By Jeffrey S. Epstein, MD, FACS

Robotics in hair transplantation: cutting through the hype.

Several robotic devices—the NeoGraft® and the ARTAS®—have been introduced to assist with hair Epstein robot-opttransplants. These devices, which have been 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, these robotic devices are designed to reduce the number of assistants required to properly perform hair transplant procedures.

They mechanically facilitate or actually perform the removal of hair grafts through follicular unit extraction (FUE). This technique involves the removal of grafts one by one, and is an accepted alternative to the more popular follicular unit grafting (FUG) technique, which obtains the grafts from a single donor-site incision.

The FUE technique has rapidly grown in popularity because there is no donor-site incision scar. This allows 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, and there is no need to shave the back of 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 take to obtain them. In most cases, strip procedures result in a fine-line donor-site scar that is not detectable even with short haircuts.

Hair Transplants Inc

The ARTAS completely automates the graft-extraction process, relying on sophisticated computer

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technology to remove each graft by itself. The NeoGraft, which facilitates the removal of each graft, 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. These devices can make the graft-removal process more efficient, and they avoid the making of a 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.

Epstein bio
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. He can be reached at