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November 19th, 2012


Follicular Unit Extraction (FUE) has come a long way since Dr. Bernstein first described the procedure in medical literature in his 2002 publication, “Follicular Unit Extraction,” published in the journal Dermatologic Surgery. In this video, Dr. Bernstein discusses the transition from hand-held extraction instruments to the computer-driven, image-guided ARTAS® System for FUE.

Here is a more detailed summary of the video:

When we first wrote the first paper on Follicular Unit Extraction in 2002, our main concern was the fact that as you extract the follicle, some of them would be sheared or shredded and we wouldn’t be able to capture the entire follicular unit. Over the years, we’ve done work to refine the procedure — and this has not only been our work, but the work of many of our colleagues — and what we found is that if you try to take one instrument to go down over the follicular unit, because the follicular unit splays — it’s like wheat almost, a bushel of wheat, where on the surface it’s very tight and under the skin it spreads out — because of this configuration as this instrument that cuts the surface of the skin goes deeper, it cuts off the bulbs. Or does what we call transects the follicles.

What we soon learned was that if you use a sharp instrument to score the skin and go through the top part of the follicular unit, you can then use a blunt instrument to kind of blunt dissects or gathers the rest of the unit without cutting off the follicles. We call this step the two-step technique. Hand-held devices that are based upon this two-step technique seem to be better at removing follicles without damage than using just a single sharp punch.

The ultimate two-step technique is now the ARTAS System, by Restoration Robotics, where you actually have a robot very quickly switching from the sharp instrument, which scores the surface, to using a blunt dissection to go down deeper into the tissues in order to preserve these follicles and not to injure them or transect them while they are being removed from the scalp.

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