Bernstein Medical patient explains where his hair loss journey began and how he discovered Dr. Bernstein. He provides a detailed account of his hair restoration process, and discusses his experience.
Synopsis: Hair restoration has advanced dramatically in the past 25 years, most recently with the growing popularity of FUE. The challenge of FUE is that the grafts are more fragile compared to the follicular units generated in traditional FUT/strip procedures. Innovations such as the ARTAS Robot and other devices attempt to address this problem. With the increasing participation of ISHRS members – now 1,200 strong – progression in this field should continue at an accelerating pace.
In appreciation of National Hair Loss Awareness Month, Bernstein Medical has launched a fundraiser for the ISHRS’s pro bono program, ‘Operation Restore’. This program provides free hair transplants for those who experience localized hair loss due to trauma or illness.
Q: I was thinking of having an FUE procedure done in Turkey, but I am concerned that it will be done with just technicians. Any thoughts? — E.E. ~ Mount Vernon, N.Y.
A: I do not have first-hand information on the clinics in Turkey, but there is a recent “Letter to the Editor” in Hair Transplant Forum International, the official publication of the “International Society of Hair Restoration Surgery” that you might find informative. From the article:
“In Turkey, there are 300 FUE clinics in Istanbul alone, but unfortunately at only 20 of them operations are done by doctors. We do not exactly know how many of those 300 clinics have legal permissions, but we know very well that an average of 500-1,000 FUE operations are done per day.”
If you would like to read the entire article, the reference is: A Report from Turkey – the situation in a top FUE destination. Hair Transplant Forum International July/August 2017 p 162.
Q: I have heard that shock loss is somewhat common after a hair transplant. Do women experience less shock loss than men? — N.R. ~ Mineola, N.Y.
A: The risk of shock hair loss is generally greater in women than in men since women usually have a more diffuse pattern of thinning. This is because females generally have more miniaturized hair, the hair that is most subject to post-op shedding.
Q: Is it true that performing FUE hair transplant procedures by hand is better because the physician can better adjust and feel the follicle when extracting? — M.H. ~ Great Neck, N.Y.
A: The ARTAS robot is a physician controlled, computerized device that uses a three-dimensional optical system to isolate follicular units from the back of the scalp in a hair transplant. The robotic system assists the physician in the extraction of grafts with precision and speed. Although there is some advantage to having “human feel” for the tissue, this is far outweighed by the fact that repetitive procedures performed manually thousands of times lead to operator fatigue and result in increased transection and damage to grafts. With the ARTAS robotic system, the quality of the first and the last graft harvested will be the same.
Q: I have read that some doctors perform something called a trichophytic closure. What is this? — M.S. ~ Thornwood, N.Y.
A: Trichophytic closure is a way to minimize the appearance of the donor scar in a hair transplant using a strip incision. The technique provides improved camouflage of a linear donor scar in Follicular Unit Transplantation (FUT). Normally, in FUT, the surrounding hair easily covers the scar. For some patients with very short hairstyles, the resulting donor scar may be visible. With the trichophytic closure technique, Dr. Bernstein trims one of the wound edges (upper or lower), allowing the edges to overlap each other and the hair to grow directly through the donor scar. This can improve the appearance of the donor area in patients who wear their hair very short.
The trichophytic donor closure can be used on patients who have had previous hair transplant procedures and are looking for improvement in the camouflage of their donor scar. It is particularly useful in hair transplant repair or corrective work. Trichophytic closures work best with sutured incisions. Stapled closures have their own advantages. The doctor will recommend which type is best in your case.
Robert M. Bernstein, MD, MBA, FAAD has been recognized by his peers with inclusion in his eighteenth consecutive edition of New York Magazine’s annual ‘Best Doctors in New York’ issue. Dr. Bernstein helped re-invent hair transplant surgery by pioneering the Follicular Unit Transplantation (FUT) procedure and by becoming an early proponent of robotic hair transplant surgery (Robotic FUE). He is the only hair restoration surgeon named to the prestigious “Best Doctors” list for as many years. Of being included in the 2017 issue, he said: “New York has some of the finest doctors in the world, so to be considered among the best by my peers is quite an honor. It is equally satisfying when a patient tells us that we helped change their life.”
Q: What is the difference between the ARTAS 9x and the earlier versions of the robot? — T.J. ~ Washington, D.C.
A: The differences can be grouped into four broad categories:
1. Speed: The 9x is 20% faster than the 8x. This is achieved through the ARTAS robot’s ability to more quickly and accurately align with the follicles, faster movement from follicular unit to follicular unit while harvesting, and a shortened dissection cycle (less than 2 seconds). In addition, the 9x uses white LED lights instead of red, which permits an increased work flow from the ability to simultaneously incise and extractions grafts. The decreased strain on the eyes from the white lights (compared to red) makes this possible.
2. Accuracy: The 9x uses smaller needles that minimize wounding and donor scarring. It is especially useful for patients with fine hair or those who want to keep their hair short.
3. Functionality: The robotic arm on the 9x has a 1-inch base extender that gives the machine a longer reach and decreases the need for the patient to be repositioned. The ARTS 9x also has a smaller robotic head allowing the robot to harvest the grafts at a more acute angle. The ARTAS 9x also allows for more site making options due to the universal blade holder and the ability to program a change in the orientation of the incision in different regions of the scalp. The ARTAS 9x also uses a new harvesting halo to secure the tensioner (the grid-like device that indicates where the robot should harvest) which is faster to apply and more comfortable for the patient.
4. Use of Artificial Intelligence: The technology notifies the physician early-on if the harvesting is not precise, so that action can be taken to ensure most effective results. The ARTAS software can now detect areas with low (or no) hair density and prevent those areas from being over-harvested. This also decreases human error and saves time by automatically blocking these areas with low density. Finally, the ARTAS Hair Studio, can now create a 3-D image of the patient’s head with only one photo (as opposed to the prior requirement of 3 to 5).
Synopsis: Since the introduction of robotic FUE technology over five years ago, there have been numerous upgrades to the system. The current paper describes the most recent advances. These include a more user-friendly interface, the ability to select for larger follicular units, greater range-of-motion of the robotic arm, improved methods for stabilizing the scalp and newly designed needles for more accurate harvesting.