Evolution of FUE Instrumentation: From Hand-held Punch to Robotic Extraction

Dr. Bernstein: Follicular unit extraction was originally done with the small hand-held punch. The problem with a handheld punch is that in order to make a cut, you have to rotate it back and forth in your fingers, and that would take the alignment away from the angle of the hair, and that would increase the risk of cutting through the follicular unit; in other words, to avoid damaging the follicles, you would have to line the instrument up perfectly with the follicular units but the back and forth motion would throw that alignment off. So doctors then switched to a motorized punch; all you would have to do is hold the punch in the right position. But the problem with this instrument was that it would rotate so quickly, and it was so sharp, it was easy to accidently cut through the follicles, essentially like butter So then we started using a two-step procedure: we’d first score the skin with a sharp instrument but a blunt tool would go deeper into the tissue. A very clever variation on this was developed by Jim Harris, called the “Safe System.” It used the same instrument for both steps: it would rotate quickly to score the skin and it would cause a sharp cut initially. Then, it would slow down as it cut deeper into the tissue. This converted the punch into a duller, dissecting instrument. However, the “Safe System” was still a handheld system: the angle was still controlled by the physician and, over hundreds of extractions, one really doesn’t have consistency. The hair transplant robot solves all of these problems. It has the technology of the sharp/blunt dissection, where it is sharp on the surface, and then it has a blunt instrument that goes deeper into the tissue. It is also controlled by a 3-D imaging system to make sure that the head of the robot is perfectly aligned with the hair follicles.

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