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Guest Columnist Author: Jeffrey S. Epstein, MD, FACS Last Updated: Sep 7, 2017 - 10:06:33 PM

Are Hair Transplant Surgeons Really Necessary?

By Jeffrey S. Epstein, MD, FACS
May 15, 2013 - 2:33:40 PM

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Robotics in hair transplantation: cutting through the hype.

( - Several robotic devices including the NeoGraft® have been introduced to assist with hair transplants. These devices, aggressively promoted to the public, are in some cases intended to help inexperienced doctors speed the learning curve and begin performing hair transplants. In other cases, they are designed to reduce the number of assistants required to perform hair transplant procedures.

They mechanically facilitate or actually perform the removal of hair grafts through follicular unit extraction (FUE) - a technique that involves the removal of grafts one by one, an accepted alternative to the more popular follicular unit grafting (FUG) technique, which obtains the grafts from a single incision. FUE has rapidly grown in popularity because there is no donor-site incision scar, allowing most patients to cut their hair very short or even shave it completely without a scar.

This may not be such an advantage over the strip procedure, for a properly performed strip procedure results typically in a higher percentage of hair regrowth without the need to shave the patient's head (unlike with FUE) to obtain more than several hundred grafts. Strip procedures are also less expensive per graft, due to the less time it takes to obtain them.

The ARTAS completely automates the graft-extraction process, relying on sophisticated computer technology to remove each graft by itself. The NeoGraft is more reliant on the surgeon, but the device "comes" with manufacturer-provided technicians who can perform the graft extractions and even oversee the making of the recipient sites.

With the extensive marketing of these new devices, it is important to distinguish hype from reality. They do confer some advantages, namely making the graft-removal process more efficient and avoiding a linear donor-site incision. The NeoGraft unfortunately has been marketed directly to the consumer through fear tactics, implying that strip procedures leave a bad scar while the NeoGraft leaves no scar at all. This is not true, nor is the implication that all hair transplants yield similar results, and that the potential for scarring in the donor area is the critical factor in choosing a technique (and therefore a surgeon). These devices DO NOT and cannot assure an aesthetic result. Like any other plastic surgery procedure, hair transplantation requires the artistic judgment and execution of the surgeon, whose plan can only be carried out by a team of experienced assistants.

I am all for technology. I use a powered device to assist in the extraction of grafts in many of my FUE cases. However, I also personally perform each step of the hair-transplant process from the initial consultation to the actual procedure, including the making of every recipient site (which determines the angulation and pattern of growth) and follow-up care. There is no substitute for artistic ability and proper planting when it comes to hair transplantation, and there never will be.

Reprinted and edited from Plastic Surgery Practice Magazine, April 201

Jeffrey S. Epstein, MD, FACS, is the director of the Foundation for Hair Restoration, and maintains full-time offices in Miami and New York City.

He is also a voluntary assistant professor at the University of Miami Department of Otolaryngology, Division of Facial Plastic Surgery.

Dr Epstein can be reached at (212) 759-3484 or



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