May 11th, 2018 – Robert M. Bernstein MD, a pioneer in modern hair transplantation, led five robotic hair restoration physicians in an intensive master class focusing on ARTAS robotic techniques, surgical planning and aesthetics. The day included a live ARTAS Robotic FUE procedure, a series of twelve presentations and a Q & A period. The ARTAS Hair Transplant System, developed by Restoration Robotics, is the only robotic system in the world designed to aid surgeons in hair restoration procedures.
Dr. Bernstein closed the 2017 ARTAS Users Meeting with a discussion of five advanced techniques in robotic hair transplant procedures that he developed at Bernstein Medical. His presentation covered the benefits of pre-making recipient sites, long-hair FUE, tensioner placement, feathering edges in harvesting, and robotic graft selection. The “Hair Restoration Pearls” presentation included case studies, photographs, and videos demonstrating the techniques to the audience of hair restoration physicians. The two-day affair; which was held in Coronado, California; was a huge success, with over 260 attendees from around the world representing 204 robotic hair restoration practices.
Q: How are specifications for recipient sites inputted into the ARTAS® robot? — A.F., Queens, NY
A: At the outset of the procedure, the physician sits at a computer terminal that is connected to the ARTAS Robot and enters the specifications directly into the robot’s software. Variables programmed in this manner include: the number of recipient sites, density of sites, angle that the hair will extrude from the skin, depth of recipient sites, and the minimum distance away from existing hair follicles that a site can be created.
Q: How does the ARTAS System avoid damaging hair follicles in the balding area during recipient site creation? — R.K., Brooklyn, NY
A: The ARTAS robot’s optical guidance system enables it to accurately create recipient sites in areas of thinning hair without damaging existing hair follicles. During the recipient site creation process, the robot uses its advanced image-guided optical system to scan the surface of the skin, locate existing hair follicles in the recipient area, and then create recipient sites at a specified distance from these existing hairs.
The ARTAS robot carries out this process rapidly, accurately, and consistently according to the physician’s programmed specifications. Thanks to the microscopic precision of the image-guided technology, the robotic hair transplant system can avoid injury to follicles that can result when Follicular Unit Extraction (FUE) is performed using manual techniques.
Dr. Bernstein appeared as a guest on The Bald Truth, where he was interviewed by Spencer Kobren, the show’s host, about the ARTAS® Robotic System for FUE hair transplant surgery and the latest updates to the robotic system. He also discussed increasing demand for both FUE procedures and hair transplants, in general, around the world.
Q: Why is using the robot to create recipient sites useful in a hair transplant? — S.K., Jersey City, NJ
A: The ARTAS® Robotic Hair Transplant system eliminates the inconsistencies inherent in creating large numbers of recipient sites by hand. The robot can create sites at a rate of up to 2,000 per hour. Although there is more set-up time compared to sites made manually, once the physician specifies the parameters such as punch depth, punch angle, and site direction, recipient site creation is precise and rapid.
One of the benefits of robotic site creation is that the distribution of grafts over a fixed area of the scalp can be exact. For example, if one wants to transplant 1,000 grafts evenly over 50cm2 of area, this can be done with great precision and with uniform site spacing. In addition, the physician can vary the densities in select regions of the scalp and the robot will adjust the densities in other areas so that the total number of sites remains the same.
Another benefit of the new technology is that the robot can be programmed to avoid existing hair and select which specific hair diameters to avoid. The robot is programmed to keep a specified distance from the existing hair to ensure that the resident follicles will not be damaged and that the distribution of new hair is even and natural. This computerized mechanism appears to be more accurate than what can be done by hand and, importantly, does not sacrifice speed in the process.
Q: How do recipient sites get made in Robotic FUE? And how does the robot know where to create the sites? — K.K., Bergen County, NJ
A: In performing recipient site creation, the ARTAS Robotic Hair Transplant system automates another part of the hair transplant process that is repetitive and prone to human error. In robotic site creation, the physician first designs the hair restoration and then specifies the angle of hair elevation, hair direction, site depth, average density, and total number of the recipient site incisions. The robot then creates the sites according to these specifications.
During site creation, the robot automatically uses its image-guided technology to avoid hairs of a certain diameter (specified by the doctor). The robot creates sites at a minimum distance from hairs of the specified diameter (the distance is also specified by the physician) and will do so randomly throughout the areas where the hair is finer or the scalp is bald. With this important feature, the new distribution of sites can be made to complement the distribution of existing hair. Observation of the ARTAS System suggests that it performs recipient site creation with greater precision and consistency than can be accomplished manually.
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 6-7, 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.
Q: How does the ARTAS robot control the depth of the incision in Robotic FUE? — B.V., Old Greenwich, CT
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.
While there have been significant advances in new stem and cell-based hair loss therapies, surgical hair restoration remains today the only effective treatment option for restoring lost hair.
Dr. Robert M. Bernstein presented the ARTAS Hair Studio™ digital hair transplant design software and robotic recipient site creation using the ARTAS® Robotic Hair Transplant system, each advances in key aspects of hair transplantation, at the International Society of Hair Restoration Surgeons (ISHRS) annual meeting in Kuala Lumpur, Malaysia on Saturday, October 11th, 2014.
Q: I’ve heard that your ARTAS hair transplant robot can now create the recipient site in a hair transplant procedure. Has it been done on humans or is it still in an experimental phase, and if so can you tell if it looks as natural as when the surgeon does it? — P.S., Miami, Fl
Dr. Bernstein discusses the breakthrough technology of the ARTAS® Robotic Hair Transplant system — and how the robot has improved since its initial launch — 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.
Q: I understand that in robotic hair transplant, a robot performs the extraction part of the FUE procedure. What’s the outlook on the robot doing more of the hair transplant procedure? — B.B., Greenwich, CT
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 then prepare a “recipient site” on 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.
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? — S.S., Shanghai, China
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.
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.
Q: Why does the ARTAS® Robotic System only do FUE, not FUT? — V.Z., Chicago, Illinois
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.
Dr. Bernstein introduced new technology that allows the ARTAS Robotic System to accomplish a critical step in hair transplant surgery, the creation of recipient sites. Presenting at the 2nd ARTAS User Group Meeting on February 7th and 8th, 2014, Dr. Bernstein previewed the recipient site creation technology that brings the robotic system one step closer to performing critical aspects of the labor-intensive, hair transplant procedure.