Robotic FUE (Artas), powered FUE, and manual FUE are the three main methods currently in existence for the extraction of individual follicular units. The first method is manual FUE where small punches are rotated entirely by hand. The second method is powered FUE, which involves the use of electrical/mechanical devices to rotate the punches–these are still manipulated by hand but use small motors to help with the incision process. The third method is robotic FUE whereby a computer uses a mechanical arm to select and incise follicular units using tiny punches–this is probably the method most people are excited about as it is so high-tech.
Using any one of these methods does not guarantee success. It is very important for the physician to also consider a multitude of variables that can affect the results of the procedure. For example, the rotation of the punch can be unidirectional (spins in one direction) or oscillatory (spins back and forth); the oscillation can be small (e.g. a wiggle) or large (e.g. one full rotation); the tip of the punch can be sharp or dull; the velocity of the rotation or oscillation can be slow or quick; the tip of the punch can be angled inwards, outwards, or splay outwards; the punch tip can be smooth or serrated; the punch barrel can be smooth, fluted, or hexagonal; the size of the punch can be small or large, the motion of incision can be straight or curved; and the initial pressure can be downward, lateral, circular, anterograde, or retrograde.
These are some of the factors that must be adjusted to account for individual variability and Dr. Nakatsui’s experience will be helpful in giving you the best possible result. Dr. Nakatsui has tried many different systems and methods and depending upon the patient, chooses which system will be used. For the majority of patients, he will use one of the powered devices, such as the SAFE system or the newest WAW system.
He has also looked very carefully at the Artas robotic FUE system and after discussions with many of the elite hair transplant surgeons in the world, some of whom purchased the Artas system only to sell it thereafter, decided that as of 2020 robotic FUE technology has not quite arrived. However, Dr. Nakatsui remains hopeful that future advances will improve the technology. The main problem with robotic FUE is that although it can adjust for some variables, it does not take into account all of the variables discussed above. As a result, a standard approach will work very well in some cases but will work less well in other cases. Sometimes it takes a human touch and human judgment to account for all variables.