Hair transplantation is a very popular procedure in the United States, with over 88,000 procedures being performed last year. At Vorteil, guys frequently ask about the differences and pros/cons between robotic surgery (Artas, Neograft) and traditional “strip” surgery. Let’s look at each of these two topics and discuss the relevant concepts a guy should know before pulling the trigger on a procedure.
First, let’s talk about “strip” surgery, also known as Follicular Unit Transplantation (FUT) surgery. Strip surgery is considered the gold standard in hair transplantation, a tried-and-true technique that has been perfected since Dr. Limmer introduced it in the early 1990’s. FUT involves carefully removing a section of scalp from the back of the head and using specialized microscopes to dissect the hair follicles. These hair follicle grafts are then meticulously implanted one by one into the areas of the scalp that are prone to hair loss.
The advantages of strip surgery, compared to robotic surgery, are numerous. First, the graft survival rate (ie: the percentage of the grafts that are implanted that actually survive and grow) is higher. The reason is that high-powered magnification is used to dissect the grafts. This results in optimal visualization and leads to less graft trauma and destruction. Second, because it takes less time to perform the procedure, the cost is generally less. Third, the back of the head (ie: donor site) does NOT need to be completely shaved before the procedure. In our experience at Vorteil, where we perform both the robotic procedure and the strip, the healing times are pretty comparable. Yes, stitches are placed for 14 days, but rarely does a guy complain about these. The strip method will leave a thin, linear scar on the back of the scalp. At Vorteil, our board-certified dermatologist performs a special scar technique that results in a fine, hair line scar. For men with longer hair, the scar on the back of the scalp is a non-issue because the hair covers it completely. If you have short hair (eg: #1 buzz/military cut), then the scar will be visible with the strip method. Numbness can occur with the strip method, but usually comes back within weeks to months.
The robotic surgery utilizes hundreds of small punch grafts taken from the donor site, which are then implanted into the balding areas. Total scar area is actually larger for this method than the strip; instead of a line scar, there are hundreds of tiny dots that cover the entire back of the scalp. The grafts that are taken with the robot are also not as robust as they are with the strip method. This is mainly due to the damage to the connective tissue surrounding the hair follicle, as robotic surgery leads to trauma to this area of the grafts. Consequently, the survival rate is significantly lower, resulting in less hair growth. The advantage of the robotic method is mainly for two populations of men. 1. For those guys who have a very short hair style (shaved or #1 buzz) and 2. For those guys who have had many (>4) strip procedures in the past. More than four procedures is associated with abundant scar tissue and a “tight” scalp, which sometimes results in a wider than normal scar with another strip surgery. Healing times are comparable between the strip and robotic surgery (about 2-3 days), with discomfort minimal for each. Most patients require no more than ibuprofen or extra strength Tylenol for a few days.
Vorteil’s Bottom Line: Hair transplantation using the strip method is superior to the robotic method in all but a few instances and is still considered the gold standard.