NeoGraft and ARTAS Devices for Hair Transplant: Worth It?

By JeffreyEpsteinMD

The purpose of this guide is to educate prospective hair transplant patients about the NeoGraft® and ARTAS® devices.  I write this from the perspective of having been in practice for almost 20 years, and have come to value the importance of proper techniques and artistry in the entire hair transplant procedure, which help create natural appearing results.

The ARTAS® and NeoGraft® devices both assist with hair transplants, following their introduction over the past two years.  While aggressively promoted to the public as the superior technique for performing hair transplants, they work by actually performing (ARTAS®) or facilitate (NeoGraft®) the extraction of hair grafts through what is called the FUE technique.  FUE, a technique I have been performing for over five years, involves the removal of hair grafts one at a time, thus avoiding any linear donor site incision that is associated with the removal of a donor site incision by the strip (or FUG) technique. neograft worth it for hair transplantation?

While the FUE technique has become more and more popular over the past several years, in no way has it eclipsed the frequency of use of the strip technique amongst those surgeons in the ISHRS (International Society of Hair Restoration Surgery), which is the world’s largest association of doctors specializing in hair transplantation.  The reality is, the only true advantage of the FUE technique over the strip is that the FUE avoids a linear donor site incision, thus it not only sounds less invasive, but it also allows most patients to cut their hair very short or (sometimes) even shave it completely without a linear donor site scar.  I say sometimes because in around 30% of men, the tiny punch holes where the hair grafts were extracted heal as small white dots that can be visible with very short haircuts.  Note further that most of my patients who have a properly performed strip procedure are able to cut their hair freely, for the donor site scar is usually not visible except with a near shave cut.  In addition, the strip procedure has other benefits, including typically a higher percentage of hair regrowth, no need to shave the head to extract the grafts, and a lower cost per grafts). 

The ARTAS® utilizes computer technology to guide the device in the removing of each graft by itself.  The NeoGraft® is more reliant on a human to use the device to extract the grafts, but manufacturer-provided technicians can be sent to the doctor’s clinic to perform the graft extractions and even oversee the making of the recipient sites.  This means that minimal input is required of the surgeon into those steps that I view as the most critical in terms of achieving natural appearing results.

Despite extensive marketing-  in particular of NeoGraft®, which is distorts the truth to generate fear over having a strip procedure-  it is important that the hype is distinguished from reality.  Both devices have some advantages, in particular they can help speed up the graft extraction process and potentially harvest very good FUE grafts, but the use of these devices does not assure an aesthetic result.  Like all other plastic surgery procedures, hair transplantation results are largely dependent upon how the procedure is performed, namely the artistic execution and technical skills of the surgeon particularly in the key steps of the procedure. 

The most important of these key steps is the making of recipient sites.  It is in this step that the following outcomes are determined:  angulation of hair growth; pattern of irregularity and feathering of the hairline; design of the hairline; and varying density throughout the scalp.  Once these recipient sites are made, it is then up to the team of qualified  assistants to carry out the surgeon’s vision, through the proper planting of different grafts in different areas.  It is only then that the most aesthetic results can be achieve

I fully support the increasing involvement of technology in all areas of surgery.  For over 24 years, I have been a student of facial plastic surgery, (another 19 years in surgical hair restoration) and have appreciated the improvements in outcome that I can achieve through various devices and products.  Fact, I utilize a powered device to assist in the FUE graft removal process in many cases.  However, there can be no replacement for a surgeon’s experience and aesthetic involvement in a hair transplant procedure to assure that the results will truly be natural appearing.

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Comments (9)

Hello: My name is Dr. Don R. Mueller. I had the Artas hair restoration procedure performed on me, but unfortunately. I ended up with tinnitus (ringing in the ear) in my left ear. I would appreciate telling you of the potential hazards of the Artas procedure to warn unsuspecting "hair transplant" people. Don Don R. Mueller, Ph.D.
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I am not sure how tinnitus would be caused by ARTAS procedure. It is probably unrelated problem. We are one of the most experienced centers in the world with ARTAS and never encountered such a problem or heard about it from the company Restoration Robotics....
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Here is the typical experience of the ARTAS patient: http://www.youtube.com/watch?v=hbYY3I6H1xI&list=UUhXJ0SEYih622hFwl1vdP0A&feature=share&index=3 and also my explanation of the procedure during the interview with April Rose http://www.youtube.com/watch?v=7udWCyEp_ZA&feature=share&list=UUhXJ0SEYih622hFwl1vdP0A&index=1
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These are valuable perspectives. I am in no way saying that FUE is not a good procedure - in fact, over the past 5 years, I have performed over 700 FUE procedures (along with over 2500 strip procedures), and FUE has become a bigger and bigger part of my practice, approaching 200 procedures a year. My point is- ARTAS, NeoGraft- they are not a procedure, merely a tool used to obtain hair grafts that then need to be transplanted into the scalp properly by the surgeon and his team in order to achieve an aesthetic result.

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Our center also operates both Neograft and ARTAS under one roof. Few centers in the world have both systems and experience with both. Patient satisfaction is incredible. The lack of a line scar and quick recovery are invaluable. The results are also natural and no studies have shown FUE to be any different then strip surgery in outcomes. Both methods(FUE and strip) are very good and each patient should evaluate the options when considering which way to go. However, we believe volume and experience matters. The other authors make very good points.
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As Dr Epstein put it in his note _ it all depends on how it is done! I have been an early adopter of Neograft and later ARTAS robotic technology and probably (to my knowledge) have been operating the only center in the world that has experience with BOTH technologies. We have done a couple hundred patients with FUE technology. We have been there from the beginning and the only thing I can say that it works. And it works without scars that can be very problematic, especially for the younger crowd. And without pain and long recovery associated with strip procedures. FUE procedure slowly will replace strip procedure just like in my early years in surgery 25 years ago laparoscopy replaced open techniques of abdominal suurgery
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