Bernstein Medical - Center for Hair Restoration - ARTAS Robot Accuracy
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Dr. Bernstein Presenting at ARTAS Users Meeting 2018 in Las Vegas, Nevada Dr. Bernstein Presenting at ARTAS Users Meeting 2018 in Las Vegas, NV

Earlier this month, Bernstein Medical physician Dr. Robert M. Bernstein presented at the annual ARTAS Users Meeting in Las Vegas, Nevada discussing the newest hair restoration techniques and the upgrade of the ARTAS 9x. Over 200 medical professionals met to share their knowledge of and experience with the ARTAS Robot for hair restoration.

Dr. Bernstein Presents Advances of the ARTAS 9x Robotic Hair Transplant System

On March 9th, 2018 at the 2018 ARTAS Users Meeting in Las Vegas, Nevada Dr. Robert M. Bernstein, a Clinical Professor of Dermatology at Columbia University and founder of Bernstein Medical – Center for Hair Restoration, presented the latest in Robotic Hair Transplantation using the ARTAS® Robot. Dr. Bernstein described the benefits of the new technology, such as decreased time and increased accuracy of the robotic procedure.

Dr. Bernstein worked with ARTAS engineers in the development of these new advances and tested them in our New York facility. These updates make Robotic FUE a faster and more efficient procedure.

Dr. Bernstein Presenting Long-Hair Robotic FUE at ARTAS Users Meeting 2018 Dr. Bernstein Presenting Long-Hair Robotic FUE at ARTAS Users Meeting 2018

The ARTAS 9x includes software and hardware updates such as white LED lights that are easier on the users’ eyes, a base extender, smaller size needle options, a more ergonomic headrest, automated scar detection, faster harvesting, and streamlined ARTAS Hair Studio software.

One important upgrade of the ARTAS 9x is the use of white LED light and yellow colored tensioner. This allows technicians to extract the grafts while the system is still harvesting the hairs — without causing eye fatigue. This advance alone can significantly reduce operating time. The base extender and the smaller robotic head of the ARTAS 9x allows for a longer reach so less repositioning of the patient is needed.

The ARTAS 9x also has artificial intelligence that detects and blocks out existing scarred portions of the donor area from being harvested. The streamlined ARTAS Hair Studio of the ARTAS 9x only requires one picture to create a 3D image of the patient’s scalp, while the previous version needed multiple.

Long-Hair Robotic FUE

Dr. Bernstein discussed Long-Hair Robotic FUE and its immediate cosmetic benefit to the patient. Traditional FUE procedures require the hair in the entire donor area to be clipped close to the scalp leaving a wide band of the harvested area visible. In Long-Hair FUE, the patient grows his hair longer on the back and sides of the scalp which can then be used to cover the harvested area. Dr. Bernstein explained that before the procedure the surgeon lifts the hair up and clips a long thin band of donor hair and then extracts the follicular units from this part of the donor area. After the procedure, the patient can comb his hair down to cover this harvested area. He explained how this can be done through one long band or, when more grafts are needed, two parallel bands in order to harvest the maximum number of grafts.

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Q: What is the difference between the ARTAS 9x and the earlier versions of the robot? — T.J. ~ Washington, D.C.

A: The differences can be grouped into four broad categories:

1. Speed: The 9x is 20% faster than the 8x. This is achieved through the ARTAS robot’s ability to more quickly and accurately align with the follicles, faster movement from follicular unit to follicular unit while harvesting, and a shortened dissection cycle (less than 2 seconds). In addition, the 9x uses white LED lights instead of red, which permits an increased work flow from the ability to simultaneously incise and extractions grafts. The decreased strain on the eyes from the white lights (compared to red) makes this possible.

2. Accuracy: The 9x uses smaller needles that minimize wounding and donor scarring. It is especially useful for patients with fine hair or those who want to keep their hair short.

3. Functionality: The robotic arm on the 9x has a 1-inch base extender that gives the machine a longer reach and decreases the need for the patient to be repositioned. The ARTS 9x also has a smaller robotic head allowing the robot to harvest the grafts at a more acute angle. The ARTAS 9x also allows for more site making options due to the universal blade holder and the ability to program a change in the orientation of the incision in different regions of the scalp. The ARTAS 9x also uses a new harvesting halo to secure the tensioner (the grid-like device that indicates where the robot should harvest) which is faster to apply and more comfortable for the patient.

4. Use of Artificial Intelligence: The technology notifies the physician early-on if the harvesting is not precise, so that action can be taken to ensure most effective results. The ARTAS software can now detect areas with low (or no) hair density and prevent those areas from being over-harvested. This also decreases human error and saves time by automatically blocking these areas with low density. Finally, the ARTAS Hair Studio, can now create a 3-D image of the patient’s head with only one photo (as opposed to the prior requirement of 3 to 5).

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In a study ((Shin JW, Kwon SH, Kim SA, Kim JY, Na JI, Chan Park K, Huh CH. Characteristics of robotically harvested hair follicles in Koreans. J Am Acad Dermatol, 2014 Sep 13. pii: S0190-9622(14)01789-7.)) published in the January 2014 issue of the journal ‘Dermatologic Surgery,’ researchers from the Republic of Korea collected and analyzed robotically harvested follicular units in a clinical setting using the ARTAS® Robotic System. This is the first time such data has been collected from Korean patients.

Specifically, they looked at the yield of follicular units, the ratio of successfully extracted follicular units to the total number of attempted extractions, and the rate at which hair follicles were transected, or damaged, during the procedure.

They found that the ARTAS system was able to harvest multiple hairs with high yields and low transection rates.

The Study: Characteristics of Robotically Harvested Hair Follicles in Koreans

The researchers collected data on robotically harvested follicular units from 22 Korean patients in a clinical setting using the ARTAS system. To reduce variation due to differences in patients, they collected follicular units from the same scalp location on each patient.

On average, the researchers found that 95% of extraction attempts were successful in producing a follicular unit, while the remaining 5% of attempts resulted in follicular units either being lost inside the robot’s suction system or becoming attached to the robot’s dissection instrument.

Of the successfully extracted follicular units, the average transection rate was 4.9%. This is 16% to 38% lower than has been reported elsewhere ((Wasserbauer S. Robotic assisted harvest of follicular units: Abstract book of 19th annual scientific meeting of International Society of Hair Restoration Surgery; September 14-18, 2011; Anchorage, AK. pp. 252-6.)), ((Kasai K, Haruyama I, Aikawa Y, Saito K. Advantages and disadvantages of FUE using ARTAS system form Japanese: Abstract book of 21st annual scientific meeting of International Society of Hair Restoration Surgery; October 23-26, 2013; San Francisco (CA). pp. 387-8.)). The researchers hypothesized that this lower transection rate could be due attribute these differences to the variability of a patient’s hair profile (e.g., waviness, thickness, color) and the surgeon’s minute control of the depth of punches.

Finally, they found that the robot was able to harvest follicular units that contained multiple hair follicles, anywhere from 2 to 5 follicles with the average being 2.4; However, they also found that as the number of hair follicles inside a follicular unit increased, the likelihood of transecting one or more follicles also increased.

The researchers concluded that the robot efficiently harvests not only follicular units with single hairs but also follicular units with multiple hairs. A limitation of the study was not comparing the characteristics of robotically harvested follicular units to manually harvested follicular units within the same group of patients.

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Health News DigestDr. Bernstein discusses the breakthrough technology of the ARTAS® Robotic Hair Transplant system — and how the robot has improved since its initial version — in an article in Health News Digest.

Not only is the mainstreaming of the hair transplant robot changing perceptions of surgical hair restoration in the public eye, says author of the article Wendy Lewis, but the robot is increasingly in demand at the leading hair restoration facilities across the country.

In the article, Dr. Bernstein describes how the robot is the latest evolution of the popular Follicular Unit Extraction hair transplant procedure:

According to Robert M. Bernstein, MD, FAAD, founder of Bernstein Medical – Center for Hair Restoration in New York City, “Follicular unit extraction (FUE) procedures have progressed from using labor-intensive, hand-held instruments all the way to a computer-assisted, image-guided robot. It dissects follicular units accurately and consistently, thousands of times in a single session.”

ARTAS Robot In Use at Bernstein MedicalARTAS Robot In Use at Bernstein Medical

In a recent interview with Bald Truth’s Spencer Kobren, Dr. Bernstein noted that the impression many physicians have of the FUE robot is of the initial iteration that was launched more than three years ago. In the Health News Digest article, Dr. Bernstein again makes the point that the ARTAS robot of 2014 is better than version 1.0:

“Robotic extraction has been greatly improved since the first machines were introduced over three years ago and the ARTAS robot is now used by over 70 surgeons worldwide,” said Dr. Bernstein. “We are comfortable offering it to patients as the state of the art procedure for permanent hair restoration. […] According to Dr. Bernstein, “With the addition of recipient site creation to the ARTAS Robotic System, we are one step closer to fully-automated robotic hair transplantation.”

Another breakthrough advance of the ARTAS system is the interactive visualization software called ARTAS Hair Studio:

Using actual photos of the patients, the ARTAS Hair Studio software generates a three-dimensional model on a touchscreen tablet, which allows physicians to customize a recipient site pattern design – creating hairlines and specifying hair location, distribution densities and growth directions. It also permits patients to visualize how a simulated number of grafts will appear on the scalp, with the intention of increasing the predictability and confidence of the outcome.

Dr. Bernstein has used the robot for FUE procedures at the state-of-the-art Bernstein Medical – Center for Hair Restoration since the fall of 2011. All FUE procedures at Bernstein Medical are currently performed using the ARTAS system. Bernstein Medical is a beta-testing site for developments to the robot, including several improvements to the punch mechanism, as well as the development of robotic recipient site creation. Dr. Bernstein is an advisor to the company that developed the robot, Restoration Robotics, Inc., out of Mountain View, California.

HealthNewsDigest.com is an 11 year old online magazine that is considered the premier electronic health news network and #1 provider of health news content. It is syndicated to thousands of major health industry websites and journalists in 164 countries. The author of the article is President of Wendy Lewis & Co. Ltd. Global Aesthetics Consultancy, author of 11 books, and Founder/Editor-in-Chief of BeautyintheBag.com.

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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 than a human surgeon viewing the grafts with the naked eye? — S.V., Middle Village, N.Y.

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 subtle nuances of the skin and follicular units 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 extent. 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 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 these limitations. The robot magnifies the skin, detects each follicular unit and the nuances of the skin/hair characteristics, and then extracts that follicular unit with 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 not 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 three 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.

Video Display of the ARTAS Robot Image-Guided System




Display: ARTAS Robot Image-Guided System

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The Aesthetic Guide - ARTAS® Improves Hair Graft Accuracy and Consistency

Dr. Robert Bernstein discusses the benefits of the ARTAS® Robotic Hair Transplant system in The Aesthetic Guide, a leading periodical in the field of aesthetic surgery. The article examines how robotic Follicular Unit Extraction (FUE) procedures are an improvement over FUE using handheld devices.

In the article, Dr. Bernstein explains how surgeons performing manual FUE need to calculate the angle, spacing, direction, depth, and orientation for each follicular unit harvested. The fact that this process must be repeated up to thousands of times per patient gives the manual FUE procedure significant variability.

Dr. Bernstein touches on a key reason why the image-guided robot is an improvement over manual techniques:

“The ARTAS robot is one of the first technologies used in practice where the computer of the robot is actually obtaining feedback from the anatomy of the patient. In this case, the robot is getting feedback regarding the distribution and direction of hair follicles. That information is communicated to the computer in real time and the computer makes adjustments as it continues to harvest the grafts, which is why the system is so accurate.”

The robot’s capability of making microscopic adjustments in real time, based on the characteristics of the patient’s skin, is a technological breakthrough in the field of hair restoration. Not only does the robot not tire when performing thousands of graft dissections, it estimates the position of the follicle under the skin more reliably than a human. According to Dr. Bernstein; “the accuracy of the robot remains consistent,” throughout the entire procedure, graft by graft.

The Aesthetic Guide - ARTAS Improves Hair Graft Accuracy and Consistency

This accuracy and consistency is critical in a hair transplant because the yield of healthy, viable grafts is one of the key factors in a successful procedure. If a surgeon, using manual techniques, transects (or cuts) a graft or doesn’t cut deeply enough into the skin tissue, then that graft might not survive the transplant. If a number of transected or damaged grafts don’t survive the transplant, then the result of the procedure will be limited in the aesthetic benefit that the surgery was designed to provide.

The article, which is titled “ARTAS Improves Hair Graft Accuracy and Consistency,” notes that Dr. Bernstein was one of the first physicians in the United States to use FUE robot in his practice, “one of the leading hair restoration centers in the country.”

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Q:  I’ve heard that robotic-assisted FUE is better than manual FUE, but what exactly is the main advantage of Robotic FUE? — N.K., Bergen County, NJ

A: Robotic FUE is a significant improvement over other FUE techniques for a number of reasons. The accuracy and ability of a robot to perform countless repetitive motions are key reasons why robotic techniques are an improvement over manual techniques.

In a manual procedure, the skill and speed of a physician are under constant stress, as he or she must follow the angle and depth of the hair precisely hundreds to thousands of times. This task is almost impossible for even the best surgeons to perform without risking harm to the integrity of the follicles. Entering the skin at the wrong angle risks transecting or cutting the follicles and may render them useless for transplantation. Making too shallow an incision can also damage follicles, as the important base of the follicle can become sheared off when it is subsequently extracted.

The robot is engineered to avoid these problems, and so the number of viable grafts that the robot extracts is increased. As a result, the likelihood of the success of the transplant is greater using the robotic system.

Read more about Robotic Hair Transplant

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