Robotic Hair Transplantation
Overview of Robotic Hair Transplant Procedures
Robotic hair transplant surgery is a logical advance in the technology of Follicular Unit Extraction (FUE), a procedure first described and popularized by Drs. Rassman and Bernstein in 2002.1 The potential advantages of Robotic FUE (R-FUE) over traditional FUE procedures include:
ARTAS Robotic System for FUE
at Bernstein Medical
- Increased accuracy of harvesting grafts to minimize damage to follicles
- Ability to use FUE in a wider variety of patients
- Reduced harvesting time
- Increased graft survival
Follicular Unit Extraction is a harvesting procedure where hair is removed directly from the donor region of the scalp as individual, naturally-occurring groups of 1-4 hairs. The technique consists of two main steps: 1) Separation of the follicular units from the surrounding skin, and 2) Extraction (removal) of the follicular units from the scalp.
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Step one, the separation of the follicular units from the surrounding donor tissue, is a highly repetitive and labor intensive process that requires great precision. This step requires the centering of the punch over the follicular unit and the alignment of the dissecting instrument with the follicles to prevent damage. This step, which must be repeated manually hundreds to thousands of times in a typical FUE hair restoration procedure, subjects the patient to significant human variability and error.2
The problem associated with the initial step of separating follicular units from the surrounding tissue has been a major challenge for FUE practitioners.1 A significant advance towards minimizing trauma to follicular units in this first step was to divide it into two parts; sharp, followed by blunt dissection. This additional step reduces the chance of injury to the lower part of the follicles during dissection.3,4,5 The current robotic system is based on this concept.
Robotic FUE at Bernstein Medical
The robotic FUE device used at Bernstein Medical, called the ARTAS™ System, was developed by Restoration Robotics, Inc. for specific use in Follicular Unit Extraction. Bernstein Medical is the first hair restoration center on the East Coast and one of the first worldwide to use this new technology in clinical practice. The Bernstein Medical – Center for Hair Restoration serves as a beta-site to study new product features and enhancements in the ARTAS Robotic FUE system.
Dr. Bernstein performing
Robotic FUE using ARTAS SystemDr. Bernstein’s contributions and expertise have made the ARTAS System more user friendly, improved the harvesting technique and made it a more compelling procedure for patients. We are the first to offer our Robotic FUE patients smaller customized punch sizes and computerized follicular unit graft selection. These techniques enhance follicular unit extraction based on the hair characteristics of each individual patient.
As a beta-site for this new technology, we have participated in developing many of the nuanced modifications that continually improve the technique. The initial version of the robot required many intra-operative adjustments, such as changes to depth, angulation, and the speed of punch rotation. The current system needs less human intervention and is simpler to operate, but significant experience is still critical to achieving the best results.
The robot is more versatile in its ability to harvest grafts from patients with different hair characteristics and from different parts of the scalp compared to hand-held systems. Although there is still variability in the ease of extraction among patients of different racial backgrounds, in our experience, the differences are less when compared to a manual device. Also, with the robotic system it seems easier to extract grafts from the sides of the scalp where the hair lies flatter on the skin.
ARTAS Robot harvesting follicular units
from the back of a patient’s scalpBernstein Medical offers patients undergoing Robotic FUE the option of different punch sizes. We have found that a 0.9mm punch (the standard is 1.0mm) shortens healing time, decreases donor scarring and increases the number of follicular units that can safely be harvested in a specific area. It also creates grafts that require less trimming. Some patient, especially African-Americans, have less transection with the larger punch, so it is important to be able to customize the technique to the particular person.
Another important modification of the FUE technique introduced at Bernstein Medical is pre-making recipient sites.6,7 This is done either prior to extraction in a one-day procedure or at the beginning of the first day in a two-day procedure. With this change, as soon as the grafts are harvested, they can be placed immediately into the recipient scalp. Not only does this minimize the time that grafts are outside the body, but; by allowing the healing process to begin in the recipient area; it minimizes popping, increases visibility when placing (due to less bleeding), and may create a better environment in which the newly transplanted grafts can grow.
ARTAS System for Robot FUE
The ARTAS FUE robot is an image-guided system composed of a robotic arm, dual-needle punch mechanism, video imaging system, and a user interface. Its extraction technique consists of a double-punch arrangement with an inner (sharp) punch and outer (dull) punch. The inner punch has cutting capabilities to score the upper most part of the skin and the outer punch has a blunt edge used for dissection of the follicular units from the surrounding tissue that minimizes injury to the grafts. The image-guided system allows this step to be accomplished with great precision. The patient lies on a specially designed operating table that allows access of the robotic arm to the donor area of the scalp.
- 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. [↩]
- Harris JA. The SAFE System: New Instrumentation and Methodology to Improve Follicular Unit Extraction (FUE). Hair Transplant Forum Intl. 2004; 14(5): 157, 163-4. [↩]
- Rassman WR, Harris J, Bernstein RM. Follicular Unit Extraction. In: Haber RS, Stough DB, editors: Hair Transplantation, Chapter 17. Elsevier Saunders, 2006: 133-137. [↩]
- Bernstein RM, Rassman WR. New Instrumentation for Three-Step Follicular Unit Extraction. Hair Transplant Forum International 2006; 16(1): 229, 237-9. [↩]
- Bernstein RM, Rassman WR. Pre-making recipient sites to increase graft survival in manual and robotic 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. [↩]