Dr. Bernstein and Dr. Shaver 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.
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.
Synopsis: With the latest version of the ARTAS platform, 9x, Restoration Robotics has designed a faster and more accurate system for hair transplantation. The improved accuracy of harvesting and shortened procedure time increases graft viability, while smaller needles reduce scarring and allow patients to wear shorter hairstyles. Many of the changes in this upgrade have been made as a response to specific physician feedback.
Synopsis: 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.
Synopsis:There has been a change in the nomenclature of the FUE procedure. It will not be called Follicular Unit Excision, describing the two main components of an FUE procedure, incision (separatioin of the follicle from the tissue) and extraction (the removal of the follicular unit from the scalp once it is separated). Drs. Robert M. Bernstein and William R. Rassman’s commentary explains the importance of this change in terminology.
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.
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.
Synopsis: 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.
In April 2017, Bernstein Medical 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 in to the main viewing screen, and improved ARTAS Hair Studio software.
Dr. Bernstein closed the 2017 ARTAS Users Meeting with a discussion of five advanced techniques in robotic hair transplant procedures that he developed at Bernstein Medical. His presentation covered the benefits of pre-making recipient sites, long-hair FUE, tensioner placement, feathering edges in harvesting, and robotic graft selection. The “Hair Restoration Pearls” presentation included case studies, photographs, and videos demonstrating the techniques to the audience of hair restoration physicians. The two-day affair; which was held in Coronado, California; was a huge success, with over 260 attendees from around the world representing 204 robotic hair restoration practices.
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.
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.
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.
Dr. 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.
Dr. Andrew Ordon — Emmy-nominated co-host of the award-winning talk show “The Doctors” — and Dr. Robert Bernstein met at Bernstein Medical – Center for Hair Restoration in New York City on March 3, 2016 to discuss the latest advances in robotic hair transplantation.
Dr. Bernstein appeared as a guest on The Bald Truth, where he was interviewed by Spencer Kobren, the show’s host, about the ARTAS® Robotic System for FUE hair transplant surgery and the latest updates to the robotic system. He also discussed increasing demand for both FUE procedures and hair transplants, in general, around the world.
Dr. Bernstein was quoted in a New York Post article on the growing popularity of surgical hair restoration. In the article, Dr. Bernstein explained how celebrity hair transplants have become a driving factor behind the fading of the decades-long stigma of hair transplants.
On being chosen for his sixteenth consecutive ‘Best Doctors’ issue, Dr. Bernstein said: “I am honored to be considered among the best doctors in New York and it is a credit to the hardworking staff at Bernstein Medical that, after two decades of incredible progress, we are still making significant advances in the surgical treatment of hair loss.”
Recognition of Dr. Bernstein and his contributions to the field of surgical hair restoration comes as he continues to push the envelope with advances in Robotic FUE hair transplants, improving more traditional hair restoration techniques and exploring adjuvant treatments such as Platelet Rich Plasma (PRP).
Q: What is the main difference between hair transplants using the robot versus other procedures? — M.P., Flatiron, NY
A: There are two basic types of hair transplant procedures, Follicular Unit Transplantation (FUT or strip surgery) and Follicular Unit Extraction (FUE). In FUT, donor hair is harvested by removing a long thin strip from the back of the scalp. Individual follicular units are then obtained from this strip using stereo-microscopic dissection. In FUE, individual follicular units are harvested directly from the donor area using a sharp, round cutting instrument. The ARTAS Robotic System performs the follicular unit isolation step of an FUE procedure and can also create recipient sites according to specifications determined by the hair restoration surgeon. In performing each of these steps, the robot uses its image-guided technology to locate the next target and position the cutting instrument, and it does so with precision and speed that cannot be accomplished using manual FUE techniques or instruments.
Q: I have been reading about Robotic FUE and have seen some photos on your website of you operating the ARTAS robot using what looks like a remote control. What is that thing and how does it control the robot? — C.B., Greenwich, CT
A: The ARTAS robot uses a dual operating system when performing follicular unit extraction. One station consists of a desktop computer adjacent to the robot. This station is used to establish the basic parameters of the transplant such as the spacing of grafts, the angle and depth of the harvest, which size follicular units will be targeted, and a host of other important variables.
The hand-held pendant is used by the operator situated next to the patient. The remote has more limited options – the main ones being depth adjustment and to immediately suspend the action of the robot. Many of the parameters are determined automatically by the robot’s computer to maximize the accuracy of the harvesting. The robot also makes real-time adjustments to these variables during the hair restoration procedure.
The physician sets the parameters at the computer monitor and, once the settings are determined, he/she sets the tensioner grid on the patient’s scalp. The tensioner determines where the grafts will be harvested. The grid is moved approximately every 130 harvests. The robot can be operated at the computer terminal and through a mobile pendant. The physician often alternates with a trained assistant between that station and using the pendant.
Besides the involvement in the operation of the robot, there are many other important physician-dependent steps to the hair transplant including the planning and design of the procedure, and recipient site creation. Other steps, such as the microscopic sorting and trimming of harvested follicular unit grafts and graft placement, are often performed by trained staff, but require the physician’s close supervision.
Dr. Robert M. Bernstein introduced a new capability of the ARTAS® robotic system, “Follicular Unit Graft Selection,” at the ARTAS User Group Meeting on February 6-7, 2015 in Newport Coast, CA. He presented the new technology and the preliminary results of a bilateral pilot study of the technique conducted at Bernstein Medical.
Q: How does the ARTAS robot control the depth of the incision in Robotic FUE? — B.V., Old Greenwich, CT
A: The ARTAS robotic system is equipped with advanced sensors that determine the precise depth of the sharp and blunt needles used both in the graft harvesting step and for recipient site creation. The robot automatically adjusts to the precise depth needed for the non-traumatic extraction of the grafts. The tip of the punching mechanism contains depth markings so that the physician can visually override the punch when he wants to fine-tune its action. While monitoring the procedure in real time, if it is observed that the punches are too superficial or too deep, punch depth can be modified using the robot’s computer system.
The physician can also use the ARTAS system to precisely control the depth of recipient sites. As with harvesting, the robot automatically adjusts the depth based on parameters set by the physician and the doctor can then make further adjustments, in real-time, during the procedure.
Q: Does Follicular Unit Extraction performed by a robot hurt more than regular FUE? — R.T., Greenwich, CT
A: As with manual FUE, robotic FUE hair transplantation is an outpatient procedure performed under long-acting local anesthesia – a combination of lidocaine and bupivacaine. After the initial injections, the patient does not experience any pain or discomfort.
Before starting local anesthesia, we give most patients oral valium and intra-muscular midazolam (a very fast acting sedative that is very relaxing). While some patients doze off at the beginning of the procedure, others prefer to watch TV, a film, or just chat.
Local anesthesia generally wears off after 4-5 hours, so for transplant sessions lasting longer than this, we will give more anesthesia before the first wears off. With Robotic FUE, there is no discomfort once the procedure is completed and the anesthesia wears off. This is in stark contrast to an FUT strip procedure which can be uncomfortable in the donor area for days to weeks.
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 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.
Q: How many follicles can you transplant with robotic FUE compared to manual FUE? — R.V., Upper West Side, N.Y.
A: We can extract the same number of follicles robotically as we can manually.
That said, the goal of any hair transplant procedure is not to transplant as many hair follicles as possible but rather to achieve the best possible cosmetic result given your degree of hair loss and the number of hair follicles available in your donor area.
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.
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.
After years of jokes about his continually receding hair line, LeBron James, winner of two NBA championships and four NBA Most Valuable Player Awards, stunned the sports world on September 16th, 2014 when he revealed a newly restored hairline while promoting his new LeBron 12 shoe at Nike World Headquarters.
Folks are now asking – what the heck happened all of a sudden? Where, when and how did LeBron get that great new hair line?
Q: I have read a bit about the ARTAS robot and how it uses an “image-guided” system, but what does that mean? And how is the robot’s imaging system different than a human surgeon viewing the grafts with the naked eye? — S.V., Middle Village, N.Y.
A: That is a great question and it gets to one of the key benefits of the robotic hair transplant system: its accuracy. When a surgeon is performing FUE using manual techniques, they must wear a headset that magnifies the scalp so they can see the follicular units more clearly than with the naked eye. The surgeon must visually and mentally process subtle nuances of the skin and follicular units for every one of the hundreds or thousands of units that are extracted. The ARTAS robot magnifies the surface of the skin in much the same way, but to a much greater extent. In addition, it is not subject to the limitations of the human eye, or human hand, and it is not subject to human error. The surgeon may not have exact hand-eye coordination. The surgeon may be concentrating on one aspect of the extraction, say following the angle of the hair, but might ignore another important aspect of the follicle, say its depth in the skin or its orientation. And, of course, the surgeon tires, both physically and mentally, from performing the hundreds or thousands of repetitive motions.
The robot’s image-guided system, on the other hand, does not experience these limitations. The robot magnifies the skin, detects each follicular unit and the nuances of the skin/hair characteristics, and then extracts that follicular unit with precision. When the imaging system detects changes to the skin, this new information is fed into the computer in real-time and the system adjusts automatically based on this feedback as it continues to harvest grafts. There is no distracting the robot, and the robot will not forget, or ignore, key variables in the extraction. The robot can extract thousands of follicular units without tiring from repetition or slowing down the extraction.
Based on my own practical experience using the robot, it is clear that the robot’s ability to estimate the position of the follicles under the skin and to extract it with precision is superior to manual techniques. Having used the ARTAS system for over three years, and having helped make improvements to the device since the first iteration, I have seen robotic technology substantially improve the outcome for my patients.
Dr. Bernstein was interviewed by Spencer Kobren on The Bald Truth, the critically acclaimed broadcast on hair loss and hair restoration. They discussed the latest in robotic hair transplant surgery, the ARTAS Robotic System, FUE and FUT hair transplant procedures, and the future of hair restoration.
Robert M. Bernstein, MD, MBA, FAAD, a Clinical Professor of Dermatology at Columbia University in New York and a pioneer of modern hair transplant procedures, is honored to be included in New York Magazine’s annual ‘Best Doctors’ issue for the fifteenth consecutive year.
Dr. Bernstein’s two decades of innovation in surgical hair restoration and dedication to his patients at Bernstein Medical – Center for Hair Restoration have earned him placement in the 2014 edition of the peer-nominated ‘Best Doctors’ issue. The respect his colleagues have for his work stems from his leadership and dedication to advancing and improving surgical hair restoration procedures.
Dr. Bernstein 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 on February 7th and 8th, 2014, 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.
Dr. Bernstein is featured in Columbia Business, the alumni magazine of the Columbia Business School, for having “revolutionized the field of hair restoration.” The article mentions his pioneering the FUT procedure — now recognized as the “gold standard” in surgical hair restoration — and robotic hair transplant surgery.
Dr. Bernstein is credited with introducing the “follicular unit” to surgical hair restoration, the innovation that allowed for a “completely natural-looking hair transplant” to be achieved. The commentary on Dr. Bernstein’s contributions to the field of hair transplantation are outlined in an historical review of dermatologic surgery that appeared in the Journal of the American Academy of Dermatology.
The 21st Annual Scientific Meeting of the International Society of Hair Restoration Surgery was held in San Francisco from October 13 through 26, 2013. The meeting covers the most important scientific and clinical advances in surgical hair restoration.
Dr. Bernstein was honored to deliver the keynote address at the ARTAS International Users Forum in San Francisco. “Follicular Unit Extraction: Then and Now,” reviewed the evolution of surgical hair restoration from FUT through FUE to the cutting edge technique of Robotic-FUE.
Dr. Bernstein was included in the ‘Best Doctors’ issue of New York Magazine for the fourteenth consecutive year. The annual special issue of the magazine contains a directory of the New York area’s best physicians. The directory is based on the results of a peer-reviewed survey that is conducted by Castle Connolly, Ltd.
Q: I heard that for someone who has had several strip procedures, the ARTAS robot for FUE does not work because it is programmed to work with “textbook male pattern baldness”, which I no longer have. I thought the scars from previous procedures, as well as the large amount of already transplanted hair, might throw off the robot’s programming (it wouldn’t quite know what to do). But if I am wrong about this then the robot may in fact be the best approach for me. Please advise. — N.C., Paris, France
A: When performing robotic hair transplants on patients with prior surgery, I program the robot to avoid scarred areas – just as we would do visually when performing manual FUE.
Q: I am an African-American man with tight curly hair. Will the FUE robot be able to work on curly hair? — E.O., Manhattan, N.Y.
A: Yes, the ARTAS robot for FUE can be adapted for African-American hair when performing follicular unit extraction. We use a punch that is 0.1mm wider in diameter than the instrument used for Caucasians. It allows us to incorporate the slightly larger volume of tissue that results from the curved hair and enables us to accomplish the hair transplant with less in jury to follicles than if a smaller instrument were used.
Dr. Bernstein was quoted in an article on robotic follicular unit extraction (FUE) that appeared in Brazil’s Veja Magazine. It is titled, “Vai Ficar Mais Fácil Deixar de Ser Careca,” which translates to, “It Will Be Easier To Stop Being Bald.”
Q: I read on your blog that the ARTAS robot doesn’t work well in patients who want FUE but have blond hair. I have dark skin and hair, does that present a problem for the machine? — J.S., London, England, U.K.
A: The ARTAS Robot performs follicular unit extraction just as well with blond hair as dark hair, but not white hair. It is simple to just to dye the white donor hair prior to the procedure. This donor hair will be clipped very short the morning of surgery removed anyway, so it will not present too much of a cosmetic issue.
Dr. Bernstein and Bernstein Medical – Center for Hair Restoration were featured in New You magazine’s article “My Hair Lady.” The main topic of the article is hair transplantation in women, however it also touches on hair loss in women, Follicular Unit Transplantation (FUT), medication and other products.
Dr. Bernstein heads discussion on Robotic FUE at the 20th annual meeting of the International Society of Hair Restoration Surgery (ISHRS) which took place October 17-20, 2012. He led a roundtable discussion in the ‘Coffee with the Experts’ session on robotic follicular unit extraction. He was also a panelist at the Finasteride Symposium and gave a presentation on protocol in prescribing Finasteride to hair restoration patients.
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.
In the latest in a long line of improvements made to hair restoration procedures, Dr. Bernstein has published an article in Hair Transplant Forum International which improves the FUE procedure even further, whether performing follicular unit extraction with the FUE robot or by hand.
In his article, Dr. Bernstein suggests two techniques to enhance the FUE procedure. First, he recommends that surgeons create recipient sites prior to extraction, in order to decrease the time grafts are in their holding solution outside the body. Second, he suggests adding time between site creation and graft harvesting and placement, to allow recipient site healing to progress.
Dr. Bernstein was featured in a CBS News report on robotic hair transplantation. During Dr. Max Gomez’s visit to the Bernstein Medical – Center for Hair Restoration, Dr. Bernstein discusses with Dr. Gomez the difference between FUT and FUE hair transplants, how the robotic system works, and the benefits of extracting hair follicles using robotic FUE rather than by traditional hand-held methods.
New York, NY — Robert M. Bernstein, M.D., F.A.A.D., the world-renowned hair transplant physician, pioneer of the Follicular Unit Transplantation (FUT) and Follicular Unit Extraction (FUE) and founder of Bernstein Medical – Center for Hair Restoration, was included in New York Magazine’s ‘Best Doctors‘ issue for the thirteenth consecutive year.
“It is such an honor to be recognized by New York Magazine. Our passion for providing the best hair loss treatments has served as the impetus for pushing the envelope in utilizing new state-of-the-art hair restoration techniques such as Robotic assisted hair transplants.”
Dr. Bernstein not only pioneers hair transplant procedures, but hair restoration technology as well. The NY1 television station, based in New York City, visited Bernstein Medical to see a demonstration and talk about the newest tool in the hair restoration toolkit, the ARTAS Robot for Hair Restoration.
The NY1 piece shows the robotic FUE system in action at Bernstein Medical, with views of the robotic arm, the image-guided system, the punch tool, and the user interface.