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When we first wrote the first paper on Follicular Unit Extraction in 2002, our main concern
was the fact that as you extract the follicle, some of them would be sheared or shredded
and we wouldn’t be able to capture the entire follicular unit. Over the years, we’ve done
work to refine the procedure — and this has not only been our work, but the work of
many of our colleagues — and what we found is that if you try to take one instrument
to go down over the follicular unit, because the follicular unit splays — it’s like
wheat almost, a bushel of wheat, where on the surface it’s very tight and under the
skin it spreads out — because of this configuration as this instrument that cuts the surface of
the skin goes deeper, it cuts off the bulbs. Or does what we call transects the follicles.
What we soon learned was that if you use a sharp instrument to score the skin and go
through the top part of the follicular unit, you can then use a blunt instrument to kind
of blunt dissects or gathers the rest of the unit without cutting off the follicles. We
call this step the two-step technique. Hand-held devices that are based upon this two-step
technique seem to be better at removing follicles without damage than using just a single sharp
punch.
The ultimate two-step technique is now the ARTAS System, by Restoration Robotics, where
you actually have a robot very quickly switching from the sharp instrument, which scores the
surface, to using a blunt dissection to go down deeper into the tissues in order to preserve
these follicles and not to injure them or transect them while they are being removed
from the scalp.