as many later referred to it, offered no strip scar.The company focused on this message and completely avoided the issue of quality of growth and let the public assume that all results would be the same.
  • 39. The second reason that Neograft made an impact on the industry is because they introduced what was essentially the first turn key hair transplant clinic in the world. For a fairly nominal fee one could purchase a Neograft machine, rent a small office and maybe hire a receptionist and they could start offering surgery after taking a single weekend training course. Neograft has a team of traveling technicians that would also travel to new clinics to help get them up and running but the formula was simple. Sell as many machines as possible for a decent price. It worked and now Neograft is one of the more recognized names to anyone researching hair restoration. Any doctor or clinic that has the slightest interest in offering hair restoration alongside tummy tucks and Botox injections can now do so.
  • 40. The Future of HairTransplant Technology The ARTAS robotic surgical hair transplant system
  • 41. In 2011 the potential future of hair transplant technology received 510K clearance by the United States FDA.The ARTAS速 system by Restoration Robotics was introduced shortly thereafter.This is the first and currently the only robotic hair restoration system. It is exactly as it sounds. A robotic arm with a punch tipped apparatus makes incisions and scores grafts for extraction.The system is actually fairly limited in that it does not remove grafts on its own and it does not place any grafts.Trials are currently underway however to allow the system to make incisions for placement
  • 42. The idea behind the ARTAS速 system is that it takes the element of fatigue away from the procedure and introduces the use of highly developed algorithms that supposedly offer faster and more reliable scoring of grafts. One unique aspect of the system is that it is constantly being updated based on regular system feedback from each individual machine in use. This means that with every software update that the system goes through it is bringing the lessons learned from the cumulative number of surgeries performed prior to the update.
  • 43. This has the potential of offering exponential improvements for the accuracy and reliability of the system. Currently the system is using punch sizes of .9mm to 1.1mm but in the early days of its use it was using punches as large as 1.6 and 1.7mm respectively.The progress has been steady and currently Restoration Robotics is working on improving the system to allow for .825mm punches.
  • 44. Current limitations of the ARTAS速 hair transplant technology include the ability to only work on darker, straighter hair. It has trouble removing grafts from certain areas of the scalp on even the best candidates so supervising doctors must have the ability to compensate by offering alternative means of extraction with either hand held motorized punches or manual punches.

Editor's Notes

  1. He performed hundreds of hair transplant procedures and he documented his work in such detail that it is thought that no one has documented as thoroughly since. He wasn't the first in Japan to perform hair transplantation as there was Dr. Sasagawa who actuallydeveloped his own hair transplant technology by making custom needles in 1929 but the paper he published showed he was unsuccessful with heterograft transplantation.
  2. If a doctor points to a picture and says "This is you." and you don't like the picture thenit is easier to point at another picture and say, "But this CAN be you if you pay me to move these 67 plugs for you.
  3. When I say that the tissue is rotated I mean literally it is rotated like twisting a wet towel. It isnt fully removed because, get this, you need to keep it attached to the major blood vessels that keep the tissue alive.