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Robotic Hair Transplants & Hair Restoration
Flagship: 110 East 55th Street, New York, NY
212-826-2400 - [email protected]
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Dr. Bernstein answers frequently asked questions about hair transplantation, hair loss, and medical treatment for hair loss.

Hair Restoration Answers

Can Kevis Products Prevent Hair Loss?

Q: Can using Kevis prevent hair loss? — H.T., New York, NY

A: Kevis has a line of natural products including shampoos, accelerators, lotions and conditioners claimed to treat hair loss by blocking DHT. The primarily ingredient is HUCP, or hyaluronic acid. Hyaluronic acid has not been shown to prevent hair loss.


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Hair Restoration Answers

What Part of FUE Hair Transplant is Performed by ARTAS Robotic System?

Q: With the ARTAS robotic system for FUE hair transplantation, by Restoration Robotics, what part of the FUE hair transplant procedure can actually be done by the robot? — A.M., Los Angeles, CA

A: The ARTAS System is a computer-guided method of harvesting follicular units in the donor area during Follicular Unit Extraction (FUE). The initial phase of FUE, where the follicles are selected, scored and separated from the surrounding scalp is done by the ARTAS System. All other phases of the procedure including; actual follicular unit graft removal from the scalp, hairline design, recipient site creation and placement of the grafts into the balding scalp are done by the surgical team.

In the near future, improvements in the ARTAS System should allow it to be able to actually extract the separated grafts from the scalp. Eventually, the engineers hope to be able to increase the capability of the system so that it can create recipient sites and implant the extracted grafts into them.

Read about Robotic FUE Hair Transplantation


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Hair Restoration Answers

How Does the ARTAS Robot Work?

Q: How does the ARTAS robotic hair transplant system actually work? — J.N., Fort Lee, NJ

A: The ARTAS System for Follicular Unit Extraction (FUE) combines several features including an interactive, image-guided robotic arm, special imaging technologies, small skin punches of two different sizes, and a computer monitor. After the system is positioned over the patient’s donor area of the scalp, ARTAS is capable of identifying and isolating follicular units from the surrounding scalp.

After the robotic arm is aligned with the follicular unit, a sharp 1-mm punch is used to cut through the upper part of the skin (the epidermis and upper dermis).

Immediately following this, a duller, 1.3mm punch is used to separate the deeper part of the follicular unit from the remainder of the dermis and subcutaneous fat. Once separated by the robot, the follicular units are manually removed from the scalp and stored until they are implanted into the patient’s recipient area.

Read about robotic FUE hair transplantation


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Hair Restoration Answers

What Does the ARTAS Robotic System for Follicular Unit Extraction (FUE) Actually Do?

Q: What does the ARTAS robotic system for Follicular Unit Extraction (FUE) actually do? — E.J., Plainsboro, NJ

A: The ARTAS robotic system for hair restoration is a computer assisted system, made by a company called Restoration Robotics, that utilizes image-guided robotics to increase the quality of the hair follicles harvested during FUE. It aids in the initial part of the FUE hair transplant procedure where follicular units are separated from the surrounding tissue. The system is operated under direct physician supervision.

Read about robotic FUE hair transplantation


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Hair Restoration Answers

Is Nizoral An Effective Hair Loss Medication?

Q: I use Nizoral for my dandruff. Does it work for hair loss too? — M.D., Danbury, CT

A: The active ingredient in Nizoral is Ketoconazole. This medication, originally developed to treat fungus infections, has slight anti-androgen action. It is supposed to work in hair loss by inhibiting the action of DHT on hair follicles. Although, in theory, it should be useful for androgenetic hair loss, there have not been conclusive scientific studies to show that it works to treat balding when used as a topical application for balding.


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Hair Restoration Answers

When Was the ARTAS Robotic System Approved For FUE Hair Transplants?

Q: When was the ARTAS robot for FUE approved for use in hair transplantation? — J.B., Jersey City, NJ

A: Restoration Robotics’ ARTAS System for robotic follicular unit harvesting, received 510K clearance by the Food and Drug Administration (FDA) on April 14, 2011. The indication is for “harvesting hair follicles from the scalp in men diagnosed with androgenetic alopecia (male pattern hair loss) with black or brown straight hair.”

Read about robotic FUE hair transplantation


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Hair Restoration Answers

What is Restoration Robotics?

Q: What is Restoration Robotics? — L.N., East Brunswick, NJ

A: Restoration Robotics is a medical device company, based in Mountain View, California, that has developed a computerized instrument to assist in the graft extraction phase of follicular unit extraction (FUE) hair transplant procedures. Their patented device, called “ARTAS,” is an image-guided system for FUE. Their website is: www.restorationrobotics.com.

Read about robotic FUE hair transplantation


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Hair Restoration Answers

When Are Surgical Staples Removed After Hair Transplant?

Q: I hear you leave staples in sometimes up to three weeks after a hair transplant. Why do you leave staples in that long? – M.C., Boca Raton, FL

A: My reason for leaving some staples in longer is that the tensile strength of the wound continues to increase (significantly) during the first three week period after surgery — actually, it will continue to gain strength for up to one year post-op. To give the wound the best chance to heal, on average, I take out alternating staples at 10 days and the remaining staples at 20 days.

Although patients do complain that they are uncomfortable, removing half at 10 days offers enough relief for those who are bothered by them. The advantage of leaving the staples in longer is that the wound heals with a finer scar. And for patients who are very active, it allows them to resume activities more quickly. For each patient, I modify the time left in by surgery, length of incision, tension, and also the patient’s needs and ability to have them removed.

In contrast to sutures, staples do not leave any track marks and do not need to be removed as quickly. Sutures can also damage the surrounding hair by strangulating the follicles. Staples are interrupted (placed individually), so they don’t cause damage to the follicles adjacent to the wound edge.

Read more details about our use of surgical staples on the Donor Area page.


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Hair Restoration Answers

Are Propecia Side Effects Irreversible?

Q: I heard that the sexual side effects of Propecia are irreversible. Is this true? — L.R., Parsippany, NJ

A: The sexual side effects of finasteride (Propecia) begin to subside soon after the medication is discontinued. This would make sense since the drug finasteride is a reversible inhibitor of DHT. Although it is possible for side effects to be persistent after stopping the medication, this situation seems to be very uncommon and a cause and effect relationship is still in question.

One should consider that sexual dysfunction is relatively common in the adult male population and millions of patients take finasteride. Thus, there is a likely probability that some patients on finasteride may experience sexual dysfunction unrelated to the medication and, therefore, when the medication is stopped, the side effects would not be expected to go away.

Another thing to consider is that once a patient experiences sexual dysfunction (from a medication or another reason) psychological factors may come into play that make the side effects persist, even though they are unrelated to the medication or other underlying cause that may now be gone.

It is important to keep in mind that medication plays an important role in the prevention and treatment of androgenetic alopecia and decisions to use medications should be done thoughtfully and in an informed way. Blog postings can offer some subjective information, but they do not constitute true research and should be used in conjunction with the information provided by your physician and other informed sources.

Learn more about Propecia (finasteride) and other hair loss medication.


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Hair Restoration Answers

What Is The Status Of The Latisse For Hair Loss Study?

Q: I saw your post on the clinical trials of Latisse (bimatoprost) for hair loss on the scalp. What is the status of the study? — B.V., New Providence, NJ

A: Allergan, the company that makes Latisse, conducted safety and efficacy testing of three formulations of the drug for men with androgenetic alopecia (male pattern baldness). Latisse is a drug that is approved by the FDA to help eyelash growth at a concentration of 0.03 %. The drug is applied daily to the upper eyelid.

Allergan studied the results of three formulations of Latisse (Bimatoprost .03% Opthalmic Solution) comparing them to results of a control option and also an over-the-counter minoxidil 5% solution. The drugs were applied directly to the scalp, and the progression of hair loss was measured.

This study began in June 2011 and the results were published in April 2014. The results of the study did not indicate that Latisse would be a viable alternative to use on the scalp to prevent hair loss.

It should also be noted that the cost of bimatoprost, the active ingredient in Latisse is significantly more expensive than minoxidil, the active ingredient in Rogaine. This means that even if the two treatments were equally effective, it would be cost-prohibitive to treat baldness with Latisse.

Latisee (Bimatoprost .03% Opthalmic Solution) has not been FDA approved for the treatment of scalp hair loss.

For more information, view the results and details of the study on ClinicalTrials.gov .

Read more about Latisse/Bimatoprost.


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Hair Restoration Answers

Using the Term “Re-do” in Describing Additional Hair Transplant Repair Procedures

Is it appropriate to call hair transplant repair a “re-do” of a hair transplant? This question is the basis of a discussion Dr. Bernstein had with a UK-based hair restoration physician. Read on for the full exchange.

Question submitted by Nilofer Farjo:

In the last couple of years I have heard the term “redo” being used in the UK and more recently at an International conference. This term is used to describe a surgical case where the patient is unhappy with their result and the surgeon “redoes” the equivalent number of grafts or partially redoes the number at no charge. It seems that this has become normal practice for some hair surgeons and begs the question of why there are so many of these cases that it has now crept into everyday vocabulary. I admit that I get one or two cases per year with less than expected density which usually resolves given extra time but occasionally this isn’t the situation and the results are not as good as expected. This situation certainly is neither commonplace nor expected. So in the “redo” scenario are the doctors performing less than optimum surgery or are the patients being given the wrong expectations?

I had one such patient attend for consultation a week ago. He had 2 operations at 2 different clinics and he came to me because they both failed. His first operation was an FUE procedure and the second a strip surgery. On examining the patient he had sparsely placed grafts in his forelock with little native hair left and was completely bald behind. He had never been prescribed medication. I told him that his transplant(s) hadn’t failed but that a number of things had happened: he probably got shock loss after each surgery, he continued to thin in the forelock and crown and he wasn’t advised properly. I asked if he had returned to the clinics. No to the FUE as it was overseas, yes to the second clinic where they offered a “redo”. The patient refused as “the first operation didn’t work.”

So my question is should we be actively doing something to discourage the use of terms such as “the redo” that seem to me to not only admit to liability for a bad result but to make it an expected rather than an uncommon outcome?

Response by Robert M. Bernstein:

In my opinion, the term “re-do” is quite descriptive and is fine as is. The issue at hand is not the terminology, but the cause of the patient’s dissatisfaction. I think that the question Nilofer poses – “So in the redo scenario are the doctors performing less than optimum surgery or are the patients being given the wrong expectations?” – speaks to the crux of the problem. Unfortunately, the problems that can lead to a patient being unhappy are many.

In the initial physical examination, problems result when there is an inadequate assessment of a person’s donor area and factors such as low density, high miniaturization, an ascending posterior hairline, or a very tight scalp, are overlooked. Problems may also arise from a cursory assessment of the recipient area, so that severe solar change (that can compromise skin elasticity and vascular perfusion) goes unnoticed.

In the surgical planning problems may be caused by placing the frontal hairline too low or too broad (often in response to a demanding patient) or trying to cover an area of scalp (such as the crown) that is too great for a given donor supply. It also includes operating on a patient too young for the surgeon to adequately determine the stability of the donor supply or even to adequately assess the maturity of the patient’s decision making process.

In the discussion with the patient, problems include over-promising density from the transplant, underestimating potential future hair loss, and denying the existence of shock hair loss as an unavoidable risk of the procedure.

The intra-operative problems and poor surgical techniques that can contribute to poor growth, or cosmetically unappealing hair transplants, are well documented in the medical literature and too numerous to detail in this brief commentary. However, it is has been my experience that, with some exceptions, doctors trying to “fix” their own work usually make the same mistakes again and again.

The reason I am fond of the term “re-do” is that, without a detailed explanation by the doctor as to the exact problem (and the way to correct it), the term implies that the patient will get the same treatment the second time around. If the doctor knows how to correct the problem, then he should have done it right the first time. And if it were truly an act of nature, then what would keep those “natural” forces from acting the same way again?

If I were a patient with an unsuccessful hair transplant and the doctor was kind enough to offer me a re-do, I would graciously thank him… and then head for the hills.


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Hair Restoration Answers

What is the Latest in Hair Transplant Robotics?

Q: I have read your page on robotics in hair restoration and am interested in learning more. Are there any updates in the development of the system you mentioned? — W.T., London, UK

A: Restoration Robotics, Inc. — based in Mountain View, CA — has spent the last few years developing and testing a robotic hair transplant device for follicular unit extraction (FUE). The ARTAS robot system has recently received 510(k) approval from the Food and Drug Administration, meaning that the company may now begin marketing the system for use in hair restoration clinics.

The FDA classifies the device as a “computer assisted hair harvesting system” and describes it as being used to identify and extract follicular units and to help the surgeon do the same during hair transplantation.

The ARTAS robot consists of a computer assisted station with needle mechanism, force sensor, robotic arm, and video imaging system. The software that runs the instrument helps the surgeon target follicular units for extraction and also uses stereoscopic video images to guide the needle mechanism and robotic arm.

We will update you as more information becomes available about the ARTAS system and Restoration Robotics.

See a photo of the ARTAS robot and stay on top of developments by visiting our Robotic Hair Transplantation page


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Hair Restoration Answers

Is Genetic Hair Loss Linked to Other Diseases?

Q: There was a retrospective study by Lotufo et al. linking male pattern baldness to heart disease. Do you think there are other links like this for androgenetic alopecia? — J.L., San Francisco, CA

A: Family studies revealed both the androgen receptor locus on the X chromosome, as well as a new locus on chromosome 3q26. Association studies performed in two independent groups revealed a locus on chromosome 20 (not near any known genes) as well as the androgen receptor on the X chromosome.

So far, the genetic studies for androgenetic alopecia (AGA) have not revealed identification of a particular gene other than the androgen receptor, as well as the two candidate regions on chromosomes 3 and 20. Inasmuch as the androgen receptor can be involved in other diseases, this might be a feasible connection. Until candidate genes are identified that underlie AGA, it is impossible to predict where the commonalities might lie.

Excerpted from Angela Christiano, Hair Transplant Forum International 2011; 21(1): 14-15.

Read more about Hair Loss Genetics, and see some other Hair Restoration Answers posts on the topic.


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Can Body Hair Transplant be Negatively Affected by Finasteride?

After trading anecdotes with fellow hair loss physicians about how finasteride can reduce body hair in some patients, Sharon A. Keene, M.D. took the next logical step and asked whether finasteride might have a negative effect on patients who have body hair transplant (BHT) procedures.

In a review of scientific literature on whether finasteride effects body hair growth, Dr. Keene finds that current research is inconclusive.

Finasteride, the drug in the hair loss medication Propecia, works by blocking the 5-alpha-reductase type 2 enzyme (5-AR Type 2) which is needed by the body to covert testosterone to DHT. DHT causes common baldness, by making hair follicles shrink and eventually die.

In looking at DHT’s effect on body hair growth, current research strongly suggests that it does play a key role. Males born with a deficiency of 5-AR Type 2, and thus no DHT, have reduced, or absent, body hair growth (and no loss of scalp hair).

It would seem logical then, that when finasteride is used to re-grow hair on the scalp, it would also inhibit the growth of hair on the body. However, the genetic variation among people is too great to determine exactly how much of an influence it plays.

With this uncertainty of DHT’s effects on body hair, it is impossible to say, without further study, if finasteride would have the same effect on body hairs which are transplanted to the scalp. In Dr. Keene’s conclusion, she suggests:

A patient on finasteride for at least a year who undergoes BHT is probably safe to continue it, as remaining body hairs are apparently not sensitive to the effects of this drug.

You can read the full discussion and review of current research in the January/February 2011 issue of Hair Transplant Forum International, the official newsletter of the International Society of Hair Restoration Surgery (ISHRS).


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What is Toppik Made From?

Q: What are the fibers in Toppik made from? — A.P., Toronto, Canada

A: Toppik is made from an organic protein called keratin – the same protein that comprises one’s hair and nails. It works by thickening the hair and adding color to the scalp, making the hair appear fuller in those with hair loss or general thinning.

Read more about Toppik and other products on our Cosmetic Camouflage Products page.

Read more about Hair Loss page.


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Updated: 2019-11-15 | Published: 2009-07-02


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