Masters of Beauty Ep. 22: Hair Restoration with ARTAS iX by Venus Concept

This audio podcast has been transcribed using an automated service. Please forgive any typographic errors or other transcription flaws.

Dr. Anil Shah (00:00):

I'm please to be joined by the head of, uh, restoration, robotics, uh, robotic division, uh, a Petrovich. Um, we actually did a podcast, uh, where we talked for like an hour and a half, two hours, um, and, uh, kind of dive into a lot of the details about restoration, uh, robotics and, uh, why I think the artist is the, of harvesting hair. Um, so we're gonna kind of focus our discussion today. Um, I'll give in case you don't know is just amazing. He's been working with, um, robotic care for over 14 years. He is the director of the robotics, R and D. So all those cool things that you're, you're interested about, what's coming in the future what's gonna happen. And, uh, he knows, he knows more than to any hair surgeon, officer, cuz he's working on the front end of the robotic end end of this. Um, and so without further to do a, we're just gonna kind of jump in there. So first of all, congratulations for everything that, uh, you've accomplished and, and achieved. And behind me is your latest accomplishment. This is the IX artist IX. Um, and so first,

Oggie Petrovic (01:05):

Yeah,

Dr. Anil Shah (01:07):

So first things first let's go into it. Why the IX, why did you change the platform? Cause you already had a great device with the previous artist. So what was the need to switch to the IX?

Oggie Petrovic (01:19):

Uh, right. So, um, so first of all, thanks. Uh, thanks, uh, so much for having me on your or, uh, program Dr. SHA. So, um, the story about IX, uh, begins, uh, actually with the implantation, um, at the time when we were, this was about, uh, four years ago or so when we were, um, developing, we were starting to develop implantation. We were considering, you know, how do we integrate this new product into the, um, artistes? And one idea was to just modify the nine X and add implantation to the nine X. Uh, another option was actually to create a completely new device just for implantation only. Um, and at the end, uh, we decided to actually update the nine X, uh, apply technology upgrades, uh, and lessons learned, uh, from the field and, uh, create the that's, how we got to IX system.

Dr. Anil Shah (02:10):

Okay. And so, um, now on these upgrades for the IX, what's, what's different about it. So what, what can it do that the nine X? Why did you switch platforms? Is it like, does it see better? Does it have better vision? Does it have more capability with its char? Um,

Oggie Petrovic (02:25):

Yes. Yeah. So of course they can do implementation. And then, uh, if you compare side by side IX and nine, nine X systems, you can, uh, immediately notice that the footprint of the IX system is, uh, much smaller and, uh, that is, uh, that makes it much more mobile. We decided to, uh, make it more, uh, easy, more portable. So, uh, we integrate at the touch screen, uh, into the cart. So, um, uh, it's, it's easier to, to move around. Um, we decided to make it, uh, make, uh, the mechanisms smaller, um, or this is the end piece that actually harvests the hair. So it's easier to work around. Uh, the mechanism itself is, uh, quieter. Um, we, uh, uh, we, we made, we made systems upgrade to use the, uh, uh, quieter motors. Um, and then, uh, we also, um, uh, add a new L E D lights, which provide better illumination, uh, ultimately the better vision system them too. And then of course the centerpiece is the new robotic arm, uh, which, uh, replaces the old industrial, um, uh, kind of more industrial looking arm with something that's already, uh, qualified for medical use. So it's a medical grade robotic arm, uh, the top, top quality right now in the industry.

Dr. Anil Shah (03:38):

You, you know, I had my hair done with both, I had it done with the nine X and I've had it done with the IX. And some of the things that I've noticed is that with the IX, it, first of all, noticeably quieter, like you mentioned, but it also felt like it was, um, again, me being as a patient kind of back there, um, not that it was uncomfortable with the, the nine X, but it felt like maybe the touch was just a little bit gentler and more consistent. Um, and, uh, I don't know, is that, is that true? And is it a different mechanism that's propelling the IX versus the Ninex?

Oggie Petrovic (04:10):

Um, yeah. Yeah, so the, the mechanism is mover. Um, also the arm itself has a larger reach, which allowed us to, uh, uh, accommodate different, uh, patient, uh, more comfortable, uh, positions for the patient. Now for the IX system, the patient can be, uh, laying prone, uh, which is more, more comfortable, which adds to the patient's experience about the whole procedure.

Dr. Anil Shah (04:34):

Have you noticed a difference in precision though with the IX versus the IX? I mean, to me again, this is me as, as, as a doctor surgeon, um, it feels like the other one was more like an air driven. It was just kind of pushing through there versus this one feels like a, I think the, it feels different. And so I think that part feels like is, is there more precision into that? Is that something I'm just reading into that?

Oggie Petrovic (04:55):

Uh, sure, sure. Yeah. So, um, so first of all, both systems have excellent accuracy that, uh, uh, we are known for as a company, um, and the NEX system indeed does use air to propel the needle, uh, which makes this Cato sound, um, it's, um, uh, it's it, uh, at the end of the stroke, you can kind of, uh, hear it, um, as, as you end as the needle, uh, finishes the stroke. And then of course, uh, the impact with the, uh, skin is, is, uh, is a bit, uh, is a bit gentler too. Yes.

Dr. Anil Shah (05:26):

Okay. And then I think also it feels different in the back of the head. So is the spin mechanism, is the RPMs different in the IX versus the nine? Or is it, uh, the same? It feels, it feels a little bit different. I, again,

Oggie Petrovic (05:37):

Right. So, so the major upgrade that we release immediately with the IX is the, the punch itself. So we released the ultra punch, um, which, uh, um, uh, which is a bit sharper punch that we used to to have. Um, however, uh, we, we have clinical data and we had great results and great feedback from the doctors that, uh, the, our yield has improved. Um, and, uh, that punch, I think has a lot to do how, um, uh, how the actual dissection, uh, process is perceived and how it pro uh, progresses. In addition to that, uh, we have also modified, uh, we have refined our, uh, R P am our, the way the punches are spinning. Uh, so we are now actually, um, modulating the speed of the punch as it enters the skin. So that way, um, we can, uh, kind of glide in at the, uh, at the very top. It's very easy for punch to go in with the high RPM and then slow, we slow down. So we don't damage the sensitive part of the follicle.

Dr. Anil Shah (06:40):

Yeah. That that's something I've observed. Cause I, again, I've done this multiple ways. I've done it with handheld, which again, right. Biggest issue with handheld is, um, uh, it wasn't necessarily an RPM issue, a start stop. It was, can you get your hand? Can you get the angle and are you gonna transact it? And, um, you know, the RPMs are gonna be consistent. It's really hard with your foot to kind of turn on, turn off. Um, but that being said again, the more and more I would look at my handheld and I look at other doctors handheld, the best case scenario you're gonna get is 70% success. I thought the nine X was already just a huge quantum with over that, the consistency of the graphs. But I feel, I didn't know that there was that much more room to get better, but I think for me looking at the graphs, they were really consistent with the nine. It seems to be almost like identical when you're looking at each graph when they're coming out. And that, that consistency is just another level of, um, I guess the best word to describe that is robotic precision when you're looking at this. Oh

Oggie Petrovic (07:38):

Yeah. Each right. Right. So each, uh, for example, for each, uh, uh, each, uh, follicle, um, we, all our centering is, uh, guaranteed to be within hundred microns where the graph is. Okay. So that's, you cannot achieve that by, by hand and also by just couple of degrees or so, uh, in terms of the angle, that's very hard to achieve, uh, for, uh, by hand and the system and, um, gives you that for every single follicle.

Dr. Anil Shah (08:07):

So let let's talk about that. Let's dive into that a little bit, a hundred microns being as accurate as a hundred microns. So a thousand microns is about a millimeter, a hundred microns is 0.1 millimeters of accuracy that is unbelievably accurate. And again, um, my, my, my, I wear lots of hats. Yeah. I'm not wearing a hat right now, but I've wear lots of hats. But one of the things I do is search and I, I wear loops of different magnification. The largest loops you can practically wear about seven X there's no away. You can be within 0.1, um, millimeters or a hundred microns every time with your hand consistently with the exact angle and putting the right time to spin it with your foot pedal on the pedal enough. There's no way human can do that. Accurately enough. They can do it a few times, but they're not gonna do it time after time after time getting that consistency with an, how accurately can the new IX C um, pair? What, what vision is it looking at?

Oggie Petrovic (09:06):

Yeah, so the actual camera, um, accuracy is, uh, 40 microns. Um, so typical, FOLs about a hundred mile, uh, with, you know, um, uh, uh, about skin. It's about like a millimeter that's visible. Um, and, uh, we present also to, uh, users, uh, on the, on the screen that can also see the graphs and, uh, that magnification is about 10 X. Um, and, uh, what, uh, what that is useful for is for example, as the dissection, uh, proceeds, uh, maybe, um, the doctor wants to see the graft and they can actually, uh, what, what we see is that the, um, you can extract the graft, just lay down on the skin and then the camera can, uh, uh, serve as a microscope. You can kind of see how the graphs look like. Um, um, do, do you need to change the angle? Um, um, do you see any transactions and then basically, um, uh, that we found that to be very, uh, useful in certain cases,

Dr. Anil Shah (10:04):

So, correct me if I'm wrong. So all these parameters talking about changing it, this is me as, as an artist user. Yeah. Way back when this is like four years ago, I found that I was changing the, a little bit more looking at things and kind of having to like change it. I, I don't think I really change much in the parameters because it seems like as the robot goes and does things, it seems like it's just like it's adapted. And after like the first grid, it's pretty perfect. Is that, um, accurate, not accurate what I'm saying? So cuz for me looking at it, yeah,

Oggie Petrovic (10:38):

Yeah, we are done. We used to have probably about 10 parameters or so, so I think we are down to about three or four now. So, um, you know, one parameter is that we still allow users to control, uh, the depth if they want to go deeper or shallow with the punch, another important, uh, uh, parameters, an angle. Um, so if, um, um, if the user wants to, if the doctor wants to, to change the angle, for example, if somebody has more curly, hair's correct. Uh, they can adjust that. Um, and then of course there's a parameter of how many hair do we want to take out? So, uh, uh, you know, basically the density of harvesting, that's the spacing, uh, PR. So that way you can control, you know, okay on this patient, I want, I need certain amount of graphs. Uh, it's a small case. I'm gonna make the spacing larger. If it's a, if it's a, it's a big case then, uh, and uh, patient has enough density then, then uh, then you take more. Um, so those are our main parameters, uh, changed by, by the physician.

Dr. Anil Shah (11:39):

Let's talk about that last parameter, cause this is something that I think is not emphasized enough. So, um, uh, it's no secret that a lot of patients are wanting to do U and FCU is it's the treatment of choice for hair transplantation. Uh, but the problem with that is when I'm seeing in my office is patients getting multiple, multiple treatments. And when you're looking at the back of the head and I'm gonna show you the back of my head, I've had two. Um, and if it's done right, not that I'm done with artists, if it's done right, you should not be able to tell even when your head is like at a one guard what's been harvested. And the problem I'm seeing is that these patients are getting these really obvious patterns where you can see where the hair was harvested and it was over harvest in one spot, you know? And it's, so I, I think with the, with the artists, it's basically, I've never seen that one of my patients is it, it's almost impossible to create these obvious hair patterns and over harvesting all that, is that correct?

Oggie Petrovic (12:32):

Yes. Yeah. So we have specific, uh, specific logic to prevent, uh, over harvesting. So that's, uh, that's uh, one, uh, one part of the system that we closely look, look at, of course. Um, and, um, in general, when you acquire, when you look at the back of the head with the system, uh, the camera will tell you the exact dense city of that area. So, um, so the physicians can a adjust and say, Hey, hold on. Like, uh, the actual density in this area is lower or higher. And then I, I might need to adjust a little bit. This is something I didn't know before.

Dr. Anil Shah (13:07):

Yeah. And I like, I, I adjust this during the case. For example, if I, I want someone that, uh, mostly a front hairline, I might pick one, if I want someone with, um, you know, um, uh, kind of pre this full of ahead, maybe in the crown, I might go with skip ones and, and choose. And I think that's nice that you can actually do that on the robot where you're actually kind of selecting, um, you know, the best hairs, uh, that, that you're gonna, um, choose for the case. You don't have to worry about the over harvesting component. You don't have to worry about these obvious, you know, hair where, you know, I, I go as short. My hair's a little bit obvious, really long, little ponytail, sorry, but it it's, I go pretty short on my side sometimes when I cut it. And, um, even at a one guard, you cannot see that I've had, um, you know, hair harvested, you know, before. Um, so is there an AI component to this? So is this robot getting smarter every time I'm using it? Um, you know, is it getting smarter from 2021? Is it smarter than 2020? Um, is every user's data going in there and making it smarter what's happening with that AI component? I'm almost,

Oggie Petrovic (14:05):

Yeah. Yeah. So, so you touched a bit on the, um, on the hair selection, uh, for example, with the F1 F two S so, uh, we have worked with physicians, uh, to train our algorithms if physician train algorithms to basically select the hair and, uh, and get the hair properties. So, um, that part of the, of the system is, uh, is definitely AI driven. And then of course, any of the changes to the PR these are intelligent parameters that we have. So anytime, uh, the, you as a physician, you want to make adjustment, well, it takes some, uh, uh, a little bit of adjustments from the system to, to, to reach that parameter. So there's that feedback always, uh, uh, in there, um, we do have capability to do, uh, uh, self-learning. Um, this is, uh, one area that we closely monitor, especially for safety and regulatory. So it's a, it's a big topic right now in, uh, in medical field. So we are taking cautious steps there, uh, but, uh, definitely we are incorporating, uh, the latest, uh, basically data driven techniques, uh, to, uh, help with the surgery.

Dr. Anil Shah (15:11):

Now, it's interesting because the analogy, a lot of people compare, um, artists to is Tesla. And I have, I actually have two Teslas love Tesla, um, but the autopilot component, um, they call it autopilot. It's a really complex, and I think that this analogy of comparing robotic hair transplant, right, and, um, autopilot in my car completely different because if there's something that's specifically designed and purposefully and probably the best, um, possible scenario for using robotic care transplant and AI, it's gonna be harvesting hair from the back of the head, because once you have hair consistent and you can make hair black, you can just dye that someone has blonde hair or white hair. Um, you're essentially have very few parameters that have to be changed that much. It's can you manually necessarily change this and can identify what it wants to identify and which the robot does amazingly.

Dr. Anil Shah (15:59):

So Tesla, on the other hand, I love Tesla. Again. I own two of them. I'm trying to put them down, but to drive on autopilot that has so many things it's looking at that occasionally it's not going to do what it wants to do. So I have lots of issues with my Tesla autopilot. I wouldn't trust it to do anything again, I'm not gonna just fall asleep in my Tesla. I'm not gonna fall asleep with the artist, but at least I know that this is, um, it needs very little adjustment afterwards. I mean, it's, it's just so honed in.

Oggie Petrovic (16:28):

Yeah. Yeah. And you are definitely touching and, you know, Tesla's, Tesla's autopilot is, is, is, is amazing, amazing, uh, piece of technology. Right. And, uh, you know, in the medical field, um, we have the same scrutiny, maybe even, uh, a bit more, uh, uh, when we are to apply these, uh, new methods that are, uh, are very, uh, uh, hotly, uh, discussed, uh, and, uh, and, uh, push right now from artificial intelligence.

Dr. Anil Shah (16:55):

Okay. So I wanna jump into the myths of, um, artists. So I'm gonna bring up a myth. I, I know some of these answers have paid, but I'm gonna bring up things that patients bring up. Or if I look on the web, um, as, you know, the web is full of information, um, some of it's super accurate and some of it, you know, um, might not be real, real news. Um, okay. So first question I get from the first question I, I see out there is the artist is slow and the artist can harvest it slower than a human and can only harvest I've seen anywhere from a hundred to 200 hairs per hour. Um, your thoughts on that statement, we're gonna go dive into all these things, but first we'll go with artist speed. Augie.

Oggie Petrovic (17:40):

Yeah. So, um, so artist speed. Um, so, or speed of transplantation. We, we usually look at the two, two, so

Dr. Anil Shah (17:49):

First yeah, yeah. Harvesting first instead of, uh,

Oggie Petrovic (17:51):

Implanting. Yeah. Yeah. So for, uh, harvesting, right. So there is a total amount of time that the patient stays, um, uh, in a chair, you know, including the breaks and all the setups. So that's the clinical speed and, you know, that has to be taken into, into account, um, because there is some preparation, uh, of the instruments, uh, the, the robot needs to start up, uh, um, and the, uh, patient may take breaks. So we call that a clinical speed. And then there is a robotic speed, which is the speed of extraction. Once everything is in place, the tensioner is there, you know, what is the speed of, uh, which the system can extract? So, um, our requirement, our system is to extract that 600 graphs are higher, um, clinically like with everything included and then robotically, uh, over a thousand. Okay. So, um, that way, um, now, uh, there are teams, uh, harvesting teams that are really well trained.

Oggie Petrovic (18:48):

They, they, they, they well together and they work well with the, with the robotic system and, you know, patient is compliant. They know how to, uh, how to, uh, prepare and, and deal with the patient. Um, some, some teams can reach speeds of thousand over a thousand clinically and over thousand 2000 robotically too. So it a lot also on the users and also in the patients as well and how they handle being in the chair and, you know, how, how you treat the patient comfort. Um, and, you know, are they, um, um, uh, are they, are patients relaxed? So, so those are some of the external components to the system, uh, that influence the speed.

Dr. Anil Shah (19:30):

Okay. So let's just emphasize that number, cause it's gonna make it super clear. The fastest speed you can do an hour is 2000. And I think on the nine X, it was about 1250. So that's noticeably improved as far as speed. Um, if you're doing this by hand as a frame of reference, you're looking at chair time if at least five hours for 2000 graphs, and I can paint this room behind us in about five minutes, but guess what if I paint it in five minutes, how's it gonna look? It's not gonna look good. So speed. Isn't, it's not just fast, it's accurate and fast, which is super critical. So you see some people who are doing things fast by hand, maybe they're doing 500 graphs maybe, but how many of those are gonna are gonna be achieve transected, have issue consistency issues. And you're talking 2000 exquisite grabs.

Dr. Anil Shah (20:17):

So that's, there's no other technology that comes even close to that. That's amazing. And at my record, I think is about 1350. I mean, look that up maybe 13 50, 14, 50, and that's just us kind of working with that again. I, I wish I could get to 2000, but you know, 13, 50, 1450s where we're at with, with artists. Um, another question that comes up, um, the artist punch is ginormous. I'm gonna have holes in the back of my head that are ginormous and with our handheld, it's a micro punch and you won't even see any scarring AIE.

Oggie Petrovic (20:53):

So, um, we have, we are fol our punches are, are following the industry standards, right? So our most commonly used punch is, um, uh, 19 gauge that's, uh, zero point, uh, 0.9. We have also 18 gauge, which is one millimeter. And at some point actually we nine next, we even had a 20 gauge, which is 0.8 millimeter punch too. Um, so, so we closely followed the standards that are set. Um, and, um, one thing that we found, I wanna talk a little bit about the 20 gauge or 0.8 millimeter a punch is, um, that, uh, we had that available. Um, however, we did not see, uh, even the doctors were talking a lot about it. We didn't get received to many orders, uh, of this punch because, uh, probably, uh, because, uh, when you use a very thin punch, what happens is that, uh, you don't have, you get less and less supportive tissue around the follicle. And, uh, at the end, uh, lots of doctors, uh, uh, did not do, do not prefer that they would prefer to have some supporting tissue. Uh, that's why, uh, but we have even made that very, very, uh, fin punch, uh, fully tested release, and, uh, package into kit. Um, however, um, our most used punch is 19 gauge and then 18 gauge as well.

Dr. Anil Shah (22:16):

Yeah. So let, let's kind of break this down for our audience, so they understand what we're dealing with. So a hair is about six, a single hair. If you go to a double, triple, um, quadruple hair, you're gonna be a round 0.8 millimeters with no buffer around. So it does not make sense in my opinion, clinically, to be using a 0.8, um, you know, 0.8 millimeter punch there's, it's just not, you're just not putting the buffer zone. And even though you can make this smaller, the, the, the problem with that is that you're gonna be having issues with hair viability, which is the, a whole point of this. Uh, and what you mentioned earlier is what is the, um, the upside of doing this? Um, how big of a punch can you make before you get sparring? They've actually looked at this parameter in less than 1.5 millimeters actually does not lead to sparring for us.

Dr. Anil Shah (23:05):

I think I like anywhere from a 0.9 is where I is my sweet spot for artists, uh, seems to be enough of a, uh, room and, and comfort around the graph. Um, and a lot of my patients, uh, just like me have different ethnicities and they might have I'm, um, half Indian, half Italian. So a lot of my hairs are fours. Sometimes I get fives and there's no way you're gonna harvest a five hair graft with, uh, the 0.8 punch. It's not gonna happen. So you need to have a 0.9 to get those safely and have that kind of tissue around it. So clinically, um, I think that it's a marketing thing that some offices look at, and if they're actually using those punches, I bet you, your data would support that it actually leads to less favorable results. Is that true that using a really small punch versus a 0.8 or a 0.9, a 0.9 or, um, you know, uh, around there would lead to more favorable results?

Oggie Petrovic (23:55):

Yeah, yeah, of course, of course. And, um, um, I do wanna point out that, uh, our, uh, punch the ultra punch, um, uh, follows the standards of, uh, having the cutting edge, uh, being on the outside. Uh, and then on the, uh, inside it's dollar, it's kind of like a funnel. Um, so what that does is, um, actually as the follicle is being dissected, it's also being squeezed in, um, and, uh, pushed into the punch. So that's also, um, um, uh, another, another reason, uh, why changing of the size, uh, can, uh, you have to be looking really carefully when somebody talks about what is the punch size and what's the punch diameter, you know, what, what are they talking about? Are they talk, you know, where is this, uh, uh, ultimately the cutting edge of the punch,

Dr. Anil Shah (24:44):

Another, another myth out there. Um, the, the robot is gonna do everything for me, and I want a doctor to design things and, and, and make my exam site. So I want this, uh, doctor surgeon to do this, and I don't want the robot doing everything for me because, um, I don't trust the robot doing everything for me. Uh, thoughts on that. How does that break down that process of a patient getting done? Is that even possible for someone just to come in and not see a surgeon? And, and is it possible not to have a team, um, you know, or is it basically it's it's um, let's talk about that.

Oggie Petrovic (25:19):

Um, sure. Yeah. Even even done by hand, uh, the physicians have, uh, their team, uh, staffers helping out. So with the, with the extraction, so the doctor would do the dissection and then the team would be, uh, doing quality control extraction. So there's always a team involved. Um, of course, and then, especially for harvesting, which is, as we mentioned, it's very, um, tedious, uh, requires a lot of accuracy. The doc, you know, the doctor gets tired. Um, it doesn't, there is not too much of a, it's more of a mechanical process. There is not too much of a Artie or, you know, that's, it's perfect application of a, of a device or a body device, which can always achieve consistent results. So that's on the harvesting side. It's, it's very clear, um, in, uh, for, um, design of sites and implantation where, uh, hair is gonna be placed in the front. Um, the doctor definitely has the final say, uh, of, uh, you know, what's the proper distribution. Um, and you know, that can be done by hand. Um, you know, however, we also have our software that lets the doctor exactly define how we, where these areas are going to be. So, um, there is, uh, it's, it's hard to argue, um, that, um, uh, that the doctor, uh, or handheld approach is superior, uh, to a medical device that went through the whole, uh, FDA process and testing and, and all, all, all that.

Dr. Anil Shah (26:45):

Yeah. And, and I think that clinical decision making, I mean, I'm still like when I'm, I'm transplanting someone's hair, um, you know, whether it's my own, you can see me arguing for 45 minutes with my wife as I'm drawing my hairline. Yeah. I I'm still, as the surgeon, I'm still deciding where we're harvesting from how we're harvesting, how we're getting the patient prepared, we're drawing the hairline, what kinda design coming up. It's definitely a back and forth process with the patient. Um, the advantage I have over a different practice that does not have artists is I can actually have this tool that can make me a reach level that's superhuman. And anytime you can do that as a patient, you're getting things that are above and beyond what, um, human picking capabilities can do. So that's why I think that it's still a very interactive experience with the patient and we're still around this device and we're still working with you.

Dr. Anil Shah (27:31):

We're still making sure everything is in check and we're still also kind of guiding this. Uh, so it's definitely a back and forth process. So yeah, that's definitely something that I see that patients are fearful of, of, of this robot to sort of, you know, doing everything. Um, let's talk about a couple future applications of the robot if that's okay. And then no, course we'll just wrap it up. Um, okay. So, um, with the robot, um, kind of one of the things you you touched on earlier was about implantation. So let's talk about that. I have an IX, I have not implanted yet with my IX, which I'm excited about dealing, but let's talk about how does that work with implantation.

Oggie Petrovic (28:08):

Yeah, sure. Uh, first of all, you should definitely, uh, try it out. Um, and, um, for our listeners, uh, I will try to explain, uh, very, uh, uh, briefly. So, um, the implantation feature builds actually on the older feature that we already had in the, in the nine X, which is called the site, making the making, uh, allows the doctor to create, as I mentioned, uh, before the plan, uh, how the follicles, uh, are going to be distributed in, in the front, what are the densities, what are the angles? And then this treatment plan is then transferred to the system and then the system can create sites. And now with implantation, it can actually implant, um, the process of implantation, um, uh, is called stick and place. So, um, the system automates, uh, a well known, uh, handheld procedure, which, uh, involves making a decision with a sharp, uh, needle, um, and then inserting a graft, uh, use, uh, follicle, um, using an actuator, um, and planting it to exact, uh, correct depth. Now these, uh, graphs or follicles that are being stored in cartridges, uh, and these cartridges are 25, uh, uh, at, uh, you can, uh, put 25 graphs at the time they they're stored, um, in, uh, in a solution, uh, after being loaded. So what the see systems, as it goes for one cartridge, one, one graft at a time implants, and then when the cartridge is complete, then another cartridge is loaded until, uh, the whole process is complete.

Dr. Anil Shah (29:40):

So this is interesting to me because the stick in place technique, it's a stick and it's an immediate placement. Correct. Um, and so How, how long of a delay is it between a stick in the place? Is it like, um, do you know the exact number or off the top of

Oggie Petrovic (29:53):

Your head? It's, uh, uh, it's a minimal, so it's a, basically a simultaneous process as, uh, as the needle is creating the incision. We are already pushing the graft in, and that's one benefit of the stick in place method is that, um, first of all, it's, uh, it has a, a minimal, uh, trauma puts a minimal trauma on the, on the follicle. And in addition, it minimizes, uh, bleeding in comparison to, um, site making methods. So there, once you make a incision, that incision is immediately, um, closed with a planted follicles. So there is a much, much less bleeding for the patient, uh, when, uh, when you perform stick in place.

Dr. Anil Shah (30:34):

So, so one thing I noticed with my own hair, cause I had my hair done, you know, kind of implanted traditionally was that day, two day three day four. I'm getting crusting around my, my graphs. I'm wondering if there's less crusting and less losing around the graphs that that might be one side benefit that patients may observe. I don't know if you have enough feedback from your, from your, uh, clinical providers on that.

Oggie Petrovic (30:56):

I don't remember feedback about crusting. We do have a lot of, uh, return patient that have been done robotically so, so far. Uh, and we have went through the FDA study. We have, uh, excellent, uh, results. So, um, but, um, um, we, we, our, um, precision again at every time when we, uh, plan the follicle, just like with harvesting, we can, um, uh, uh, exactly specify effort, which we want to plan. So the doctor can plan in maybe, uh, exactly like one millimeter, uh, above the skin, maybe at the skin. So, so those are some of the, again, important parameters that, uh, will, um, result in a, in, in, uh, that will, uh, make it a good result at the end. Right.

Dr. Anil Shah (31:41):

Yeah. So I'm super excited about that. So it's super excited to get that going in, in my practice with that. And, um, you know, so, um, uh, future advantages for the robot. Um, so the tensioner right now, so for those of you back that, why is the tensioner one size? Could you make the tensioner the whole size of the head? Would that be too? Uh, it wouldn't work that way.

Oggie Petrovic (32:01):

Yeah. Yeah. That's how we started. However, that's not very comfortable for patients. So if you have a huge tensioner, so, um, then, um, you have to put a lot of force in order to get, if you, if you're trying to stretch the whole back of the head. So in order to get that good tension in the middle, you have to put a lot of force. Um, and that, that pre pretty much pins the patient down, you know, they don't feel very comfortable. Um, so that's, that's one disadvantage of, of hearing a big, uh, a big tension or, and then another disadvantage is that, um, let's say if you're going, uh, um, closer to the ears, some like, like if you start going to this area, it's kind of hard to maneuver with the large, uh, with a huge tensioner. Um, so, um, so for now what we have done, and I wanna point out that our tensioner is, uh, 30% larger, uh, than our original tensioner, which allows for about, uh, higher of hundred 50 graphs, um, uh, which, which is a significant improvement from, uh, uh, from before.

Dr. Anil Shah (33:06):

Where, where do you see, um, the artist IX going? Where do you see it taking, um, the artist, uh, platform and the experience for patients in, in the next few years?

Oggie Petrovic (33:16):

So, um, for our, um, is already of harvesting grafts for the, for the patient is already very high. So, so the improvements will be on the workflow and the ease of use, um, you know, one feature that, uh, we are closely, uh, looking at and, uh, researching is out extraction. Um, so out extraction is a, is a feature where, um, after the, the section is complete, um, then, uh, the system would, uh, pull up, um, graft, pull up the follicles, inspect them, sort them, and prepare them for implantation. So that's, uh, that's one, uh, area of, uh, research for us, for hair transplant.

Dr. Anil Shah (33:57):

Amazing. And so for me, looking at this as both a hair surgeon and as a hair patient, um, I think, um, when I see, uh, patients thinking about what a process you're thinking to get, um, if you're gonna do your hair, you have limited number of pairs to harvest in your lifetime. If you're gonna do it, value each hair value, each care, make sure that each, each hair is being treated properly and, uh, you know, use a device. And I think surgeons who don't have an artist, I think the one reason they don't have an artist, the consistent thing I hear from them is it just costs a lot. But that being said, if I want a Tesla, guess what it costs a lot. So if you want like the world technology, you need to have a world technology in your it's so worth it for the patient.

Dr. Anil Shah (34:44):

So for patients thinking about this saying, well, yeah. Um, I don't, I don't think patients see that much of a difference in artist doctors versus non artist doctors, but there's definitely a difference in quality and for surgeons. Well, yeah, I get it. If you don't want to spend money on technology and all that, I, I don't want to spend, uh, um, money on something, but if it's such a huge advantage for my patients and it's gonna offer them better quality, why would I not? I have to do that. That's my, that's my obligation as a doctor to give them the best treatments they can get. So it's a no brainer with artists versus, you know, something else. Um, a thank you so much for joining me on a late night. I know it's, you're, you're working hard at developing all these tech. I just get to play with, um, fascinating, always fascinating to talk to you about everything. Um, hopefully can chat soon. Okay?

Oggie Petrovic (35:30):

Okay. Anytime Dr. Thank you.