Robotic FUE Hair Transplants
Robotic hair transplantation is a significant advance in the technology of the Follicular Unit Extraction (FUE) procedure. In Robotic FUE, the ARTAS® System automates the harvesting of follicular unit grafts, enabling the FUE to be performed with unparalleled precision. The advantages of FUE over traditional hair transplants are having no linear scar in the donor area and having no post-operative limitations on physical activity.
The ARTAS robot’s advanced optical guidance system locates and extracts follicular units according to specifications programmed by the physician. It carries out this process hundreds to thousands of times per session with speed and accuracy that is impossible to duplicate with the human hand. The robot can also create recipient sites for the placement of follicular unit grafts according to an aesthetic plan designed by the physician.
Bernstein Medical is a Center of Clinical Excellence for ARTAS Robotic Procedures
Bernstein Medical’s Robotic Hair Transplant CenterSM of New York is among the first facilities in the world to utilize the ARTAS Robotic System to perform FUE, a procedure pioneered by Dr. Bernstein. Our practice is a beta-test site for this innovative hair transplant technology. Dr. Bernstein is a medical advisor to Restoration Robotics, the company that manufactures the ARTAS robot.
In addition to enhancing the core technology, Bernstein Medical has introduced new applications of the robotic system including custom punch sizes, robotic recipient site creation and follicular unit graft selection. Every FUE procedure at Bernstein Medical is performed using the ARTAS Robotic System.
Robotic FUE Advantages
FUE, which was first described and popularized by Drs. Rassman and Bernstein in 2002,1 requires surgeons to extract hundreds to thousands of follicular units in a single session. Using hand-held instruments, this is a labor-intensive process that subjects the patient to significant human variability and error.2
In manual FUE procedures, the doctor visually selects the follicular units to be extracted, estimates the angle the hairs grow out of the scalp, centers the extraction tool over the unit, incises the skin at a specific angle and depth, and then manually removes the follicular unit graft from surrounding tissue. The smallest deviation with a hand-held instrument can “transect” (damage) the follicular unit rendering it of little value in the transplant. The ARTAS Robotic System helps to minimize transection caused by human error and thus improves the quality of the hair restoration procedure.
The ARTAS robot also minimizes human error in the creation of recipient sites – tiny holes created in the balding area of the scalp where grafts are placed. There are several parameters in the creation of recipient sites that affect the aesthetic outcome of the transplant. Some of these include: angle of hair elevation, hair direction, site depth, average density or spacing, and total number of recipient site incisions. The physician uses the ARTAS system to program these parameters and the robot executes the plan with greater precision, speed, and consistency than can be accomplished manually. Read more about robotic recipient site creation.
The robot’s software allows the physician to specify which size follicular units to harvest and thus enables the doctor to select those containing the most hair. This has many benefits, but most important are to minimize donor wounding and make the process more efficient. Read more about robotic graft selection.
Potential advantages of robotic procedures over manual FUE
- Increased accuracy of graft harvesting
- Increased survival of harvested follicular units
- Reduced harvesting time
- Computerized selection of follicular units to maximize hair and minimize wounding
- Easier extraction of grafts from the sides of the scalp
- Easier extraction of grafts in patients from different racial backgrounds or with atypical hair characteristics
- Increased speed and accuracy in creating recipient sites
Video Animation of a Robotic 2-Step Follicular Unit Dissection
Robotic Hair Transplants at Bernstein Medical
Dr. Bernstein collaborates with Restoration Robotics on an on-going basis to improve the ARTAS system. Advances introduced at Bernstein Medical include more efficient harvesting, robotic recipient site creation, follicular unit graft selection, an enhanced user interface, pre-making recipient sites and a variety of other important modifications described below.
Bernstein Medical was the first practice to offer customized punch sizes to suit the individual patient. A 0.9mm punch (the standard is 1.0mm) shortens healing time, decreases donor scarring, and increases the number of follicular units that can be harvested without damaging neighboring follicles. The smaller punch also creates grafts that require less trimming of the tissue that surrounds the follicular unit. Some patients, especially African-Americans, have less transection with the larger punch, so the ability to customize the tool to the patient can have a significant effect on the outcome of the transplant.
The physician can now use the ARTAS hair studio to guide the robotic in creating recipient sites. The physician inputs the hair transplant design and specifies the angle, depth, distribution and spacing of recipient sites. The robot then proceeds in making these sites with the same uniformity and precision that it used to harvest grafts. An important capability or the robot is the ability to avoid existing hair when creating these sites – a task very tedious to carry out by hand.
The ARTAS Robot at Bernstein Medical is programmed to skip over 1-hair follicular units. By avoiding the smallest follicular units, the robot harvests more hairs per extraction attempt and, thus, creates less wounding and scarring in the donor area. If smaller FUs are needed, such as to create a natural-looking hairline, robotically-extracted follicular units of 3 or more hairs can be dissected into smaller units. The Bernstein Medical team uses its expertise at stereo-microscopic dissection, gained over years of performing FUT hair transplants, to enhance the Robotic FUE procedure.
Another important modification of the FUE technique introduced at Bernstein Medical is pre-making recipient sites.3,4 Using this strategy, recipient sites are created before follicular units are extracted in a typical one-day procedure (or at the beginning of the first day in a two-day procedure). As soon as harvesting is complete, grafts are placed into recipient sites. This minimizes the time grafts are outside the body, increases visibility when placing the grafts (due to less bleeding), minimizes graft popping, and allows the recipient area to start the healing process earlier. A better environment for newly transplanted grafts increases the chances that they will survive the transplant and increases the likelihood of a positive aesthetic outcome.
Video of Robotic FUE Procedure
The ARTAS Robotic System for FUE
The ARTAS system is comprised of a robotic arm with extraction and site creation capabilities, a video imaging system, and a computer user interface. The extraction mechanism is a double-punch arrangement with an inner (sharp) punch and outer (dull) punch.
During extraction, the inner punch scores the upper-most part of the skin and mild suction stabilizes the skin and allows the robot to follow the movements of the patient’s head. The rotating blunt edge of the outer punch then dissects the follicular unit from the surrounding tissue. This minimizes mechanical trauma and injury to the grafts. The entire process uses image-guided technology, allowing this step to be accomplished with microscopic precision.
The robot also has the ability to create recipient sites according to the physician’s specifications using an imaging and design technology called the ARTAS Hair Studio. Read more about the ARTAS Robotic System for FUE.
Animation Overview of the ARTAS Robotic System
Developments in Robotic FUE Technology
- Dr. Bernstein: Stigma of Hair Transplant Surgery is Fading
- Dr. Wolfeld Presents Robotic Hair Transplantation at International Cosmetic Surgery Conference
- Long-Hair Robotic FUE
- Robotic FUE Transection Rate Compares Favorably with Manual FUE Transection Rates
- Commentary on Robotic FUE in Hair Transplantation
- ARTAS Robotic System Provides Minimized Donor Area Scarring
- Dr. Bernstein Introduces Robotic Graft Selection at ARTAS Annual Meeting
- Dr. Wolfeld Presents Robotic Hair Transplant Advances at Main Plastic Surgery Meeting
- Study: High Hair Yields, Low Hair Follicle Transection Rates with ARTAS Robotic System in Korean Patients
- Dr. Bernstein Presents Advances in Robotic Hair Transplants at ISHRS 2014
Video: Dr. Bernstein With “First Of Its Kind” Robotic Hair Transplant System
- Rassman WR, Bernstein RM, McClellan R, Jones R, et al. Follicular Unit Extraction: Minimally invasive surgery for hair transplantation. Dermatol Surg 2002; 28(8): 720-7. [↩]
- Bernstein RM, Rassman WR. Anderson KW. Follicular Unit Extraction Megasessions: Evolution of a technique. Hair Transplant Forum International 2004; 14(3): 97-99. [↩]
- Bernstein RM, Rassman WR. Pre-making recipient sites to increase graft survival in manual and robot FUE procedures. Hair Transplant Forum Intl. 2012; 22(4): 128-130. [↩]
- Bernstein RM. Integrating Robotic FUE into a Hair Transplant Practice. Hair Transplant Forum Intl. 2012; 22(6): 228-229. [↩]