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

Is it Safe to Implant 6,000 Grafts in 2 Days Using FUE?

Q: Is it safe to implant 6,000 grafts in 2 days with an FUE procedure? — L.P. ~ Port Washington, N.Y.

A: A 6,000-graft procedure would be a very large hair transplant. Transplanting this many grafts at once would necessitate grafts being placed very close together. In this situation, the blood supply may not be adequate to support the growth of the newly transplanted grafts.

Another reason for concern is that when harvesting, FUE yields about 20 grafts/cm2. A 6,000-graft procedure would require 300 cm2. Since the donor area is about 30 cm long, this would require a donor height of 10 cm, clearly extending beyond the permanent zone of the scalp of most patients.

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Bernstein Medical In The News

Dr. Bernstein Gives First Master Class in Robotic Hair Transplantation

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.

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Bernstein Medical In The News

Dr. Bernstein Featured in ARTAS Live Webinar

Dr. Bernstein's slide on Dr. Robert M. Bernstein were guest speakers in the ARTAS live webcast series where they discussed “What’s New in Robotic FUE.” They 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.

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Hair Restoration Answers

When is it Best to Feather in Robotic FUE?

Q: I thought that FUE extraction is performed in a way that it cannot be detected. Therefore, it is best to distribute the pattern evenly starting from the safe zone and fading out on the sides. The ARTAS results often show a smaller extraction area and harder edges (no transition from extraction to non-extraction area). Does this lead to a higher risk to detect the surgery? — H.K. ~ Chicago, I.L.

A: Feathering of the extraction zone in FUE is a technique where the distance between the extractions gradually increases as one reaches the border of the extracted zone. When this technique should be used depends upon the short- and long-term goals of the patient. If the patient’s main goal of the FUE procedure is to wear their hair very short, then the technique of feathering and rounding the edges to have a less distinct border is appropriate, as this will decrease the visibility of the harvested area.

However, if a person does not wear his hair very short (nor plans to) and maximizing the donor supply is paramount, then a more organized pattern, with less feathering, will give a greater long-term yield and a more even distribution. The reason is that the healing of FUE wounds distorts adjacent follicular units making subsequent extraction in the same regions more difficult and increases the risk of transection. For this reason, in subsequent procedures we generally prefer to harvest in new areas. If we need to harvest more hair from the same area, we rarely go back more than once.

When one feathers extensively in the donor area, this utilizes a larger surface area of the scalp with less graft yield, so it may become necessary to go back over the same area to obtain additional grafts, often multiple times. This risks increased transection and an uneven, mottled appearance to the donor area.

If a person wears his hair very short, then feathering is critical (even though it makes subsequent extraction more problematic). It is very easy to feather and round edges with the ARTAS robot, but we make the decision to do so based upon the specific needs and goals of the patient.

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Hair Restoration Answers

Is Manual FUE Better Than Robotic FUE Because The Physician Can “Feel” The Follicle During Extraction?

Q: Is it true that performing FUE hair transplant procedures by hand is better because the physician can better adjust and feel the follicle when extracting? — M.H. ~ Great Neck, N.Y.

A: The ARTAS robot is a physician controlled, computerized device that uses a three-dimensional optical system to isolate follicular units from the back of the scalp in a hair transplant. The robotic system assists the physician in the extraction of grafts with precision and speed. Although there is some advantage to having “human feel” for the tissue, this is far outweighed by the fact that repetitive procedures performed manually thousands of times lead to operator fatigue and result in increased transection and damage to grafts. With the ARTAS robotic system, the quality of the first and the last graft harvested will be the same.

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Bernstein Medical In The News

Hair Transplant Pioneer Dr. Robert Bernstein is Included in New York Magazine ‘Best Doctors of New York’ Issue for 18th Year

Best Doctors 2017 - New York MagazineRobert M. Bernstein, MD, MBA, FAAD 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 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 as many years. Of being included in the 2017 issue, he 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.”

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Bernstein Medical In The News

Dr. Bernstein Presents Advanced Robotic Hair Transplant Techniques at 2017 ARTAS Users Meeting

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

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Hair Restoration Answers

Do You See An Impact Of Your Involvement With Restoration Robotics In The Development Of ARTAS?

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 Robotics in the development of new improvement and advances they are often introduced first in our practice.

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Bernstein Medical In The News

Dr. Bernstein Named a Top 100 Influencer on Robotics

Onalytica - Robotics Top 100 InfluencersOnalytica, 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.

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Hair Restoration Answers

Can I Have Robotic FUE If I Have Gray Hair or Curly Hair?

Q: I have read that the ARTAS System works best on straight black hair. Is this an option for gray hair? How about wavy or curly hair? – P.W., Fort Lee, NJ

A: The ARTAS robotic system can be used in patients with any hair color although in order for the robot to visualize white hair (or very light blond hair) the hair must be dyed. Curly hair is also not a problem as the donor hair in a robotic procedure is shaved to approximately 1 mm in length so a wave or curl is eliminated. In patients of African descent, where the hair below the surface of the skin may be curved, a slightly larger punch can be used. we have patients dye their hair the evening before or the day of the procedure. For convenience, only the hair in the donor area (back and sides) where the robot will be doing the harvesting needs to be dyed.

In patients who prefer not to shave or dye the entire back and sides of the scalp, we can perform the ARTAS robotic FUE using the long-hair technique. With this technique, you will grow your hair on the back and sides of the scalp a bit longer so it can cover the harvested area. On the day of the procedure, we will lift up the hair, clip a long thin band of donor hair and then extract follicular units from this limited region of the scalp. After the procedure, you can simply comb down your hair to cover the donor zone. The area that has been harvested (and possibly dyed depending on your hair color) will not be visible.

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Bernstein Medical In The News

Dr. Robert M. Bernstein Presents “Graft Selection” Advance in ARTAS Robotic Hair Transplant System at ISHRS World Congress

Dr. Bernstein Speaks at ISHRS 2016Dr. Bernstein 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.

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Bernstein Medical In The News

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

New York Magazine 'Best Doctors' 2016Robert 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).

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Hair Restoration Answers

Can I Have a Hair Transplant if I Have a Scar in My Donor Area? If So, Which Do You Recommend, FUT or FUE?

Q: I have a diagonal scar in the middle of my donor area that I got during a childhood accident and I am concerned that it will limit my options for hair restoration. Will this type of scar prevent me from having either FUT or FUE? Do you recommend one or the other? — R.F., Upper West Side, NY

A: Traumatic scars in the donor area do not preclude us from performing a hair transplant. With an FUT/strip procedure, we can remove all or part of the scar when we excise the donor strip. In Robotic FUE, the ARTAS Robot can be programmed to avoid a scar during harvesting. In either procedure, we can improve the appearance of the scar by implanting follicular unit grafts directly into the scar tissue. The hairs will grow permanently in the scar, just like ones we implant in the recipient area, and the scar will become harder to detect.

It is important to note that transplanted hair will not grow in a thickened scar. If your scar is thickened, the doctor can thin it out (soften it) with injections of cortisone. They are usually repeated at 4-6 week intervals in advance of the procedure. The number of injection sessions required depends upon the thickness of the scar and your individual response to the medication.

The presence of a traumatic scar should generally not determine which type of transplant you have. That should be decided in consultation with your physician based on factors such as how much volume you need, how you intend to style your hair, how short you would like to keep it, how soon you need to return to strenuous physical activity, and other general considerations for a hair transplant.

We recently posted photos from a patient who had a robotic hair transplant with a scar in his donor area. The photos include images of his donor area (with scar) before his procedure, immediately after robotic graft harvesting and 11 days post-op. View this patient’s before after photos.

Video: How Does the ARTAS Robotic Hair Transplant System Locate and Dissect Follicular Units?

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Bernstein Medical In The News

Key Advance in Robotic Hair Transplants Presented by Dr. Robert Bernstein at 2016 ARTAS Users Meeting

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

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Hair Restoration Answers

How are Recipient Sites Programmed into the ARTAS Robot?

Q: How are specifications for recipient sites inputted into the ARTAS® robot? — A.F., Queens, NY

A: At the outset of the procedure, the physician sits at a computer terminal that is connected to the ARTAS Robot and enters the specifications directly into the robot’s software. Variables programmed in this manner include: the number of recipient sites, density of sites, angle that the hair will extrude from the skin, depth of recipient sites, and the minimum distance away from existing hair follicles that a site can be created.

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Hair Restoration Answers

How Does the ARTAS Robot Avoid Transection of Hair Follicles During Recipient Site Creation?

Q: How does the ARTAS System avoid damaging hair follicles in the balding area during recipient site creation? — R.K., Brooklyn, NY

A: The ARTAS robot’s optical guidance system enables it to accurately create recipient sites in areas of thinning hair without damaging existing hair follicles. During the recipient site creation process, the robot uses its advanced image-guided optical system to scan the surface of the skin, locate existing hair follicles in the recipient area, and then create recipient sites at a specified distance from these existing hairs.

The ARTAS robot carries out this process rapidly, accurately, and consistently according to the physician’s programmed specifications. Thanks to the microscopic precision of the image-guided technology, the robotic hair transplant system can avoid injury to follicles that can result when Follicular Unit Extraction (FUE) is performed using manual techniques.

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Bernstein Medical In The News

Interview on Hair Loss and Hair Transplantation

Part 1

Hair Loss in the Younger Person

Interviewer: I brought a fair number of questions related to aspects of androgenetic alopecia and hair transplantation, but I will also ask you some questions regarding two other types of hair loss, like alopecia areata and cicatricial alopecia. Most of our listeners are fairly educated about the different hair restoration options available to them, so I’ll tailor my questions primarily for this type of audience.

The first question that I want to direct here is the dilemma that many young people face when they’re losing their hair and are considering getting a hair transplant. They typically don’t know the degree to which their hair loss is going to progress. When you’re in your 20s and 30s, you want to have a decently low-running hairline and you want to have a crown that looks full. But given that you don’t know how far your hair loss is going to go, how would you address this scenario for people in that age range?

Dr. Bernstein: That is the main problem with treating younger people. We don’t really know how they’re going to progress. It is so important to wait, usually until the person is 23 to 25 before you can really get a sense of how much hair loss they are going to lose. And even at that age it’s sometimes very difficult to tell. That’s even after considering things such as family history.

A problem with treating a younger person with surgical hair restoration is that they often want things that are unrealistic. A person in their 20s is what we call “backward-looking.” They’re looking to when they were a teenager and they want their flat hairline back and all their old density. But hair transplants are forward-looking. We need to consider what they’re going to be like in ten or twenty years – not how they looked in the past.

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