Hair Loss Cure 2020

I originally wrote this post in 2013 and it was only two paragraphs long. It also had a dancing ARTAS robot video embedded.

At the time, the pioneering ARTAS^® hair transplant robot from Restoration Robotics was all the rage. It was FDA-approved for robotic hair transplant surgery in 2011.

I forgot about this subject in recent years till I read a February 2023 article on “lunchtime” robotic hair transplants.

Note that Restoration Robotics undertook an IPO in 2017 (ticker “HAIR”), but then merged with Venus Concept (ticker “VERO”) in 2019. Venus Concept also makes the Neograft^® hair restoration system.

Update: A great new video from Dr. Ken Anderson showing ARTAS robot-assisted hair follicle extraction.

ARTAS Graft Excision and Implantation

When I first covered this subject in 2013, I became convinced that automation was the future of follicular unit extraction (FUE) hair transplant procedures. At least when it came to AI- and algorithm-driven faster, more precise and higher quality graft excisions and extractions. And not susceptible to human technician error from fatigue or insufficient training.

Moreover, I wrote another post in 2014 about the future potential for ARTAS recipient site creation and even implantation. This was further confirmed by the highly regarded Dr. Robert Bernstein’s support and testing of this previously unimaginable concept. In 2018, he introduced robotic implantation of follicular unit grafts at the ISHRS 26th World Congress. Key quote:

“With implantation, three of the four aspects of a hair transplant (excision, site creation, implantation) have now been successfully automated. Only graft extraction is left as the remaining step.”

Note that the terminology of “excision” versus “extraction” is confusing for me, especially since I rarely cover hair transplants on this blog, Having said that, even the pros have issues in deciding on whether the “E” in FUE stands for extraction or excision.

Dr. Bernstein is currently using the latest ARTAS® iX Robotic System per his site. On there, he states that this robot automates two key steps in an FUE hair transplant: follicular unit graft harvesting and recipient site creation.

The ARTAS Robotic System allows surgeons to place new hair in the areas of the scalp that are currently thinning, while protecting the existing healthy hair in those regions. It does this via the use of advanced image-guided technology.

Update: In a March 2023 article on robotic hair transplant surgery, Dr. Jon Mendelson says something interesting about his new ARTAS:

“It’s really in the past year or so where the software upgrades, the algorithms, can measure the length of the hair, the depth of the hair, the orientation, and the angle of the hair and can harvest it, extract it and even implant it.”

Robotic Hair Transplant Popularity in 2023

I also wrote another ARTAS related post in 2014 when the company made its 100th robotic system sale. Quite an impressive accomplishment when considering that the ISHRS has around 1,000 surgeon members from around the world. And the more selective IAHRS currently has just 60 members. I would guess that over 300 hair restoration surgeons around the world must be using ARTAS by now?

On Venus Concept’s YouTube channel, they had quite a few ARTAS related videos in 2021, but none in 2022. In contrast, their Twitter and Instagram accounts both covered ARTAS hair transplants in 2023.

Robotic hair transplantation technology still has some issues that prevent its widespread adoption. Some of the decisions on how to use ARTAS must be made by the surgeon on a real-time basis.

Patients must shave their heads before the donor area hair follicles are harvested. This is required in order to overcome problems in those with curly hair. For African hair types that curl below the skin surface, a slightly larger punch needs to be used. If you have grey, white or blonde scalp hair, it must be dyed for the robot to visualize it correctly.

ARTAS graft extraction is also limited to the clearly defined permanent donor zone. In contrast, human surgeons can expand the donor area slightly when suitable. They can even use body hair from the nape of the neck, beard, chest and other regions.

Moreover, many patients refuse to be treated by a robotic system, and many surgeons still remain skeptical about its benefits. And some just prefer not spending a large amount of money on such technology.

So in summary, humans (both surgeons and technicians) are still crucial during a hair transplant procedure in 2023. In fact, experienced hair transplant technicians are in very short supply and can make a great living in this industry.

Cost

Unfortunately, the advent of robotics and automation in the hair restoration field does not seem to have reduced the price of a hair transplant. An ARTAS hair transplant will still cost most people at least $10,000 in the US. Many patients would probably become converts if the price of a robotic hair transplant was half that of a regular FUE hair transplant.

Watch this video on YouTube

In my old posts on Bimatoprost, I mentioned the related glaucoma drug Latanoprost. While Bimatoprost is a synthetic prostamide analog, Latanoprost is a prostaglandin F2α analog and it prolongs the anagen phase of the hair cycle via the prostaglandin effect.

Latanoprost Hair Growth — Latanoprost for hair growth trial at Sinclair Clinic. Source: 9News Australia.

Latanoprost for Hair Growth Trial

The renowned Dr. Rodney Sinclair and his Melbourne based Sinclair Dermatology clinic will test Latanoprost eye drops for hair growth in a new clinical trial. I have covered Dr. Sinclair numerous times on this blog, including in my post on “Oral Minoxidil“. Most recently, his clinic has taken the lead in testing Hope Medicine’s HMI-115 prolactin receptor antibody.

Latanoprost (sold under the brand name Xalatan) is a medication that is used to treat increased pressure inside the eye. This includes ocular hypertension and glaucoma. It was approved for medical use in the US in 1996. However, it is not FDA approved to treat hair loss. One of the noted side effects of Latanoprost (off-label use) is an increase in the thickness and density of eyelash hair.

However, this type of cosmetic use near the eye region can come with serious side effects in the eyes. Moreover:

“The overgrowth of lashes may result in lash misdirection and distichiasis, and an extra row of hair at the aperture of the meibomian glands that can result in eye irritation.”

Prostaglandin Analogs

Latanoprost is a prostaglandin F2α (PGF2α or PGF2a) analog, similar to Travoprost and Tafluprost. A 2012 German study of 16 men with androgenetic alopecia found that Latanoprost significantly increased hair density (terminal and vellus hairs) at 24 weeks compared with baseline. A 2015 review concluded that the most promising alternative clinical uses of prostaglandin F2α analogs beyond the eyelashes include: androgenic alopecia; chemotherapy-induced alopecia; and alopecia areata.

Even over 20 years ago, a detailed 2002 study on stump-tailed macaques found that Latanoprost had a potent positive effect on hair growth. Note that Aneira Pharma is developing a hair loss product that will likely contain Latanoprost, Cyclosporine and Minoxidil.

Also, Dermaliq Therapeutics (US) is working on a topical Prostaglandin F2α analogue product for male pattern baldness. I covered the company in my post on increasing PGE2 and PGF2α for hair growth. On a related note, make sure to read my posts on PGD2 inhibition for hair growth.

Misplaced Skepticism

Most readers are skeptical about existing drugs such as Bimatoprost and Latanoprost doing much for scalp hair growth. However, in my opinion, we should welcome every new mechanism of targeting hair regrowth. Even if each one is “only” as effective as the tried and tested topical Minoxidil.

Some products might just make existing hair thicker rather than re-grow lost hair. However, this thicker scalp hair is then less easily destructible by the ravages of dihydrotestosterone (DHT). Moreover, if we have many different alternatives to tackle hair loss, the chances are that each of us can find at least three products that cause him or her no side effects.

Ultimately, a cocktail of topical products could multiply the hair growth effect. A number of new companies that sell topical finasteride are also including Latanoprost as part of the ingredients. Delivery mechanisms continue to improve, resulting in superior product absorption and penetration into the scalp.

ARTAS Robotic Hair Transplant Advancements