Bernstein Medical Center for Hair Restoration - Graft Survival During Hair Transplant

Graft Survival During Hair Transplant

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Dr. Bernstein closed the 2017 ARTAS Users Meeting with a discussion of five advanced techniques in robotic hair transplant procedures that he developed at Bernstein Medical. His presentation covered the benefits of pre-making recipient sites, long-hair FUE, tensioner placement, feathering edges in harvesting, and robotic graft selection. The “Hair Restoration Pearls” presentation included case studies, photographs, and videos demonstrating the techniques to the audience of hair restoration physicians. The two-day affair; which was held in Coronado, California; was a huge success, with over 260 attendees from around the world representing 204 robotic hair restoration practices.

Pre-Making Recipient Sites
There are several advantages of pre-making recipient sites in Robotic FUE procedures. One of the most important is that grafts are out of the body for a shorter period, which increases graft survival. During placement, there is less bleeding and greater graft stickiness, which result in increased visibility for the physician, less graft popping, and up to a 30% decrease in placing time. By pre-making sites, the physician can determine the exact number of grafts needed in the hair transplant. Also, the healing process can begin in the recipient area in advance of placing. This creates a fertile bed of oxygenated tissue with factors that promote healing and the subsequent growth of the follicular unit grafts.

Long-Hair Robotic FUE

In Long-Hair Robotic FUE, the patient has their hair temporarily lifted with tape during the hair transplant surgery. The physician then harvests from the donor area in a linear configuration so that, after the procedure, the long hair is let down covering the harvested area. The long-hair technique can be applied using one harvesting row (which yields up to 1,600 grafts), a double-row (2,000 grafts), or two separate rows (2,400). Long-Hair Robotic FUE, using the ARTAS Robotic Hair Transplant System, allows the donor area to be camouflaged immediately after surgery and does not limit a patient’s ability return to work. It also makes robotic hair transplants more practical for women, who usually prefer not to shave their donor area.

Tensioner Placement

Dr. Bernstein discussed a new two-handed technique for applying the robotic tensioner to the patient’s scalp. The tensioner applies traction to the scalp, stabilizes the skin, limits bleeding, and provides a system of fiducials that the ARTAS robot “reads” for proper orientation. Dr. Bernstein showed a video in which he demonstrates the technique and discusses the importance of applying the silicon straps as vertically as possible to ensure the greatest tension and stability. The two-hand technique allows for reduced stress on the physician’s hands, better control, and more accurate placement of the tensioner. It also facilitates easier edge engagement to create tension on the skin in preparation for harvesting.

Feathering Edges
Feathering is a common technique to avoiding a squared-off, geometric look after the FUE procedure. It allows the patient to maintain a natural look while wearing their hair short after the procedure. Dr. Bernstein presented two different ways to feather using existing capabilities of the ARTAS system. Dr. Bernstein showed how the physician can both round the edges of the harvest area and decrease the density on the outer edges, with simple, reproducible techniques. Most importantly, he discussed the situations in which feathering is important and the ones in which it should not be used.

Robotic Follicular Unit Graft Selection

Robotic graft selection is an advance over the harvesting technique used in earlier iterations of the ARTAS robot. The robot previously harvested grafts at random. By creating a software algorithm designed to skip over one-hair units and select only the larger follicular units, the harvesting process improved in efficiency. According to Dr. Bernstein’s study, the clinical benefit is 11.4% more hairs per graft and 17% more hairs per harvest attempt using this technique. Larger follicular unit grafts can be dissected into one-hair units for use in the frontal hairline and other cosmetically important areas in order to create the most natural aesthetic outcome in the hair transplant while minimizing the number of recipient wounds.

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Q: Does minoxidil play any role in the survival of the grafts after a Neograft/FUE procedure? — J.W., Philadelphia, PA

A: When a doctor performs a hair transplant, the hair should be taken from the permanent zone so, by definition, that hair is not affected by medication (i.e. does not need to be maintained by either minoxidil or finasteride). If the doctors using Neograft are suggesting that minoxidil increases survival, then they are probably harvesting hair outside the permanent zone. To clarify, I use the ARTAS robotic system for our FUE procedures, not Neograft, as the former is a far more accurate device for harvesting.

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Recipient Site Creation at Bernstein MedicalDr. Bernstein creating recipient sites using the ARTAS robot

Hair transplant pioneer Dr. Robert M. Bernstein and his colleague Dr. William R. Rassman have received a patent on a new method that improves the outcome of Follicular Unit Extraction (FUE) — the type of procedure used in half of all hair transplants performed world-wide. The key invention is the addition of a delay between the creation of recipient sites and the insertion of follicular units into those sites. The delay allows the healing process to commence before grafts are inserted, resulting in increased success of the transplant and an improved outcome.

Dr. Bernstein introduced the concept of “pre-making recipient sites” into medical literature in a 2012 publication in Hair Transplant Forum International, has discussed the idea extensively, and presented findings at the 2015 ISHRS Annual Scientific Meeting. However, this is the first time he has patented a hair restoration technique.

The first 24 hours after any wound to the skin is a critical period of time in the healing process. Dr. Bernstein describes this initial period in his 2012 publication:

During the first 24 hours following recipient wound creation, a flurry of biologic activities take place that facilitate healing. These include: the migration of platelets with subsequent release of cytokines, growth factors and pro-inflammatory proteins (histamine, serotonin, kinins, prostaglandins, etc.) that increase blood vessel permeability and stimulate cell migration. Allowing these processes to begin before implantation of the grafts should be beneficial to their healing and subsequent growth. ((Bernstein RM, Rassman WR. Pre-making recipient sites to increase graft survival in manual and robotic FUE procedures. Hair Transplant Forum Intl. 2012; 22(4): 128-130.))

By making recipient sites in advance of harvesting the grafts, three important things are achieved by the surgeon:

  1. The time in which follicular unit grafts are outside the body is decreased
  2. The placement of grafts is facilitated, making it less likely that they are injured in the insertion process
  3. The early phases of the healing process (e.g., blood clot formation, creation of new blood vessels) naturally complete, resulting in a more stable, “fertile” site supplied with oxygen and nutrients essential for graft survival.

Dr. Bernstein proposed “pre-making” recipient sites in 2012 as a way to improve the Follicular Unit Extraction (FUE) procedure, and robotic-assisted FUE (Robotic FUE) in particular. This is due to the fact that the positioning of the patient makes it problematic to create recipient sites and place grafts while follicular units are being extracted from the donor area. This is not the case in Follicular Unit Transplant (FUT) procedures, in which a donor strip is removed from the patient then dissected on a dissecting table. In FUT, recipient sites can be created and grafts can be placed concurrently with the dissection process.

“Pre-making” recipient sites is a protocol that should be followed during all FUE hair transplant procedures. It is also applicable in hair multiplication and hair regeneration techniques that are being studied as a way to provide an unlimited amount of donor hair for hair restoration purposes.

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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).

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Dr. Bernstein Leads Robotic FUE 'Coffee With Experts' At ISHRS 20th Annual Meeting

Dr. Bernstein heads discussion on Robotic FUE at the 20th annual meeting of the International Society of Hair Restoration Surgery (ISHRS) which took place October 17-20, 2012.

Dr. Bernstein led a roundtable discussion in the ‘Coffee with the Experts’ session on robotic follicular unit extraction. See above photo of the session (click on it to view a larger version). Some of the topics he covered were; the proper indications for FUE, the advantages of Robotic FUE over other methods, how doctors can best implement robotic hair transplants in their practices and recent advances in robotic technology. He was also a panelist at the Finasteride Symposium and gave a presentation on protocol in prescribing Finasteride to hair restoration patients.

Program biography on Dr. Bernstein

Robert M. Bernstein, M.D., F.A.A.D., A.B.H.R.S., Clinical Professor of Dermatology, Columbia University, is an early adopter of the ARTAS System for Robotic-FUE. Bernstein Medical, PC, serves as a beta-site to study new product features and enhancements. Dr. Bernstein’s contributions and expertise have materialized in making the ARTAS System more user friendly, improving the harvesting technique and making the ARTAS procedure more compelling for patients at this early stage of commercialization of the product. Pre-Making Recipient Sites to Increase Graft Survival in Manual and Robotic FUE Procedures, has been submitted for publication.

Dr. Bernstein’s comments on roundtable discussion

One of the most important new advances in hair transplantation is Robotic Follicular Unit Extraction (R-FUE). I have been using the new ARTAS Robot, manufactured by Restoration Robotics, for almost a year now. It has made FUE a more exacting and reliable procedure. The “Coffee with the Experts” session that I gave on the topic of Robotic FUE at the ISHRS was standing room only, attesting to the great interest that members of our society have in this new technology.

The theoretical advantage of using a robot to minimize human error in a very repetitive procedure was acknowledged by most members of the discussion group. The ARTAS system has the advantage of using a combination of sharp punch and blunt dissection, a model that was based on Dr. Jim Harris’ SAFE System and one that we have found to work best with the hand-held devices. It also allows us to remove grafts with forceps, rather than by suction. This feature is important since strong suction used to remove the grafts can be more damaging than mechanical removal with forceps.

Its dissection technique uses two punches which are concentrically arranged – a small diameter, sharp bi-beveled punch is nested within an outer, dull punch. The inner punch has a cutting end to score the upper most part of the skin and the outer punch has a blunt edge that dissects the follicular units from the surrounding tissue. We have also found that grafts harvested with Robotic FUE showed less transection compared to other devices that we have used and contained more of the surrounding protective tissue, so it is assumed that this will lead to improved graft survival, but this has not yet been proven.

We find that the robot is more versatile in its ability to harvest grafts from patients with different hair characteristics and from different parts of the scalp. Although there is still variability in the ease of extraction among patients of different racial backgrounds, in our experience, the differences are less when compared to a hand-held system. Also, with the robotic system it seems easier to extract grafts from the sides of the scalp where the hair lies flatter on the skin.

In our practice, we are now able to comfortably extract 2,000 grafts in one day and over 2,500 grafts in two consecutive days. Some of the doctors at the discussion claimed to be able to consistently extract far greater numbers in a single session using manual methods, but it is hard to compare speed without comparing graft quality and transection rates.

One of the exciting things about the new device is that it is continuously evolving. As a beta-site studying new enhancements and features, we have seen all the nuanced changes that continually improve the technique. The initial version of the robot required many intra-operative adjustments to depth, angulation, and the speed of punch rotation, so there were a number of adjustments to monitor. The current system needs far less human intervention than with earlier versions and is simpler to operate, but significant experience is still needed to get the best results. Of course, all the other issues of a hair transplant including; planning, design, site creation, atraumatic graft insertion, etc. persist.

One of my special interests had been to offer patients Robotic FUE with a smaller punch size. We have been working with a 0.9mm punch (the standard is 1.0mm) and have found that this shortens healing time, decreases donor scarring and increases the number of follicular units that can safely be harvested in a specific area. It also creates grafts that require less trimming. On the other side of the coin, some patients, especially African-Americans have less transection with the larger punch, so it is important to be able to customize the technique to the particular person.

Another important modification of the technique that we have implemented since the introduction of the ARTAS system, but that is also applicable to FUE in general, is pre-making recipient sites. This is done either prior to extraction in a one-day procedure or at the beginning of the first day in a two-day procedure. With this change, as soon as the grafts are harvested, they can be placed immediately into the recipient scalp. Not only does this minimize the time that grafts are outside the body, but; by allowing the healing process to begin in the recipient area; it minimizes popping, increases visibility when placing (due to less bleeding), and may create a better environment in which the newly transplanted grafts can grow.

Some of the concerns that doctors had were the relatively high start-up cost in purchasing the robot, the amount of set-up time at the beginning of each procedure and the need, at present, to use two ORs – one for robotic harvesting and one for placing. At present, the patient can only lie on the robotic device face-down. While this position is necessary for the robotic arm to have full access to the donor area, it does not allow easy access to the front or top of the scalp. As a result, graft placement must be performed using a separate operating chair, necessitating the use of two operating rooms for one patient. It is anticipated that within a year, the robotic operating table will be re-designed so that harvesting and placing can be performed in the same room.

Besides some set-up time, one of the things that slows down the robotic process is the tensioner mechanism used to stretch the scalp. Although this feature has the advantage of decreasing damage to follicles, it must be moved every 100 to 150 grafts. With a larger and easier to use tensioner already designed, the delay from its re-positioning should be significantly decreased.

Another concern expressed was that the robot harvests grafts in a somewhat geometric pattern. With experience, one is able to overlap grids and feather the edges so that this appearance, even if temporary, is minimized. New software is planned which can do this automatically.

At the time of the meeting, there were twelve centers in the United States offering Robotic FUE with additional practices in the queue. There was also a strong interest in Robotic FUE among physicians outside the US, particularly in South Korea, Taiwan and Japan.

Read about the latest in Robotic FUE

Read about how Dr. Bernstein has improved Robotic FUE procedures

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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).

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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).

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Q I had a hair transplant 15 months ago at a well known clinic in Manhattan. There were about 1000 grafts transplanted in the front hair line. At this point I am upset with my results. My guess is that only about 50 new hairs have grown. My question is what would cause this to happen? It seems to me that the hair transplant took longer than expected and my grafts died before they were placed! Please help! — B.E., Ithaca, N.Y.

A There are many factors that can contribute to poor growth during the hair restoration process including grafts that are left out of the holding solution too long or kept under the microscope for a prolonged period of time where they dry out.

Grafts can be injured in the dissection process or can be traumatized during the placing – if they are grasped too tightly or manipulated too much.

If properly hydrated, grafts can survive outside the body for many hours, so this in itself is generally not a problem.

There is no way to really tell what the exact problem(s) may be without watching the entire hair restoration procedure, since so many steps are involved that can affect the survival of the grafts. All of these steps must be carefully controlled to insure optimal growth.

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