title: Rapid Fire Hair Implanter Carousel. A new surgical instrument for the automation of hair transplantation.
abstract: BACKGROUND
  As hair transplantation evolved into a procedure in which large numbers of very small grafts are moved in a single session, new problems have emerged. These include greater staffing requirements, longer operating time, additional technical difficulties, and increasing problems with quality control.
  
  
  OBJECTIVE
  To introduce a new surgical instrument, the Rapid Fire Hair Implanter Carousel (Carousel), which can automate the most labor-intensive parts of the hair transplantation process, site creation and implant placement, by combining them into a single step and delivering them in rapid sequence. This instrumentation should help to minimize some of the human factors contributing to graft injury and to simplify and increase the speed of the hair transplant procedure.
  
  
  METHODS
  In a patient with a Norwood IIIA balding pattern, 400 follicular implants were placed into a specific section of the bald scalp. The remainder of the bald scalp was transplanted with 800 follicular implants placed in the traditional way. The two areas were monitored and compared for intraoperative bleeding, ease of placing, total placing time, postoperative healing, and hair growth. Photographic documentation was obtained after surgery and at each postoperative visit.
  
  
  RESULTS
  The Carousel visually produced less bleeding when compared with the manual approach. The Carousel was easier to use than the manual technique, since it eliminated graft insertion as a separate step. This was evidenced by the significantly shorter time required to insert the implants (40 grafts/minute with the Carousel vs 6.6 grafts/minute manually) and the decreased need for secondary manipulation once the grafts were inserted. Postoperative healing of the two groups were the same with regard to the duration of crusting and erythema. The rate of hair growth and the total amount of hair observed at 4 months were the same when identical size areas in test and control sides were compared.
  
  
  CONCLUSIONS
  In this single patient pilot study, the Carousel greatly facilitated the placement of grafts by decreasing bleeding and obviating the extra step needed for the insertion of the implants. As a result, the total operative time decreased, shortening the time the grafts were outside the body, and decreasing the risk of desiccation and warming. By minimizing the human factor in this labor-intensive part of the procedure, the quality of the hair transplant should increase. It is anticipated that these benefits will result in increased hair yield. Further studies are needed, in a larger patient group, so that these benefits can be demonstrated.
authors.affiliation: New Hair Institute, Los Angeles, California, USA.
authors.forename: W R
authors.initials: WR
authors.lastname: Rassman
authors.forename: R M
authors.initials: RM
authors.lastname: Bernstein
mesh_terms: D000328:Adult; D000505:Alopecia / Q000601:surgery*; D017558:Elective Surgical Procedures / Q000295:instrumentation* / Q000379:methods*; D018859:Hair Follicle / Q000637:transplantation*; D006801:Humans; D008297:Male; D010865:Pilot Projects