Megasessions for Robotic Hair Restoration

November 2016 | Volume 15 | Issue 11 | Original Article | 1407 | Copyright © November 2016

João Carlos Pereira MD,a João Carlos Pereira Filho MD,b and João Pedro Cabrera Pereira MDc

aDERM - Private Clinic and Day Hospital, São José do Rio Preto, SP, Brazil; College Medicine of Catanduva, SP, Brazil bSobrapar - Skull and Face Institute, Campinas, SP, Brazil cPhysician University Santo Amaro, UNISA, Santo Amaro, SP, Brazil

A robotic system can select and remove individual hair follicles from the donor area with great precision and without fatigue. This report describes the use of the robotic system in a megasession for hair restoration. Patients were instructed to cut their hair to 1.0 to 1.2 mm before surgery. The robot selected and removed 600 to 800 grafts per hour so the follicular units (FU)s could be transplanted manually to recipient sites. The robot arm consists of a sharp inner punch and a blunt outer punch which together separate FUs from the sur- rounding tissue. Stereoscopic cameras controlled by image processing software allow the system to identify the angle and direction of hair growth. The physician and one assistant control the harvesting with a hand-held remote control and computer monitor while the patient is positioned in an adjustable chair. When the robot has harvested all the FUs they are removed by technicians with small forceps. Hairline design, creation of recipient sites, and graft placement are performed manually by the physician. Clinical photographs before and after surgery show that patients experience excellent outcomes with the robotic megasession. Phy- sician fatigue during graft extraction is reduced because the robot performs the repetitive movements without fatigue. Variability of graft extraction is minimized because the robot’s optical system can be programmed to choose the best FUs. The transection rate is reduced because the robot’s graft extraction system uses two needles, a sharp one to piece the skin and a blunt needle to dissect the root without trauma. A robotic megasession for hair restoration is minimally invasive, does not result in linear scars in the donor area, and is associated with minimal fatigue and discomfort for both patient and physician. Healing is rapid and patients experience a high level of satisfaction with the results. J Drugs Dermatol. 2016;15(11):1407-1412.


In 1959 Dr. Norman Orentreich, in an effort to study the pathogenesis of alopecia and other dermatological conditions, reported that skin grafts removed from the scalp (a donor area) and other areas demonstrated hair growth when transplanted to other areas of the skin of the same individual.1 After washing, shaving, and cleansing the donor skin for surgery, Orentreich anesthetized the area and made circular incisions with punches of 6, 8, and 12 mm diameter. He made sure that the excisions were carried below the hair follicle before removing the grafts and transplanting them to another site. This pioneering work, preceded by that of Japanese physicians of the 1930s and 1940s, formed the basis for Orenteich’s donor dominance theory which states that transplanted hair in the recipient site expresses traits similar to the growth characteristics of the donor hair follicles.2 Orenteich’s technique was the forerunner of Follicular Unit Transplantation (FUT, or strip surgery) and Follicular Unit Extraction (FUE) hair restoration procedures nearly 60 years later. Today hair restoration surgery is a cosmetic procedure sought by men of all ages with various patterns of baldness. Hair follicles are manually removed from the occipital or other donor area of the scalp and transplanted in the desired area by a physician and one or more assistants, depending on the harvesting