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MEGA session - 5000 ARTAS FUE- ONE DAY Surgery - More grafts than STRIP

The attached photo is the above mega-strip scar, excised, 1 day post-op. A .85 punch was used. The two photos on the right are of a different patient’s extraction sites. The lower photo is 3 months post-op. Even under magnification, I could only find one of the 12 extraction sites as indicated by the blue arrow. Because the image is magnified, one might think there are wide spaces between the follicular units. Note the white arrows. The white arrows indicate natural spaces where there were never any grafts removed. This is what can be achieved through minimal-depth extraction and by using a physician directed, smaller punch as opposed to larger robot directed punches. ACell doesn’t always eliminate hypopigmentation but it certainly improves the appearance of donor areas. ACell is approved by the FDA as a regenerative product and we have seen up to 70% follicle regeneration using ACell with minimal depth extraction and the average regeneration of about 50%.

CITNews also posts as 35YrsAfter and works at Dr. Cole’s office


Cole Hair Transplant
1045 Powers Place
Alpharetta, Georgia 30009
Phone 678-566-1011
I am not a doctor and the content of my posts are my opinions, not medical advice.
Please feel free to call or email me with any questions. Ask for Chuck

[quote][postedby]Originally Posted by Sure Hair Transplants[/postedby]
You are comparing that scar to this guy 10 days post??[/quote]

No not at all. A rep dropped into this thread and appeared to be entertained (see above animation).

CITNews works at Dr. Cole’s office


Cole Hair Transplant
1045 Powers Place
Alpharetta, Georgia 30009
Phone 678-566-1011
I am not a doctor and the content of my posts are my opinions, not medical advice
e

Those before and afters were impressive. See - I looked at the photos, they were good and I said so. Can you not look at the before and after of 3500 FUE with ARTAS - only 10 days post and not admit what is obvious - that the donor looks AMAZING! Or how about the video with a completely skin shaved donor where there is barely any scarring - again. Nothing personal - but how can you say there is going to be horrible donor scarring when clearly there is not even only 10 days post. Again, I just look at before and afters and comment on proof and reality. I understand you can’t endorse ARTAS, but just because you don’t like the technology does not take away from the fact the scarring - 10 days out is AMAZING. FAR FAR FAR FAR superior to ANY STRIP surgery.

I watched the video you posted of your 1500 graft case. Did he have 1500 grafts removed and placed over the course of 2 surgeries? in the video, you showed about 2/3 of the donor extraction sites. Liberally, with a counting incision device we could count 333 extraction sites. There surely weren’t 1167 extractions taken from the remaining 1/3 on the right side?

CITNews works at Dr. Cole’s office


Cole Hair Transplant
1045 Powers Place
Alpharetta, Georgia 30009
Phone 678-566-1011
I am not a doctor and the content of my posts are my opinions, not medical advice

Wow. You equate a a FUE surgery to a brutal STRIP surgery, suggest it needs repair - when by the way some of the founding fore fathers of FUE not only embrace but USE and practice ARTAS FUE in their clinic, then when I post amazing 10 days post FUE results you refuse to address them and then try so slam our FUE work? The issue is that anyone who reads this thread will see REAL PHOTOS AND REAL RESULTS - and that my friends counts for any of your unreal thoughts and ideas about bad scarring, and whatever negative reviews you have. We do great work. PROOF is in video.

333 grafts eh? (I’m Canadian so we use EH). I’ll answer this simply via the following. Does this before and after look like 333 grafts? Didn’t think so :slight_smile:

Why does it bother you so much that we can do great work? Because it’s not your shared view? Either way the result speaks for itself.

I love this thread because you talk about a repair and then can’t address the undeniable fact that those 3500 grafts are not visible only 10 days out. I am still waiting for you to bring any VIDEO/PHOTO and proof to validate anything you have said - which to this point - for the record you have not.

The comment relates to the number of extraction sites that are visible in post surgery photos. At best, he can see a little over 300 extraction sites. That’s a long way from 1500 extraction sites.

I don’t think it’s possible to suggest that FUE done by any means leaves an undetectable donor area in all instances. when one claims to extract 1500 grafts, but they extract far fewer grafts (in this instance about 333 in 75% of the donor area), they are asking for trouble. People are not fools. Those of us who have been doing this a long time certainly are not fools. When we can look at a donor area and we see a widely scattered extraction pattern that is not consistent with 1500 grafts extracted, you are asking for trouble. Are we supposed to believe you or our lying eyes?

Look, it is impossible to comment on the before and after photo in this instance. In the before photo there is a hint that there is some pre-existing hair along the hairline that has been trimmed down and obscured by over exposure. The hair in the before is much shorter. The hair in the after is longer. It is clear that some grafts were placed in the peaks as these grafts are clearly obvious. In front of these larger grafts are some finer, lighter hairs. Grafted hairs should all be the same color and darker rather than lighter. The curtains don’t match the carpet in this case. The longer hair alone in the after photos can make this NW 2 look like he has far more hair. In other words, you have to do better than this to convince an expert in the field of surgically treating hair loss. You need much better before and after photos. Furthermore, if you want to be taken seriously, don’t show a donor area that had no more than 350 grafts taken from the 75% we can see and pass it off as a donor area where 1500 grafts were harvested. And….yes we can see hypopigmented extraction sites in your donor area. It is not surprising that we can see them, but there are certainly fewer than 1500. If you had harvested 1500 grafts, we might be impressed. In that you did not harvest 1500 grafts, and you claimed to have harvested 1500 grafts we have to question you.

An average donor area in a Caucasian male has about 15,200 follicular units in the safe donor area. A maximal harvest in a single pass consists of about 25% of the donor area. That is far less than the 5000 grafts you claim to have harvested in this individual. Now, you did extend your harvest outside the safe donor area primarily in the mid-occipital area. However, you did not extend enough to have harvested 5000 grafts. Moreover, your extraction pattern is not maximal. It is closer to 10% rather than 25% of the donor area as many areas are skipped altogether. Now add to this that you claim the patient is 60 years old. The Artas is not indicated for use in non-pigmented hair. You can dye the hair, but you can’t dye all of it. Also, dying the hair will leave a dark pigment on the skin that one can see. We don’t see this. To achieve 5000 grafts, you would have to maximally harvest the donor area. In that the Artas cannot see white hair, even if you did dye the hair, you can’t dye all of it so it’s impossible for the Artas to maximally harvest a patient with white hair. When you add to this photos where you claim to have harvested 1500 grafts, but in 75% of the donor area you chose to exhibit, we see no more than 350 extraction sites. Now, if I add to this that in the best of hands, it is possible to harvest 5000 grafts, but you will see 5000 extraction sites. The individual patient where you can harvest 5000 grafts from the safe donor area in a single pass makes up less than 5% of all hair transplant patients. Your patient would have to be in the top 1 to 5% of all patient donor areas to harvest 5000 grafts in a single pass. Yet, as men mature, they tend to loose follicular density rather than increase follicular density. To achieve 5000 grafts with an Artas, you would have needed to attempt over 6000 extractions and this becomes mathematically impossible. Nothing in your stories adds up.

I don’t know if you are intentionally trying to mislead people or whether you are just plain dumb. Here are a couple of tips for you. In your videos, just show your results and talk about what really happened. Don’t try to pass off a NW 6 as a guy heading to a NW7. Don’t say a that all the hair on his head is from a transplant when it is clear that he started with a retained frontal tuft and that tuft is still there. You might fool a patient who does not know any better, but any seasoned veteran in hair transplant surgery knows that a retained frontal tuft always makes the result look much better than if they frontal tuft was not retained. Don’t exaggerate your results to make it seem that your results are much better than what others with equal or more talent can achieve. Don’t claim to have performed a world record type procedure, when it is clear that you have not. You are acting like a used car salesman and it shows. Tone it down just a little and I’m sure you will have a very successful life.

There is a lot of accusations here and I will reply to all of them. However, I want to be clear:

Dr. Cole. In all due respect. You wrote:

In average donor area in a Caucasian male has about 15,200 follicular units in the safe donor area. A maximal harvest in a single pass consists of about 25% of the donor area. That is far less than the 5000 grafts you claim to have harvested in this individual. Now, you did extend your harvest outside the safe donor area primarily in the mid-occipital area. However, you did not extend enough to have harvested 5000 grafts. Moreover, your extraction pattern is not maximal. It is closer to 10% rather than 25% of the donor area as many areas are skipped altogether."

I’ll go with these numbers. In essence you are saying that if we had extracted 10% of the harvested area in the safe zone you are suggesting that would be around 1,500 grafts. In a gentleman who is older - who is outside the safety zone - you would agree, in your opinion - that he has probably no more than 25,000 grafts in this area - so you are suggesting we pulled around 2500 grafts give or take?? I just want to clarify what you are suggesting the amount of grafts we extracted were.

Luckily I do have photos :slight_smile:

If you read the previous posts, you will see what this pertains to.

Here are the 1500 FUE photos. We were testing a 1mm punch with this gentleman prior to purchasing the ARTAS to see how the healing would be. The photo in the Youtube Video here –http://www.youtube.com/watch?v=a8qeBmJAJ8I

Shows this patient after his first day of surgery. We chose this photo because in the post second day we used gauze. That being said you can see the photo here of this gentleman after his first day, donor.

This is a photo of the gentleman on the morning of his SECOND day of surgery.

This is the photo of the gentleman post second day in the recipient. You can see - very simply that there are far more than 500 grafts place. We drilled PRECISELY 1500 grafts and planted abour 1250-1350. This patient was done in early 2012, so I am looking to find out the exact planted graft count. This patient was also informed that the survival rate might be lower and was provided the exact graft count.

You can see above the gauze around his head in the after second day and sadly, around the back of his head. Nonetheless the recipient shows the amount of grafts and no doubt 1500 “attempts” were had. Thus in the video above, you can see how impressive the results are regarding scarring.

As mentioned before I like facts and photos :slight_smile:

Just to also advise everyone that I we are obtaining a copy of the 5000 graft FUE case from ARTAS which STATES, PRECISELY how many punches were extracted in the case in this thread.

I honestly believe that slamming someone, and taking personal shots, just because you believe something different is extremely unprofessional. We have proof. Real numbers and that is far more important than any persons “perception”

Furthermore. This article here --> http://www.hairsite.com/hair-loss/board_entry-id-114196.html

You can read from Dr. James Harris the reality on the Robot as follows:

Dear Dr. Cole:

I appreciate your comments and concerns however it’s obvious that many of your statements, and the conclusions drawn from them, are based on incorrect notions and ignorance about of some of the basic facts regarding the ARTAS System. There are numerous instances of these lapses, and in fact too many to address, but in the body of your text below I will attempt to provide explanations IN RED about some of your misperceptions and mischaracterizations of the ARTAS System and the physicians using the system.

Respectfully,
James Harris, MD, FACS

Ziering Medical video series: ARTAS automated hair transplant (Hair Transplant)
posted by Dr. Cole , Atlanta, Ga, 14.01.2013, 20:07

The mean follicle transection rate is 8% with the robot. That means some times it will be over 15%. And sometimes it will be 1%. In fact the usual range is 2-12%

In my opinion, a mean rate of 8% is too high, but when the rate soars over 10%, you should look for ways to bring the transection amputation rate down. There in lies a major problem with Artas physicians. THE ARTAS PHYSICIANS FOR THE MOST PART DON’T KNOW HOW TO DO FUE SO WHEN THINGS GO TO HELL IN A HAND BASKET WITH THEIR ROBOTIC EXTRACTIONS; THEY HAVE NOTHING TO OFFER OTHER THAN AN UNACCEPTABLY HIGH ARTAS T-RATE. Transection rates are by no means the gold standard in assessing the success of a particular technique. The problem is that you may have a case with a very low transection rate (say less than 4%) but the patient has poor growth (and you cannot possibly deny this has ever happened to you) so obviously there were other factors that contributed to the failure and most of these relate to graft handling. During graft extraction from the skin, especially with limited depth sharp dissection, excessive crushing trauma can be inflicted on the follicles that will affect growth. Technicians can mishandle the grafts and cause desiccation or trauma during insertion. The loss of grafts from these factors can make an 8% transection rate pale in comparison.
What the ARTAS System and it’s blunt punch dissection technique offers is a deeper level of dissection which means less tethering and therefore less force and less trauma during graft removal. The other factor is that on the average the system creates grafts with more fat and connective tissues around the follicles which has been shown in studies to be beneficial to graft survival. These factors allow good hair restoration surgeons to provide the highest quality FUE results. The ARTAS System is a tool, an instrument, for conducting FUE and you can’t logically ascribe unethical intentions or “disinterest” on the part of the physicians that use it.

As mentioned and acknowledged by those using the ARTAS the transection rate in many cases are under 8%. This patient above in no exception.

Thus, based upon the above, one does not need to extract 6000 grafts in order successfully pull 5000 grafts (this would suggest the transection rate to be around 20% which is completely false).

This is reality. Fact. Truth.

:slight_smile:

Regarding the post-op donor area pic with 300 / 1500 grafts debate:

I see only a few hundred little red scabs. But I see way more than 300 spots in that guy’s donor zone which appear to be missing a graft and looking kinda pink. Perhaps not every graft extraction hole was wearing a crimson red scab at the time of the pic.

Random question about the ARTAS:

Does this robot have the capacity to do “low depth extractions” in any way? Like perhaps an adjustable setting in the future if not already built in today?

I don’t wish to derail the discussion into a debate about donor regeneration. But GENERALLY SPEAKING there seems to be an increasing amount of evidence throughout the HT world that some donor site regrowth is possible in the right circumstances. I’m asking if the ARTAS has the potential to take advantage of this phenomenon in the future or if its method of action rules it out.

Hi Cal:

You wrote

"Regarding the post-op donor area pic with 300 / 1500 grafts debate:

I see only a few hundred little red scabs. But I see way more than 300 spots in that guy’s donor zone which appear to be missing a graft and looking kinda pink. Perhaps not every graft extraction hole was wearing a crimson red scab at the time of the pic."

Thanks for the comment and posting the obvious :slight_smile:

You wrote

Random question about the ARTAS:

Does this robot have the capacity to do “low depth extractions” in any way? Like perhaps an adjustable setting in the future if not already built in today?

I don’t wish to derail the discussion into a debate about donor regeneration. But GENERALLY SPEAKING there seems to be an increasing amount of evidence throughout the HT world that some donor site regrowth is possible in the right circumstances. I’m asking if the ARTAS has the potential to take advantage of this phenomenon in the future or if its method of action rules it out.

To my knowledge - and speak frequently with them - the answer is no as far as low depth extraction. They are currently building an extension on the machine to make recipient sites - this seems to be where the next step is going as far as the ARTAS.

At the end of the day - the ARTAS is a tool sold by a company to make money - and unless there is definitive evidence that donor regeneration is possible, it would be bas business on their end to take such a step. This is of course only my opinion.

We have been paying close attention to donor regeneration with those mentioned on this site and have actually emailed them to see if we may be able to work together but have yet to hear back. I’ll keep you posted.

Let me make this clear. You are dishonest in your presentation of the Artas and your procedures. All Artas physicians now recognize that the number of excision attempts is well below the number of grafts removed. This is the missed graft rate. you are not a physician so you have no clue what you are doing or what you are producing. Why would Artas sell a device to a non-physician? I don’t have a clue.

Anyway, Artas has many problems. One of them is the missed graft rate. The other is the transected follicle rate. The other is the transected graft rate. Who is paying for all of these mistakes? Patients!.

i think you feel that I’m attacking the Artas because i make my own equipment. Let me make this clear. Artas never came out with a good product before they began marketing their robot. I made 5 versions before i ever marketed a single version or even used a single version. The simple fact is that good equipment will do a good job. Bad equipment will do a bad job. One cannot turn something bad into good. This is true in many ways. i can put my great equipment in the hands of bad surgeons all day long and they will not do a good job. Only good surgeons can make great equipment work well. When you have poor hands, you have no choice. You have to go to the poor option or the Artas. If the doctor is bad, he buys the Artas. If the doctor is good, he buys a better product. A great product cannot turn a bad doctor into a good doctor. A bad product like the Arats cannot turn a bad doctor into good because the product was bad to begin with.

I do not think I have run into any individual on the forums to date that I would label as someone whose name begins with L and ends with R with an A and I in the middle though not necessarily in that order. Sure hair, i think you are the first poster I’ve met in a moderated forum with such a designation. I would not walk from you clinic. I would run from it.

Now, if you want to involve Craig Ziering or Jim Harris in this conversation, since you want to toss them into the mix, feel free to do so. I’d love to hear their comments about your absurd claims to have done a 5000 graft FUE case with the Artas. If they substantiate your claims, we can then begin to have a very serious conversation. I highly doubt that either is dumb enough to back your ridiculous claims especially based on your absurd photos that you feel are supportive despite the fact that your photos clearly refute all of your claims.

Dear readers,
There are just 2 pieces of information I would like to share.

In ESHRS (European society of hair transplant surgery) meeting some time ago, the ARTAS marketing rep gave a presentation about their robot.

They said its FDA approved and a beneficial (I forget the exact word) to any hair transplant doctor’s practice.

Seems a fair enough statement?!
But I asked them 2 questions -

  1. You know ARTAS is approved only for straight, fine calibre brown hair? So why are you not mentioning this tiny detail here. Its not approved for any other hair type.
    Giving part information to doctors could land them in trouble with their patients.
    (I do not remember his exact reply, but suffice to say, he did not talk to me for the next 2 days).

  2. I asked did ARTAS give meaningful improvement for an HT doctor who IS an expert already.
    The reply was that Dr. Harris evaluated the ARTAS and his own method and found no meaningful improvement.

So, I raised a question, wouldn’t it be better to learn all aspects of HT surgery from an expert (not cheap 2 day workshops), learn all the aspects of HT for an year at let us say USD 1,00,000/- rather than pay USD 2,50,000?- for a so called robot and end up paying additional USD 1/- for every time the robotic punch goes in whether it gets an intact graft.

You guessed correct… I got no reply.
Regards,
Dr. A

P.S. - If you think there are any inaccuracies in my above post, please remember this conversation was not private but carried out in front of the entire ESHRS conference.

[quote][postedby]Originally Posted by Sure Hair Transplants[/postedby]
Those before and afters were impressive. See - I looked at the photos, they were good and I said so. Can you not look at the before and after of 3500 FUE with ARTAS - only 10 days post and not admit what is obvious - that the donor looks AMAZING! Or how about the video with a completely skin shaved donor where there is barely any scarring - again. Nothing personal - but how can you say there is going to be horrible donor scarring when clearly there is not even only 10 days post. Again, I just look at before and afters and comment on proof and reality. I understand you can’t endorse ARTAS, but just because you don’t like the technology does not take away from the fact the scarring - 10 days out is AMAZING. FAR FAR FAR FAR superior to ANY STRIP surgery.[/quote]

I am not a doctor but I have seen and read enough to know that the white dots do not appear right away 10 days after surgery. You need to wait a year or longer, then shave the patient’s head and see what happens to his donor. That will be the real proof.

[quote][postedby]Originally Posted by Dr. Arvind[/postedby]

  1. You know ARTAS is approved only for straight, fine calibre brown hair? So why are you not mentioning this tiny detail here. Its not approved for any other hair type.
    [/quote]

Isn’t that interesting!!! Thanks for sharing Dr. Arvind. I didn’t even know that they needed FDA approval for the robot.

[quote][postedby]Originally Posted by Sure Hair Transplants[/postedby]
Wow. You equate a a FUE surgery to a brutal STRIP surgery, suggest it needs repair - when by the way some of the founding fore fathers of FUE not only embrace but USE and practice ARTAS FUE in their clinic [/quote]

To be fair and let’s give credit where credit is due, there is only ONE inventor of FUE and it is Dr. Ray Woods.

Not true at all. Woods was/is not inventor of fue.

[quote][postedby]Originally Posted by Dr. Arvind[/postedby]
Not true at all. Woods was/is not inventor of fue.[/quote]

Dr. Arvind, can you let us know who was the first doctor who invented FUE as a commercially viable mainstream treatment for hair loss?

[quote][postedby]Originally Posted by Dr. Arvind[/postedby]
Not true at all. Woods was/is not inventor of fue.

[postedby]Originally Posted by HairSite[/postedby]

Dr. Arvind, can you let us know who was the first doctor who invented FUE as a commercially viable mainstream treatment for hair loss?[/quote]

Dr Okuda, Japan .

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