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Follicular Unit Extraction

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Change in Terminology of FUE

International Society of Hair Restoration Surgery (ISHRS)International Society of Hair Restoration Surgery (ISHRS)

On March 6th, 2018 the International Society of Hair Restoration Surgery announced an update to the terminology of the FUE hair transplant technique. FUE historically stood for Follicular Unit Extraction but has now been changed to Follicular Unit Excision. The change in terminology is intended to emphasize the surgical nature of the procedure.

In a Follicular Unit Excision (FUE), an “incision” is first made around each follicular unit with a punch mechanism that separates it from the surrounding tissue. The isolated units are then “extracted” from the scalp. Once removed from the donor area the follicular unit grafts are placed into the recipient region of the scalp. Thus, Follicular Unit “Excision” has two components, incision and extraction. The incision part of the procedure is what classifies FUE as a surgical procedure.

An ISHRS member survey conducted in 2017 shows that a total of 635,189 surgical hair restoration procedures were performed in 2016; this is a 60% increase from 2014. The survey stated that 92.5% of ISHRS members performing follicular unit excision (FUE) will allow the patients, when appropriate, to choose the type of procedure they prefer.

The International Society of Hair Restoration Surgery (ISHRS) is a global hair transplant non-profit organization with more than 1,200 members in 70 countries. Since its inception in 1993, the ISHRS has been dedicated to achieving excellence in patient outcomes by promoting the highest standard of patient care, medical ethics, and research in the hair restoration industry.

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Hair Restoration Research

Innovations In Robotic Hair Restoration

Robert M. Bernstein, MD, New York, NY, [email protected]

The goals of most improvements in hair transplant techniques over the past 50 years have been to make donor harvesting less invasive, to increase accuracy for optimized growth, to generate grafts in a size that mimics nature, and to create recipient sites that result in natural hairlines that are aesthetically pleasing, but undetectable as a restoration.

One of the self-limiting factors in hair restoration, particularly follicular unit extraction (FUE), is that it has traditionally been subject to error caused by fatigue and other limitations of the human operator. This is a fundamental reason why the introduction of robotic technology for performing critical aspects of the FUE procedure has been such a game changer. In the hands of an experienced hair surgeon, the ARTAS™ Robotic Hair Transplant System is a powerful tool for creating natural and reproducible outcomes.

With the latest version of the platform, the recently released 9x upgrade, Restoration Robotics™ has engineered a faster and more accurate system for hair restoration. The improved accuracy of harvesting and shortened procedure increase graft viability. The smaller needles reduce scarring for a faster return to normal activity while allowing patients to wear shorter hairstyles.

Brief History of Hair Transplant Techniques

Norman Orentreich is widely credited with introducing the concept of “donor dominance” in the 1950s—the idea that transplanted hair continues to display the same characteristics of the hair from where it was taken. ((Orentreich N: Autografts in alopecias and other selected dermatological conditions. Annals of the New York Academy of Sciences 83:463-479, 1959.)) This means that continued growth at the recipient site is predicated on harvesting viable hairs from the donor site. In other words, the genetics for hair loss reside in the follicle rather than in the skin. However, due to limitations in graft harvesting technology, cosmetic outcomes of early transplant procedures were often unsatisfactory.

The large scars associated with early “hair plug” techniques were largely eliminated by the introduction of mini-grafts in the 1970s. ((Rassman WR, Pomerantz, MA. The art and science of minigrafting. Int J Aesthet Rest Surg 1993;1:27-36.)) This was followed by micro-grafts of 1-2 hairs. Mini-micrografting could be repeated hundreds or even thousands of times to cover large areas of baldness—but early manual techniques for doing so often yielded inconsistent graft quality and still resulted in scarring on the patient’s scalp, albeit less noticeable than previously. ((Rassman WR, Carson S. Micrografting in extensive quantities; The ideal hair restoration procedure. Dermatol Surg 1995; 21:306-311.))

In follicular unit transplantation (FUT), introduced in 1995 by Bernstein and Rassman, individual follicular units were dissected from the donor strip and became the new building blocks of the hair transplant. ((Bernstein RM, Rassman WR, Szaniawski W, Halperin A. Follicular Transplantation. Intl J Aesthetic Restorative Surgery 1995; 3: 119-32.)) Importantly, proper execution of FUT required the use of a stereo-microscope, a technique that was pioneered by Dr. Limmer. ((Limmer BL. Elliptical donor stereoscopically assisted micrografting as an approach to further refinement in hair transplantation. Dermatol Surg 1994; 20:789-793.)) FUT/strip became popular because it produced completely natural results with minimal recipient site scarring and could be used to cover large areas of the scalp.

A limitation of FUT, however, was that patients often needed to wear longer hair styles to cover the linear scar in the donor area. Nevertheless, FUT improved graft viability, consistency, and naturalness compared to mini-micrografting, and it remains in use today as an option for patients who want to maximize hair yield and are not concerned about the linear scar.

In the mid-1990s, Dr. Woods began using a small punch-like instrument to create small, circular incisions in the skin around follicular units, separating them from the surrounding tissue. The follicular units are then pulled, or extracted, from the scalp, leaving tiny holes that heal in a few days. Dr. Woods was reluctant to share his techniques with the medical community; in 2002 Drs. Rassman and Bernstein, working with Columbia University, developed their own technique and published it in Dermatologic Surgery. The procedure then spread rapidly, and now over half of all hair transplant procedures performed today worldwide utilize FUE techniques. ((Rassman WR, Bernstein RM, McClellan R, Jones R, et al. Follicular Unit Extraction: Minimally invasive surgery for hair transplantation. Dermatol Surg 2002; 28(8): 720-7.))

A major advance to the FUE technique came with the two-step process devised by Dr. Harris. In his technique, a sharp punch was first used to score the surface of the skin and then a dull punch was used to dissect deeper into the tissue to avoid transection of follicles. This two-step technique was to become the basis for the future mechanism of robotic FUE. ((Harris JA. The SAFE System: New Instrumentation and Methodology to Improve Follicular Unit Extraction (FUE). Hair Transplant Forum Intl. 2004; 14(5): 157, 163-4.))

FUE procedures allow recipients to wear shorter hairstyles due to the absence of a linear scar in the donor area, and they can typically return to physical activity sooner than after FUT. Yet, inherent difficulties in performing FUE, namely the requirement of keeping the follicular extraction instrument parallel and oriented along the axis of the follicle through the length of the graft, make it a technically challenging procedure. The introduction of the ARTAS Robotic Hair Transplant System in 2011 changed that dynamic by offering precision, control, and repeatability in follicle harvesting. Because it manages the exacting and repetitive work of extracting hundreds to thousands of grafts in a single session, physician fatigue and error are minimized. The potential to transect or damage the hair is reduced, and graft viability is increased.

Generational Improvements in Robotic Hair Transplantation

The first iteration of the ARTAS robot helped deliver accuracy and reproducibility in the form of a physician-assisted, computerized device with a three-dimensional optical system to locate and harvest follicular units directly from the donor area. By 2013, robotic recipient site making was added to help make the sites more uniform in depth and distribution and to avoid existing, healthy hair. Upon the recommendation of Dr. Bernstein, the manufacturer added another important upgrade in 2016 with a graft selection algorithm to select follicular units for harvesting based on the number of hairs they contain, producing greater hair density while leaving fewer scars in the donor area. ((Bernstein RM, Wolfeld MB. Robotic follicular unit graft selection. Dermatologic Surgery 2016; 42(6): 710-14.))

Restoration Robotics recently released the 9x ARTAS Robotic Hair Transplant System, the latest generation of its platform. It is faster and more accurate than previous versions and has better functionality. It also has improved artificial intelligence (AI) that reduces the potential for over-harvesting and enhances capabilities in recipient site making.

The easiest feature to appreciate with the 9x is that its raw speed is approximately 20% faster than the 8x. This is achieved by faster alignment with follicles, without sacrificing any precision in the approach angle for harvesting. The 9x features a dissection cycle of less than 2 seconds, meaning it can safely harvest roughly 1,300 grafts per hour—while still analyzing the scalp in micron-level precision. As with previous ARTAS versions, the cutting action is a two-step process, with an inner needle engaging the hair while the blunt outer punch separates the follicular unit from the remaining tissue.

Faster overall dissection is achieved with the 9x because the robot moves from one to the next follicle unit by skimming over the surface of the scalp, rather than retracting away from it between harvests.

The increased precision of the ARTAS 9x allows for the use of smaller needles for harvesting in appropriate candidates. The initial ARTAS system could only be used with a needle/punch apparatus that cut 1.0mm on the surface. The next iteration used a needle and punch of 0.9mm at the surface. The 9x has a 0.8mm option to allow very short hairstyles, although care should be taken in patient selection as there is less tolerance with a smaller punch.

The optics of the 9x have been completely reconfigured to use white LED illumination versus red, which allows extraction while harvesting without eye fatigue. The 9x is also easier to operate with some key features: a 1” extension on the robotic arm for longer reach and less need to reposition the patient; a smaller robotic head to permit acute angles of approach for harvesting; additional site making options, such as the ability to change the orientation (i.e., from sagittal to coronal) in different zones on the scalp; and a harvesting halo that is faster to apply and more comfortable for the patient.

AI and the Future of Hair Restoration

One of the more impressive aspects of working with the ARTAS System in hair restoration procedures is its already powerful AI. This feature makes it possible to detect select follicle units for harvesting. It also gives the platform the capability to automatically adjust the angle of approach, thereby reducing the potential to transect the hair follicle during harvesting.

One of the major upgrades in the 9x is the addition of an “empty site warning” that signals the operator that the harvest is not precise, allowing for adjustments in real-time. This builds on the already intuitive and user-responsive interface to add further quality control. Automatic scar detection has also been added so that the robot will skip over low-density areas to have more uniform harvesting. This is particularly important to our practice where we specialize in repair and corrective procedures.

The ARTAS platform is integrated with ARTAS Hair Studio™, an app-based technology with which the surgeon can consult with the candidate to simulate the final outcome. The ARTAS Hair Studio is also used by the physician to design the pattern for recipient site creation. With the 9x, Hair Studio has been upgraded so that instead of stitching together multiple photos to create a three-dimensional representation of patient’s scalp, it does so in a single photograph, making it faster and more efficient.

What is fundamental to understand about the 9x upgrade is that many of the additions have been specifically engineered based on user feedback, my own included. Restoration Robotics continues to work closely with physician users to understand needs in the clinic to produce a platform for hair restoration that is responsive to needs of the end user and the end beneficiary (the patient). In my hands, the 9x takes and makes an already powerful tool for hair restoration even faster and more accurate.

The statements, views, opinions, and analysis concerning Restoration Robotics and its technology expressed in this article are solely mine and are not intended to reflect the statements, view, opinions, and analysis of Restoration Robotics.

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Hair Restoration Research

Advances in Robotic FUE

Robert M. Bernstein, MD, New York, NY, [email protected]; Michael B. Wolfeld, MD, New York, NY, [email protected]

Disclosure: Drs. Bernstein and Wolfeld hold equity interest in Restoration Robotics, Inc. Dr. Bernstein is on its medical advisory board.

Since the publication of “What’s New in Robotic Hair Transplantation” (Hair Transplant Forum Int’l. 2017; 27(3):100-101), there have been important improvements to the robotic system in both its incision and recipient site creation capabilities. These advances fall into four overlapping categories:increased speed, increased accuracy, increased functionality, and improved artificial intelligence (AI). The overlap occurs since improvements in functionality, accuracy, and AI can also increase the overall speed of the procedure. A faster procedure decreases the time grafts are outside the body and allows the physician to perform larger cases without placing additional oxidative stress on the follicles.

Increased Speed

The speed of the robot has increased through faster and more precise alignment with the hair in the follicular units.
The robot also saves a significant amount of time by staying closer to the scalp (approximately 2mm) while moving from unit to unit, rather than retracting after each harvest. By shortening the distance the robotic arm moves between incisions, the dissection cycle has decreased to less than 2 seconds, giving the robot a raw speed over 2,000 grafts per hour. In a clinical setting, this enables harvesting of up to 1,300 grafts per hour.

Although the obvious way to increase speed is to simply make the robot go faster, there are limitations to this, as it would decrease the ability of physicians to make real-time adjustments to the system. The robot has an automatic feedback loop that makes intra-operative modifications as the harvesting proceeds, and this significantly decreases the need for human intervention. However, when there is scarring or other situations of excessive patient variability, it is necessary for occasional “tweaking” (particularly of punch depth) to achieve an optimal outcome. In these situations, faster robot speed may be counterproductive.
With this in mind, new ways have been found to speed up the procedure without limiting the operator’s ability to respond. One has been to change the color of the light emitted by the optical system. In the past, a beam of red light illuminated the fiducials that the robot uses to guide the robotic arm, but the glare of this light is very difficult on the eyes.

Fig 1. Touchscreen user interfaceFIGURE 1. Yellow fiducials and white light guide incision.

By enabling the optical system to read “eye-friendly” white light, the surgical team is now able to remove grafts as soon as they are separated from the surrounding tissue, rather than having to wait for an entire grid to be finished.This allows the two steps in follicular unit excision—the graft separation from surrounding tissue (incision) and the actual removal (extraction)—to proceed in parallel, rather than in series, in order to decrease operating time.

The new optical system also enables the robot to recognize the tensioner from a distance. Previously, the physician had to manually bring the robot toward the scalp (a step called “forced drag”), until the robot was close enough to recognize the fiducials on a grey-colored tensioner. This now happens automatically, with the robot recognizing a yellow tensioner from a distance and then homing in on the fiducials as it moves closer to the scalp, eliminating the time needed for the extra step (Figure 1).

FIGURE 2. 3-D image for site creation using one photoFIGURE 2. 3-D image for site creation using one photo

Recipient site creation has been a significant new capability of the robotic system. The advantages of robotic site creation include the ability to avoid existing terminal hair (minimizing injury) and to create new recipient sites in a precise distribution that complements the existing hair. A limitation of this technology is that the physician needs to develop a 3-D computer-based model of each patient’s scalp to communicate the transplant design to the robot. The old model required the fusion of 5 two-dimensional images, a process that required a significant amount of time. The newest iteration can build a three-dimensional model using only one image, greatly decreasing the time needed for this important step (Figure 2).

Increased Accuracy

There has been a recent trend in FUE towards using smaller punches. Although these authors feel that in many cases the increased risk of transection from smaller diameter punches outweighs the benefit of reduced wounding and concomitant smaller scars, it is important that the robot has this capability for physicians who prefer these punches.

The sharp/blunt system in the original robot (released in 2011) used a 1.0mm sharp pronged needle that penetrated the skin about 1mm and was immediately followed by a rotating, dull punch with a slightly larger diameter that went deeper into the scalp. The current system includes a 0.9mm needle that is the workhorse for most cases. With refinements in the optical system, the needle/punch diameter was able to be reduced further. The new needle option is 0.8mm.

The needle has also been redesigned so that the physician can choose between 2 and 4 prongs, with the former being preferable in softer tissue and the latter in firmer skin or scarred scalp (Figures 3 through 6).

FIGURE 3. 1.0, 0.9 and 0.8mm needlesFIGURE 3. 1.0, 0.9 and 0.8mm needles
FIGURE 4. Recipient wounds: 0.8mm (left) and 0.9mm (right)FIGURE 4. Recipient wounds: 0.8mm (left) and 0.9mm (right)


FIGURE 5. 0.8mm needle: 1-, 2-, 3- , and 4-hair follicular unit graftsFIGURE 5. 0.8mm needle: 1-, 2-, 3- , and 4-hair follicular unit grafts
FIGURE 6. 0.9mm needle: 1-, 2-, 3- , and 4-hair follicular unit graftsFIGURE 6. 0.9mm needle: 1-, 2-, 3- , and 4-hair follicular unit grafts

Increased Functionality

In prior iterations, when the robotic arm was in a position that was too cramped and from which it could not automatically recover, the user needed to go through a six-step manual process using a stand-alone pendant to guide the robot to a neutral “safe” position.

FIGURE 7. Compact robotic head FIGURE 7. Compact robotic head

The Arm Brake Release is a new functionality that places a single button on the arm that, when pressed, quickly moves the arm away, allowing the operator to readjust the patient’s position.
Modifications of the robotic arm (which give it greater reach) and changes to the robotic head (which reduce its bulk) enable the robot to access a much greater area of the scalp without the need for repositioning the patient. This reduces a significant amount of procedural time as well. Another advantage of the smaller head is that the robotic arm can approach the patient at more acute angles without collision, adding more flexibility to both harvesting and site creation (harvesting to 35°, site making to 30°). The more acute angles required a redesign of the headrest so that the arm would have unimpeded access to the scalp (Figure 7).

FIGURE 8. Universal blade holderFIGURE 8. Universal blade holder

Prior iterations of the robotic system used hypodermic needles of varying sizes (18g-21g) for recipient site making. In response to the wide range of physician preferences, the robot now has a universal holder that can accommodate almost any type of site making tool. These include square-tipped blades, angled blades, and chisel and spear point blades, as well as the original hypodermic needles. These can be easily interchanged during the procedure (Figure 8).

Artificial intelligence

FIGURE 9. Automatic scar detection FIGURE 9. Automatic scar detection

An automatic collision recovery system will automatically retract the robotic arm if the arm approaches the patient at an angle that is too acute, or cramped to operate, or if any part of the robot (other than the operating tip) inadvertently touches the patient. Once retracted, the patient can be repositioned so that the FUE session can proceed.
One of the frustrations of FUE is the occasional empty site that represents either a graft that was pushed too deeply into the scalp or one that was completely removed. The new empty site warning icons complement physician observation by using color-coded symbols (green, yellow, and red) to alert the doctor to the occurrence of empty sites.
Finally, the ARTAS software can now automatically detect regions with low (or no) hair density and block those areas from being harvested. This capability decreases human error and saves time by automatically performing a function that prevents creating zones with very little or no hair coverage (Figure 9).

In sum, new improvements in the speed, functionality, accuracy, and artificial intelligence of the robotic system have significantly shortened the duration of the overall procedure. Besides being more convenient for patients and more expedient for the operating physician, the shortened operating time decreases the time grafts are outside the body, an important factor in ensuring optimal growth of the transplanted hair.

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Hair Restoration Research

Commentary on Redefining the “E” in FUE: Excision = Incision + Extraction

Robert M. Bernstein, MD, New York, NY; William Rassman, MD, Los Angeles, CA
Hair Transplant Forum International 2018; 28(1):6

Robert M. Bernstein and William R. Rassman began a chain of responses
to this change of nomenclature:

This article on FUE ((Mejia, R. MD, Florida, J, USA. Redefining the “E” in FUE: Excision = Incision + Extraction. Hair Transplant Forum International 2018;28(1):1,5–11.)) name change adds significant clarity to the nomenclature of hair transplantation. Renaming Follicular Unit Extraction to Follicular Unit Excision acknowledges two distinct steps — incision and extraction — that will make communicating with our patients easier and more concise. It will also allow clinicians and researchers to think more clearly about the two steps of FUE, both separately and together, when addressing such issues as transection, suction injury, punch design, automation, and robotics. Although Shakespeare aptly pointed out that at times a name can be quite irrelevant: “What’s in a name? That which we call a rose by any other name would smell as sweet” [Romeo and Juliet, II, ii, 1-2], in this case the important change in wording should have lasting significance.

For further information read the ISHRS newsletter on the updated terminology.

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Bernstein Medical In The News

New Nomenclature for FUE

By Robert M. Bernstein, MD

When Dr. Rassman and I coined the term Follicular Unit Extraction (FUE) in our 2002 publication “Follicular Unit Extraction: minimally invasive surgery for hair transplantation” we used the term to imply that this new procedure was less invasive than a traditional FUT/strip procedure ((Rassman WR, Bernstein RM, McClellan R, Jones R, et al. Follicular Unit Extraction: Minimally invasive surgery for hair transplantation. Dermatol Surg 2002; 28(8): 720-7.)), ((Bernstein RM, Rassman WR, Szaniawski W, Halperin A. Follicular Transplantation. Intl J Aesthetic Restorative Surgery 1995; 3: 119-32.)) Recently, FUE has been marketed by some practices as being non-surgical and this has given rise to the procedure being performed without physician participation (in some practices even without physician oversight).

The fact is that the FUE procedure is more than just the extraction of follicular unit grafts. The surgeon must first create an incision with a punch tool before the grafts can be extracted. The punch tool can be manually operated, automated or robotic. ((Bernstein RM. Integrating Robotic FUE into a hair transplant practice. Hair Transplant Forum Intl. 2012; 22(6): 228-229.)) The extraction can be performed with forceps or suction. This process of incising and then extracting grafts is a surgical procedure and is, therefore, better described by the word excision.

To avoid giving the erroneous impression that an FUE procedure is non-surgical, the term FUE will now be short-hand for Follicular Unit Excision. This better describes the two main components of an FUE procedure, incision (the separation of the follicular unit from the surrounding tissue) and extraction (the removal of the follicular unit from the scalp once it is separated).

OLD Terminology

FUE = Follicular Unit Extraction = the entire harvesting procedure

NEW Terminology

FUE = Follicular Unit Excision = incision (cutting) + extraction (removal)

It is important to note that this is just a change in terminology, not in the technique itself. The FUE procedure has not changed. The FUT/strip procedure and its nomenclature have also not changed. ((Bernstein RM, Rassman WR, Seager D, Shapiro R, et al. Standardizing the classification and description of follicular unit transplantation and mini-micrografting techniques. Dermatol Surg 1998; 24: 957-63.)) It is also important to understand that both FUE and FUT/strip refer to harvesting techniques and not to implantation of grafts into the recipient areas of the scalp (a process that is basically similar in both procedures).

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Hair Restoration Research

What’s New in Robotic Hair Transplantation

Robert M. Bernstein, MD, New York, NY, [email protected]; Michael B. Wolfeld, MD, New York, NY, [email protected]; Jennifer Krejci MD, San Antonio, TX, [email protected]

Disclosures: Dr. Bernstein and Dr. Wolfeld hold equity interest in Restoration Robotics, Inc. Dr. Bernstein is a medical consultant to the company and is on its medical advisory board.

ABSTRACT

Since the introduction of robotic FUE technology over five years ago, there have been numerous upgrades to the system. The current paper describes the most recent advances. These include a more user-friendly interface, the ability to select for larger follicular units, greater range-of-motion of the robotic arm, improved methods for stabilizing the scalp and newly designed needles for more accurate harvesting.

Background

The ARTAS Robotic System, developed by Restoration Robotics Inc., was first available for commercial use in 2011. Continued improvements in both its hardware and software have made it an increasingly valuable tool for physicians performing follicular unit extraction (FUE). Over 180 hair restoration surgeons world-wide currently use robotic technology to assist them in their FUE procedures. Recent advances in the robotic system have increased its speed and precision and new modifications have made it more user-friendly. The robotic system can be used for both harvesting and site creation. This writing focuses on improvements to robotic graft harvesting.

Touchscreen User Interface

Fig 1. Touchscreen user interfaceFig 1. Touchscreen user interface

The robotic system is an interactive, computer-assisted suite of hardware and software that uses optical-guidance robotics to identify and isolate follicular units in the donor area and create sites for grafts in the recipient area. In the earlier iterations, doctors used a mouse to control the operations of the robot. This required the physician to be seated with one hand resting on the mouse and slowed down the procedure. A touch screen has been developed to make operating the robot more intuitive and to speed up the ability to make real-time adjustments while the physician is standing and observing the patient. Most of the controls are aggregated to one area on this screen for ease of use. The touchscreen can be used alone or with the traditional mouse and keyboard, depending upon the user’s preference. (Figure 1.)

Follicular Unit Graft Selection

Fig 2. Follicular unit graft selectionFig 2. Follicular unit graft selection

The follicular unit (FU) graft selection capability of the robotic system has been added to enable physicians to select follicular units based on hair content. The physician now has the option to harvest larger follicular units and skip over smaller ones, particularly one-hair units. The purpose is to harvest the most hair through the smallest number of wounds. FU graft selection has two main benefits: 1) It can generate a greater number of larger FU grafts to maximize the fullness of the restoration, and 2) it can be used to harvest larger FUs that can be microscopically dissected to generate a greater number of smaller grafts with a minimal number of donor wounds. Skipping over one-hair follicular units increases the number of hairs per graft by 11.4% with the one-pass method (selecting for FUs with 2 or more hairs) and 6.6% with the two-pass technique (adding a second pass to harvest 1-hair FUs skipped in the first pass) compared to a random selection of grafts. ((Bernstein RM, Wolfeld MB. Robotic follicular unit graft selection. Dermatologic Surgery 2016; 42(6): 710-14.)) (Figure 2.)

Locking Tensioner Tool

The tensioner is a compressible, polycarbonate device that is used to assist the vision system and to stretch and stabilize the skin prior to extraction. Fiducials, on the top of the tensioner’s rectangular surface, are used by the robot’s optical system to orient the arm for harvesting and to record the location of previously harvested grafts. (A fiducial is a marker placed in the field of view of an imaging system for use as a point of reference or a measure.) The undersurface has pins that grip the skin. (Figure 3.) The tensioner is compressed with a handle placed on the donor scalp and then allowed to passively expand, stretching the skin. (Figure 4.) It is secured with elastic straps to the patient’s headrest. (Figure 5.)

Fig 3. Pins on undersurface of tensionerFig 3. Pins on undersurface of tensioner
Fig 4. Tensioner with locking tool and standFig 4. Tensioner with locking tool and stand

The re-designed tensioner tool has a thumb-activated catch and release mechanism, so that once the tensioner is grasped, constant pressure is not needed. This makes it easier to operate and places significantly less stress on the physician’s hands. It also allows the tensioner and handle to be loaded and placed on a stand that holds the instrument and protects the pins when not in use. This keeps the handle in a position to be grabbed easily. (Figure 4.) The handle can thus be set up in advance, increasing the speed of this step of the procedure.

Improved Halo

Fig 5. Double-notched halo to secure elastic strapsFig 5. Double-notched halo to secure elastic straps

The tensioner is held in place by 1) pins that grip the skin, 2) the recoil of the compressed tensioner, and 3) elastic straps that are stretched and secured in grooves located on the base of the headrest and/or on a halo device. The advantage of a halo is that the forces are lateral (rather than downward) and thus more comfortable for the patient. It also causes less torque on the tensioner, allowing it to better follow the contour of the patient’s scalp. A newly designed halo has a double-notch and central protuberance that makes the bands more secure and enables the physician to more rapidly secure the bands using one hand. (Figure 5.)

Arm Spacer to Increase Range of Motion

Fig 6. One-inch spacer to increase range of motionFig 6. One-inch spacer to increase range of motion

A one-inch extension of the robotic arm allows the instrument to harvest at a more acute angle than was previously possible. It also increases the range of motion of the robotic arm. It is particularly useful when harvesting on the sides and lower occipital regions of the scalp. The greater reach increases the number of grafts that can be harvested without repositioning the patient, thereby saving operating time and leaving the patient undisturbed. (Figure 6.)

Improved Image Processing for Glare

Glare can interfere with the optimal functioning of the optical system. It may be caused by the light of the needle mechanism or the natural light of a bright operating room. When glare is present, it affects how the system identifies the hair and can prevent the system from recognizing hair that would be eligible for harvesting. With improved digital image processing, the system can better visualize existing hair, even in areas of glare within the grid. As a result, the number of grafts harvested per grid is increased.

Assisted Force-Drag

For the robotic arm to engage with the donor scalp, it must be aligned with the fiducials on the top of the tensioner. In the past, this alignment had to be performed manually. The new “Assisted Force-Drag” technology enables the robot to self-align to the tensioner as soon as the fiducials are detected by the vision system. This feature obviates the need for the manual step and allows for an overall faster workflow.

Puncture Depth (PD) Band Detection

Fig 7. Bands on 2- and 4-pronged needlesFig 7. Bands on 2- and 4-pronged needles

The robot uses a two-step, sharp/blunt punch technique based on the ideas of Dr. Jim Harris. Puncture depth bands enable the robot’s computer to measure the depth of the needle (punch) in the scalp. The robot then uses this information to improve the accuracy of the subsequent puncture. Puncture depth band detection may be affected by the presence of blood, hair, and shadows from the tensioner. Improved algorithms that guide PD band detection have increased its accuracy by 9% compared to earlier versions, even in the face of these artifacts. (Figure 7.)

4-Prong Needle

The robot was initially designed with a two-pronged, sharp-punch. The advantage of this design was that the long prongs were able to anchor lax skin. A disadvantage was that it was less efficient when the scalp was tighter, or more fibrotic, and when the arm had to operate at a more acute angle to the surface of the scalp. To mitigate this limitation, a 4-prong needle was developed. The 4-prongs allow for cleaner incisions with better anchoring to tissue at acute angles. This advance results in improved yield, especially in areas below the occiput and on the side of the head. It is also more effective in patients with tougher tissue. (Figure 7.) A 3-pronged needle is currently being developed for tight and/or fibrotic skin as well as lax skin.

6-mm Punch

Fig 8. 6-mm punchFig 8. 6-mm punch

The original robotic system used a 4-mm rotating dull-punch to dissect the body of the graft from the surrounding tissue. The limitation of this design is that it was less effective in patients with longer hair follicles (i.e., greater than 4.5mm). With longer hair follicles, the collar of the 4-mm punch pushed on the skin and, as a result, splayed the grafts and/or bent the bulbs.

The new punch is 6-mm tip-to-shoulder so that full dissection of longer follicles can be accomplished with less distortion of the skin. This modification avoids damage to the lower portion of the grafts. (Figures 8, 9.).

Fig 9. Grafts 7-mm in length harvested using a 19-gauge, 4-prong needle and 6-mm dull punch
Fig 9. Grafts 7-mm in length harvested using a 19-gauge, 4-prong needle and 6-mm dull punch

The Future

A host of new modifications are in the pipeline. In addition to the 3-prong needle, a color camera is being developed that allows the robot to read white-light. This will make the operating field easier on the eyes (compared to the current red lights). Other advances include improved dissection, a smaller punch (0.8mm), an automatic scar detector, a 20% increase in harvesting speed, the ability for physicians to harvest at an angle as low as 30 degrees from the scalp, and several advances that will make site creation more user-friendly.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Why Visit a Practice That Specializes in Both FUT and FUE?

Q: Why go to a hair restoration practice that specializes in both FUT and FUE? — L.P., Bayside, NY

A: This is a great question, but the answer may be counterintuitive in today’s age of specialization. The answer is that you should always go to the practice that offers both. To deliver the best care, hair restoration physicians should have expertise in both Follicular Unit Transplantation (FUT) and Follicular Unit Extraction (FUE) techniques and should offer both in their practices. There are at least five good reasons why:

1. FUT and FUE are both excellent techniques, but have different indications for their use; therefore, a patient might benefit from one technique over the other. If the doctor offers both procedures, the physician will be able to choose the best one for the specific patient rather than treating everyone with a single type of procedure.

The main advantage of FUT is that it typically gives the highest yield of hair. Therefore, when the patient’s primary goal is to achieve maximum fullness, FUT should be performed. There are many well-described reasons for this, including the precision of stereo-microscopic dissection (which helps preserve follicles and the protective tissues around them) and the ability to harvest efficiently from a more select area of the donor zone.

The main advantage of FUE is no linear scar. Therefore, when the patient’s primary goal is to be able to wear his hair very short, FUE should be performed. FUE is also indicated when there is an increased risk of a widened scar or when scalp laxity does not permit a strip excision. The patient may sometimes choose FUE simply to avoid the stigma of a linear donor scar.

2. The same patient may benefit from both procedures

There are situations in which both procedures are useful in the same patient. For example, FUT may first be used to maximize yield, but then, after several sessions, the scalp may become too tight to continue to perform FUT, or the donor scar may become wider than anticipated. In the former case, the physician can switch to FUE to obtain additional grafts; in the latter case, FUE may be used to camouflage the scar of the FUT procedure.

3. There is a cross-over set of skills from FUT to FUE

To do an FUE procedure well, the follicular unit grafts that are extracted should be examined carefully under a stereomicroscope and, when needed, trimmed and sometimes subdivided into individual hair follicles (such as for hairlines, eyebrows, temples, etc.). Stereo-microscopic dissection is basic to FUT and is a skill that is second-nature to the staff of hair restoration practices that regularly perform FUT procedures, so this critical step will not be hit or miss. A doctor and staff who perform only FUE will often lack this skill.

4. Practices that offer both procedures are usually more experienced

It is easier to learn and train one’s staff in just one hair transplant technique. In particular, FUE procedures require a smaller staff than FUT and, thus, many doctors entering the field of hair restoration surgery will perform FUE, but not master the skill or make the commitment (financial, time, and infrastructure) to hire and train the staff to perform FUT.

5. Better decision making

One could argue that if a doctor performed only one procedure, but the patient needed the other, then he/she would refer the patient to a colleague. Although this sounds nice in theory, it is very rare for a doctor to refer a surgical case to a colleague if it is a condition that he/she actually treats. More likely, the doctor will convince the patient (and probably himself) that the procedure he offers is the appropriate one, even though it may not be the case.

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Hair Restoration Answers

In Hair Transplant Repair, Can You Remove Plugs By Follicular Unit Extraction?

Q: I was wondering if it was possible to use Follicular Unit Extraction (FUE) on the old plugs instead of graft excision. — N.B. ~ Westport, C.T.

A: Graft excision generally works better than FUE in removing old plugs and mini-grafts. The reason is that, in these grafts, the hair is not aligned due to the scar tissue that tugs on, and bends the hair. Because the hair direction is altered from the scar tissue, there is much more damage when the grafts are removed with the tiny FUE punches. In addition, FUE only removes a very small part of the plug. If the hair in the plug is pointing in the wrong direction or the plug is in the wrong location, the entire graft needs to be removed.

Another benefit of graft excision is that we can remove the underlying scar tissue and improve the appearance of the underlying skin. In FUE, only a tiny bit of the scar tissue is removed and, since FUE holes are left open, FUE actually causes its own scarring. With graft excision, the sites are sutured closed so some scar tissue is removed and the quality of the underlying skin looks more natural.

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Bernstein Medical In The News

Dr. Bernstein in New York Magazine ‘Best Doctors’ Issue for Seventeenth Consecutive Year

Dr. Robert M. Bernstein, pioneer of modern hair transplant procedures and a Clinical Professor of Dermatology at Columbia University in New York, was selected for the 17th consecutive time to be included in New York Magazine’s annual ‘Best Doctors’ issue.

New York Magazine Best Doctors 2016New York, NY — Robert M. Bernstein, MD, MBA, FAAD, FISHRS, a Clinical Professor of Dermatology at Columbia University in New York and distinguished pioneer of modern hair transplant surgery, was included for the seventeenth consecutive time in the ‘Best Doctors’ edition of New York Magazine. Dr. Bernstein was selected by his peers as one of New York’s top doctors on account of his prominent work in developing Follicular Unit Transplantation (FUT), Follicular Unit Extraction (FUE), and Robotic Hair Transplantation (Robotic FUE).

Dr. Bernstein said: “It is exciting to be part of the continuing progress made in the treatment of hair loss as technological advances in both robotics and traditional surgery converge to improve the care of our patients.”

Bernstein Medical – Center for Hair Restoration, founded by Dr. Bernstein in 2005, is a center of innovation for the hair restoration industry. So far in 2016, Dr. Bernstein has patented a modified FUE procedure and published research on improvements to the ARTAS® Robotic Hair Transplant System. Each of these advances is designed to enhance surgical outcomes for hair transplant patients. Bernstein Medical is a beta-test site for Restoration Robotics, Inc.; the company that produces the ARTAS robot and Dr. Bernstein is a medical advisor to the company.

The ‘Best Doctors’ issue is a special annual edition of New York Magazine that contains a peer-nominated list of 1,300 of New York City’s top physicians. The list of doctors is cultivated by Castle Connolly, Ltd., through a survey of physicians in the New York Tri-State area, which includes New York, New Jersey, and Connecticut. Doctors who are nominated must pass a rigorous physician-led review of their qualifications, skill in diagnosis and treating patients, and reputation. Castle Connolly also publishes America’s Top Doctors, which has included Dr. Bernstein in all fifteen editions, and Top Doctors: New York Metro Area, which has included Dr. Bernstein in fifteen consecutive editions.

Posted by Robert M. Bernstein M.D.
Bernstein Medical In The News

2015 ISHRS Survey: Hair Transplant Surgery More Popular Than Ever

The 2015 hair restoration practice census, published by the International Society of Hair Restoration Surgery (ISHRS), showed that hair transplantation is an increasingly popular treatment for hair loss. The biennial survey found that 397,048 procedures were performed in 2014, an estimated increase of 28% over the previous survey, published in 2012. Three prior surveys found increases of up to 12%, so the rate of surgical hair restoration seems to be accelerating.

Since 2006, the number of procedures worldwide has increased 76%, with the estimated global hair restoration market now valued at approximately $2.5 billion annually.

Age
Over half of all men and women treated were younger than 50. Men aged 30-39 made up the biggest percentile at 31.7%, followed by those aged 40-49 (26.9%). It was the inverse for women, however, with those aged 40-49 making up the biggest percentile at 27.7%, followed by women in the 30-39 year old bracket (27.0%).

Gender
In 2014, 84.7% of surgical patients were men and the rest (15.3%) were women. The number of women receiving a hair transplant increased by 12% since 2012. There was also a 21% increase in non-surgical female patients.

Procedure
While Follicular Unit Transplant (FUT) procedures accounted for over half of all hair transplants, Follicular Unit Extraction (FUE) is gaining rapidly, with a 51% increase over the 2012 results (from 32.2% in 2012 to 48.5% in 2014). See the chart:

FUT vs FUE (2004-2014)
Posted by Robert M. Bernstein M.D.
Bernstein Medical In The News

New York Magazine ‘Best Doctors’ Issue Includes Dr. Bernstein for Sixteenth Consecutive Year

Dr. Robert M. Bernstein, pioneer of modern hair transplant procedures and a Clinical Professor of Dermatology at Columbia University in New York, was included in New York Magazine’s ‘Best Doctors’ issue for the 16th consecutive year.

Best Doctors 2015 - New York Magazine

New York, NY — Robert M. Bernstein, MD, MBA, FAAD, a Clinical Professor of Dermatology at Columbia University in New York and renowned pioneer of Follicular Unit Transplantation (FUT) and Robotic Follicular Unit Extraction (Robotic FUE) hair transplant procedures, was included in New York Magazine’s annual ‘Best Doctors’ issue for the sixteenth consecutive year.

On being chosen for his sixteenth consecutive ‘Best Doctors’ issue, Dr. Bernstein said: “I am honored to be considered among the best doctors in New York and it is a credit to the hardworking staff at Bernstein Medical that, after two decades of incredible progress, we are still making significant advances in the surgical treatment of hair loss.”

Recognition of Dr. Bernstein and his contributions to the field of surgical hair restoration comes as he continues to push the envelope with advances in Robotic FUE hair transplants, improving more traditional hair restoration techniques and exploring adjuvant treatments.

Among the improvements Dr. Bernstein has made to the robotic hair transplant procedure include: automated selection of follicular unit grafts, robotic creation of recipient sites, reducing wound size, and a “long-hair” FUE technique that allows a patient to have an FUE hair transplant without the donor area being visible in the post-op period. Collectively these improvements make the robot more efficient, reduce scarring from the procedure, and improve the outcome for patients. Dr. Bernstein’s internationally renowned hair restoration facility, Bernstein Medical – Center for Hair Restoration, is a beta-testing site for Restoration Robotics, Inc., the company that produces the ARTAS® robot. Dr. Bernstein is a medical advisor to the company.

New York Magazine’s ‘Best Doctors’ issue is a special annual edition of the acclaimed magazine which contains a directory of the New York City area’s best physicians. The directory is created by Castle Connolly, Ltd., through a survey of doctors in the New York Tri-State area. To be included, doctors in New York, New Jersey and Connecticut are nominated by their peers and then must pass a rigorous physician-led review of their qualifications, reputation, and skill in diagnosis and treating patients. Castle Connolly also publishes America’s Top Doctors, which has included Dr. Bernstein in all fourteen editions.

About Robert M. Bernstein, M.D., F.A.A.D.

Dr. Robert M. Bernstein is a Clinical Professor of Dermatology at Columbia University in New York, founder and lead surgeon at Bernstein Medical – Center for Hair Restoration, and renowned pioneer of Follicular Unit Transplantation (FUT) and Robotic Follicular Unit Extraction (Robotic FUE) hair transplant procedures. Dr. Bernstein was the first to describe Follicular Unit Transplantation and Follicular Unit Extraction in the medical literature, and his more than 60 medical publications have fundamentally transformed surgical hair restoration. Dr. Bernstein has received the Platinum Follicle Award, the highest honor in the field given by the International Society of Hair Restoration Surgery (ISHRS), and has appeared as a hair restoration expert on many notable television programs and news and lifestyle publications over the years. Examples include: The Oprah Winfrey Show, The Dr. Oz Show, The Today Show, Good Morning America, ABC News, CBS News, New York Times, Wall Street Journal, Men’s Health Magazine, and more. He is co-author of Hair Loss & Replacement for Dummies. Dr. Bernstein graduated with honors from Tulane University, received the degree of Doctor of Medicine at the University of Medicine and Dentistry of NJ, and did his training in Dermatology at the Albert Einstein College of Medicine. Dr. Bernstein also holds an M.B.A. from Columbia University.

About Bernstein Medical – Center for Hair Restoration

Bernstein Medical – Center for Hair Restoration, founded by Dr. Bernstein in 2005, is dedicated to the diagnosis and treatment of hair loss in men and women using the most advanced technologies. The state-of-the-art facility is located in midtown Manhattan, New York City and treats patients who visit from 58 countries and all 50 states. The board-certified physicians and highly-trained clinical assistants at Bernstein Medical take pride in providing the highest level of treatment and care for all patients. In 2011, Bernstein Medical became one of the first practices in the world to offer Robotic FUE hair transplant procedures using the image-guided, computer-driven technology of the ARTAS Robotic System. Bernstein Medical is a beta-testing site for this technology.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

What Is Your Opinion on Doctors Performing Only FUT or Only FUE?

Q: It seems that some doctors offer only FUT and others only FUE. What is your opinion on that? — D.E., Portland, M.E.

A: Both FUT and FUE are excellent techniques, but have different indications. To deliver the best care for our patients, hair restoration physicians should have expertise in both procedures, and they should offer both in their practices.

Update: I have expanded the answer to this question in a new Answers post.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

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

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? — C.B., Greenwich, CT

Dr. Bernstein Operating the ARTAS FUE Robot
Dr. Bernstein Operating the ARTAS FUE Robot

A: The ARTAS robot uses a dual operating system when performing follicular unit extraction. One station consists of a desktop computer adjacent to the robot. This station is used to establish the basic parameters of the transplant such as the spacing of grafts, the angle and depth of the harvest, which size follicular units will be targeted, and a host of other important variables.

The hand-held pendant is used by the operator situated next to the patient. The remote has more limited options – the main ones being depth adjustment and to immediately suspend the action of the robot. Many 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.

The physician sets the parameters at the computer monitor and, once the settings are determined, he/she sets the tensioner grid on the patient’s scalp. The tensioner determines where the grafts will be harvested. The grid is moved approximately every 130 harvests. The robot can be operated at the computer terminal and through a mobile pendant. The physician often alternates with a trained assistant between that station and using the pendant.

Besides the involvement in the operation of the robot, there are many other important physician-dependent steps to the hair transplant including the planning and design of the procedure, and recipient site creation. Other steps, such as the microscopic sorting and trimming of harvested follicular unit grafts and graft placement, are often performed by trained staff, but require the physician’s close supervision.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Is a Robotic FUE Hair Transplant Painful?

Q: Does Follicular Unit Extraction performed by a robot hurt more than regular FUE? — R.T., Greenwich, CT

A: As with manual FUE, robotic FUE hair transplantation is an outpatient procedure performed under long-acting local anesthesia – a combination of lidocaine and bupivacaine. After the initial injections, the patient does not experience any pain or discomfort.

Before starting local anesthesia, we give most patients oral valium and intra-muscular midazolam (a very fast acting sedative that is very relaxing). While some patients doze off at the beginning of the procedure, others prefer to watch TV, a film, or just chat.

Local anesthesia generally wears off after 4-5 hours, so for transplant sessions lasting longer than this, we will give more anesthesia before the first wears off. With Robotic FUE, there is no discomfort once the procedure is completed and the anesthesia wears off. This is in stark contrast to an FUT strip procedure which can be uncomfortable in the donor area for days to weeks.

Posted by Robert M. Bernstein M.D.
Hair Restoration Research

Study: High Hair Yields, Low Hair Follicle Transection Rates with ARTAS Robotic System in Korean Patients

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.

Posted by Robert M. Bernstein M.D.
Bernstein Medical In The News

FUE Hair Transplant Most Likely Responsible for LeBron James’ New Hairline

After years of jokes about his continually receding hairline, LeBron James, basketball superstar and winner of two NBA championships and four NBA Most Valuable Player Awards, stunned the sports world on September 16th, 2014 when he revealed a newly restored hairline while promoting his new LeBron 12 shoe at Nike World Headquarters.

FUE Hair Transplant Most Likely Responsible for LeBron James’ New Hairline

Folks are now asking – where, when and how did LeBron get that great new hairline?

While no one knows for sure (and LeBron, so far, hasn’t said a word), Katie Nolan, the host of FoxSports.com’s No Filter, rejects the idea that LeBron’s new life in Cleveland is less stressful than it was in Miami and that’s what allowed his hairline to return. Instead, she strongly suspects that it is the result of an advanced surgical hair restoration technique called Follicular Unit Extraction, or FUE, which produces hair transplant outcomes that look completely natural.

She also suspects the use of low-level laser therapy (LLLT) which new research has shown to be an effective treatment for male and female pattern hair loss.

Katie Nolan breaks it all down for you in her No Filter segment below, “LeBron James unveils his new hair (and some shoes).”

Read about FUE Hair Transplants

View Before & After Photos of some of our hair transplant patients

Visit Bernstein Medical for a one-on-one hair loss consultation with one of our board certified physicians

Posted by Robert M. Bernstein M.D.
Bernstein Medical In The News

Dr. Bernstein on The Bald Truth: Robotic Hair Transplantation, FUE & the Future of Hair Transplants

The Bald TruthWatch the video and read the interview transcript in our section on Robotic FUE

Dr. Bernstein was interviewed by Spencer Kobren on The Bald Truth, the critically acclaimed broadcast on hair loss and hair restoration. They discussed the latest in robotic hair transplant surgery, the ARTAS® Robotic System, FUE and FUT hair transplant procedures, and the future of hair restoration.

Spencer Kobren: It’s great to have you back. And I know you only have about a half an hour – actually about 20 minutes now… Let’s get straight to the point. You heard my opening, you kind of know how I feel about the way that the industry is moving, the direction the industry is moving in, and also my concern about now that these devices are really starting to become a bigger part of the market, I believe that these devices are getting into the wrong hands. Now let’s just start with why you’ve embraced it and then we can go into how the industry is evolving.

Dr. Bernstein: Follicular Unit Transplantation via strip was a pretty straight-forward procedure, and once we figured out how to use microscopes to dissect out the follicular units and train the staff on microscopic dissection, it was pretty much a slam dunk. It was just a question of other doctors embracing it and patients understanding what it is and demanding the procedure. With Follicular Unit Extraction it’s really a much different animal. The technique is very, very tricky. And the reason why it’s tricky is because the dissection is done essentially blind. The hair follicle changes direction as it goes deeper in the skin, and also the hairs that comprise a follicular unit splay outward — they fan outwards — so it’s very tricky to get a very small punch around an intact follicular unit. When you do this by hand thousands of times, it’s really, really hard for a physician to concentrate and be consistent and not get bored out of his mind. Also, you don’t have all the visual cues that you have under a microscope. So this repetitive procedure lends itself to robotics. For years we worked on the technique, first with a sharp punch, then a dull punch, then a two-step technique where we used a sharp punch to score the skin and then a deeper [duller] punch under it. Each got better and better, but it never was really consistent, and it certainly was very, very dependent on the user, the patient, and how you’re feeling that day. So this procedure lends itself to robotics. I first learned about the robotic procedure very early in 2011 and when I first saw the robot it made total sense to me.

The Bald Truth is America’s longest running self help radio show for men’s hair loss. Kobren is the Founder and President of the American Hair Loss Association and a founder of the International Alliance of Hair Restoration Surgeons (IAHRS).

Posted by Robert M. Bernstein M.D.
Bernstein Medical In The News

Dr. Bernstein, Robotic Hair Transplant Pioneer, Honored to be Included in 15th Consecutive ‘Best Doctors’ Issue of New York Magazine

Dr. Robert M. Bernstein has been included in New York Magazine’s annual ‘Best Doctors’ issue for the 15th consecutive year. Dr. Bernstein, a Clinical Professor of Dermatology at Columbia University, is a world-renowned hair transplant surgeon and pioneer of robotic hair transplant procedures.

Best Doctors 2014 - New York Magazine
New York Magazine ‘Best Doctors’ 2014

New York, NY — Robert M. Bernstein, MD, MBA, FAAD, a Clinical Professor of Dermatology at Columbia University in New York and a pioneer of modern hair transplant procedures, is honored to be included in New York Magazine’s annual ‘Best Doctors’ issue for the fifteenth consecutive year.

Dr. Bernstein’s two decades of innovation in surgical hair restoration and dedication to his patients at Bernstein Medical – Center for Hair Restoration have earned him placement in the 2014 edition of the peer-nominated ‘Best Doctors’ issue. The respect his colleagues have for his work stems from his leadership and dedication to advancing and improving surgical hair restoration procedures.

When asked about being included in his fifteenth consecutive issue of ‘Best Doctors,’ Dr. Bernstein said:

“As a physician, my singular focus is on providing patients with the best options for hair restoration and performing transplant surgery using the most advanced technologies. That my work is recognized by the medical community is both an honor and a testament to how far the field of hair transplantation has come since the days of the older, less-natural procedures.”

Dr. Bernstein’s latest work is in developing new applications for robotic hair transplant procedures. In addition to being among the first in the world to incorporate the ARTAS® robotic system into his practice, Dr. Bernstein was the first to describe Follicular Unit Transplantation (FUT) and Follicular Unit Extraction (FUE) into the catalog of medical literature. He has authored over 60 publications in scientific journals. These writings have fundamentally transformed the hair transplant procedure from older “plug procedures,” into a modern technique that uses precise robotic technology to extract individual follicular units from the back of the scalp. A recent historical review of dermatologic surgery published in the Journal of the American Academy of Dermatology recognized Dr. Bernstein’s work in FUT and FUE as allowing “the once elusive goal of a completely natural-looking hair transplant to finally be achieved.”

New York Magazine’s ‘Best Doctors’ issue is a special annual edition of the acclaimed magazine which contains a directory of the New York area’s best physicians selected by Castle Connolly, Ltd. Physicians throughout New York, New Jersey and Connecticut are nominated by their peers as part of their survey and must also pass a rigorous physician-led review of the doctor’s qualifications, reputation, skill in diagnosis and treating patients.

About Robert M. Bernstein, M.D., F.A.A.D.

Dr. Robert M. Bernstein’s published articles on Follicular Unit Transplantation have been called “Bibles” on that methodology. He has received the Platinum Follicle Award, the highest honor in the field, and has been named the Surgeon of the Month and Pioneer of the Month by the International Society of Hair Restoration Surgery (ISHRS). Dr. Bernstein has appeared as a hair restoration expert on many notable television programs and in many news and lifestyle publications over the years. Examples include: The Oprah Winfrey Show, The Dr. Oz Show, The Today Show, Good Morning America, ABC News, CBS News, New York Times, Wall Street Journal, Men’s Health Magazine, and more. He is also co-author of Hair Loss & Replacement for Dummies. Dr. Bernstein graduated with honors from Tulane University, received the degree of Doctor of Medicine at the University of Medicine and Dentistry of NJ, and did his training in Dermatology at the Albert Einstein College of Medicine. Dr. Bernstein also holds an M.B.A. from Columbia University.

About Bernstein Medical – Center for Hair Restoration

Bernstein Medical – Center for Hair Restoration, the facility Dr. Bernstein founded in 2005, is dedicated to the diagnosis and treatment of hair loss in men and women using the most advanced technologies. The state-of-the-art facility is located in midtown Manhattan, New York City and treats patients from around the world. In 2011, Bernstein Medical became one of the first practices in the world to offer Robotic FUE procedures using the image-guided, computer-driven technology of the ARTAS Robotic System. Bernstein Medical is a beta-testing site of the robot’s new capability including the creation of hair transplant recipient sites. The board-certified physicians and highly-trained clinical assistants at Bernstein Medical take pride in providing the highest level of treatment and care for all patients.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

How Experienced Are Bernstein Medical Hair Restoration Technicians?

Q: I know Dr. Bernstein is one of the leading hair restoration surgeons in the country, but what about his medical assistants? How experienced are the hair restoration technicians that help him during surgery? — E.N., Redding, C.T.

A: My medical assistants and technicians are full time employees, and many of them have worked closely with me for many years. In fact, many of them have been with me since the inception of FUT, the procedure I pioneered way back in 1995. I do not hire, nor have I ever hired, per diem technicians.

All my hair restoration technicians are highly skilled and experienced in stereo-microscopic dissection and follicular unit graft placement. Even with Robotic FUE, being highly skilled and experienced in stereo-microscopic dissection is important since every graft that the robot harvests is examined, counted, and, when necessary, trimmed to ensure they are of the highest quality before being implanted into the scalp.

Because of the intense in-house training of our staff, we have received national accreditation from the “Accreditation Association for Ambulatory Health Care” (AAAHC/Accreditation Association) for maintaining rigorous standards in patient care.

Read more about how we train our surgical staff.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Can A Hair Transplant Restore Hair Loss After Radiation Treatment?

Q: I received radiation therapy to my scalp two years ago to treat a brain tumor. I lost my hair during treatment and it has not grown back. The doctors said that this treatment might result in permanent hair loss. Is a hair transplant a viable option after radiation treatment? — K.G., Darien, C.T.

A: Unlike chemotherapy which generally causes a reversible shedding of hair (called anagen effluvium), radiation therapy can cause both reversible shedding and the permanent loss of hair follicles (scarring alopecia).  Hair can be successfully transplanted into these scarred areas – but there must be enough donor hair to do so. If the radiotherapy was localized, a hair transplant procedure is often quite effective – although several procedures may be required to achieve adequate coverage of the irradiated areas.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

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

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

Posted by Robert M. Bernstein M.D.
Bernstein Medical In The News

Press Release: Hair Restoration Pioneer Introduces Next Step in Robotic Hair Transplants

ARTAS Robotic System display monitor showing parameters for the creation of recipient sitesARTAS Robotic System display monitor showing parameters for the creation of recipient sites

New York, NY (PRWEB) — Robert M. Bernstein, M.D., F.A.A.D., A.B.H.R.S., founder of Bernstein Medical – Center for Hair Restoration, 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, 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.

The ARTAS System is currently able to harvest intact follicular unit grafts from the permanent area in back of one’s scalp using precise robotic technology. This is the most difficult aspect of a follicular unit extraction hair transplant – the newer type of hair restoration procedure that avoids a linear scar in the back of the scalp. Now that site creation can also be done robotically, only one step remains – graft placement.

The ARTAS Robotic System maps the surgeon's hairline design onto a 3-D model of the patient's headThe ARTAS Robotic System maps the surgeon’s hairline design onto a 3-D model of the patient’s head

For the recipient site creation, the doctor first draws a hairline and other markings directly onto the patient’s scalp to delineate the surgical plan. Next, multiple photographs are taken and fed into software, called the ARTAS™ Hair Studio, which converts the images into a 3-D model of the actual patient. This computer model can be manipulated and saved for the patient’s procedure. Using the ARTAS™ Hair Studio software, the physician then specifies the angle, direction, density, and randomness of the recipient site incisions to create the most natural look. During the procedure, the robot uses image-guided technology to avoid existing hairs while it creates up to 1,500 recipient sites per hour. In performing recipient site creation, the robot automates a process that can be physically demanding and prone to human error.

On the advancement, Dr. Bernstein said:

“This development is a crucial step towards a robotic system that can perform every aspect of a hair transplant. A great deal of credit goes to the engineers of Restoration Robotics who have worked to make automated recipient site creation a reality. I am proud that this work not only improves hair transplants for patients, but adds to the increasingly important trend of using robotic technology in medicine.”

The site creation technology that Dr. Bernstein debuted at the ARTAS User Group Meeting; which was held in California (Laguna Niguel, CA) on February 7th and 8th, 2014; will be available to hair restoration physicians in the fall of 2014. Gabe Zingeratti Ph.D, head of R&D at Restoration Robotics, Inc., presented details of the technology, which was beta-tested at Bernstein Medical – Center for Hair Restoration. With the next generation ARTAS® Robotic System rolling out in the coming months, the focus of research will then be on the final phase of robotic hair transplantation, the robotic insertion of follicular unit grafts into recipient sites. This last step will take several more years to develop.

The ARTAS Robotic System, developed by Restoration Robotics, is currently in use by hair restoration physicians around the world to automate the extraction of grafts of skin and hair called follicular units.. Follicular units, which are natural groupings of one to four hair follicles, form the biological basis of the modern hair transplant procedure. Once extracted from the back of the patient’s scalp, the follicular unit grafts are then inserted into recipient sites in the balding area of the scalp where they grow hairs that are immune to the effects of common hair loss.

No stranger to innovative advances in hair transplant surgery, Dr. Bernstein introduced Follicular Unit Transplantation (FUT) to medical literature in a 1995 publication. FUT transformed hair transplants from the use of large grafts of skin and hair, known colloquially as “hair plugs,” to a more medically-oriented procedure that produces completely natural-appearing results. Dr. Bernstein with his colleague Dr. Bill Rassman again broke new ground with his 2002 publication that introduced the concept of Follicular Unit Extraction (FUE) to scientific literature. Dr. Bernstein was the first physician on the East Coast of the United Sates, and one of the first in the world, to use the ARTAS System to perform FUE using the new robotic technology.

About Robert M. Bernstein, M.D., F.A.A.D.

Dr. Robert M. Bernstein is a Clinical Professor of Dermatology at Columbia University and founder of Bernstein Medical – Center for Hair Restoration. His landmark scientific papers are considered seminal works in the field of hair transplant surgery. Other publications include textbook chapters on dermatologic surgery and books, like Hair Loss and Replacement for Dummies, aimed at the consumer audience. He has been selected as one of New York Magazine’s “Best Doctors” for fourteen consecutive years and has appeared as a hair loss and hair transplantation expert on The Oprah Winfrey Show, The Dr. Oz Show, Good Morning America, The Today Show, CBS News, Fox News, and The Discovery Channel. Dr. Bernstein has been interviewed or featured in articles in the New York Times, GQ Magazine, Men’s Health, Interview Magazine, Vogue, and others.

About Bernstein Medical – Center for Hair Restoration

Bernstein Medical – Center for Hair Restoration, founded in 2005, is a state-of-the-art facility and international referral center for the treatment of hair loss that is located in midtown Manhattan, New York City. Hair transplant surgery, hair repair surgery, and eyebrow restoration are performed using Dr. Bernstein’s pioneering techniques of Follicular Unit Transplantation (FUT) and Follicular Unit Extraction (FUE).

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

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

Q:  Is it true that hair transplants can now be done totally by a robot? — M.S., Los Angeles, California

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.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Is a Hair Transplant Possible Using Someone Else’s Hair?

Q: Can you do a hair transplant using someone else’s hair? — K.K., Garden City, N.Y.

A: Unfortunately, this is not possible because your body would reject the hair transplant without the use of immunosuppressive drugs. The problem with immune suppressants is that they will lower your natural immune response, increasing your susceptibility to infections and even cancer, and you’ll have to take them for the rest of your life.

A transplant using someone else’s hair is also not desirable for aesthetic reasons. There’s the style of the hair, its texture, thickness, color, etc. Trying to find the perfect donor whose hair would complement and flatter your particular features and blend in with your remaining hair would be a significant, if not impossible, challenge. It would be possible, however, to transplant the hair from one identical twin to another, but most likely if one went bald, so would the other.

Posted by Robert M. Bernstein M.D.
Bernstein Medical In The News

Dr. Bernstein’s Key Contributions to Hair Restoration Outlined in Historical Review of Dermatologic Surgery

Journal of the American Academy of DermatologyDr. Bernstein is credited with introducing the “follicular unit” to surgical hair restoration, the innovation that allowed for a “completely natural-looking hair transplant” to be achieved. The commentary on Dr. Bernstein’s contributions to the field of hair transplantation are outlined in an historical review of dermatologic surgery that appeared in the Journal of the American Academy of Dermatology.

Dr. Bernstein is noted as being responsible for moving the field of hair restoration surgery away from large graft “plugs” and mini-micrografts to follicular units:

The following year, dermatologists Bernstein et al laid down the conceptual framework for follicular unit transplantation in their 1995 article, “Follicular transplantation.” In 1997, they detailed its clinical application in the paired articles, “Follicular transplantation: patient evaluation and surgical planning” and “The aesthetics of follicular transplantation.”

The 2 advances, the application of the stereomicroscope to follicular dissection and the use of follicular units as the basic element of hair transplantation, arose from a background in dermatology. They moved the field of hair restoration surgery from plugs and mini-micrografting, where this basic anatomical feature of the hair follicle was ignored, to follicular unit transplantation, where the follicular unit became sacrosanct. These 2 ideas, when put to clinical use, allowed the once elusive goal of a completely natural-looking hair transplant to finally be achieved.

Dr. Bernstein’s pioneering of the Follicular Unit Transplant (FUT) procedure still resonates, almost two decades later, as the follicular unit continues to be the anatomical structure that is transplanted in hair transplant surgeries worldwide.

The article then describes how Dr. Bernstein, along with his colleague Dr. Rassman, laid the foundation for the next major developments in hair restoration; first with his description of the Follicular Unit Extraction (FUE) technique and more recently with innovation in robotic hair restoration technology.

With the publication of the article, “Follicular unit extraction,” in 2002, the follicular unit extraction procedure gained popular appeal and was rapidly adopted by doctors worldwide. The authors cautioned on the limitations of this harvesting technique and the risk of follicular damage. Dermatologists Berman, Zering, and Bernstein, along with their colleagues in other specialties, continue to work on the problem of harvesting in follicular unit extraction, with the application of robotic technology showing particular promise.”

Taken together, these passages underscore how Dr. Bernstein’s research and medical publications have fundamentally transformed the field of hair restoration to the benefit of patients and physicians alike. While many other very talented physicians have had a substantial impact on hair restoration procedures ever since the hair transplant concept was first proposed by Dr. Norman Orentreich in the 1950s, Dr. Bernstein has contributed the key innovations that have made modern, natural-looking hair transplant surgery a medical and aesthetic possibility.

The article is titled, “Current status of surgery in dermatology.” The Journal of the American Academy of Dermatology is the official journal of The American Academy of Dermatology (AAD), the largest, most influential and most representative dermatology group in the United States.

Reference

C. William Hanke, Ronald L. Moy, Randall K. Roenigk, Henry H. Roenigk Jr., James M. Spencer, Emily P. Tierney, Cynthia L. Bartus, Robert M. Bernstein, Marc D. Brown, Mariano Busso, Alastair Carruthers, Jean Carruthers, Omar A. Ibrahimi, Arielle N.B. Kauvar, Kathryn M. Kent, Nils Krueger, Marina Landau, Aimee L. Leonard, Stephen H. Mandy, Thomas E. Rohrer, Neil S. Sadick, Luitgard G. Wiest, Current status of surgery in dermatology, Journal of the American Academy of Dermatology, Volume 69, Issue 6, December 2013, Pages 972-1001, ISSN 0190-9622, http://dx.doi.org/10.1016/j.jaad.2013.04.067.

Read more about Dr. Bernstein’s history of innovation in hair transplant surgery

Read Dr. Bernstein’s landmark medical publications

Download and read ‘Current status of surgery in dermatology’ (pdf)

Posted by Robert M. Bernstein M.D.
Bernstein Medical In The News

Dr. Bernstein Gives Keynote Presentation On Robotic Hair Transplantation

Dr. Bernstein Presenting 'Follicular Unit Extraction: Then and Now'
Dr. Bernstein Presenting ‘Follicular Unit Extraction: Then and Now’

Dr. Bernstein was honored to deliver the keynote address at the ARTAS International Users Forum in San Francisco, California. Dr. Bernstein’s presentation, “Follicular Unit Extraction: Then and Now,” was a review of the evolution of surgical hair restoration from Follicular Unit Transplantation (FUT) through Follicular Unit Extraction (FUE) to the cutting edge technique of Robotic-FUE.

The presentation described the steps that resulted in the use, and growth in popularity, of the state-of-the-art ARTAS Robotic System for FUE. Dr. Bernstein pointed out that with the introduction of each procedure — FUT, FUE, and Robotic-FUE — there was initially a rocky reception with physicians. In each instance, however, the surgeons’ concerns were overcome first by strong, patient interest and then by clinical studies that confirmed the procedures’ usefulness.

Dr. Bernstein discussed how FUE procedures progressed from the use of hand-held instruments to the computer-assisted, image-guided ARTAS Robot. One of the initial hurdles of FUE procedures using hand-held devices was a high rate of follicular unit transection (cutting of the follicles). Restoration Robotics, Inc., the company that developed the ARTAS system, used a “sharp/blunt” punch technique that was introduced by Jim Harris in his 2004 publication on the SAFE System for FUE. The sharp/blunt technique, that was validated in 2006 by Dr. Bernstein’s research publication, “New Instrumentation for Three-Step Follicular Unit Extraction,” reduced transection of follicles when compared to older instrumentation. Dr. Bernstein then detailed modifications to the system that he proposed in order to improve the ARTAS robot. These improvements include: a smaller tip for the sharp/blunt punch, selection of larger over smaller follicular units, tensioner placement, ‘feathering’ the ends of the tensioner, and pre-making recipient sites before extracting the follicular unit grafts.

Looking to the future, Dr. Bernstein mapped out the further evolution of the Robotic FUE procedure and the tasks it will be required to perform. In future procedures, the physician will not only guide the robot on extracting follicular units, but also in creating recipient sites and, further down the road, placing grafts into the recipient sites. Graft placement will represent the most significant challenge to the robotic system as this step is the most sensitive to patient to patient variability. Once this last step is accomplished, a fully automated hair transplant should be possible, eliminating much of the human error in the mechanical aspects of the hair restoration process.

More photos from the event:

Posted by Robert M. Bernstein M.D.
Bernstein Medical In The News

Dr. Bernstein Selected For 14th Consecutive NY Magazine ‘Best Doctors’ Issue

New York Magazine’s 2013 ‘Best Doctors’ issue includes Dr. Robert M. Bernstein, a pioneer of modern hair transplant procedures, making this the 14th consecutive year Dr. Bernstein has appeared in the special annual issue.

New York Magazine 'Best Doctors' 2013New York, NY — Robert M. Bernstein, M.D., F.A.A.D., Clinical Professor of Dermatology at Columbia University in New York and a pioneer of modern hair transplant procedures, was included in the ‘Best Doctors’ issue of New York Magazine for the fourteenth consecutive year.

Dr. Bernstein earned his placement in the Best Doctors issue, and his reputation as world-renowned hair restoration physician, through a 20 year career of developing surgical techniques and adopting and guiding technological advances in the industry. His more than 60 medical publications on Follicular Unit Transplantation (FUT), Follicular Unit Extraction (FUE), and Robotic FUE (R-FUE) have revolutionized the field of hair restoration and provide the foundation for hair transplant surgeons worldwide.

The New York Magazine ‘Best Doctors’ issue is an annual issue of the magazine that contains a directory of the New York area’s best physicians. The directory is based on the results of a peer-reviewed survey that is conducted by Castle Connolly, Ltd. The company also publishes the guidebook “Top Doctors: New York Metro Area,” based on the same survey of doctors. As part of the survey, physicians are nominated from across the New York metropolitan area including Manhattan, Brooklyn, Queens, The Bronx, Staten Island, Westchester County, Long Island, and counties in New Jersey and Connecticut. The recommendations are based on the nominated doctor’s qualifications, reputation, skill in diagnosis, skill in treating patients, and other criteria. A physician-led research team at Castle Connolly tabulates and vets the nominations and compiles the final list.

Bernstein Medical – Center for Hair Restoration, the facility Dr. Bernstein founded in 2005, is a state-of-the-art hair loss treatment facility in New York City that serves men and women from around the world. The center specializes in FUT, FUE and R-FUE hair transplants, and also performs corrective hair transplants and offers medical treatments for hair loss patients who are not indicated for a transplant. In 2011, Bernstein Medical became the first hair restoration facility on the East Coast to offer Robotic FUE procedures using the ARTAS Robotic System. Dr. Bernstein has worked closely with Restoration Robotics, Inc. to improve both the robotic technology and the R-FUE procedure protocol.

Dr. Bernstein has appeared on many notable media programs and publications over the years. Some of these include: The Oprah Winfrey Show, The Dr. Oz Show, The Today Show, Good Morning America, ABC News, CBS News, The Early Show, Fox News, National Public Radio, NY1, New York Times, Wall Street Journal, Men’s Health Magazine, GQ Magazine, Telemundo, “O” the Oprah Magazine, and more. He is co-author of Hair Loss & Replacement for Dummies and has received the Platinum Follicle Award, Surgeon of the Month, and Pioneer of the Month honors from the International Society of Hair Restoration Surgery (ISHRS).

Posted by Robert M. Bernstein M.D.
Bernstein Medical In The News

Bernstein Medical Named Best Small and Medium Sized Company to Work For in New York State

Innovative Bernstein Medical Awarded As Best New York Small Business To Work ForBernstein Medical Wins 2013 ‘Best Companies to Work For in New York’ Award. Sandra Medina (2nd from left) an Employee for 18 years, accepts award.

Dr. Bernstein has received plaudits for his innovation and leadership in hair transplantation and medical hair restoration. However, what is less frequently noted is that he holds an MBA from Columbia University and has applied some of this knowledge toward making his company a leader in the business community as well.

Now, Bernstein Medical – Center for Hair Restoration is receiving its own recognition for leadership in appreciating the value of its workers. The Society for Human Resource Management (SHRM) has named Bernstein Medical the number one small or medium-sized business to work for in the state. The 2013 ‘Best Companies to Work For in New York’ list placed Bernstein Medical at the top slot, out-ranking companies from New York City as well as Rochester, Syracuse, and elsewhere in the state.

Bernstein Medical was also featured in the 2013 awards program:

“A recognized leader in the development of hair transplantation techniques and clinical research, the center was the third in the world and one of 12 current hair restoration practices to utilize and control the ARTAS Robot in follicular unit extraction procedures. Seminars, meetings and continuing education classes help the physicians, surgical team and front-office staff to maintain a high degree of ethics, innovation and the latest skills.

The long-term, family-forward attitude of the workplace is supported by a retirement plan and package that couples a 401(k) with both safe harbor and profit-sharing benefits. […] A team culture allows those who work there to voice their ideas and opinions with confidence.”

Created in 2007, these celebrated annual awards are a distinctive program that evaluates and ranks the best places of employment based on employee satisfaction and engagement, as well as workplace practices and policies. The assessment is made using a two-part survey process. In the first part, the employer provides details about company benefits, policies, and practices. The second, and most important, part is a confidential employee survey in which employees evaluate their workplace experience.

The program is a partnership of New York State SHRM, Best Companies Group, Journal Multimedia Corporation and The Business Council of New York.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Why FUT Hair Transplant For One Person, FUE For Another?

Q: A while ago I saw you and you recommended FUT hair transplantation, but my friend came in and you recommended FUE. How come? — C.T., Hackensack, N.J.

A: I think that both procedures are excellent, which is why I do them both. My recommendations are determined by the individual patient. His or her age, desire to wear hair cut very short, athletic activities, donor density and miniaturization, extent of hair loss, and potential future balding are all important aspects in the decision process.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Does the ARTAS FUE Robot Work with Dark Hair?

Q: I read your post that the ARTAS robot doesn’t work well in patients who want FUE but have blond hair. I have dark skin and hair, does that present a problem for the machine? — J.S., London, England, U.K.

A: The ARTAS Robot performs follicular unit extraction just as well with blond hair as dark hair, but not white hair. It is simple to just to dye the white donor hair prior to the hair transplant procedure. This donor hair will be clipped very short the morning of surgery removed anyway, so it will not present too much of a cosmetic issue.

See before & after hair transplant photos organized by hair character

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

How Long Are FUT and FUE Hair Transplants Visible After Procedure?

Q: How long are FUT and FUE visible after the procedures? — S.V., Weston, C.T.

A: The recipient area is visible after both procedures for up to 10 days. The donor area in FUT is generally not visible immediately after the procedure. In FUE, the donor area must be shaved, so that will be visible for up to two weeks (the time it takes for the hair to grow in).

Posted by Robert M. Bernstein M.D.
Bernstein Medical In The News

Press Release: Hair Restoration Pioneer Improves Robotic FUE Hair Transplant Procedures

New York, NY (PRWEB) — Robert M. Bernstein, M.D., F.A.A.D., A.B.H.R.S., a world-renowned hair transplant surgeon, presented a series of improvements to hair transplant procedures which use the ARTAS Robotic System for Follicular Unit Extraction (FUE). These updates include revisions to the FUE surgical protocol and technical adjustments to the robotic extraction system. He presented his refinements at the first user meeting held by the developers of the system; Restoration Robotics, Inc.; on September 14 – 16 in Denver, Colorado.

Dr. Bernstein receives recognition from Restoration RoboticsDr. Bernstein receives recognition from Restoration Robotics

Dr. Bernstein described his series of improvements in a lecture to an elite group of physicians who are among the first adopters in the industry of the image-guided, robotic-assisted system. The updates are designed to improve the results of FUE hair transplantation by enhancing both the surgical protocols of the procedure as well as the functionality of the robotic system. In FUE, small groups of one to four hairs, called follicular units, are extracted individually from the back and sides of the scalp and are then implanted into recipient sites, which are tiny holes that the surgeon creates in a balding area of the scalp.

Dr. Bernstein discussing robotic-assisted FUE at Restoration Robotics' first user meetingDr. Bernstein discussing robotic-assisted FUE at Restoration Robotics’ first user meeting

The most important update to the FUE procedure that Dr. Bernstein proposed is for surgeons to create recipient sites before they extract the grafts, rather than create the sites after grafts are extracted. Drawing on his decades of experience in hair transplantation, Dr. Bernstein developed this technique of “pre-making” recipient sites in order to maximize survival of the grafts during the hair transplant. Using this technique, extracted grafts are outside the body for a shorter duration of time. It also minimizes instances of “popping,” in which grafts are exposed to desiccation (drying) and hypoxia (low oxygen) before they are inserted back into the scalp. By “pre-making” the recipient sites, these harmful factors are mitigated and a greater number of the grafts grow into viable, hair-producing follicular units. Dr. Bernstein encourages surgeons to use this technique on all FUE procedures, whether using manual methods or robotic instrumentation.

When asked to comment on his improvements to the robotic FUE procedure, Dr. Bernstein said:

“It was fortuitous timing that the ARTAS Robot became available just as I was developing my refinements to the FUE procedure. The combination of the automated robot for graft extraction with the technique of pre-making recipient sites has led to a significant improvement in hair transplant surgery.”

Dr. Bernstein is the founder of Bernstein Medical – Center for Hair Restoration, and he is recognized world-wide for his innovative work in the treatment of hair loss. He is among the first hair transplant surgeons in North America to utilize the ARTAS Robot for FUE in his practice.

Being an early adopter of the advanced follicular unit extraction system has enabled him to work with Restoration Robotics to refine it to his exacting standards. Dr. Bernstein has, again, put his fingerprints on a revolutionary upgrade to the hair transplantation industry. He was the first to describe FUT and FUE procedures in the medical literature, in 1995 and 2002 respectively. In contrast to FUE, where follicular units are extracted individually, in FUT procedures a strip of skin is removed from the back of the scalp, it is then dissected into follicular units, and those follicular unit grafts are then implanted into recipient sites in the patient’s scalp.

About Dr. Bernstein

Robert M. Bernstein, M.D., F.A.A.D., A.B.H.R.S. is a Clinical Professor of Dermatology at Columbia University and a pioneer in the field of hair restoration. His landmark scientific papers are considered seminal works in the field of hair transplant surgery, and he is the most widely published author on the topic having published more than sixty articles, editorial reviews, books, and textbook chapters.

Dr. Bernstein has been selected as one of New York Magazine’s “Best Doctor’s” for thirteen consecutive years and he has appeared as a hair loss and hair transplantation expert on The Oprah Winfrey Show, The Dr. Oz Show, Good Morning America, The Today Show, The Discovery Channel, CBS News, Fox News, and National Public Radio. Dr. Bernstein has been interviewed or featured in articles in GQ Magazine, Men’s Health, Interview Magazine, Vogue, the New York Times, and others.

About Bernstein Medical – Center for Hair Restoration

Bernstein Medical – Center for Hair Restoration is a state-of-the-art hair restoration facility and international referral center, located in midtown Manhattan, New York City. The center is dedicated to the diagnosis and treatment of hair loss in men and women. Hair transplant surgery, hair repair surgery, and eyebrow restoration are performed using Dr. Bernstein’s pioneering techniques of Follicular Unit Transplantation (FUT) and robotic Follicular Unit Extraction (R-FUE).

Posted by Robert M. Bernstein M.D.
Bernstein Medical In The News

‘Best Doctors’ Issue Of NY Magazine Includes Dr. Bernstein For 13th Consecutive Year

Dr. Robert M. Bernstein — pioneer of the follicular unit transplantation (FUT), follicular unit extraction (FUE), and Robotic FUE hair transplant procedures — was selected for the 13th consecutive year to be included in New York Magazine’s ‘Best Doctors’ issue.

New York Magazine - Best Doctors 2012New York, NY — Robert M. Bernstein, M.D., F.A.A.D., the world-renowned hair transplant physician, pioneer of the Follicular Unit Transplantation (FUT) and Follicular Unit Extraction (FUE) and founder of Bernstein Medical – Center for Hair Restoration, was included in New York Magazine’s ‘Best Doctors‘ issue for the thirteenth consecutive year.

When asked of his inclusion in this annual peer-reviewed list, Dr. Bernstein, a Clinical Professor of Dermatology at Columbia University in New York City, said:

“It is such an honor to be recognized by New York Magazine. Our passion for providing the best hair loss treatments has served as the impetus for pushing the envelope in utilizing new state-of-the-art hair restoration techniques such as Robotic assisted hair transplants.”

New York Magazine’s Best Doctors issue is a directory of physicians that is compiled through a peer-review survey conducted by Castle Connolly Medical Ltd. The company also publishes “Top Doctors: New York Metro Area,” a guidebook based on the results of the same survey of doctors. Each year, physicians in the New York metropolitan area — including Manhattan, Brooklyn, Queens, The Bronx, Staten Island, Westchester County, Long Island, and counties in New Jersey and Connecticut — nominate their choice of the best doctors in a specific field. The physicians make their recommendations based on criteria including: qualifications, reputation, skill in diagnosis, and skill in treating patients.

Dr. Bernstein, a native New Yorker, has spent two decades developing new hair transplant techniques. His medical publications on FUT and FUE hair transplantation have revolutionized the field of hair restoration surgery and provide the basis for modern techniques used by hair transplant surgeons worldwide. Bernstein Medical – Center for Hair Restoration is a state-of-the-art hair restoration facility in New York City. Located in midtown Manhattan since 2005, the center is dedicated to the diagnosis and treatment of hair loss in men and women and specializes in both corrective hair transplants as well as the traditional restorative FUT and FUE techniques. Dr. Bernstein is the first hair transplant doctor on the East Coast to offer Robotic FUE hair transplantation to hair loss patients.

Dr. Bernstein has regularly appeared in notable media programs and publications over the years. Some highlights include: The Oprah Winfrey Show, The Dr. Oz Show, The Today Show, Good Morning America, CBS News, The Early Show, Fox News, National Public Radio, NY1, New York Times, Men’s Health Magazine, GQ Magazine, Telemundo, “O” the Oprah Magazine, and more. He is co-author of Hair Loss & Replacement for Dummies.

Posted by Robert M. Bernstein M.D.
Bernstein Medical In The News

Dr. Bernstein Featured With “First Of Its Kind” Robotic Hair Transplant System On NY1

Dr. Bernstein Featured With "First Of Its Kind" Robotic Hair Transplant System On NY1
Dr. Bernstein with ARTAS System for Robotic FUE

Dr. Bernstein not only pioneers hair transplant procedures, but hair restoration technology as well. The NY1 television station, based in New York City, visited Bernstein Medical to see a demonstration and talk about the newest tool in the hair restoration toolkit, the ARTAS Robot for Hair Restoration.

The NY1 piece shows the robotic FUE system in action at Bernstein Medical, with views of the robotic arm, the image-guided system, the punch tool, and the user interface.

The segment also reports that Dr. Bernstein is among the first hair transplant physicians to use the technology:

Removing those units has always proved to be the toughest part of this method, but the robot changes that, which is why even Dr. Robert Bernstein — the man who’s widely credited with developing follicular unit transplantation and follicular unit extraction — jumped to be among the first in the U.S. to use the device.

Dr. Bernstein speaks to one of the main benefits of the robot, the increased efficiency in extracting follicular unit grafts.

NY1 serves 2.1 million people in the tri-state area, including all five boroughs — Manhattan, Brooklyn, Queens, Staten Island, and The Bronx –– parts of Westchester and Hudson Valley, as well as cities and towns in Bergen County and Hudson County in New Jersey.

Read more about Robotic Hair Transplantation

Posted by Robert M. Bernstein M.D.
Bernstein Medical In The News

ARTAS Robotic FUE System And Dr. Robert Bernstein on NY1

Dr. Bernstein discusses ARTAS Robotic FUE system on NY1

NY1, a New York City television channel, has featured Dr. Bernstein in a segment on robotic hair transplantation.

Here is a transcript of the video:

A new robot could help return hair to those of us who, as we get older, find ourselves a bit follically challenged. Called the ARTAS System from Restoration Robotics, it was recently approved by the FDA to help with a type of hair transplantation technique called follicular unit transplantation where follicular units, groups of one to four hairs, are removed directly from the back of the head and transplanted on the top and front. Removing those units has always proved to be the toughest part of this method, but the robot changes that, which is why even Dr. Robert Bernstein – the man who’s widely credited with developing follicular unit transplantation and [follicular unit extraction] – jumped to be among the first in the U.S. to use the device.

“A follicular unit is about a half a millimeter and you have a one-millimeter circle that has to go dead center over it to punch this out. So when you’re doing it by eye and you’re doing thousands of them over time you’re missing them over time it’s not exactly precise. The robot is dead center each time and follows the angle of the hair,” explains Bernstein.

While the robot doesn’t really have any direct impact on how the transplant will ultimately look – that’s still up to the doctor’s expertise and artistic skill. What it does do is give the doctor a better quality sample of hair with which to work.

“There’s always damage to the follicles when you’re doing it because you’re doing it by hand through these very tiny incisions and so the yield is going to be less and so with a robot if you try to get out 100 follicles you’ll get very close to 100 follicles,” says Bernstein.

Again, the robot just makes the incision, the doctor still has to pull the hair, make sites on the front where the transplants will go and then actually make the transplants. However, developers say they are working on having future versions of the ARTAS System help with the entire process.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

ARTAS Robot vs. Neograft Machine in Follicular Unit Extraction

Q: I wanted to find out about the difference between what Dr. Bernstein does with his robotic system versus NeoGraft. — G.M., Newark, NJ

A: The ARTAS robotic system, used at Bernstein Medical, has robotic control, video imaging and uses a blunt dissection technique. This allows for very precise extraction of follicular units from the donor area with minimal transection. The Neograft machine for FUE is a manually operated machine which uses sharp edge dissection. Because it relies on manual controls rather than robotics, it is less accurate and the cutting tip causes more graft injury. The precision of the robot allows the grafts to be harvested with less trauma and will thus result in better growth. In my opinion, these differences are very significant.

Read more about the differences between the ARTAS Robot and Neograft

Posted by Robert M. Bernstein M.D.
Bernstein Medical In The News

New York Times Notes Robotic FUE At Bernstein Medical

Eyebrow transplant and restoration article - New York TimesThe New York Times, once again, has recognized Dr. Bernstein’s pioneering hair restoration techniques. The NYT Fashion and Style section noted that he is, “the first hair transplant surgeon on the east coast,” to use the ARTAS robotic system for Follicular Unit Extraction.

This precision, image-guided robot is unique in its, “use of digital mapping and tracking to extract and harvest ‘follicular units.'”

For more information about the ARTAS System see our Robotic Hair Transplantation section of our website.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

What Part of FUE Hair Transplant Does ARTAS Robotic System Perform?

Q: Does the robotic hair transplant system do the whole operation or does the doctor do any of it? — B.W., Brooklyn, NY

A: The ARTAS robot only performs a small part of the FUE procedure, although it is an important one. FUE comprises four basic steps:

  1. Isolation of follicular units from the surrounding skin
  2. Removal of follicular units from the scalp
  3. Making recipient sites
  4. Placing grafts into these sites

The robot only performs the first step, follicular unit isolation.

Even in this first step, however, physician control is extremely important, as the doctor must determine the precise depth to which both the sharp and blunt dissection are set. They must also make constant adjustments to the angle that aligns the instrument with the graft.

The ARTAS robotic system gets all of its cues from the surface of the skin, so that it can place the target follicular unit in the exact center of the cutting field of the robotic tip. It can also align the tip parallel with the emergent hairs. However, the angle of the hair as it emerges from the scalp is slightly different than the angle below the skin and the doctor needs to tell the robot what this angle is. Fortunately, the robotic imaging system provides the doctor with the information he needs to make this determination.

Read about Robotic Hair Transplantation.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Is Robotic FUE Faster Than Traditional FUE Hair Transplantation

Q: Is Robotic FUE faster than traditional FUE hair transplants? — F.W., Hoboken, NJ

A: Yes. Although, the speed of removal per graft is about the same, the actual procedure time is shortened when using the robotic device. The ARTAS robotic FUE system has a longer set-up time, but this is more than offset by the fact that the robot doesn’t “tire” during longer procedures.

For more information, visit the page on Robotic FUE Hair Transplantation or read answers to questions on Robotic FUE.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

How Many Devices Exist for Robotic FUE Hair Transplantation?

Q: How many different kinds of robotic devices are there? — T.R., Boca Raton, FL

A: There is only one, the robot called the ARTAS System for FUE, made by Restoration Robotics. The Neograft machine, occasionally confused with a robotic device, is actually a hand-held instrument that is not robotically controlled and lacks image-based tracking. It is, therefore, not capable of eliminating the operator error and variability of hand operated devices and does not decrease the damage to follicles, called transection, inherent in manual techniques.

Read more about Robotic FUE hair transplantation.

Posted by Robert M. Bernstein M.D.
Bernstein Medical In The News

Dr. Bernstein Discusses Robotic FUE In American Health & Beauty Article

Dr. Bernstein is quoted extensively in an article on robotic hair transplantation in the online magazine American Health & Beauty.

ARTAS Robotic FUE Imaging System
ARTAS Robotic FUE Imaging System
Click for larger version

In “ARTAS: A Faster and More Accurate Hair Transplant Using Robotics?” Dr. Bernstein explains the benefits of robotic FUE over traditional FUE hair transplant procedures. He describes how the new robotic device overcomes some important limitations of FUE when performed manually. To better understand the role of the new instrument, Dr. Bernstein simplifies the FUE procedure into four basic steps and discusses where the image-guided robotic system fits into this process.

Dr. Bernstein explains how the new technology enables the robotic device to preserve follicular units and minimize damage to grafts though its image-guided system.

“ARTAS allows us to do the FUE procedure with much less damage to the graft which means much healthier grafts. Grafted follicles extracted by ARTAS are not cut, which has been a problem with FUE, but the grafted follicular units are actually chunkier with more protective tissue around them, resulting in a better graft survival with the robotic FUE vs. doing FUE manually,” says Dr. Bernstein.

Follicular Unit Grafts Removed by ARTAS Robotic System

Follicular Unit Grafts Removed by
ARTAS Robotic System
Click for larger version

In addition to extracting grafts that have a higher chance of surviving the extraction and transplantation process, the article discusses the increased speed and accuracy of the automated procedure, as well as the safety mechanisms built into the robotic unit.

Always with an eye towards the future of hair transplantation, Dr. Bernstein predicts what he sees as an inevitable rise in the use of robotics in the field:

“I imagine that within a relatively short time, everybody will be offering the robot-assisted device when considering FUE procedures, because it’s just a better way of doing it: more accurate, quicker extraction and healthier grafts.”

The ARTAS System, developed by the California-based Restoration Robotics, Inc., will be available for FUE hair transplant procedures at Bernstein Medical – Center for Hair Restoration in November 2011.

Read the full version of the article.

You can read much more about the ARTAS System for FUE or Robotic FUE hair transplantation.

Posted by Robert M. Bernstein M.D.
Bernstein Medical In The News

Hair Transplant Pioneer To Use Robotic ARTAS System For FUE Hair Transplantation

Press Release

Dr. Robert M. Bernstein – pioneer of the follicular unit transplantation (FUT) and follicular unit extraction (FUE) hair transplant procedures – will become the first hair restoration physician on the East Coast to employ the robotic ARTAS™ System for FUE hair transplantation.

New York, NY — Robert M. Bernstein, M.D., F.A.A.D., world-renowned pioneer of the Follicular Unit Transplantation (FUT) and Follicular Unit Extraction (FUE) hair transplant techniques and founder of Bernstein Medical – Center for Hair Restoration, will become the first hair transplant surgeon on the East Coast to use the robotic ARTAS System for Hair Restoration. Procedures using the computer-driven, automated system will begin in November 2011 in his state-of-the-art New York City facility.

ARTAS Robotic System for FUE at Bernstein Medical
ARTAS Robotic System for FUE
at Bernstein Medical

Dr. Bernstein, a Clinical Professor of Dermatology at Columbia University in New York, said that he is excited to incorporate the image-guided robotic system into his FUE procedures. “The ARTAS System is a ground-breaking technology for hair transplantation that will provide significant benefits to our patients,” said Dr. Bernstein. “From the accuracy of follicular unit graft extraction to the automation of what is normally a labor and skill intensive procedure, the outcome is better hair restoration results and faster, more comfortable procedures.”

The ARTAS System for Hair Restoration, developed by Restoration Robotics, Inc., overcomes some of the human limitations in performing FUE hair transplant procedures. Greater accuracy in extracting follicular unit grafts, combined with the sharp/blunt extraction technique, allows for graft removal with less damage to the graft and greater preservation of its protective tissues. A lower rate of damage increases the probability that the grafts will survive the transplant process, leading to better hair restoration results. The automation of what is a technically challenging and physically demanding process for the physician when performed manually, contributes to a shorter procedure and a decreased need for local anesthetic.

By utilizing the latest and most effective advancements in hair transplantation technology, Dr. Bernstein, a New York native, is extending his record as a true pioneer in the field of hair restoration. His landmark medical publications on follicular unit transplantation and follicular unit extraction revolutionized the field and provide the foundation for techniques in use by hair transplant surgeons across five continents. His medical practice has been devoted exclusively to the treatment of hair loss since 1995 and he now performs both restorative and corrective hair transplant procedures at his state-of-the-art hair restoration facility in mid-town Manhattan.

Dr. Bernstein has appeared on a wide variety of notable media programs and publications. Some of these include: The Oprah Winfrey Show, The Dr. Oz Show, The Today Show, Good Morning America, ABC News, CBS News, Fox News, National Public Radio, New York Times, Men’s Health Magazine, GQ Magazine, Univision, Telemundo, “O” the Oprah Magazine, and more. He is co-author of Hair Loss & Replacement for Dummies and The Patient’s Guide to Hair Restoration. He has been selected as one of NY Magazine’s “Best Doctors in New York” for 12 consecutive years.

Posted by Robert M. Bernstein M.D.
Bernstein Medical In The News

Article Details Benefits of ARTAS Robotic System for FUE Hair Transplant Surgery

Robotics in FUE hair transplant surgery is a topic that is attracting increasing attention in the world of hair restoration. As we have discussed, the ARTAS robotic system for hair restoration is the newest technology in this ever-evolving field.

Before & 9 Months After FUE with ARTAS Robotic System
Before & 9 Months After FUE with ARTAS Robotic System
Click image for larger version

This new system, developed by Restoration Robotics, Inc., is more than just a new tool for performing Follicular Unit Extraction. Rather, it is a complex system that uses the latest in mechanical and software technology to automate FUE surgery. The robot not only allows doctors to perform this typically labor and skill intensive procedure, but it provides a variety of benefits to their patients. Among these benefits are increased accuracy in follicular unit graft harvesting, reduced harvesting time, and increased graft survival.

An article in the September/October 2011 issue of the journal Aesthetic Trends & Technologies adds detail to our knowledge of the benefits of the ARTAS System. The article, titled, “How Technology is Changing the Hair Restoration Industry,” first gives a basic overview of the system and why it was developed. It then goes on to describe how a specially-designed device, called a skin tensioner, along with an image-guided system, tracks each follicular unit on the patient’s scalp and allows for the precise control of graft extraction.

From the article:

The technology determines the location, angle, and direction of each individual hair follicle; and via complex algorithms and computer programming, it is able to determine almost instantaneously the proper approach to harvest each follicular unit. The image-guided robotic arm begins harvesting the hair follicles in random patterns, according to the harvest spacing set by the physician. These random patterns make the procedure virtually undetectable after the wounds have healed.

The accuracy and performance of the image-guided robotic system is notable and contributes significantly to the improved outcome of the FUE procedure. As Miguel Canales, M.D., Medical Director for Restoration Robotics, says in the article, the transection rate, or rate at which follicular units are damaged in the extraction process, is consistently less with robotic controlled FUE compared to that performed manually.

This kind of consistency yields a benefit not only to seasoned hair restoration surgeons, but to physicians of all skill levels. James Harris, M.D., a hair restoration physician based in Colorado, says that a novice physician, who might only be able extract 50-70 grafts in one hour using the traditional manual technique, extract 600-700 an hour. For a procedure of 1,500 grafts, the physical demand on both the physician and the patient is substantially reduced with the ARTAS System versus the standard manual graft excision techniques in FUE surgery.

Before & 7 Days After FUE with ARTAS Robotic System
Before & 7 Days After FUE with ARTAS Robotic System
Click image for larger version

The developers of the ARTAS System were also conscientious of the safety of the FUE patient. An array of sensors monitors patient movement and causes the system to respond to the force of the punch used in graft excision or to any instances where the system’s casing touches the patient. If the force exerted is too strong, or if the casing touches the patient, the system automatically backs away from the patient, allowing the physician to make sure that all is well before the surgery proceeds. According to the article, there were no safety-related “adverse events” in trials with over 350 patients.

From the efficiency of the ARTAS System in extracting follicular unit grafts, to the quality of the grafts, to patient safety, the benefits are many for the physician. The patient will receive a high quality hair transplant with a less intensive time commitment, less local anesthesia needed to numb the area, improved hair growth rates, and a better overall FUE hair transplant experience.

Download and read the article here (pdf).

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

What is the Difference Between NeoGraft and ARTAS Robotic System for FUE Hair Transplant Surgery?

Q: What is the main difference between NeoGraft and the ARTAS™ robotic system? — H.T., Staten Island, NY

A: The Neograft device is basically a powered FUE tool. It is still done by hand and therefore risks operator induced errors and damage to hair follicles. The ARTAS System, made by Restoration Robotics, uses electronic image-based tracking capabilities to map the individual follicular units. It does so to determine the optimal approach for automated graft harvesting. The robotic harvesting device produces consistently high quality grafts and low dissection rates.

For more information on these systems, visit the Follicular Unit Extraction (FUE) section or read Dr. Bernstein’s answers to questions on Robotics.

Read about Robotic FUE Hair Transplantation

Posted by Robert M. Bernstein M.D.
Bernstein Medical In The News

Restoration Robotics Receives FDA Approval for FUE Hair Transplantation

Restoration Robotics, Inc. — based in Mountain View, CA — has developed a robotic system for follicular unit extraction (FUE), called the ARTAS™ robotic system for hair restoration. The computerized device has received 510(k) approval from the Food and Drug Administration. Restoration Robotics is due to begin marketing the system for use in hair restoration clinics in the United States.

The FDA classifies the ARTAS robotic system for hair restoration as a “computer assisted hair harvesting system” and describes it as being used to identify and extract follicular units to aid the surgeon during hair transplant procedures.

The 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.

At present, the device is used only for the graft harvesting aspect of the follicular unit transplant procedure.

Bernstein Medical – Center for Hair Restoration has been using the ARTAS robot for FUE since December 2011.

The following is an excerpt of a press release about the ARTAS™ System by the developer of the device, Restoration Robotics, Inc.

ARTAS System Receives FDA Clearance for Ground-Breaking Technology Treating Hair Loss

Restoration Robotics, Inc., a medical device company that pioneered the first robotic follicular unit harvesting system, today announced that it has received FDA 510K clearance for its revolutionary ARTAS System


ARTAS System for FUE Hair Transplantation

Mountain View, CA – April 14, 2011 – Restoration Robotics, Inc. a privately-held medical device company, today announced that its revolutionary technology, the ARTAS™ System, has received 510K clearance from the Food & Drug Administration (FDA) for harvesting hair follicles from the scalp in men diagnosed with androgenetic alopecia (male pattern hair loss) with black or brown straight hair. The ARTAS™ System was developed in close collaboration with several leading hair restoration physicians to enhance the quality of follicular unit harvesting for the benefit of physicians and their patients.

“We are thrilled to receive FDA clearance, and look forward to rolling out the ARTAS™ System to leading hair restoration physicians,” said Jim McCollum, Chief Executive Officer, Restoration Robotics. “Hair loss is a very real issue for millions of men in the United States. We’re pleased to offer a powerful new technology for patients who are interested in a safe new way to enhance their quality of life.”

ARTAS™ is a physician-controlled, state-of-the-art, interactive, computer-assisted system that enables harvesting of hair follicles during hair restoration procedures. It combines several features including an image-guided robotic arm, special imaging technologies, small dermal punches, and a computer interface. The ARTAS™ System is capable of identifying and harvesting individual follicular units to implement the follicular unit extraction (FUE) technique.

Read more about developments in Robotic FUE

Posted by Robert M. Bernstein M.D.
Bernstein Medical In The News

Hair Transplant Pioneer Dr. Robert M. Bernstein in New York Magazine “Best Doctors” for 12th Consecutive Year

Dr. Robert M. Bernstein, pioneer of the follicular unit transplantation and follicular unit extraction hair transplant procedures, was selected as one of New York metropolitan area’s top physicians.

NY Magazine - Best Doctors - 2011

New York, NY — Robert M. Bernstein, M.D., F.A.A.D., world-renowned pioneer of the Follicular Unit Transplantation and Follicular Unit Extraction hair transplant techniques and founder of Bernstein Medical – Center for Hair Restoration, was included in New York Magazine’s Best Doctors issue for the twelfth consecutive year.

Dr. Bernstein, a Clinical Professor of Dermatology at Columbia University in New York, said that he is honored to be recognized again for the Best Doctors issue. He said, “My inclusion in the Best Doctors issue for the twelfth year in a row is a testament to the hard work and dedication of my staff, our consistently high quality of care, and our passion for treating patients who are struggling with hair loss.”

The New York Magazine Best Doctors issue is an annual compilation of physicians that is based on a peer-review survey conducted by Castle Connolly Medical Ltd., a research company that publishes Top Doctors: New York Metro Area. Each year, medical professionals in the New York metropolitan area nominate their choice of the best doctors in a field. The physicians make their recommendations based on several criteria including: professional qualifications, reputation, skill in diagnosis, and skill in providing treatment for patients.

Dr. Bernstein, a New York native, is a true innovator in the field of hair restoration. His medical publications on follicular unit transplantation (FUT) and follicular unit extraction (FUE) have revolutionized hair transplantation and provide the foundation for techniques in use by hair transplant surgeons across five continents. His medical practice has been solely devoted to the treatment of hair loss since 1995 and he has provided hair loss treatments and hair restoration surgery at his state-of-the-art hair restoration facility in New York City since 2005. The Bernstein Medical – Center for Hair Restoration, located in midtown Manhattan, is dedicated to the diagnosis and treatment of hair loss in men and women and specializes in both restorative and corrective hair transplants.

Dr. Bernstein has appeared on a wide variety of notable media programs and publications. Some of these include: The Oprah Winfrey Show, The Dr. Oz Show, The Today Show, Good Morning America, ABC News, CBS News, Fox News, National Public Radio, New York Times, Men’s Health Magazine, GQ Magazine, Univision, Telemundo, “O” the Oprah Magazine, and more. He is co-author of Hair Loss & Replacement for Dummies and The Patient’s Guide to Hair Restoration.

Posted by Robert M. Bernstein M.D.



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