Dr. Bernstein was quoted in a New York Post article on the growing popularity of surgical hair restoration. In the article, Dr. Bernstein explained how celebrity hair transplants have become a driving factor behind the fading of the decades-long stigma of hair transplants.
“Soccer players, football players — they’re admitting they’ve had the surgery. Patients bring in pictures of [George] Clooney, Brad Pitt. The stigma of the old plugs is fading,” [said Dr. Bernstein.]
While celebs aren’t writing signed confessions, there’s plenty of speculation about which high-profile men may have gotten procedures — such as LeBron James, Kevin Costner, John Travolta and Jeremy Piven.
Advancement in hair transplant technology may also be lending a hand. Follicular Unit Transplant (FUT) surgery and newer techniques, such as Robotic FUE, have all but eliminated the old corn-row style “hair plugs” that were commonplace twenty years ago.
The article discusses how the hair restoration industry saw a 27% increase in hair transplant procedures worldwide since 2012. The newest data released by the International Society of Hair Restoration Surgery (ISHRS) values the global surgical hair restoration market at nearly $2.5 billion.
Dr. Robert M. Bernstein, pioneer of modern hair transplant procedures and a Clinical Professor of Dermatology at Columbia University in New York, was included in New York Magazine’s ‘Best Doctors’ issue for the 16th consecutive year.
New York, NY — Robert M. Bernstein, MD, MBA, FAAD, a Clinical Professor of Dermatology at Columbia University in New York and renowned pioneer of Follicular Unit Transplantation (FUT) and Robotic Follicular Unit Extraction (Robotic FUE) hair transplant procedures, was included in New York Magazine’s annual ‘Best Doctors’ issue for the sixteenth consecutive year.
On being chosen for his sixteenth consecutive ‘Best Doctors’ issue, Dr. Bernstein said: “I am honored to be considered among the best doctors in New York and it is a credit to the hardworking staff at Bernstein Medical that, after two decades of incredible progress, we are still making significant advances in the surgical treatment of hair loss.”
Recognition of Dr. Bernstein and his contributions to the field of surgical hair restoration comes as he continues to push the envelope with advances in Robotic FUE hair transplants, improving more traditional hair restoration techniques and exploring adjuvant treatments such as Platelet Rich Plasma (PRP).
Among the improvements Dr. Bernstein has made to the robotic hair transplant procedure include: automated selection of follicular unit grafts, robotic creation of recipient sites, reducing wound size, and a “long-hair” FUE technique that allows a patient to have an FUE hair transplant without the donor area being visible in the post-op period. Collectively these improvements make the robot more efficient, reduce scarring from the procedure, and improve the outcome for patients. Dr. Bernstein’s internationally renowned hair restoration facility, Bernstein Medical – Center for Hair Restoration, is a beta-testing site for Restoration Robotics, Inc., the company that produces the ARTAS® robot. Dr. Bernstein is a medical advisor to the company.
New York Magazine’s ‘Best Doctors’ issue is a special annual edition of the acclaimed magazine which contains a directory of the New York City area’s best physicians. The directory is created by selected by Castle Connolly, Ltd., through a survey of doctors in the New York Tri-State area. To be included, doctors in New York, New Jersey and Connecticut are nominated by their peers and then must pass a rigorous physician-led review of their qualifications, reputation, and skill in diagnosis and treating patients. Castle Connolly also publishes America’s Top Doctors, which has included Dr. Bernstein in all fourteen editions.
About Robert M. Bernstein, M.D., F.A.A.D.
Dr. Robert M. Bernstein is a Clinical Professor of Dermatology at Columbia University in New York, founder and lead surgeon at Bernstein Medical – Center for Hair Restoration, and renowned pioneer of Follicular Unit Transplantation (FUT) and Robotic Follicular Unit Extraction (Robotic FUE) hair transplant procedures. Dr. Bernstein was the first to describe Follicular Unit Transplantation and Follicular Unit Extraction in the medical literature, and his more than 60 medical publications have fundamentally transformed surgical hair restoration. Dr. Bernstein has received the Platinum Follicle Award, the highest honor in the field given by the International Society of Hair Restoration Surgery (ISHRS), and has appeared as a hair restoration expert on many notable television programs and news and lifestyle publications over the years. Examples include: The Oprah Winfrey Show, The Dr. Oz Show, The Today Show, Good Morning America, ABC News, CBS News, New York Times, Wall Street Journal, Men’s Health Magazine, and more. He is co-author of Hair Loss & Replacement for Dummies. Dr. Bernstein graduated with honors from Tulane University, received the degree of Doctor of Medicine at the University of Medicine and Dentistry of NJ, and did his training in Dermatology at the Albert Einstein College of Medicine. Dr. Bernstein also holds an M.B.A. from Columbia University.
About Bernstein Medical – Center for Hair Restoration
Bernstein Medical – Center for Hair Restoration, founded by Dr. Bernstein in 2005, is dedicated to the diagnosis and treatment of hair loss in men and women using the most advanced technologies. The state-of-the-art facility is located in midtown Manhattan, New York City and treats patients who visit from 58 countries and all 50 states. The board-certified physicians and highly-trained clinical assistants at Bernstein Medical take pride in providing the highest level of treatment and care for all patients. In 2011, Bernstein Medical became one of the first practices in the world to offer Robotic FUE hair transplant procedures using the image-guided, computer-driven technology of the ARTAS Robotic System. Bernstein Medical is a beta-testing site for this technology.
Q: What is the main difference between hair transplants using the robot versus other procedures?
A: There are two basic types of hair transplant procedures, Follicular Unit Transplantation (FUT or strip surgery) and Follicular Unit Extraction (FUE). In FUT, donor hair is harvested by removing a long thin strip from the back of the scalp. Individual follicular units are then obtained from this strip using stereo-microscopic dissection. In FUE, individual follicular units are harvested directly from the donor area using a sharp, round cutting instrument. The ARTAS Robotic System performs the follicular unit isolation step of an FUE procedure and can also create recipient sites according to specifications determined by the hair restoration surgeon. In performing each of these steps, the robot uses its image-guided technology to locate the next target and position the cutting instrument, and it does so with precision and speed that cannot be accomplished using manual FUE techniques or instruments.
Q: I have been reading about Robotic FUE and have seen some photos on your website of you operating the ARTAS robot using what looks like a remote control. What is that thing and how does it control the robot?
Dr. Bernstein Operating the ARTAS FUE Robot
A: The ARTAS robot uses a dual operating system when performing follicular unit extraction. One station consists of a desktop computer adjacent to the robot. This station is used to establish the basic parameters of the transplant such as the spacing of grafts, the angle and depth of the harvest, which size follicular units will be targeted, and a host of other important variables.
The hand-held pendant is used by the operator situated next to the patient. The remote has more limited options – the main ones being depth adjustment and to immediately suspend the action of the robot. Many of the parameters are determined automatically by the robot’s computer to maximize the accuracy of the harvesting. The robot also makes real-time adjustments to these variables during the hair restoration procedure.
The physician sets the parameters at the computer monitor and, once the settings are determined, he/she sets the tensioner grid on the patient’s scalp. The tensioner determines where the grafts will be harvested. The grid is moved approximately every 130 harvests. The robot can be operated at the computer terminal and through a mobile pendant. The physician often alternates with a trained assistant between that station and using the pendant.
Besides the involvement in the operation of the robot, there are many other important physician-dependent steps to the hair transplant including the planning and design of the procedure, and recipient site creation. Other steps, such as the microscopic sorting and trimming of harvested follicular unit grafts and graft placement, are often performed by trained staff, but require the physician’s close supervision.
Dr. Bernstein Presenting at ARTAS User Group Meeting 2015
Dr. Robert M. Bernstein introduced a new capability of the ARTAS® robotic system, “Follicular Unit Graft Selection,” at the ARTAS User Group Meeting on February 7th, 2015 in Newport Coast, CA. He presented the new technology and the preliminary results of a bilateral pilot study of the technique conducted at Bernstein Medical.
In robotic graft selection, the hair restoration surgeon programs the ARTAS robot to harvest follicular units based on the number of hairs in each unit. The robot first selects and then isolates larger follicular units of 2-hairs or more. If too few 1-hair units are extracted, the surgeon can program a second pass at extracting only the smallest grafts. As an alternative, the larger units can be divided into smaller ones using stereo-microscopic dissection. The goal is to both minimize wounding and harvest an adequate distribution of varying size follicular units to satisfy the surgeon’s, and ultimately the patient’s, aesthetic hair restoration needs. The new robotic graft selection system enables the robot to intelligently and efficiently harvest follicular units.
Results of the bilateral pilot study showed that the robot’s new graft selection capability was superior to random graft selection, the robot’s default setting, in the amount of hairs extracted per harvest attempt. Dr. Bernstein described how he was able to generate more transplantable grafts with fewer attempts at harvesting. By splitting larger follicular units into smaller grafts under stereo-microscopic dissection, he was able to produce additional grafts for use in the transplant without causing further wounding.
When the new computerized graft selection capability is coupled with dissection of larger units, the result is a substantial improvement over randomized graft selection. Read more about Robotic Graft Selection and the pilot study.
Q: How does the ARTAS robot control the depth of the incision in Robotic FUE?
A: The ARTAS robotic system is equipped with advanced sensors that determine the precise depth of the sharp and blunt needles used both in the graft harvesting step and for recipient site creation. The robot automatically adjusts to the precise depth needed for the non-traumatic extraction of the grafts. The tip of the punching mechanism contains depth markings so that the physician can visually override the punch when he wants to fine-tune its action. While monitoring the procedure in real time, if it is observed that the punches are too superficial or too deep, punch depth can be modified using the robot’s computer system.
The physician can also use the ARTAS system to precisely control the depth of recipient sites. As with harvesting, the robot automatically adjusts the depth based on parameters set by the physician and the doctor can then make further adjustments, in real-time, during the procedure.
Q: Does Follicular Unit Extraction performed by a robot hurt more than regular FUE? — R.T., Greenwich, CT
A: As with manual FUE, robotic FUE hair transplantation is an outpatient procedure performed under long-acting local anesthesia – a combination of lidocaine and bupivacaine. After the initial injections, the patient does not experience any pain or discomfort.
Before starting local anesthesia, we give most patients oral valium and intra-muscular midazolam (a very fast acting sedative that is very relaxing). While some patients doze off at the beginning of the procedure, others prefer to watch TV, a film, or just chat.
Local anesthesia generally wears off after 4-5 hours, so for transplant sessions lasting longer than this, we will give more anesthesia before the first wears off. With Robotic FUE, there is no discomfort once the procedure is completed and the anesthesia wears off. This is in stark contrast to an FUT strip procedure which can be uncomfortable in the donor area for days to weeks.
Restoration Robotics, the company that developed the ARTAS® Robotic Hair Transplant system, has published a white paper case study on how Dr. Bernstein utilizes the robotic system’s tools to minimize scarring after Robotic FUE.
The paper describes how a Bernstein Medical patient — a 45 year old man with Norwood Class 5A male pattern baldness — had 2,540 follicular units harvested with the ARTAS robot, generating a total of 2,768 grafts. Some of the tools and techniques that Dr. Bernstein employed include:
Small 19g dissecting needle — the small needle leaves a smaller wound that heals more rapidly than previous needles.
Software programmed to avoid 1-hair follicular units — the extraction of follicular units with more than one hair maximizes the number of hair follicles per graft and reduces the number of donor wounds that need to be made.
Minimum distance between harvest sites — by increasing the distance between harvested follicular units (from 1.7mm to 2.0mm), Dr. Bernstein enabled “feathering” between harvested and non-harvested zones. This blending of harvest zones into non-harvested zones makes the harvested area less noticeable.
In the third month after his Robotic FUE hair transplant surgery, the patient’s donor area was reviewed for scarring with hair shaved at four different lengths.
See images of the patient’s donor area below:
Before Robotic Hair Transplant
Day 2 Following ARTAS Procedure
3mo Post-op: Shaved with #2 Clipper
3mo Post-op: Shaved with #1 Clipper
3mo Post-op: Shaved with Peanut Clippers
3mo Post-op: Shaved with Peanut Clippers (Close Up)
3mo Post-op: Shaved to the Skin
3mo Post-op: Shaved to the Skin (Close Up)
The case study illustrated that the ARTAS Robotic Hair Transplant system’s suite of tools can minimize the detectability of scars after an FUE hair transplant.
Michael B. Wolfeld, M.D., a board certified plastic surgeon in New York City, presented advances in robotic hair transplant procedures to the 88th annual Plastic Surgery “The Meeting,” the largest international conference on plastic surgery. Dr. Wolfeld presented topics such as robotic harvesting of follicular unit grafts and robotic recipient site creation using the ARTAS® Robotic Hair Transplant system at the conference that was held in Chicago, Illinois from October 10-14th, 2014.
Dr. Wolfeld Performing Robotic Hair Transplant at Bernstein Medical
Chicago, Illinois — Dr. Michael B. Wolfeld, a board certified plastic surgeon, presented recent advances and best practices in robotic hair transplant procedures to an audience of over one hundred plastic surgeons in their annual Plastic Surgery “The Meeting,” the largest international conference in the field. The 88th annual conference was held in Chicago, Illinois from October 10-14, 2014.
Dr. Wolfeld discussed the ARTAS® Robotic Hair Transplant system’s capabilities, such as follicular unit isolation during the graft harvest stage and the recently developed ability to create recipient sites. He also discussed ARTAS Hair Studio™, a new software suite that allows physician and patient to collaborate on a hair restoration treatment plan and then upload that plan into the robot for implementation. Together, these advances represent the state-of-the-art in surgical hair restoration and the integration of the two most critical phases of a hair transplant, the design and planning phase and the performance of the surgical procedure.
Featured in Dr. Wolfeld’s presentation was the new capability of the ARTAS robot to create recipient sites, small incisions in the patient’s scalp into which grafts of naturally-occurring groups of 1-4 hairs, called follicular units, are inserted. Dr. Wolfeld outlined how the robot performs this phase of the procedure with greater precision and consistency than a surgeon using manual instrumentation. His presentation showed how the physician can specify characteristics of recipient sites including the direction, angle, and depth of the incisions; the total number and density in the scalp of the incisions; and the diameter of existing hairs that the robot should use its image-guided technology to avoid. The distribution and style of recipient sites that the robot creates can be made to complement the distribution and growth of existing hairs. As a result of these innovations, the transplant results will appear more natural.
Dr. Wolfeld described how ARTAS Hair Studio, software that was developed by Restoration Robotics, Inc. to interface with the ARTAS Robotic Hair Transplant system, will allow the physician to create a three-dimensional model of the patient’s head and then design and manipulate a hair restoration plan that factors in the patient’s actual hair loss pattern. The physician can then digitally add hair to the 3-D model so patients can have a preview of how the hair transplant should look. This interactive tool will foster a collaborative environment in which the patient will feel more personally involved in their hair restoration experience. It will also help the patient align their expectations with a realistic outcome that takes into account the limited number of grafts that can be extracted from the back and sides of their scalp, or what is known as the donor area.
Dr. Wolfeld explained some of the best practices in procedures performed at Bernstein Medical and detailed two case studies of patients who had robotic hair transplants at the state-of-the-art Bernstein Medical facility in New York City. One of the best practices he described is a modification of the sequence of the Follicular Unit Extraction (FUE) procedure. By “pre-making” recipient sites, or creating recipient sites before follicular unit grafts are harvested, the physician, Dr. Wolfeld explained, can shorten the time the grafts are outside of the scalp, thereby increasing the chance that grafts will survive the transplant. The case studies included one patient who had a transplant with 1500 follicular unit grafts over the course of one day and one patient who had a transplant of 2600 grafts split over two days. In both cases, recipient sites were created by the ARTAS robot before the grafts were extracted.
About Dr. Michael B. Wolfeld
Michael B. Wolfeld, M.D. is a board certified plastic surgeon and an attending physician at Lenox Hill Hospital on the Upper East Side of Manhattan, New York City. Dr. Wolfeld is an associate at Bernstein Medical where he performs hair transplants using the newest technologies including the ARTAS Robotic Hair Transplant system. He is nationally published and has given numerous lectures on topics in aesthetic surgery. Dr. Wolfeld was accepted into the highly competitive specialty of plastic and reconstructive surgery and has completed a six year training program in this specialty at the Mount Sinai Medical Center. He served as Chief Resident at Mount Sinai Medical Center and pursued an aesthetic fellowship at Lenox Hill Hospital and the prestigious Manhattan Eye, Ear & Throat Hospital. Dr. Wolfeld received his Bachelor of Science degree from Cornell University and earned his medical degree from SUNY Downstate Medical School.
About Bernstein Medical – Center for Hair Restoration
Bernstein Medical – Center for Hair Restoration; founded by Robert M. Bernstein, M.D., F.A.A.D. in 2005; is dedicated to the diagnosis and treatment of hair loss in men and women using the most advanced technologies. The state-of-the-art facility; located in midtown Manhattan, New York City; treats patients from around the globe. In 2011, Bernstein Medical became one of the first practices in the world to offer Robotic Hair Transplant procedures using the image-guided, computer-driven technology of the ARTAS Robotic System. Bernstein Medical is a beta-testing site of the robot’s new capabilities, including the creation of recipient sites.
Q: How many follicles can you transplant with robotic FUE compared to manual FUE?
A: We can extract the same number of follicles robotically as we can manually.
That said, the goal of any hair transplant procedure is not to transplant as many hair follicles as possible but rather to achieve the best possible cosmetic result given your degree of hair loss and the number of hair follicles available in your donor area.
While there is no difference between robotic and manual FUE in terms of the number of follicles that each procedure can extract, robotic FUE does have the following advantages over manual FUE:
During the follicular unit extraction (or harvesting) phase of a hair transplant, there is less chance of damaging follicular units using a robot vs. a hand held device (e.g., Neograft), because the robot is more accurate. This means more grafts survive after transplant.
Robotic graft harvesting times are shorter than manual, e.g., while on average if a physician could manually extract 200-300 grafts per hour, the same physician could robotically extract up to 500-1000 grafts per hour1. This means a shorter procedure time for the patient.
Disclaimer: The purpose of this website is to provide the public with general information on hair restoration and related medical topics. Information provided on this site should not be used for medical diagnosis and/or treatment.