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Dr. Bernstein presenting at the ISHRS 26th Annual World CongressDr. Bernstein presenting at the ISHRS 26th Annual World Congress.

Robert M. Bernstein MD, FAAD and Christine M. Shaver MD, FAAD of Bernstein Medical attended the 26th World Congress of the International Society of Hair Restoration Surgeons (ISHRS). At the congress, Dr. Bernstein introduced the newest robotic technology in the field of hair transplantation, the ARTAS iX, to an audience of over 550 hair restoration physicians.

Dr. Bernstein Introduces the ARTAS iX

Dr. Bernstein explains that the ARTAS iX now automates the implantation step of a hair transplant procedure by utilizing totally new hardware and software algorithms. The newly designed operating chair provides more flexibility for the surgeon and more comfort for the patient. This ARTAS iX also improves the accuracy and efficiency of the robotic FUE procedure.
With implantation, three of the four aspects of a hair transplant (excision, site creation, implantation) have now been successfully automated. Only graft extraction is left as the remaining step.

How Implantation Works

While performing an FUE procedure with the ARTAS iX, harvested grafts are loaded — 25 at a time – into rectangular cartridges. These cartridges are then inserted into the arm of the robot that implants the grafts directly into the scalp. A major advantage of using cartridges, rather than the manual technique, is more delicate handling of the grafts with less risk of graft injury. When grafts are implanted manually, they are typically grasped by the bulb, or just below the sebaceous glands, and then brought into the incision risking considerable damage in the process. With ARTAS iX, grafts are held at the epidermal end and then gently placed into the cartridge. This technique eliminates unnecessary injury to the growth of the transplanted hair by avoiding the lower and mid-portions of the follicles.

With the use of the ARTAS iX, the physician digitally creates a recipient site plan that communicates directly with the robot. The doctor programs the specific size, distribution, density, direction, and angle of the sites for the follicular unit grafts. The ARTAS iX’s vision system identifies where the grafts are to be placed, using the fiducials on the scalp as guides, and leads the robotic arm into position. Once the system automatically orients itself over the patient’s recipient area, implantation begins. The ARTAS iX can implant up to 500 grafts per hour.

ARTAS Robotic Hair Transplants at Bernstein Medical

Bernstein Medical was one of the first hair restoration practices in the world to use the ARTAS robot for FUE, a procedure pioneered by Dr. Bernstein and his colleague Dr. William Rassman. Bernstein Medical is a beta-test site for the ARTAS robotic systems. In 2013, Bernstein Medical was named an ARTAS Clinical Center of Excellence. Bernstein Medical is the first practice to offer the ARTAS iX.

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First Master Class in Robotic Hair RestorationFirst Master Class in Robotic Hair Restoration

May 11th, 2018 – Robert M. Bernstein MD, a pioneer in modern hair transplantation, led five robotic hair restoration physicians in an intensive master class focusing on ARTAS robotic techniques, surgical planning and aesthetics. The day included a live ARTAS Robotic FUE procedure, a series of twelve presentations and a Q & A period. The ARTAS Hair Transplant System, developed by Restoration Robotics, is the only robotic system in the world designed to aid surgeons in hair restoration procedures.

Dr. Bernstein was chosen to teach the first ever Master Class on Robotic Hair Transplantation because of his innovative work in the field of hair restoration and his contributions in the development of the ARTAS Robotic System. Dr. Bernstein is a Clinical Professor of Dermatology at the College of Physicians and Surgeons of Columbia University and founder of Bernstein Medical – Center for Hair Restoration, a state-of-the-art hair transplant facility in NYC and a beta-test center for Restoration Robotics.

Topics covered by Dr. Bernstein in the Master Class included technical aspects of robotic surgery, challenges of donor and recipient planning, hairline design, and when best to use Follicular Unit Excision (FUE). In his live demonstration and hands-on training, Dr. Bernstein also covered the techniques of Follicular Unit Graft selection and Long Hair R-FUE.

Dr. Bernstein presenting at the ARTAS Master Class.Dr. Bernstein presenting at the ARTAS Master Class.

Dr. Bernstein published “Follicular Unit Transplantation” in 1995 which now serves as the groundwork for modern hair restoration. Follicular Unit Transplantation (FUT) is the technique where the donor hair is removed from the scalp in one long thin strip and dissected into individual follicular units. Dr. Bernstein pioneered Follicular Unit Excision (FUE) in 2002, with his colleague Dr. William Rassman. Follicular Unit Excision (FUE) is the process of using an instrument to make a small incision around the skin of a follicular unit to separate it from the existing tissue. In 2011, Dr. Bernstein worked with researchers from Restoration Robotics to improve the newly released ARTAS Robotic System. Bernstein Medical was one of the first facilities in the world to use the ARTAS Robot to perform FUE hair transplantation.

In the first-ever master class, Dr. Bernstein shared his deep knowledge of hair transplantation and his experience using the ARTAS Robot with fellow hair transplant surgeons who traveled across the country for this opportunity.

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Dr. Bernstein Presenting at ARTAS Users Meeting 2018 in Las Vegas, Nevada Dr. Bernstein Presenting at ARTAS Users Meeting 2018 in Las Vegas, NV

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

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

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

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

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

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

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

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

Long-Hair Robotic FUE

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

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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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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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Dr. Robert M. Bernstein were guest speakers in the ARTAS webcast series where they discussed “What’s New in Robotic FUE”. In this live webinar, conducted by Restoration Robotics, Dr. Bernstein spoke to over 100 fellow surgeons and their staff on advances in robotic hair transplantation and led a Q and A session about the ARTAS Robotic System following the presentation. The main topics of discussion were the four key areas of the Robotic FUE procedure that are improved by the ARTAS 9x; increased speed, accuracy, and functionality, and advances in the use of artificial intelligence.

To hear what Dr. Bernstein had to say, watch the archived video (registration required).

Increased Speed

The ARTAS 9x is 20% faster than the ARTAS 8x and has a dissection cycle of less than two seconds. This new upgrade also allows for graft dissection and extraction to be performed simultaneously, increasing the speed of the procedure. Prior versions of the ARTAS robot used a red LED light which was too harsh on the human eye. The ARTAS 9x has a white LED light that allows grafts to be removed from scalp at the same time that the robot proceeds with the excision of additional grafts. The newest version of the robot uses a yellow tensioner, rather than the previous white one, enabling the robotic optical system to identify the tensioner from a greater distance. This eliminates the two manual commands needed to put the arm into position and, thus, increases the speed of the procedure.

ARTAS 9x - White vs Red LED LightPrevious versions of the robot used a red LED light (left), ARTAS 9x uses a white light (right)

Increased Accuracy

The ARTAS 9x provides physicians the option of using smaller needles with the addition of a 0.8mm needle. The smaller needle reduces scarring and enables more precise graft extraction.

“Compared to other versions of the ARTAS Robot, there is a dramatically less need for the physician to make modifications to the ARTAS 9x system. It seemed like we were driving a stick shift car, where now much of it is automatic.”

– Dr. Bernstein

Increased Functionality

Physical improvements to the robot include a smaller robotic head, improved headrest, new harvesting halo, and a robotic arm extender. The new 9x has a smaller head that allows the robot to move around the patient to approach their scalp at a more acute angle. This allows the angle of site making to go down to 30 degrees and harvesting down to 35 degrees. The site making headrest of the 9x does not include the protruding edges found in the 8x. This gives clearance for the robot to have more site making options. The new harvesting halo also places less downward pressure on the patient’s head with tension being more lateral but just as effective in stabilizing the scalp for precise excision. The 9x has an extender that allows the arm to more easily reach around the sides of the patient’s head without having to reposition the patient.

Use of Artificial Intelligence

The use of artificial intelligence (AI) in the 9x Robot leads to greater consistency and speed. AI aspects found in the ARTAS 9x include automatic collision recovery, empty site warning, automatic scar detection and new ARTAS Hair Studio technology. The motion sensor is in the arm where it attaches to head and the screen shows the physician what is happening in real-time so the position of the robotic can be adjusted easily.

Dr. Bernstein said:

“The ARTAS 8x required 6 steps to accomplish this; the 9x has a one-touch system with one button that retracts the head back to the neutral position.”

ARTAS 9x - Improved Scar DetectionARTAS 9x detects and blocks harvesting from areas with scarring

The ARTAS has a new empty site warning capability that signals the physician to make adjustments when the harvesting is sub-optimal. The ARTAS 9x also has an automatic scar detection function that allows the robot to detect areas with low or no hair density so that these areas can be automatically blocked from further harvesting. This feature is particularly useful in cases where there is significant scarring from prior surgery. There have also been advances made to the ARTAS Hair Studio. In 9x, only one photo is needed to create a 3D image of the patient’s scalp as opposed to the prior iterations that required up to five.

It is important to keep in mind that these improvements work together to increase the overall speed, accuracy and efficiency of Robotic FUE procedures.

Bernstein Medical and the ARTAS Robot

In 2011, Bernstein Medical became one of the first practices in the world to use the computer-driven technology of the ARTAS Robotic System in FUE hair transplant procedures. They have played an important role in the development of the technology ever since. Bernstein Medical is a beta-testing site for new enhancements and features to the ARTAS robot and Dr. Bernstein is on the Medical Advisory Board to Restoration Robotics, the company that makes the ARTAS robot.

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Dr. Bernstein Presenting at ISHRS 2017Dr. Bernstein speaking at the ISHRS in Prague, Czech Republic

Dr. Bernstein gave a presentation on “What’s New in Robotic FUE” at the 25th Annual Conference of the International Society of Hair Restoration (ISHRS) on Friday, October 6, 2017, in Prague, Czech Republic. He discussed the exciting new capabilities of the most recent upgrade to the ARTAS Robotic System, ARTAS 9x. The upgrades increase the speed and accuracy of the procedure while utilizing artificial intelligence to fine-tune the movements of the robotic arm.

Increased Speed

ARTAS 9x is 20% faster than the prior version, with each dissection cycle lasting less than 2 seconds. The robot can now harvest up to 1,300 grafts per hour. ARTAS 9x makes robotic hair transplants faster by enabling graft dissection and extraction to be performed simultaneously. Prior versions of the robot’s optical system used a red LED light. However, this proved to be too harsh for the human eye. ARTAS 9x solves this issue by using a white LED light, allowing grafts to be extracted while the robot dissects grafts in the scalp. Also, ARTAS 9x uses a yellow tensioner, rather than a white one, eliminating the need for two manual commands and increasing the speed of the procedure.

Increased Accuracy

ARTAS 9x has increased the accuracy of the procedure by allowing the option of smaller needles (0.8mm in addition to 0.9mm and 1.0mm). The 0.8mm needle minimizes distortion of the skin during harvesting and this improves the accuracy of the graft extraction process.

Artificial Intelligence

The ARTAS 9x uses artificial intelligence to maximize consistency in Robotic FUE procedures. It uses real-time information on the positioning of the robot and the patient to direct the robotic arm to automatically retract — but not shut down — if it detects a potential positioning issue. This increases efficiency and decreases the length of the procedure.

Artificial intelligence is also used to determine if there are any empty recipient sites on the scalp during harvesting, meaning that a graft was missed. The robot alerts the physician to this information so he/she can then adjust the algorithm to increase the efficiency of the procedure.

The software system that runs ARTAS 9x can now detect scars or areas of the scalp with few or no hairs and skip over these areas during harvesting. This saves time by blocking harvesting in areas that might result in a harvested area appearing too thin.

Other Functionality Improvements

ISHRS 25th Annual Conference ProgramISHRS 25th Annual Conference Program

There are a number of other improvements to the robotic system incorporated into ARTAS 9x. These include a smaller robotic head, an improved site-making headrest, a new harvesting halo, a robotic arm extender, and more. These modifications increase the functionality of the ARTAS Robotic Hair Transplant System and aid the physician to deliver optimal outcomes for the patient.

ARTAS Robotic Hair Transplants at Bernstein Medical

Bernstein Medical was one of the first hair restoration practices in the world to use the ARTAS robot to perform FUE, a procedure pioneered by Dr. Bernstein and his colleague Dr. William Rassman. In 2013, Bernstein Medical was named an ARTAS Clinical Center of Excellence.

As a medical adviser to Restoration Robotics, Dr. Bernstein works to improve its hardware and software systems in collaboration with the robot’s engineers and developers. Bernstein Medical is a beta-test site for the ARTAS robot with numerous advances being developed and tested in our NYC hair transplant facility.

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Dr. Robert M. Bernstein, a Clinical Professor of Dermatology at Columbia University and one of the leading pioneers in modern hair transplant surgery, is recognized for his leadership in the field of hair restoration with inclusion in his 18th consecutive edition of New York Magazine’s ‘Best Doctors of New York.’

Best Doctors 2017 - New York Magazine

New York, NY — Robert M. Bernstein, MD, MBA, FAAD, FISHRS, has been recognized by his peers with inclusion in his eighteenth consecutive edition of New York Magazine’s annual ‘Best Doctors in New York’ issue. Dr. Bernstein, a Clinical Professor of Dermatology at Columbia University and founder of Bernstein Medical – Center for Hair Restoration, helped re-invent hair transplant surgery by pioneering the Follicular Unit Transplantation (FUT) procedure and by becoming an early proponent of robotic hair transplant surgery (Robotic FUE). He is the only hair restoration surgeon named to the prestigious “Best Doctors” list for so many consecutive years.

Dr. Bernstein said:

“New York has some of the finest doctors in the world, so to be considered among the best by my peers is quite an honor. It is equally satisfying when a patient tells us that we helped change their life.”

The ‘Best Doctors of New York‘ issue is an annual edition of New York Magazine that contains a more select version of the Top Doctors: New York Metro Area list published each year by Castle Connolly Medical, Ltd. New York Magazine’s list of 1,341 doctors represents about the top 2% of doctors in the region. In each list, the area’s top physicians are organized by specialty. Dr. Bernstein is listed under dermatology with expertise in robotic hair transplantation, surgical hair restoration, and hair loss treatment. To be included, doctors in New York, New Jersey, and Connecticut are nominated by their peers then subjected to a physician-led review of their skill in diagnosis and treating patients, qualifications, and reputation. Castle Connolly Medical also publishes the America’s Top Doctors directory, which has included Dr. Bernstein in all sixteen annual editions.

Dr. Bernstein has earned top accolades from the hair restoration industry, including the International Society of Hair Restoration Surgery’s Platinum Follicle Award, for his medical contributions to the field. Renowned for developing FUT hair transplants and introducing follicular unit extraction (FUE) procedures, Dr. Bernstein became one of the first in the world to incorporate the ARTAS Robotic Hair Transplant System into his practice in 2011. He has continued innovating through his collaboration with Restoration Robotics, Inc.; the company that developed the image-guided, physician-assisted robot. Recently, he announced a major upgrade to the robot with the release of ARTAS 9x. This latest version of the robot provides improved accuracy, quicker donor healing, and a faster overall procedure.

Dr. Bernstein’s hair restoration facility, Bernstein Medical – Center for Hair Restoration, is dedicated to the treatment of hair loss in men and women using the most advanced treatments and 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.

About Robert M. Bernstein, M.D.

Dr. Robert M. Bernstein is a Clinical Professor of Dermatology at Columbia University in New York and is the founder and lead surgeon at Bernstein Medical – Center for Hair Restoration. He was the first to describe Follicular Unit Transplantation and Follicular Unit Extraction in the medical literature, and his more than 70 medical publications have fundamentally transformed the field of hair restoration surgery. 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, GQ Magazine, Men’s Health, Vogue, Interview Magazine, Columbia Business, The Columbia Journalist, The Wall Street Journal, and The New York Times. He is a 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.

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

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

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

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

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

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

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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.

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ARTAS 9x - First Commercial Case at Bernstein MedicalFirst ever case with ARTAS 9x at Bernstein Medical – Click to watch video

In April 2017, Bernstein Medical – Center for Hair Restoration became the first hair restoration practice to perform robotic hair transplant surgery using the new ARTAS Robotic System 9x. ARTAS 9x is a major upgrade of the hair transplant robot, enabling faster and more precise Robotic FUE procedures.

Some of the hardware improvements to the system include a white light LED, color camera and tensioner, 20-gauge harvesting needle, robotic base extender, new needle mechanism cover, and more comfortable headrest and halo. Software upgrades include better scar detection, faster harvesting, ability to zoom into the main viewing screen, and improved ARTAS Hair Studio software.

Color Camera and White LED Light

The original ARTAS robotic system used a black and white optical system and a red LED light. It used a red light source so that blood on the scalp wouldn’t interfere with the ARTAS algorithms. However, clinical staff found that the red light caused eye fatigue over time.

The new optical system uses color cameras and white LED lights so technicians can extract grafts while the system is still harvesting without risk of eye fatigue. The color cameras also allow the robot to associate colors with shapes increasing the visual sharpness and accuracy of the system.

ARTAS 9x - White vs Red LED LightPrevious versions of the robot used a red LED light (left), ARTAS 9x uses a white light (right)

Assisted Force-Drag

In order for the robot to begin harvesting or site making, it must first align the robotic arm to the grid area defined by a tensioner device. In previous versions of the robot, the robotic arm needed to be manually aligned with the fiducials (indicators) on the top of the tensioner. The new Assisted Force-Drag technology enables the robot to self-align as soon as the fiducials are detected by the optical system. This speeds up the procedure and makes it more efficient by minimizing set-up time between grids.

Robotic Arm Base Extender

Restoration Robotics has modified the robotic arm by adding a base extender in order to achieve a longer reach without increasing the size and weight of the robot itself. The longer reach decreases the need for patient repositioning and chair adjustments and thus decreases the duration of the procedure.

Automatic Scar Detection

ARTAS 9x - Improved Scar DetectionARTAS 9x detects and blocks harvesting from areas with scarring

The ARTAS robotic software can now detect areas with low (or no) hair density and systematically block those areas and that immediately around it from being harvested. The step was done manually in earlier versions. This shortens harvesting time in patients with scarring as it automatically prevents overharvesting in these areas.

Recipient Site Making Blade Holder

Originally, robotic site creation used needles to create recipient sites in the patient’s scalp. However, some physicians prefer to use blades over needles. To address this, Restoration Robotics has developed a blade holder so that surgeons can use either needles or blades. The new blade holder also allows the use of 3rd party blade tips, further enabling the doctor to customize the procedure.

20-Guage Harvesting Needle

The ARTAS 9x robot has the capability of using a very fine 20-guage harvesting needle and punch that permits grafts to be removed though a significantly smaller incision. When appropriate, the use of this needle allows for a harvest with less tissue attached to the grafts. This reduces the need for trimming grafts and speeds up the procedure. It further minimizes the size of the recipient wounds.

Newly Designed Robotic Arm, Headrest, and Halo

The head of the ARTAS robot arm has been reduced in size to increase its mobility and decrease the need for repositioning the patient. This increases patient comfort and shortens the operating time.

An improved site making headrest includes a new, more comfortable pillow with a memory foam layer. The harvesting halo now has rounded edges that allow for secure, faster tensioner placement.

ARTAS Hair Studio

The ARTAS Hair Studio is also improved, now requiring the physician to take just one photo to create the 3D image of the patient’s scalp. With the 9x version of the ARTAS Hair Studio, the surgeon can now zoom in on the user interface screen during recipient site creation and simultaneously examine details and monitor the entire procedure.

Robotic FUE at Bernstein Medical

Bernstein Medical’s Robotic Hair Transplant Center of New York® is among the first facilities in the world to use the ARTAS robot to perform FUE, a procedure pioneered by Dr. Bernstein. Our practice is a beta-test site for this innovative hair restoration technology and Dr. Bernstein is a medical adviser to Restoration Robotics, the company that manufactures the ARTAS robot.

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Q: As a medical advisor and an end-user of the ARTAS Robotic System, do you see any impact of your involvement with Restoration Robotics? — J.V. ~ Miami, F.L.

A: Restoration Robotics has been very responsive to the needs of its physicians and to their patients. Because I work closely with Restoration Roboticsin the development of new improvement and advances they are often introduced first in our practice.

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Onalytica - Robotics Top 100 Influencers

Onalytica, a company that provides Influencer Relationship Management software and services, has named Dr. Bernstein one of the top influencers (#39 out of 100) on the topic of robotics due to his pioneering work in robotic hair transplant surgery with the ARTAS Robotic System.

Onalytica surveyed more than 550,000 tweets mentioning “robotics” or “robotic” over a span of 90 days (September – November 2016), including over 96,000 engaged twitter users, then used proprietary software to rank the most influential individuals and brands in the Twittersphere. The listing takes into account the level of engagement of each user’s tweets, the relevance to the topic, the influencer’s number of followers, and how frequently the influencer is listed in others’ Twitter lists. Dr. Bernstein is the only surgeon, hair transplant or otherwise, listed in the Top 40 of individual influencers.

Dr. Ordon and Dr. Bernstein discussing the latest advances in the ARTAS® Robotic Hair Transplant SystemDr. Bernstein and Dr. Ordon of The Doctors discussing advances in Robotic FUE

Robotics is a hot topic in the tech sector and according to one report, the service robotics market is expected to surpass $18 billion by the year 2020. Robotics has an increasing number of uses in healthcare, and thanks to Dr. Bernstein and Restoration Robotics the ARTAS system will continue to be on the cutting edge in surgical applications of robotics in the treatment of hair loss for years to come.

Make sure to follow @bernsteinhair for the latest on robotic hair transplants.

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Dr. Bernstein Speaks at ISHRS 2016Dr. Bernstein Speaks at ISHRS 2016

Dr. Robert M. Bernstein, Clinical Professor of Dermatology at Columbia University and founder of Bernstein Medical – Center for Hair Restoration, presented the results of his study on robotic hair transplantation at the annual ISHRS World Congress held in Las Vegas, Nevada on Friday, September 30, 2016. Dr. Bernstein presented an advance in the technology of the ARTAS® Robotic Hair Transplant System, called automated or robotic graft selection, which minimizes scarring and improves outcomes of robotic hair transplant procedures.

New York, NY — Dr. Robert M. Bernstein, Clinical Professor of Dermatology at Columbia University and founder of Bernstein Medical – Center for Hair Restoration, presented results of his study, “Robotic Follicular Unit Graft Selection,” at the 2016 ISHRS World Congress held in Las Vegas, Nevada. Graft selection is a key advance in the ARTAS Robotic Hair Transplant System, a hardware and software suite that automates aspects of the Follicular Unit Extraction (FUE) hair transplant procedure. The enhancement makes Robotic FUE more efficient and improves patient outcomes.

Dr. Bernstein presented the results of a peer-reviewed, bilateral controlled, randomized study which was published in the June 2016 issue of the journal Dermatologic Surgery. The study found that robotic graft selection can yield 17% more hairs per harvest attempt and 11.4% more hairs per graft than the prior system, which selected grafts at random. By automating the graft selection process, the ARTAS robot creates fewer wounds, which leads to fewer scars in the donor area – the area in the back and sides of the scalp from which follicular units are harvested – and an improved aesthetic outcome.

Graft selection is a process in FUE hair transplants to be used as each follicular unit — a tiny, naturally occurring bundle of one to four hair follicles — is chosen for extraction. Physicians who perform FUE procedures using manual, hand-held devices visually select each of the up to two thousand grafts that are extracted in an FUE hair transplant. Complicating the process, if too many large units are extracted, there may not be enough small units for transplantation to aesthetically sensitive areas like the frontal hairline. Extracting too many small units may result in unnecessary wounding in the donor area. The surgeon has to balance extracting the greatest number of follicles with creating the fewest possible wounds.

Early versions of the ARTAS robot, which automates several key steps in an FUE procedure, selected follicular units randomly. Dr. Bernstein, who has been collaborating with Restoration Robotics Inc. since its clinical release in 2011, set about to develop this robotic graft selection function. The result of this collaboration is a sophisticated automated graft selection system that makes the ARTAS robot more efficient and improves aesthetic outcomes of Robotic FUE hair transplant procedures. Dr. Bernstein introduced preliminary results of the graft selection study at the annual ARTAS User Group Meeting in February 2015.

Dr. Bernstein presented final results of the study at the 24th ISHRS World Congress held in Las Vegas, Nevada on Friday, September 30, 2016. The International Society of Hair Restoration Surgeons (ISHRS) is the pre-eminent association of hair transplant surgeons in the world, with more than 1,200 members from 70 countries. Dr. Bernstein participates in this annual event , often to present results of a major study published that year. This year he also lead a discussion session titled “Robotic FUE – Advances and Evolution”.

About Robert M. Bernstein, MD, MBA, FAAD, FISHRS

Dr. Robert M. Bernstein is a Clinical Professor of Dermatology at Columbia University in New York; renowned hair transplant pioneer; and founder of Bernstein Medical – Center for Hair Restoration. His more than 70 medical publications have fundamentally transformed the field of hair restoration and he has received the highest honor in the field given by the International Society of Hair Restoration Surgery (ISHRS). Dr. Bernstein has been featured on: The Oprah Winfrey Show, The Doctors on CBS, Good Morning America, The Today Show, The Dr. Oz Show, CBS News, ABC News, Fox News, Univision, and many other television programs. He has been interviewed by GQ Magazine, Men’s Health, Vogue, Columbia Business, The Columbia Journalist, The Wall Street Journal, and The New York Times.

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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.

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Dr. Robert M. Bernstein, a Clinical Professor of Dermatology at Columbia University and founder of Bernstein Medical – Center for Hair Restoration, presented results of a study on a major new advance in follicular unit harvesting using the ARTAS® Robotic Hair Transplant System at the 2016 ARTAS User Group Meeting in Dana Point, CA on February 20, 2016. Dr. Bernstein described the clinical benefit of the new advanced graft harvesting capability, a technique with wide implications for the increasingly popular robotic hair restoration procedure.

Dr. Bernstein Presenting at the 2016 ARTAS User Group MeetingDr. Bernstein Presenting at the 2016 ARTAS User Group Meeting

New York, NY — Dr. Robert M. Bernstein, a pioneer of robot-assisted hair transplantation, presented results of a study on a major new advance in robotic follicular unit harvesting, a key step in the surgical procedure, at the 2016 ARTAS User Group Meeting in Dana Point, CA. He reported that the new robotic technique resulted in a clinical benefit of up to 15% more hairs per harvest attempt and 11.4% more hairs per graft than with the current iteration of the ARTAS® Robotic Hair Transplant System. The improvement in graft harvesting should result in better aesthetic outcomes for patients, and this will have wide implications around the world as robotic hair transplant procedures are booming in popularity. Dr. Bernstein presented the findings to a “who’s who” group in the new field of robotic hair restoration surgery at their annual meeting held on February 20th, 2016.

When asked about the significance of advanced robotic harvesting, Dr. Bernstein said:

“Through the hard work and ingenuity that went into developing the robot’s new graft selection capability, we have moved this new ARTAS application from the ‘proof of concept’ phase into an enabling technology that improves patient care.”

In robotic follicular unit extraction (Robotic FUE) hair transplants, the surgeon seeks to harvest as much hair as possible through the fewest number of donor sites. By maximizing the hair-to-donor wound ratio, they can maximize the cosmetic benefit of the procedure. The ARTAS robot’s new advanced graft selection capability uses its updated computer algorithm to determine which of the hundreds of follicular units — naturally-occurring groupings of one to four hair follicles — to harvest. By programming the computer to select only the larger follicular units (i.e., ones containing two or more hairs), the robot can automatically maximize the hair-to-wound ratio. The result is more hairs harvested with fewer post-transplant scars and an improved cosmetic outcome for the patient. Previously, the robot randomly selected follicular units to harvest.

Advanced Robotic Graft Selection

To demonstrate the benefit of advanced automated graft selection, Dr. Bernstein presented findings of a randomized, bilaterally-controlled study performed on robotic FUE patients at Bernstein Medical – Center for Hair Restoration. The robot was programmed to select follicular units of two or more hairs in a first pass, and then all follicular units in a second pass. The control for the experiment was an area, on the contra-lateral side, that was harvested with the graft selection capability disabled. The first pass yielded 15% more hairs per harvest attempt and 11.4% more hairs per graft compared to the control. The second pass yielded 12.3% more hairs per harvest attempt and 6.4% more hairs per graft. These findings suggest that there is a significant clinical benefit in using the advanced graft selection capability when compared to random selection of follicular units.

Robotic Hair Transplants at Bernstein Medical – Center for Hair Restoration

Dr. Bernstein performing robotic hair transplant at Bernstein Medical
Dr. Bernstein performing robotic hair transplant at Bernstein Medical

Bernstein Medical – Center for Hair Restoration was among the first hair restoration facilities in the world to use the ARTAS system to perform Follicular Unit Extraction (FUE), a procedure pioneered by Dr. Bernstein. Bernstein Medical is a beta-test site for this innovative technology. Bernstein Medical physicians have introduced many new applications to the robotic system, including: robotic recipient site creation, advanced graft harvesting, custom punch sizes, and a “long-hair” harvesting technique. Every FUE procedure at Bernstein Medical uses the ARTAS Robot. Dr. Bernstein is a medical advisor to Restoration Robotics, Inc., the company that developed and manufactures the ARTAS system.

About Robert M. Bernstein, MD, MBA, FAAD, FISHRS

Dr. Robert M. Bernstein is a Clinical Professor of Dermatology at Columbia University in New York, renowned pioneer of Follicular Unit Transplantation (FUT) and Robotic Follicular Unit Extraction (Robotic FUE) hair transplant procedures, and founder and lead surgeon at Bernstein Medical – Center for Hair Restoration. His more than 70 medical publications have fundamentally transformed the field of surgical hair restoration and he has received the Platinum Follicle Award, the highest honor in the field given by the International Society of Hair Restoration Surgery (ISHRS). Dr. Bernstein has been featured on: The Oprah Winfrey Show, The Dr. Oz Show, Good Morning America, The Today Show, The Doctors on CBS, CBS News, ABC News, Fox News, Univision, and many other television shows. He has been interviewed by GQ Magazine, Men’s Health, Vogue, Interview Magazine, NY Post, National Public Radio, Columbia Business, The Columbia Journalist, The Wall Street Journal, and The New York Times.

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Restoration Robotics

Restoration Robotics, the company that developed the ARTAS® Robotic Hair Transplant system, has published a white paper case study on how Dr. Bernstein utilizes the robotic system’s tools to minimize scarring after Robotic FUE.

The paper describes how a Bernstein Medical patient — a 45 year old man with Norwood Class 5A male pattern baldness — had 2,540 follicular units harvested with the ARTAS robot, generating a total of 2,768 grafts. Some of the tools and techniques that Dr. Bernstein employed include:

  • Small 19g dissecting needle — the small needle leaves a smaller wound that heals more rapidly than previous needles.
  • Software programmed to avoid 1-hair follicular units — the extraction of follicular units with more than one hair maximizes the number of hair follicles per graft and reduces the number of donor wounds that need to be made.
  • Minimum distance between harvest sites — by increasing the distance between harvested follicular units (from 1.7mm to 2.0mm), Dr. Bernstein enabled “feathering” between harvested and non-harvested zones. This blending of harvest zones into non-harvested zones makes the harvested area less noticeable.

In the third month after his Robotic FUE hair transplant surgery, the patient’s donor area was reviewed for scarring with hair shaved at four different lengths.

See images of the patient’s donor area below:

Before Robotic Hair Transplant
Before Robotic Hair Transplant
Day 2 Following ARTAS Procedure
Day 2 Following ARTAS Procedure
3mo Post-op: Shaved with #2 Clipper
3mo Post-op: Shaved with #2 Clipper
3mo Post-op: Shaved with #1 Clipper
3mo Post-op: Shaved with #1 Clipper
3mo Post-op: Shaved with Peanut Clippers
3mo Post-op: Shaved with Peanut Clippers
3mo Post-op: Shaved with Peanut Clippers (Close Up)
3mo Post-op: Shaved with Peanut Clippers (Close Up)
3mo Post-op: Shaved to the Skin
3mo Post-op: Shaved to the Skin
3mo Post-op: Shaved to the Skin (Close Up)
3mo Post-op: Shaved to the Skin (Close Up)

The case study illustrated that the ARTAS Robotic Hair Transplant system’s suite of tools can minimize the detectability of scars after an FUE hair transplant.

Dr. Bernstein describes advanced Robotic FUE techniques used at Bernstein Medical (VIDEO)
Read about Robotic Hair Transplantation

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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.

Kuala Lumpur, Malaysia (PRWEB) October 31, 2014 — Robert M. Bernstein, M.D., F.A.A.D., a world-renowned hair transplant pioneer, has presented two advances in robotic hair transplant surgery to the hair restoration industry’s largest conference; an interactive hair restoration design software suite called ARTAS Hair Studio™ and recipient site creation capability in the ground-breaking ARTAS® Robotic Hair Transplant system. Dr. Bernstein’s presentation highlights the fact that the ARTAS System is the first system to integrate the planning and performance of a hair transplant procedure. Dr. Bernstein presented these new technologies at the 22nd Annual Science Meeting of the International Society of Hair Restoration Surgeons (ISHRS) in Kuala Lumpur, Malaysia, on October 11th, 2014.

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

ARTAS Hair Studio is a planning tool that assists the physician in the design phase of the hair restoration procedure. Dr. Bernstein’s presentation described how this software enables the physician to generate a three-dimensional model of the patient’s head and then create a treatment plan based on parameters such as the number of recipient sites, the angle of elevation of the hairs, and the direction of the hairs. With small modifications of the software, the technology can add “virtual” hair to the 3-D model and allow patients to see how the results will actually look. This will create a more interactive, educational experience for the patient and one that helps align the patient’s expectations with what is possible given their specific hair loss characteristics.

Dr. Bernstein showed how, using the new software, the surgeon can divide the treatment area into two or more sections and then program different recipient site densities for the different areas to closely mimic how hair grows in nature. The treatment plan created using ARTAS Hair Studio can be saved and then imported into the ARTAS hair transplant robot.

Once the design specifications have been imported, the ARTAS Robot can then create the recipient sites, the tiny incisions made in a patient’s scalp, into which transplanted grafts of naturally-occurring groups of 1-4 hairs, called follicular units, are placed.

Recipient Site Creation at Bernstein Medical Using ARTAS Robotic System
Recipient Site Creation at Bernstein Medical Using ARTAS Robotic System

In his presentation to the ISHRS, Dr. Bernstein described several advantages of robotic site creation over manual site creation, including: the elimination of inconsistencies in creating large numbers of recipient sites by hand, precise distribution of follicular unit grafts, automatic adjustment to site densities, and automatic avoidance of existing hairs without sacrificing speed. The robot uses advanced sensory equipment and optical cues to locate potential recipient sites on the scalp and then quickly and accurately make the incisions based on the pre-programmed parameters. The robot can create up to 2,000 recipient sites in approximately one hour.

Dr. Bernstein noted that these advances represent an integration of the design and planning processes with the actual performance of the procedure. Whereas in the past, the doctor would describe the treatment plan to the patient and then manually implement the prescribed plan, today’s computerized robotic system allows the physician to digitally design the hair transplant treatment plan, and then that plan directs the robot in the operating room.

Restoration Robotics Inc., the company that developed the robot, collaborated with Dr. Bernstein, using the Bernstein Medical – Center for Hair Restoration facility as a beta-testing site, to upgrade the ARTAS robot and test these and other advances. The ultimate goal is to deliver a robot that will mechanize every surgical aspect of an FUE hair transplant procedure.

About Robert M. Bernstein, MD, MBA, FAAD

Dr. Bernstein’s published articles on follicular unit hair transplant procedures have been called “Bibles” for the industry. He has received the Platinum Follicle Award, the highest honor in the field. He is a fellow of 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 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 completed his training in Dermatology at the Albert Einstein College of Medicine. Dr. Bernstein is a Clinical Professor of Dermatology at 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 globe. 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 recipient sites and Dr. Bernstein is a medical advisor to the company that produces the robotic system, Restoration Robotics, Inc. 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.

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ARTAS® Robotic Hair Transplant System

Restoration Robotics, Inc. has announced that the ARTAS® Robotic System has harvested its 10 Millionth Hair, a major accomplishment for the three-year-old robot. The company attributes the success of achieving the 10 Millionth Hair in this short time span to rapid adoption by hair transplant industry leaders, like hair restoration pioneer Dr. Robert Bernstein.

The ARTAS robot is the only image-guided, physician-assisted robotic system for harvesting follicular units.

On the achievement, Jim McCollum, President and Chief Executive Officer of Restoration Robotics, said:

“The ARTAS Robotic System is fast becoming the gold standard in hair transplantation and enables hair restoration surgeons to enhance the patient experience and achieve unsurpassed outcomes. Our 10 Millionth Hair verifies the increased interest in patients pursuing a highly precise, undetectable hair transplant with a high degree of patient satisfaction. Interested patients are researching and demanding the ARTAS Robotic Hair Transplant Procedure.”

The ARTAS Robotic System received 510k clearance from the Food and Drug Administration (FDA) in 2011 after a decade of research, testing, and clinical trials. Dr. Bernstein is an advisor to the company and, since its launch in 2011, he has offered several modifications to the initial iteration of the robot that have improved its performance and usability. Bernstein Medical – Center for Hair Restoration was the first facility on the East Coast of the United States, and one of the first hair transplant practices in the world, to use the system. Bernstein Medical is also a beta-testing site for the robot, and many upgrades to the hardware and software of the unit have been tested and perfected in our Manhattan hair restoration facility. All FUE hair transplants at Bernstein Medical are performed with the aid of the ARTAS robot.

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

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

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

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

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

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

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

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

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

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

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

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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 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:

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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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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.

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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.

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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.

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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: 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

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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.

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Q: With the ARTAS robotic system for FUE hair transplantation, by Restoration Robotics, what part of the FUE hair transplant procedure can actually be done by the robot? — A.M., Los Angeles, CA

A: The ARTAS System is a computer-guided method of harvesting follicular units in the donor area during Follicular Unit Extraction (FUE). The initial phase of FUE, where the follicles are selected, scored and separated from the surrounding scalp is done by the ARTAS System. All other phases of the procedure including; actual follicular unit graft removal from the scalp, hairline design, recipient site creation and placement of the grafts into the balding scalp are done by the surgical team.

In the near future, improvements in the ARTAS System should allow it to be able to actually extract the separated grafts from the scalp. Eventually, the engineers hope to be able to increase the capability of the system so that it can create recipient sites and implant the extracted grafts into them.

Read about Robotic FUE Hair Transplantation

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Q: How does the ARTAS robotic hair transplant system actually work? — J.N., Fort Lee, NJ

A: The ARTAS System for Follicular Unit Extraction (FUE) combines several features including an interactive, image-guided robotic arm, special imaging technologies, small skin punches of two different sizes, and a computer monitor. After the system is positioned over the patient’s donor area of the scalp, ARTAS is capable of identifying and isolating follicular units from the surrounding scalp.

After the robotic arm is aligned with the follicular unit, a sharp 1-mm punch is used to cut through the upper part of the skin (the epidermis and upper dermis).

Immediately following this, a duller, 1.3mm punch is used to separate the deeper part of the follicular unit from the remainder of the dermis and subcutaneous fat. Once separated by the robot, the follicular units are manually removed from the scalp and stored until they are implanted into the patient’s recipient area.

Read about robotic FUE hair transplantation

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Robert M. Bernstein M.D.

Q: What does the ARTAS robotic system for Follicular Unit Extraction (FUE) actually do? — E.J., Plainsboro, NJ

A: The ARTAS robotic system for hair restoration is a computer assisted system, made by a company called Restoration Robotics, that utilizes image-guided robotics to increase the quality of the hair follicles harvested during FUE. It aids in the initial part of the FUE hair transplant procedure where follicular units are separated from the surrounding tissue. The system is operated under direct physician supervision.

Read about robotic FUE hair transplantation

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Robert M. Bernstein M.D.

Q: What is Restoration Robotics? — L.N., East Brunswick, NJ

A: Restoration Robotics is a medical device company, based in Mountain View, California, that has developed a computerized instrument to assist in the graft extraction phase of follicular unit extraction (FUE) hair transplant procedures. Their patented device, called “ARTAS,” is an image-guided system for FUE. Their website is: www.restorationrobotics.com.

Read about robotic FUE hair transplantation

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Robert M. Bernstein M.D.

Q: I have read your page on robotics in hair restoration and am interested in learning more. Are there any updates in the development of the system you mentioned? — W.T., London, UK

A: Restoration Robotics, Inc. — based in Mountain View, CA — has spent the last few years developing and testing a robotic hair transplant device for follicular unit extraction (FUE). The ARTAS robot system has recently received 510(k) approval from the Food and Drug Administration, meaning that the company may now begin marketing the system for use in hair restoration clinics.

The FDA classifies the device as a “computer assisted hair harvesting system” and describes it as being used to identify and extract follicular units and to help the surgeon do the same during hair transplantation.

The ARTAS 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.

We will update you as more information becomes available about the ARTAS system and Restoration Robotics.

See a photo of the ARTAS robot and stay on top of developments by visiting our Robotic Hair Transplantation page

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