The Punch Hair Matic Hair Robot is the third generation of hair transplantation device, developed for automated Follicular Unit Extraction technique (F.U.E) with precise micro grafting surgery.

The PUNCH HAIR MATIC is a patented robot using micro-instruments to remove follicular units, which makes surgery simpler, faster, and less debilitating for the patient, with more convincing aesthetic results.

The hairs taken — one, two or even three at a time, depending on the size of punches chosen — are immediately sucked up into a sterile catheter and transferred to a small hand-piece that pushes the hair into a small reception orifice (also called recipient site ) by simple pressure.

A complete session of 700 grafts can be performed by one doctor with one assistant in two hours only.
Advanced automation technology now enables the surgeon to harvest follicular units of optimum quality and reimplant them within an operating time that is quite acceptable to the patient. In fact, with the new robot, the surgery takes two to three times less time.

Instrumentation :
This patented French technology called Punch Hair Matic® (developed by Medica mat in France) meets the objectives. It is based on a pneumatic suck-and-push system which actuates two types of instruments:

1- A punching-sucking handpiece consisting of an electric micromotor with a hollow shaft receiving a small-diameter ( 0.8 mm , 1 mm , or 1.2 mm ) punch.
Punch: based on the principle of the double-bevelled Australian punch, it allows harvesting FUs of exceptional quality due to its very good rotational concentricity.
Motor: we prefer to use a motor-driven rotary lathe rather than the hand because we can better focus on the orientation of the punch instead of worrying about the force to be exerted and the angular variations that may occur when the punch is twisted between thumb and forefinger.

Handpiece: instead of  the straight handpiece I was using with the Omnigraft (1), I use a contra-angle handpiece to work much closer to the scalp  and have a better view of the operative field. The hand positioning gives support and a very small offset from the axis. This contra-angle handset is connected by tubing to a collector flask. The FUs are aspirated atraumatically and smoothly, and the operative field can be best assessed and cleaned, leaving at least 5 FUs between each harvest. This technique is termed semi-direct because the FUs are sucked into the collector flask and then put on compresses for implantation. In the direct method, the FU is fed directly through tubing into the implanting handpiece.

2- Implanting handpieces, which are transparent hollow cylinders with pneumatic pistons. The transparency of the handpiece makes it possible to view the graft before insertion, if necessary.

The FU is aspirated by the end of the cylinder and re-implanted by smooth, progressive movement of the piston with no risk of trauma to the hair and with reduced risk of “popping” compared to the other implants.

Discussion :
In FUE, the operating steps are the same as with the former punch graft technique, but the punch diameters are smaller (0.8 to 1 mm against 2 to 3 mm ), which makes it possible to obtain FUs (micrografts), leaving, after very quick healing, almost invisible tiny traces in the harvesting zone.

This very popular new hair transplantation technique is also known as suture-free or scar-free transplantation. The drawbacks of this technique are the need for shaving part of the crown, leaving small scabs that are visible for several days if the patient is short-haired, increased operating time, and higher risk of root transection during blind harvesting.

The new technology overcomes to a large extent the last two major drawbacks.
Using the punching-sucking handpiece, we can harvest up to 50 FUs per minute. Actually, it takes us 30 minutes to harvest 1000 FUs.
I first take some ten grafts in order to assess the texture and strength of the skin in the donor area. There are two cases:
- If the tissue is tight, I use 1-mm micro-punches which give very fine grafts. I can then use the 0.8-mm micro-punch for follicullar units with one or two hairs in order not to chance transection.

- If the tissue is soft, while the 1-mm punch may give cutting errors, with the 1.2-mm punches, the result is 99 % satisfactory.
The special shape of this handpiece provides for highly safe and fast harvesting. The advantage of this technique is that it leaves no linear scar, and that grafts can be taken from a sparsely haired, tight crown, or from other parts of the body (back, chest, thighs, etc.), if sufficiently hairy.
There are, however, common misbeliefs:
- It is not true that the FUE technique gives grafts of higher quality than the strip technique.
- It is not true either that the FUE technique gives more density in the recipient area.

Conclusion : Automated FUE is the ultimate technology in hair transplantation. The machine described makes it possible to harvest FUs of optimum quality, while shortening the operating time. Also, the post-operative outcomes are better, with limited pain, and no scar.