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How Does the ARTAS Robot’s Image-Guided System Work, and is it Better than Manual FUE Using the Naked Eye?

July 18th, 2014

Q: I have read a bit about the ARTAS robot and how it uses an “image-guided” system, but what does that mean? And how is the robot’s imaging system different or better than a human surgeon viewing the grafts with the naked eye?

A: That is a great question and it gets to one of the key benefits of the robotic hair transplant system: its accuracy. When a surgeon is performing FUE using manual techniques, they must wear a headset that magnifies the scalp so they can see the follicular units more clearly than with the naked eye. The surgeon must visually and mentally process every nuance of the skin and a variety characteristics of the follicular unit for every one of the hundreds or thousands of units that are extracted. The ARTAS robot magnifies the surface of the skin in much the same way, but to a much greater degree of magnification. In addition, it is not subject to the limitations of the human eye or human hand and it is not subject to human error. The human eye may be distracted by an element on the skin. The surgeon may not have exact hand-eye coordination. The surgeon may be concentrating on one aspect of the extraction, say following the angle of the hair, but might ignore another important aspect of the follicle, say its depth in the skin or its orientation. And, of course, the surgeon tires, both physically and mentally, from performing the hundreds or thousands of repetitive motions.

The robot’s image-guided system, on the other hand, does not experience those limitations. The robot magnifies the skin, detects each follicular unit and the nuances of the skin, and then extracts that follicular unit with exacting precision. When the imaging system detects changes to the skin, this new information is fed into the computer in real-time and the system adjusts automatically based on this feedback as it continues to harvest grafts. There is no distracting the robot, and the robot will never forget or ignore key variables in the extraction. The robot can extract thousands of follicular units without tiring from repetition or slowing down the extraction.

Based on my own practical experience using the robot, it is clear that the robot’s ability to estimate the position of the follicles under the skin and to extract it with precision is superior to manual techniques. Having used the ARTAS system for over 3 years, and having helped make improvements to the device since the first iteration, I have seen robotic technology substantially improve the outcome for my patients.

Read more about the ARTAS Robot and how it works


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Posted by Robert M. Bernstein M.D. on July 18th, 2014 at 8:49 am

Can You Transplant More Grafts With Robotic FUE Or Manual FUE?

May 7th, 2014

Q: Is robotic FUE different in the number of follicular unit grafts one can extract compared to manual FUE?

A: We can extract (and transplant) the same number of follicular unit grafts robotically as we can manually?

The goal of a hair transplant is not to simply transplant as many grafts as possible but to achieve the best possible cosmetic result given the number of hair follicles in your donor reserve. Remember, this is always a limited supply.

While there is no difference between robotic and manual FUE in terms of the number of follicular unit grafts that each can extract, robotic FUE does differ from manual FUE in several important ways.

First, there is generally less transection of the hair follicles with robotic FUE, since the method is more precise. This enables us to obtain follicular units with less trauma to the grafts.

Second, while the robot is not necessarily faster than the human surgeon, the robot is much more consistent since, unlike the human surgeon, it never fatigues and the accuracy is maintained throughout the entire procedure.

Read more about Robotic Hair Transplant


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Posted by Robert M. Bernstein M.D. on May 7th, 2014 at 1:17 pm

What’s the Outlook on a Hair Transplant Robot Performing the Entire Procedure?

March 31st, 2014

Q: I understand that in robotic hair transplantation, a robot performs the extraction part of the FUE procedure. What’s the outlook on the robot doing more of the hair transplant procedure?

A: Currently, the ARTAS® Robotic System is a technology for extracting grafts. This is the most difficult part of a follicular unit extraction procedure, but it is only one part.

There are two other major parts to the FUE procedure: one part is the creation of recipient sites (in our practice, we create the recipient sites first, so that once we harvest the grafts, we can immediately place them into the scalp), and the other part is graft placement.

Recipient site creation involves more than merely making holes in the recipient area. It involves making decisions on hairline design, graft distribution, hair direction, recipient site size and depth. When done manually, the surgeon first designs the new hairline so that the hair transplant will look as natural as possible, particularly as the person ages. Next, the surgeon will demarcate the extent of the area to be transplanted and decide on the graft distribution (i.e., how much hair will be placed in each part of the scalp) and will then prepare a “recipient site” in the part of the scalp that has lost hair. The surgeon will then manually create incisions in the recipient site into which the follicular units will be placed.

On February 8, 2014, Dr. Bernstein unveiled “recipient site” creation capabilities of the hair transplant robot. These new capabilities allow the doctor to import a hairline design and other markings that have been made on the patient’s scalp directly into the robot. The robot then maps the design onto a precise 3-D model of the patient’s head. The physician can then program the proper distribution, direction and depth of the future recipient sites and the robot then creates the sites according to the physician’s specifications.

Graft placement, the last step, is perhaps the most challenging to automate. Engineers are currently working to design and build the capacity to automate the placement of extracted follicular units into recipient site incisions. Done manually, it requires significant hand-eye coordination and a very slow learning curve. For the hair transplant robot, it will be a significant challenge with development taking several years or more.

Read more about Robotic Hair Transplant


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Posted by Robert M. Bernstein M.D. on March 31st, 2014 at 10:45 am

What is the Main Advantage of Robotic FUE Over Manual FUE?

March 18th, 2014

Q:  I’ve heard that robotic-assisted FUE is better than manual FUE, but what exactly is the main advantage of Robotic FUE?

A: The most significant advantage of Robotic-assisted FUE over manual FUE is the decreased chance of damaging follicular units during harvesting. During the follicular extraction phase of a manual FUE procedure, the surgeon must be both extremely precise and careful to avoid damaging the follicular units.

For example, the surgeon must have the extracting instrument perfectly centered over the follicular unit and the surgeon must take into account the angle of the hair and the way it grows. The doctor must also be consistently accurate over thousands of extractions.

The hair transplant robot, however, neither becomes tired nor inconsistent over the course of extracting thousands of follicles. The result is better quality grafts.

Read more about Robotic Hair Transplant


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Posted by Robert M. Bernstein M.D. on March 18th, 2014 at 9:08 am

Can A Hair Transplant Robot Make Transplants Look Natural?

March 11th, 2014

Q: I’ve heard it takes the artistry of the surgeon to create a natural looking hair transplant. How do you do this with a robot?

A: I currently create the recipient sites by hand using different size needles. They determine the angle, direction and distribution of the grafts, and these three variables determine the aesthetic aspects of the hair transplant.

However, I am working with Restoration Robotics to have the ARTAS System create recipient sites and we are currently beta-testing this technology. The robot can now make very precise recipient sites. The ability of the robot to mimic the art of the surgeon is in the works, and we expect it to be ready in the fall of 2014.

In this new robotic-assisted process, the surgeon designs the hairline and delineates the area to be transplanted directly on the patient’s scalp. The surgeon then photographs the patient’s scalp and feeds the photograph into the robot’s computer to create a digital 3-D image. The doctor, in order to have the robot mimic what he would do by hand, can then manipulate various parameters, such as hair angle, direction and density.

Read more about Robotic Hair Transplantation


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Posted by Robert M. Bernstein M.D. on March 11th, 2014 at 9:37 am

Why does the ARTAS® Robotic System only do FUE, Not FUT?

March 5th, 2014

Q: Why does the ARTAS® Robotic System only do FUE, not FUT?

A: Currently the robot is only used for harvesting grafts from the donor area. In FUE, the doctor punches out hundreds to thousands of individual follicular units from the back and sides of the scalp by hand using a small round instrument called a punch. The punch has to be held at exactly the right angle, with just the right pressure applied, stopped at a precise depth and, during this time, rotated (or spun mechanically) without changing the alignment.

As one can imagine, this exhaustingly tedious process can best be done using the precision of a robotic device.

In FUT, the harvesting is done by a surgeon using a scalpel to make a long incision in the back of the scalp. It only takes a few minutes. The harvested strip is removed and then placed under dissecting microscopes where the individual follicular units are isolated. This dissection, thus far, can only be done by hand. There is no robotic technology available to do this.

Harvesting the donor hair, of course, is only one part of a hair transplant. The other steps, recipient site creation (making the holes that the grafts are placed into) and actually placing the grafts into those sites are similar in both FUE and FUT.

It is anticipated that robotic site creation will be available in the fall of 2014 and robotic graft placement, the third and final step, about two years after that. At that time, the robot will be able to perform the entire FUE procedure and the last two parts of the FUT procedure.

Of course, the robot doesn’t do the surgery alone. The physician must input all the information regarding the design and planning of the procedure and closely monitor each step of the robotic process. Unlike automating industrial production, the human scalp has great variability, so there is no one formula that will be appropriate for every patient. Physician skill and involvement is just as important in robotic hair transplantation as it is with every other type of surgical hair restoration procedure.


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Posted by Robert M. Bernstein M.D. on March 5th, 2014 at 1:32 pm

What Part Of a Hair Transplant Can Be Done By a Robot?

February 18th, 2014

Q:  Is it true that hair transplants can now be done totally by a robot?

A: The ARTAS Robotic System, developed by Restoration Robotics, is the most advanced technology for extracting grafts (the first and most difficult step in a Follicular Unit Extraction procedure), but it cannot yet do the entire hair transplant procedure, nor can it work without the supervision of the hair restoration surgeon.

Currently, the  ARTAS System assists the surgeon in performing the first part of an FUE hair transplant (i.e., the extraction phase) with greater precision and consistency than can be done by hand. Engineers and researchers are currently developing the ARTAS to do the remainder of the procedure as well, i.e., making recipient sites in parts of the scalp that have lost hair and then implanting the harvested grafts into these sites.

The next step, recipient site creation, will be available in the latter half of 2014. Dr. Bernstein is already testing a beta version of this new technology. We anticipate that within two years, under the supervision of the surgeon, the ARTAS robot will be performing most of the FUE hair transplant procedure.


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Posted by Robert M. Bernstein M.D. on February 18th, 2014 at 12:15 pm

Can You Program the FUE Robot To Avoid Scars?

March 21st, 2013

Q: I heard that for someone who has had several strip procedures, the ARTAS robot for FUE does not work because it is programmed to work with “textbook male pattern baldness”, which I no longer have. I thought the scars from previous procedures, as well as the large amount of already transplanted hair, might throw off the robot’s programming (it wouldn’t quite know what to do). But if I am wrong about this then the robot may in fact be the best approach for me. Please advise.

A: When performing robotic hair transplants on patients with prior surgery, I program the robot to avoid scarred areas – just as we would do visually when performing manual FUE.


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Posted by Robert M. Bernstein M.D. on March 21st, 2013 at 8:13 am

Does ARTAS FUE Robot Work with Very Curly Hair?

February 13th, 2013

Q: I am an African-American man with tight curly hair. Will the FUE robot be able to work on curly hair?

A: Yes, the ARTAS robot for FUE can be adapted for African-American hair when performing follicular unit extraction. We use a punch that is 0.1mm wider in diameter than the instrument used for Caucasians. It allows us to incorporate the slightly larger volume of tissue that results from the curved hair and enables us to accomplish the hair transplant with less in jury to follicles than if a smaller instrument were used.

See before & after hair transplant photos of patients with curly hair

Read about Robotic Hair Transplantation


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Posted by Robert M. Bernstein M.D. on February 13th, 2013 at 11:01 am

How Does Hair Transplant Surgeon Operate the ARTAS Robot for FUE?

February 11th, 2013

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
Dr. Bernstein Operating the ARTAS FUE Robot

A: The robot uses a dual operating system when performing follicular unit extraction. The main station is at a desk top computer. This station is used to establish the precise area of hair that will be harvested, the spacing of grafts, which size follicular units will be targeted, and a host of other variables. The hand-held remote has a more limited options – the main ones being depth adjustment and to immediately to suspend the action of the hair transplant robot. Most 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.

Read about Robotic Hair Transplantation

Read articles about Robotic FUE


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Posted by Robert M. Bernstein M.D. on February 11th, 2013 at 9:41 am



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