The goals of most improvements in hair transplant techniques over the past 50 years have been to make donor harvesting less invasive, to increase accuracy for optimized growth, to generate grafts in a size that mimics nature, and to create recipient sites that result in natural hairlines that are aesthetically pleasing, but undetectable as a restoration.
One of the self-limiting factors in hair restoration, particularly follicular unit extraction (FUE), is that it has traditionally been subject to error caused by fatigue and other limitations of the human operator.
This is a fundamental reason why the introduction of robotic technology for performing critical aspects of the FUE procedure has been such a game-changer. In the hands of an experienced hair surgeon, the ARTAS™ Robotic Hair Transplant System is a powerful tool for creating natural, reproducible outcomes.
With the latest version of the platform, the recently released 9x upgrade, Restoration Robotics™ has engineered a faster and more accurate system for hair restoration. The improved accuracy of harvesting and shortened procedure increase graft viability. The smaller needles reduce scarring for a faster return to normal activity while allowing patients to wear shorter hairstyles.
BRIEF HISTORY OF HAIR TRANSPLANT TECHNIQUES
Norman Orentreich is widely credited with introducing the concept of “donor dominance” in the 1950s—the idea that transplanted hair continues to display the same characteristics of the hair from where it was taken.1 This means that continued growth at the recipient site is predicated on harvesting viable hairs from the donor site.
In other words, the genetics for hair loss resides in the follicle rather than in the skin. However, due to limitations in graft harvesting technology, cosmetic outcomes of early transplant procedures were often unsatisfactory.
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The large scars associated with early “hair plug” techniques were largely eliminated by the introduction of mini-grafts in the 1970s.2 This was followed by micro-grafts of 1-2 hairs. Mini-micrografting could be repeated hundreds or even thousands of times to cover large areas of baldness—but early manual techniques for doing so often yielded inconsistent graft quality and still resulted in scarring on the patient’s scalp, albeit less noticeable than previously.3
In follicular unit transplantation (FUT), introduced in 1995 by Bernstein and Rassman, individual follicular units were dissected from the donor strip and became the new building blocks of the hair transplant.4 Importantly, proper execution of FUT required the use of a stereo-microscope, a technique that was pioneered by Dr. Limmer.5 FUT/strip became popular because it produced completely natural results with minimal recipient site scarring and could be used to cover large areas of the scalp.
A limitation of FUT, however, was that patients often needed to wear longer hairstyles to cover the linear scar in the donor area. Nevertheless, FUT improved graft viability, consistency, and naturalness compared to mini-micrografting, and it remains in use today as an option for patients who want to maximize hair yield and are not concerned about the linear scar.