Robotic Hair Transplants & Hair Restoration
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Bernstein Medical - Center for Hair Restoration
Hair Restoration Answers

How Does Robotic FUE Differ from Other Hair Transplant Procedures?

Q: What is the main difference between hair transplants using the robot versus other procedures? — M.P., Flatiron, NY

A: There are two basic types of hair transplant procedures, Follicular Unit Transplantation (FUT or strip surgery) and Follicular Unit Extraction (FUE). In FUT, donor hair is harvested by removing a long thin strip from the back of the scalp. Individual follicular units are then obtained from this strip using stereo-microscopic dissection. In FUE, individual follicular units are harvested directly from the donor area using a sharp, round cutting instrument. The ARTAS Robotic System performs the follicular unit isolation step of an FUE procedure and can also create recipient sites according to specifications determined by the hair restoration surgeon. In performing each of these steps, the robot uses its image-guided technology to locate the next target and position the cutting instrument, and it does so with precision and speed that cannot be accomplished using manual FUE techniques or instruments.

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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.

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Bernstein Medical In The News

Dr. Bernstein Presents Advances in Robotic Hair Transplants at ISHRS 2014

ISHRS 2014 - 22nd Annual Scientific Meeting - Kuala Lumpur, Malaysia

Dr. Robert M. Bernstein presented the ARTAS Hair Studio™ digital hair transplant design software and robotic recipient site creation using the ARTAS® Robotic Hair Transplant system, each advances in key aspects of hair transplantation, at the International Society of Hair Restoration Surgeons (ISHRS) annual meeting in Kuala Lumpur, Malaysia on Saturday, October 11th, 2014.

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Hair Restoration Answers

Is it Possible To Have a Robotic FUE Hair Transplant on the Crown Area with African Hair at 26 Years of Age?

Q: I am 26 years old and have been suffering from hair loss for 8 years. I have been on Propecia (finasteride) and Rogaine (minoxidil) during those years. Unfortunately my hair loss has continued to progress aggressively. I am of half African and Caucasian descent, and my hair is curly. I understand that there are certain limitations on having hair transplants before you are 35, however I do not mind having another transplant in a few years, if necessary. — A.L., Rye, N.Y.

A: Although it is possible to have a hair transplant to the crown using robotic FUE in African American patients, given your young age and that you state your hair loss is progressing aggressively while on Propecia and Minoxidil, it is likely not a good decision to have surgery at this time.

The reason is that as your hair loss surrounding the crown expands over time, it may look unnatural to have hair transplanted solely to the crown region.

At your age, it is best to take Propecia (finasteride) and Rogaine (minoxidil), and if a transplant is indicated, to start at your frontal hairline and top of your scalp, the areas that will be most important cosmetically long-term.

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Bernstein Medical In The News

Robotic Hair Transplants: Biggest Breakthrough in Surgical Hair Restoration

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

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

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Hair Restoration Answers

How Does the ARTAS Robot’s Image-Guided System Work?

Q: I have read a bit about the ARTAS robot and how it uses an “image-guided” system, but what does that mean? And how is the robot’s imaging system different than a human surgeon viewing the grafts with the naked eye? — S.V., Middle Village, N.Y.

A: That is a great question and it gets to one of the key benefits of the robotic hair transplant system: its accuracy. When a surgeon is performing FUE using manual techniques, they must wear a headset that magnifies the scalp so they can see the follicular units more clearly than with the naked eye. The surgeon must visually and mentally process subtle nuances of the skin and follicular units for every one of the hundreds or thousands of units that are extracted. The ARTAS robot magnifies the surface of the skin in much the same way, but to a much greater extent. In addition, it is not subject to the limitations of the human eye, or human hand, and it is not subject to human error. The surgeon may not have exact hand-eye coordination. The surgeon may be concentrating on one aspect of the extraction, say following the angle of the hair, but might ignore another important aspect of the follicle, say its depth in the skin or its orientation. And, of course, the surgeon tires, both physically and mentally, from performing the hundreds or thousands of repetitive motions.

The robot’s image-guided system, on the other hand, does not experience these limitations. The robot magnifies the skin, detects each follicular unit and the nuances of the skin/hair characteristics, and then extracts that follicular unit with precision. When the imaging system detects changes to the skin, this new information is fed into the computer in real-time and the system adjusts automatically based on this feedback as it continues to harvest grafts. There is no distracting the robot, and the robot will not forget, or ignore, key variables in the extraction. The robot can extract thousands of follicular units without tiring from repetition or slowing down the extraction.

Based on my own practical experience using the robot, it is clear that the robot’s ability to estimate the position of the follicles under the skin and to extract it with precision is superior to manual techniques. Having used the ARTAS system for over three years, and having helped make improvements to the device since the first iteration, I have seen robotic technology substantially improve the outcome for my patients.

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Hair Restoration Answers

Why does the ARTAS® Robotic System only do FUE, Not FUT?

Q: Why does the ARTAS® Robotic System only do FUE, not FUT? — V.Z., Chicago, Illinois

A: Currently the robot is only used for harvesting grafts from the donor area. In FUE, the doctor punches out hundreds to thousands of individual follicular units from the back and sides of the scalp by hand using a small round instrument called a punch.The punch has to be held at exactly the right angle, with just the right pressure applied, stopped at a precise depth and, during this time, rotated (or spun mechanically) without changing the alignment.

As one can imagine, this exhaustingly tedious process can best be done using the precision of a robotic device.

In FUT, the harvesting is done by a surgeon using a scalpel to make a long incision in the back of the scalp. It only takes a few minutes. The harvested strip is removed and then placed under dissecting microscopes where the individual follicular units are isolated. This dissection, thus far, can only be done by hand. There is no robotic technology available to do this.

Harvesting the donor hair, of course, is only one part of a hair transplant. The other steps, recipient site creation (making the holes that the grafts are placed into) and actually placing the grafts into those sites are similar in both FUE and FUT.

It is anticipated that robotic site creation will be available in the fall of 2014 and robotic graft placement, the third and final step, about two years after that. At that time, the robot will be able to perform the entire FUE procedure and the last two parts of the FUT procedure.

Of course, the robot doesn’t do the surgery alone. The physician must input all the information regarding the design and planning of the procedure and closely monitor each step of the robotic process. Unlike automating industrial production, the human scalp has great variability, so there is no one formula that will be appropriate for every patient. Physician skill and involvement is just as important in robotic hair transplantation as it is with every other type of surgical hair restoration procedure.

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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.

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