Robotic Hair Restoration in Modern Aesthetics

Modern hair transplantation has evolved from punch hair transplantation into more advanced treatment options.1 Currently, the most common hair restoration techniques for commercial use are follicular unit transplantation (FUT) and follicular unit excision (FUE).2 FUT is an invasive surgical procedure where a long strip of scalp with hair follicles is excised in order to get donor hair grafts or follicular units. A scalpel is used to cut and remove a part of the skin, while stapling and suturing are used for closure.3 In contrast, FUE utilises small punches to detach demarcated hair grafts (follicular units) from the scalp.4 FUE requires hair grafts to be harvested individually in a two-step method – sharp punch placed into the scalp and forceps to manually separate grafts – which can be very laborious and tedious due to volumes of up to 2,000 to 3,000 grafts. With many of the issues and challenges with harvesting and implantation discussed above, advancements in artificial intelligence (AI), machine learning and vision have allowed for mitigation of many of the challenges faced with FUE procedures.

A new era in hair restoration The first robotic platform to contribute to the evolution of hair restoration and address its challenges in hair transplantation was the ARTAS® Robotic Hair Restoration System, developed by Venus Concept Inc. (San Jose, CA). This device focuses on AI-assisted robotic FUE. It harnesses the power of mechanical imaging, AI and the robotic execution capabilities of the system to harvest follicular units and create recipient sites. The most recent version, ARTAS iX Robotic Hair Restoration System, virtually robotises the entire hair transplantation process by adding implantation capabilities. ARTAS iX from Venus Concept is a robotic medical device that offers precise, accurate and reproducible harvesting with simultaneous recipient site-making and implantation functionalities in a single, compact platform. The ARTAS iX system contains AI integration, a high-definition multi-camera stereoscopic vision system and state-of-the-art medical-grade hardware that contributes to hair transplantation technology. ARTAS iX’s AI machine learning recognises and digitally maps past, current and future grafts on the scalp. The AI can intelligently analyse, monitor and track each hair follicle’s characteristics, such as the position, angle, size and orientation for optimal harvesting, site making and implantation, delivering repeatability and precision.

An effective alternative Manual FUE is a widely used and clinicallyproven technique in hair transplantation. However, the procedures are often long and require thousands of precise repetitive motions to accurately excise and implant individual grafts. Fatigue can cause pain and discomfort for the clinician, and potentially lead to human error and higher transection and reduced yield rates, particularly towards the end of long cases. Furthermore, manual implantation requires a significant amount of graft handling at the bulb of the hair follicle. Given the relative fragility of the follicles, increased handling can lead to a higher risk of damaging the follicle. The amount of handling, and hence opportunity for the graft to be damaged, is limited with the use of the robotic implanter. Use of an image-guided, AI controlled robotic system, such as the ARTAS iX to assist in the procedure, addresses many of the physical limitations of human vision, decision of the location from which to excise or where to implant, physical fatigue and motor skill precision. At the same time, ARTAS iX produces comparable 12-month results to those achieved using manual techniques by an experienced surgeon. The stick and place method of implantation used by ARTAS iX (placing the graft immediately after incision) reduces bleeding, and eliminates the need for continual cleaning of the recipient sites of blood as is common when sites are premade. ARTAS iX is able to excise hairs at a rate of 1,000 grafts/hour, which is at the top of the range possible by an experienced surgeon doing a manual hair transplant. Typical excision rates vary between 100-1,000 grafts/hour for the manual method. The implantation rate is 500 grafts/hour, which is significantly faster than manual stick and graft placement rates of about 400 grafts/ hour. The ARTAS iX can provide clinicallyefficient surgical workflows that are superior to manual techniques, with the potential to reduce total case time for FUE procedures, while at the same time reducing graft manipulation thanks to the stick and place technique used by the device.

How artificial intelligence and technology developments are revolutionising hair restoration

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REFERENCES

1. Chumak M, ‘Robotics in Hair Transplant surgery’, Hair by Dr. Max,

Restoration Center 2. Berman D, ‘Robotic, AI-assisted Follicular Unit Incision and

Implantation for Hair Restoration with ARTAS iX’, Berman Skin

Institute. 3. Williams KL, Gupta AK, Schultz H, ‘Ergonomics in hair restoration surgeons’, J Cosmet Dermatol, 2016. 4. Avram MR, Watkins SA, ‘Robotic Follicular Unit Extraction in Hair

Transplantation’, Dermatologic Surg, 2014.

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