The NeoGraft machine for Follicular Unit Extraction (FUE) hair transplant surgery is a device that is used to both extract follicular units from the donor area and implant them in the recipient area via a suction-based system. The device is partially automated (rather than robotic) and needs a moderate amount of operator intervention to keep the machine functioning smoothly.

A hand-held extraction device first separates the grafts from the surrounding donor tissue using a rotating sharp punch that is connected to a suction unit. Once the upper part of the graft is dissected from the surrounding tissue with the punch, the suction pulls the graft out, separating it from the remaining tissue. Suction minimizes the chance of the sharp punch cutting off the lower portion of the follicles but, by removing the protective tissue (deep dermis and fat) that normally surrounds this portion of the graft, it increases its fragility and makes it more subject to desiccation (drying) and mechanical trauma.

Once the graft is separated from the tissue, it is sucked through a tube into a small chamber. This process has the advantage of not requiring a technician to manually remove the graft from the scalp, but the disadvantage of exposing the grafts to rapidly moving dry air that is continually rushing through the tubing and chamber – that can further risk injury from desiccation.

Once approximately 50 grafts are extracted from the scalp, the chamber is opened and the grafts are manually placed in a Petri dish in a saline holding solution. The recipient sites are then made in the donor area using traditional instruments, such as hypodermic needles.

A small number of grafts are removed from the holding solution and a second arm of the Neograft machine is used to draw up the grafts (via suction), one at a time, into a needle and then, individually inject them into the pre-made recipient sites using air pressure. The advantage of the Neograft in this step is that the grafts do not have to be inserted into the site with forceps and this potential mechanical injury from forceps is avoided. A disadvantage is that the grafts are pushed into the site — the bottom of the follicles first — under high speed. Since the bottom of the follicles are exposed from the harvesting process, there is no way to assure that the grafts are properly positioned in the site — i.e. that the base of the follicles are not folded on themselves.

Comment: From this author’s observation, the Neograft machine has the advantages of eliminating mechanical injury from forceps and of potentially being faster than other Follicular Unit Extraction techniques, but this does not offset its disadvantages. The suction function of the Neograft machine introduces two risks not present with other FUE techniques:

  1. The suction has a tendency to strip the surrounding tissue from the lower portion of the grafts during their removal, exposing them to drying injury.
  2. The vacuum creates a continuous flow of dry air around the harvested grafts

The combined actions of stripping the lower portion of the graft of protective tissue and exposing it to the drying action of fast-moving air, presents a potential serious problem for graft survival. In a landmark study by Dr. Marcelo Gandelman, entitled Light and electron microscopic analysis of controlled injury to follicular unit grafts, it was shown that, during a hair restoration procedure, the drying of grafts caused more severe injury than mechanical trauma and was more likely to be a cause of poor growth.

It is this author’s opinion that several changes could be made to the Neograft machine that would decrease the chance of graft injury.

  1. Change the sharp edge of the punch to a blunt tip:
    The sharp tip increases the risk of cutting follicles if the instrument is not aligned perfectly parallel to the hair follicles. A blunt tip will be more forgiving to slight discrepancies between the angle of the punch and angles of the follicle. Dr. Jim Harris has shown that with a rotating device, a blunt tip can be as effective as a sharp one in dissecting follicular units from the surrounding tissue, with much less risk of damage. It also allows the instrument to be able to be safely passed deeper into the skin.
  2. Start the suction after the graft has been dissected from the surrounding tissue:
    The Neograft currently runs in a continuous suction mode, so that once the upper part of the graft is separated from the dermis, the vacuum pulls the lower portion of the graft away from the surrounding tissue, leaving the follicles bare. A rotating blunt tip could free the entire length of the follicle and then, once dissected, the suction could remove it from the scalp.
  3. Eliminate the air chamber:
    The graft is sucked from the scalp through a long tube into a plastic chamber. The grafts adhere to the walls of the chamber where they are subject to rapidly moving air. This holding chamber exposes the graft to significant drying and potential damage. As an alternative, it would be preferable to have the grafts immediately transferred into a chamber containing normal saline or lactated Ringer’s solution, or to eliminate the chamber altogether.

Like other FUE instrumentation, the effectiveness of the Neograft machine is dependent upon operator skill and the particular anatomic features of the patient’s scalp, making some patients better candidates for the device than others. Although the instrument — years in development — incorporates a number of innovative ideas into the field of hair transplantation, there are some aspects of the design that may compromise graft survival. It has yet to be shown, with controlled studies and longer-term use, if the Neograft machine, in its current form, has the ability to produce consistently viable grafts.

Neograft vs. ARTAS Robot

 
Neograft
ARTAS Robot
System
Hand-held dermal punch drill with foot-pedal activation susceptible to operator variability and high hair damage rates
Robotic precision, consistency enables accurate reproducible harvesting with intact graft rates >92%
Graft Quality
Grafts vulnerable to handling damage and drying that may compromise survival
Grafts with protective tissue rendering them less subject to injury
Digital Mapping
None
Real-time 3D digital analysis of hair follicle characteristics enables selection of best available hair for harvesting
Dissection & Technique
Very small sharp punches dissect fewer hairs per graft resulting in less hairs harvested

Very small sharp punches with manual alignment increase likelihood of hair transection compromising survival

Vacuum suction of grafts exposes them to possibility of desiccation and may harm survival

Two-needle blunt dissection technique produces minimal scarring with the ability to harvest many hairs per graft

Intelligent algorithms optimize alignment and dissection depths for effective harvest of intact grafts

Healthy grafts removed directly from scalp and placed in preservation media to promote graft survival



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