Bernstein Medical Center for Hair Restoration - Robotics News

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

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

Long-Hair Robotic FUE

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

Tensioner Placement

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

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

Robotic Follicular Unit Graft Selection

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

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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. Ordon and Dr. Bernstein discussing the latest advances in the ARTAS® Robotic Hair Transplant SystemDr. Ordon and Dr. Bernstein discussing the latest advances in the ARTAS® Robotic Hair Transplant System

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.

Some of the topics they discussed include the advanced LED touchscreen interface (illustrated above), a new automated graft selection capability, and the robot’s upgraded image-guidance system, which enables more precise harvesting and a further reduction of graft transection.

Dr. Bernstein appeared on “The Doctors” in 2012. On that program, he discussed how the precision technology of the ARTAS Robotic Hair Transplant System enables doctors to extract thousands of follicular units without human error entering the equation.

Video: Dr. Bernstein on “The Doctors”

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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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Dr. Bernstein Discusses the Latest in Robotic Hair Transplant Surgery on The Bald Truth

Dr. Bernstein appeared on The Bald Truth, where he was interviewed by the show’s host, Spencer Kobren, about the ARTAS® Robotic Hair Transplant system for FUE and the latest updates to the robot. He also discussed increased demand for FUE procedures, and hair transplants in general, around the world.

Bernstein Medical was among the first facilities in the world to use the ARTAS Robotic System to perform Follicular Unit Extraction (FUE) hair transplants, a procedure pioneered by Dr. Bernstein. Bernstein Medical is a beta-test site for this innovative technology. Physicians at Bernstein Medical have introduced new applications for the robot, including: custom punch sizes, robotic recipient site creation, automated follicular unit graft selection, and a “long-hair Robotic FUE” technique that allows the patient to keep their hair longer in the donor area. Every FUE hair transplant at Bernstein Medical uses the ARTAS Robotic System. Dr. Bernstein is a medical advisor to Restoration Robotics, the company that manufactures the ARTAS hair transplant system.

Watch video of the interview and read a transcript
Read more about Robotic FUE
Read our Robotic Hair Transplant FAQ

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Dr. Bernstein at ISHRS 2015 Annual Scientific MeetingDr. Bernstein at the 2015 ISHRS Annual Scientific Meeting

Small, simple modifications in the sequence of the major steps in a Follicular Unit Extraction (FUE) hair transplant procedure will be beneficial to healing and growth following the procedure, says renowned hair restoration surgeon Dr. Robert M. Bernstein. Presenting at the 23rd Annual Scientific Meeting of the International Society of Hair Restoration Surgery (ISHRS) in Chicago, Illinois, Dr. Bernstein detailed how making recipient site incisions before harvesting follicular unit grafts can improve the outcome of an FUE procedure.

For years, it was standard operating procedure in an FUE hair transplant to first harvest follicular units, then create recipient sites in the balding areas and place the extracted units into these sites. This practice persisted despite the fact that hair restoration physicians had known for years that prolonged periods of time outside the body decreased survival of follicular unit grafts. With the widespread adoption of FUE, and the long time needed for the extraction phase of the procedure, Dr. Bernstein looked for ways to streamline the process.

Dr. Bernstein Presenting at ISHRS 2015Dr. Bernstein Presenting at ISHRS 2015

By making the requisite number of recipient sites before harvesting, the grafts can be placed as soon as they are extracted. This reduces the critical period of time that grafts are out of the body. Sites created before harvesting have more time to begin healing, and so they exhibit less bleeding. This results in fewer grafts that “pop” out of the recipient site during placement. Mechanical trauma to grafts that need re-positioning after popping is also reduced. Allowing time for recipient sites to begin healing might also provide a more fertile bed for newly implanted grafts to take root. Additionally, pre-making sites provides time for crusts to form on the surface of the wound. Removing these crusts before placement decreases post-operative inflammation and promotes wound healing.

Dr. Bernstein proposed that in some large FUE sessions, in which large numbers of follicular units are transplanted, the surgeon might deliberately delay extraction to allow pre-made recipient sites additional time to heal by creating recipient sites the day before harvesting.

In sum, Dr. Bernstein provided the audience of hair restoration surgeons with a practical modification of the traditional FUE procedure that could impact the outcome of every hair transplant. Given the growth in the number of FUE hair transplants being performed (now about 50% of all hair transplant procedures) and the international platform provided by the ISHRS Annual Scientific Meeting, this small procedural adjustment could have a significant benefit for thousands of hair restoration patients around the world.

Read these publications by Dr. Bernstein on recipient site creation:

Pre-Making Recipient Sites to Increase Graft Survival in Manual and Robotic FUE Procedures (2012)
Robotic Recipient Site Creation in Hair Transplantation (2014)

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New York Post

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.

“Soccer players, football players — they’re admitting they’ve had the surgery. Patients bring in pictures of [George] Clooney, Brad Pitt. The stigma of the old plugs is fading,” [said Dr. Bernstein.]

While celebs aren’t writing signed confessions, there’s plenty of speculation about which high-profile men may have gotten procedures — such as LeBron James, Kevin Costner, John Travolta and Jeremy Piven.

Advancement in hair transplant technology may also be lending a hand. Follicular Unit Transplant (FUT) surgery and newer techniques, such as Robotic FUE, have all but eliminated the old corn-row style “hair plugs” that were commonplace twenty years ago.

The article discusses how the hair restoration industry saw a 27% increase in hair transplant procedures worldwide since 2012. The newest data released by the International Society of Hair Restoration Surgery (ISHRS) values the global surgical hair restoration market at nearly $2.5 billion.

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Dermatologic Surgery - December 2014A 2014 study in the journal Dermatologic Surgery measured follicular unit transection (follicle damage) during the extraction step of a robotic follicular unit extraction (R-FUE) procedure. The study found that robotic transection rates, using the ARTAS Robotic System, compared favorably with non-robotic (manual) FUE transection rates. ((Avram MR, Watkins SA. “Robotic follicular unit extraction in hair transplantation.” Dermatol Surg. 2014 Dec;40(12):1319-27))

The researchers found the average rate of transection over many robotic procedures to be 6.6%. This rate compared favorably to an average manual transection rate of 6.14% reported in a 2006 study ((Harris JA. “New methodology and instrumentation for follicular unit extraction: lower follicle transection rates and expanded patient candidacy.” Dermatol Surg. 2006;32:56–612.)) and was significantly lower than an average transection rate of 17.3% reported in 2008 study using manual techniques. ((Onda M, Igawa HH, Inoue K, Tanino R. “Novel technique of follicular unit extraction hair transplantation with a powered punching device.” Dermatol Surg. 2008;34:1683–8.))

While the study’s robotic FUE transection rates compared favorably to two reported manual transection rates, the authors stressed that more well-designed studies comparing robotic to manual FUE are needed.

The authors noted that “The main advantages of robotic FUE compared with the standard ellipse are its minimally invasive nature and the lack of a linear scar.”

This paper was reviewed by Dr. Bernstein. ((Bernstein RM. “Commentary on Robotic Follicular Unit Extraction in Hair Transplantation.” Dermatol Surg. 2015;41:279.))

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Dr. Bernstein Presenting at ARTAS® User Group Meeting 2015Dr. Bernstein Presenting at ARTAS User Group Meeting 2015

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 7th, 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.

In robotic graft selection, the hair restoration surgeon programs the ARTAS robot to harvest follicular units based on the number of hairs in each unit. The robot first selects and then isolates larger follicular units of 2-hairs or more. If too few 1-hair units are extracted, the surgeon can program a second pass at extracting only the smallest grafts. As an alternative, the larger units can be divided into smaller ones using stereo-microscopic dissection. The goal is to both minimize wounding and harvest an adequate distribution of varying size follicular units to satisfy the surgeon’s, and ultimately the patient’s, aesthetic hair restoration needs. The new robotic graft selection system enables the robot to intelligently and efficiently harvest follicular units.

Results of the bilateral pilot study showed that the robot’s new graft selection capability was superior to random graft selection, the robot’s default setting, in the amount of hairs extracted per harvest attempt. Dr. Bernstein described how he was able to generate more transplantable grafts with fewer attempts at harvesting. By splitting larger follicular units into smaller grafts under stereo-microscopic dissection, he was able to produce additional grafts for use in the transplant without causing further wounding.

When the new computerized graft selection capability is coupled with dissection of larger units, the result is a substantial improvement over randomized graft selection. Read more about Robotic Graft Selection and the pilot study.

Dr. Bernstein also updated the meeting attendees on the robot’s recipient site creation technique that he introduced the prior year and some best practices in incorporating the ARTAS Hair Studio software into clinical practice.

Click here to read about Robotic Follicular Unit Graft Selection

Click here to read about Robotic Hair Transplants


ARTAS User Group Meeting 2015

Dr. Bernstein Presenting at ARTAS User Group Meeting 2015
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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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The Aesthetic Guide - ARTAS® Improves Hair Graft Accuracy and Consistency

Dr. Robert Bernstein discusses the benefits of the ARTAS® Robotic Hair Transplant system in The Aesthetic Guide, a leading periodical in the field of aesthetic surgery. The article examines how robotic Follicular Unit Extraction (FUE) procedures are an improvement over FUE using handheld devices.

In the article, Dr. Bernstein explains how surgeons performing manual FUE need to calculate the angle, spacing, direction, depth, and orientation for each follicular unit harvested. The fact that this process must be repeated up to thousands of times per patient gives the manual FUE procedure significant variability.

Dr. Bernstein touches on a key reason why the image-guided robot is an improvement over manual techniques:

“The ARTAS robot is one of the first technologies used in practice where the computer of the robot is actually obtaining feedback from the anatomy of the patient. In this case, the robot is getting feedback regarding the distribution and direction of hair follicles. That information is communicated to the computer in real time and the computer makes adjustments as it continues to harvest the grafts, which is why the system is so accurate.”

The robot’s capability of making microscopic adjustments in real time, based on the characteristics of the patient’s skin, is a technological breakthrough in the field of hair restoration. Not only does the robot not tire when performing thousands of graft dissections, it estimates the position of the follicle under the skin more reliably than a human. According to Dr. Bernstein; “the accuracy of the robot remains consistent,” throughout the entire procedure, graft by graft.

The Aesthetic Guide - ARTAS Improves Hair Graft Accuracy and Consistency

This accuracy and consistency is critical in a hair transplant because the yield of healthy, viable grafts is one of the key factors in a successful procedure. If a surgeon, using manual techniques, transects (or cuts) a graft or doesn’t cut deeply enough into the skin tissue, then that graft might not survive the transplant. If a number of transected or damaged grafts don’t survive the transplant, then the result of the procedure will be limited in the aesthetic benefit that the surgery was designed to provide.

The article, which is titled “ARTAS Improves Hair Graft Accuracy and Consistency,” notes that Dr. Bernstein was one of the first physicians in the United States to use FUE robot in his practice, “one of the leading hair restoration centers in the country.”

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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.

Spencer Kobren: It’s great to have you back. And I know you only have about a half an hour – actually about 20 minutes now… Let’s get straight to the point. You heard my opening, you kind of know how I feel about the way that the industry is moving, the direction the industry is moving in, and also my concern about now that these devices are really starting to become a bigger part of the market, I believe that these devices are getting into the wrong hands. Now let’s just start with why you’ve embraced it and then we can go into how the industry is evolving.

Dr. Bernstein: Follicular Unit Transplantation via strip was a pretty straight-forward procedure, and once we figured out how to use microscopes to dissect out the follicular units and train the staff on microscopic dissection, it was pretty much a slam dunk. It was just a question of other doctors embracing it and patients understanding what it is and demanding the procedure. With Follicular Unit Extraction it’s really a much different animal. The technique is very, very tricky. And the reason why it’s tricky is because the dissection is done essentially blind. The hair follicle changes direction as it goes deeper in the skin, and also the hairs that comprise a follicular unit splay outward — they fan outwards — so it’s very tricky to get a very small punch around an intact follicular unit. When you do this by hand thousands of times, it’s really, really hard for a physician to concentrate and be consistent and not get bored out of his mind. Also, you don’t have all the visual cues that you have under a microscope. So this repetitive procedure lends itself to robotics. For years we worked on the technique, first with a sharp punch, then a dull punch, then a two-step technique where we used a sharp punch to score the skin and then a deeper [duller] punch under it. Each got better and better, but it never was really consistent, and it certainly was very, very dependent on the user, the patient, and how you’re feeling that day. So this procedure lends itself to robotics. I first learned about the robotic procedure very early in 2011 and when I first saw the robot it made total sense to me.

The Bald Truth is America’s longest running self help radio show for men’s hair loss. Kobren is the Founder and President of the American Hair Loss Association and a founder of the International Alliance of Hair Restoration Surgeons (IAHRS).

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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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Columbia BusinessDr. Bernstein is featured in Columbia Business, the alumni magazine of the Columbia Business School, for having “revolutionized the field of hair restoration.” Dr. Bernstein, who received an MBA from the renowned university in 2004, is quoted as having seen an opportunity in 1995 to transform hair transplantation from a procedure using “hair plugs” to one with significantly more natural results. In collaboration with Dr. William Rassman he introduced Follicular Unit Transplantation (FUT) which, the article notes, is now the “gold standard” for modern surgical hair restoration.

Also mentioned in the article, which is titled “Hair Hero,” are his pioneering work in robotic hair transplant procedures, his receiving the Platinum Follicle Award, and his appearances in the popular media including a feature on Good Morning America.

Dr. Bernstein is a Clinical Professor of Dermatology at the College of Physicians & Surgeons of Columbia University, where he instructs residents in general dermatology and the specialized art of hair restoration surgery.

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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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Dr. Bernstein, ARTAS Robot for FUE in Brazil's Veja MagazineDr. 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.”

The article describes how the ARTAS System improves on traditional FUE procedures. It contains a diagram which shows that the hair transplant robot can extract almost twice as many follicular units as extraction techniques that use manual methods. Whereas manual procedures can yield about 400 follicular units in one hour, the robot for FUE can extract 750 units in an hour. The article indicates that the total duration of a hair transplant procedure can be significantly reduced using the new robotic system.

The magazine, which focuses on Brazilian business and culture, quotes Dr. Bernstein:

“É muito difícil retirar os folículos manualmente”, diz Robert Bernstein, um dos pioneiros a fazer o transplante capilar manual e a user o ARTAS.”

Translated, it reads:

“It is very difficult to manually remove the follicles,” says Dr. Robert Bernstein, one of the pioneers of manual hair transplants and of the ARTAS System.

The person pictured with the article is celebrity actor Bruce Willis. Under the photo is the caption “Duro de Crescer: Raros são os atores, como Bruce Willis, para quem a ausência de fios só faz aumentar o charme.” This translates to: “Hard to Grow: Rare are the actors like Bruce Willis, for whom the absence of hair increases the charm.”

Bernstein Medical – Center for Hair Restoration treats patients from all over the world, including Brazil and South America. Anyone who is unable to visit our center in New York City for a consultation may submit a photo consultation.

Read more about the benefits of Robotic FUE

Read about our hair restoration patients

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

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

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

Program biography on Dr. Bernstein

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

Dr. Bernstein’s comments on roundtable discussion

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

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

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

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

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

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

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

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

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

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

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

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

Read about the latest in Robotic FUE

Read about how Dr. Bernstein has improved Robotic FUE procedures

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New York, NY (PRWEB) — Robert M. Bernstein, M.D., F.A.A.D., A.B.H.R.S., a world-renowned hair transplant surgeon, presented a series of improvements to hair transplant procedures which use the ARTAS Robotic System for Follicular Unit Extraction (FUE). These updates include revisions to the FUE surgical protocol and technical adjustments to the robotic extraction system. He presented his refinements at the first user meeting held by the developers of the system; Restoration Robotics, Inc.; on September 14 – 16 in Denver, Colorado.

Dr. Bernstein receives recognition from Restoration RoboticsDr. Bernstein receives recognition from Restoration Robotics

Dr. Bernstein described his series of improvements in a lecture to an elite group of physicians who are among the first adopters in the industry of the image-guided, robotic-assisted system. The updates are designed to improve the results of FUE hair transplantation by enhancing both the surgical protocols of the procedure as well as the functionality of the robotic system. In FUE, small groups of one to four hairs, called follicular units, are extracted individually from the back and sides of the scalp and are then implanted into recipient sites, which are tiny holes that the surgeon creates in a balding area of the scalp.

Dr. Bernstein discussing robotic-assisted FUE at Restoration Robotics' first user meetingDr. Bernstein discussing robotic-assisted FUE at Restoration Robotics’ first user meeting

The most important update to the FUE procedure that Dr. Bernstein proposed is for surgeons to create recipient sites before they extract the grafts, rather than create the sites after grafts are extracted. Drawing on his decades of experience in hair transplantation, Dr. Bernstein developed this technique of “pre-making” recipient sites in order to maximize survival of the grafts during the hair transplant. Using this technique, extracted grafts are outside the body for a shorter duration of time. It also minimizes instances of “popping,” in which grafts are exposed to desiccation (drying) and hypoxia (low oxygen) before they are inserted back into the scalp. By “pre-making” the recipient sites, these harmful factors are mitigated and a greater number of the grafts grow into viable, hair-producing follicular units. Dr. Bernstein encourages surgeons to use this technique on all FUE procedures, whether using manual methods or robotic instrumentation.

When asked to comment on his improvements to the robotic FUE procedure, Dr. Bernstein said:

“It was fortuitous timing that the ARTAS Robot became available just as I was developing my refinements to the FUE procedure. The combination of the automated robot for graft extraction with the technique of pre-making recipient sites has led to a significant improvement in hair transplant surgery.”

Dr. Bernstein is the founder of Bernstein Medical – Center for Hair Restoration, and he is recognized world-wide for his innovative work in the treatment of hair loss. He is among the first hair transplant surgeons in North America to utilize the ARTAS Robot for FUE in his practice.

Being an early adopter of the advanced follicular unit extraction system has enabled him to work with Restoration Robotics to refine it to his exacting standards. Dr. Bernstein has, again, put his fingerprints on a revolutionary upgrade to the hair transplantation industry. He was the first to describe FUT and FUE procedures in the medical literature, in 1995 and 2002 respectively. In contrast to FUE, where follicular units are extracted individually, in FUT procedures a strip of skin is removed from the back of the scalp, it is then dissected into follicular units, and those follicular unit grafts are then implanted into recipient sites in the patient’s scalp.

About Dr. Bernstein

Robert M. Bernstein, M.D., F.A.A.D., A.B.H.R.S. is a Clinical Professor of Dermatology at Columbia University and a pioneer in the field of hair restoration. His landmark scientific papers are considered seminal works in the field of hair transplant surgery, and he is the most widely published author on the topic having published more than sixty articles, editorial reviews, books, and textbook chapters.

Dr. Bernstein has been selected as one of New York Magazine’s “Best Doctor’s” for thirteen consecutive years and he has appeared as a hair loss and hair transplantation expert on The Oprah Winfrey Show, The Dr. Oz Show, Good Morning America, The Today Show, The Discovery Channel, CBS News, Fox News, and National Public Radio. Dr. Bernstein has been interviewed or featured in articles in GQ Magazine, Men’s Health, Interview Magazine, Vogue, the New York Times, and others.

About Bernstein Medical – Center for Hair Restoration

Bernstein Medical – Center for Hair Restoration is a state-of-the-art hair restoration facility and international referral center, located in midtown Manhattan, New York City. The center is dedicated to the diagnosis and treatment of hair loss in men and women. Hair transplant surgery, hair repair surgery, and eyebrow restoration are performed using Dr. Bernstein’s pioneering techniques of Follicular Unit Transplantation (FUT) and robotic Follicular Unit Extraction (R-FUE).

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Dr. Bernstein Featured With "First Of Its Kind" Robotic Hair Transplant System On NY1
Dr. Bernstein with ARTAS System for Robotic FUE

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.

The segment also reports that Dr. Bernstein is among the first hair transplant physicians to use the technology:

Removing those units has always proved to be the toughest part of this method, but the robot changes that, which is why even Dr. Robert Bernstein — the man who’s widely credited with developing follicular unit transplantation and follicular unit extraction — jumped to be among the first in the U.S. to use the device.

Dr. Bernstein speaks to one of the main benefits of the robot, the increased efficiency in extracting follicular unit grafts.

NY1 serves 2.1 million people in the tri-state area, including all five boroughs — Manhattan, Brooklyn, Queens, Staten Island, and The Bronx –– parts of Westchester and Hudson Valley, as well as cities and towns in Bergen County and Hudson County in New Jersey.

Read more about Robotic Hair Transplantation

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Dr. Bernstein Touts Benefits Of Robotic FUE On Bloomberg TV
Dr. Bernstein discusses the ARTAS Robot for FUE

Dr. Bernstein spoke with Bloomberg’s Matt Miller about the future of hair transplantation in a segment called, “The Bald Economy: Surgical Solutions to Hair Loss.”

Here is an excerpt from the segment:

Bloomberg’s Matt Miller: Riding the wave into the future happens to be one of the pioneers of FUE, Dr. Robert Bernstein.

Dr. Bernstein: “The robot now allows a mechanized system to do [follicular unit extraction] very, very quickly and very consistently, so that the human error in this part of the procedure is now gone.”

Matt Miller: That’s right, a robot. Dr. Bernstein is piloting a high-tech solution called ARTAS.

Dr. Bernstein: “What it is very precise at doing is getting around the follicular unit to separate it from the tissue.”

Matt Miller: The procedure, which costs twice as much as the standard surgery, has one clear advantage.

Dr. Bernstein: “The difference is, in the back, in the area where we take the hair, there will be little tiny dots that just fade into the scalp.”

Read more about the ARTAS Robot for FUE and Robotic Hair Transplantation

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Dr. Bernstein discusses ARTAS Robotic FUE system on NY1

NY1, a New York City television channel, has featured Dr. Bernstein in a segment on robotic hair transplantation.

Here is a transcript of the video:

A new robot could help return hair to those of us who, as we get older, find ourselves a bit follically challenged. Called the ARTAS System from Restoration Robotics, it was recently approved by the FDA to help with a type of hair transplantation technique called follicular unit transplantation where follicular units, groups of one to four hairs, are removed directly from the back of the head and transplanted on the top and front. Removing those units has always proved to be the toughest part of this method, but the robot changes that, which is why even Dr. Robert Bernstein – the man who’s widely credited with developing follicular unit transplantation and [follicular unit extraction] – jumped to be among the first in the U.S. to use the device.

“A follicular unit is about a half a millimeter and you have a one-millimeter circle that has to go dead center over it to punch this out. So when you’re doing it by eye and you’re doing thousands of them over time you’re missing them over time it’s not exactly precise. The robot is dead center each time and follows the angle of the hair,” explains Bernstein.

While the robot doesn’t really have any direct impact on how the transplant will ultimately look – that’s still up to the doctor’s expertise and artistic skill. What it does do is give the doctor a better quality sample of hair with which to work.

“There’s always damage to the follicles when you’re doing it because you’re doing it by hand through these very tiny incisions and so the yield is going to be less and so with a robot if you try to get out 100 follicles you’ll get very close to 100 follicles,” says Bernstein.

Again, the robot just makes the incision, the doctor still has to pull the hair, make sites on the front where the transplants will go and then actually make the transplants. However, developers say they are working on having future versions of the ARTAS System help with the entire process.

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Interview Magazine: Dr. Bernstein a Game-Changing Hair Transplant PioneerDr. Bernstein with ARTAS Robot in New York City Facility

Interview Magazine is known for its glamorous and often edgy depictions of, and insights into, the lives of fashion and movie celebrities, musicians, and other artists. The February 2012 issue features a section on the “elite league of experts” who celebs are increasingly turning to in order to maintain their high profile image. The article describes Dr. Bernstein as a “pioneer in the world of hair replacement surgery,” and as the hair transplant surgeon of choice for “VIP clients from the world of fashion and entertainment.”

Dr. Bernstein’s publication “Follicular Transplantation” is referred to as a game-changing paper that has directly led to modern techniques, including the robotic hair transplant procedures currently being performed at Bernstein Medical – Center for Hair Restoration in New York City.

The article touches on one aspect of hair transplantation that Dr. Bernstein makes clear to all hair restoration patients in their initial consultation, and that is the fact that surgical procedures are not always recommended or indicated for a patient. As he says in the article, “Surgery is a personal option and a serious business, so I don’t oversell it.”

Watch a video clip of Dr. Bernstein describing his approach to addressing patients’ hair loss.

The photograph of Dr. Bernstein that accompanies the article — a small version of which is above — is an artist’s view of Dr. Bernstein using the ARTAS Robot for FUE. The emotion of the image is heightened by the subtle connection he makes with the patient with his outstretched arm, exhibiting the care and consideration for his patients’ condition that is the hallmark of Dr. Bernstein’s practice.

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Eyebrow transplant and restoration article - New York TimesThe New York Times, once again, has recognized Dr. Bernstein’s pioneering hair restoration techniques. The NYT Fashion and Style section noted that he is, “the first hair transplant surgeon on the east coast,” to use the ARTAS robotic system for Follicular Unit Extraction.

This precision, image-guided robot is unique in its, “use of digital mapping and tracking to extract and harvest ‘follicular units.'”

For more information about the ARTAS System see our Robotic Hair Transplantation section of our website.

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Dr. Bernstein in Japanese Magazine
Dr. Bernstein and ARTAS Robot

Dr. Bernstein’s pioneering work in developing FUT and FUE hair transplant procedures has influenced hair restoration physicians across the globe. Recently, his use of the ARTAS System for robotic FUE has grabbed international attention.

Yomitime, a Japanese web-zine, recently featured Dr. Bernstein and his foray into robotic hair restoration. The article describes the “cutting-edge” ARTAS robot, while also covering the basics of Dr. Bernstein’s FUT and FUE procedures.

Patients of Bernstein Medical fly in from around the globe to receive world-class treatment for their hair loss. This past year alone he has treated patients from India, Japan, South Korea, Saudi Arabia, Mexico, France, Germany, United Arab Emirates, Brazil, Israel, the UK and Russia.

For more about visiting our office from abroad, visit Our Patients in the New Patient Information section. Or, to have a consultation with Dr. Bernstein via the internet, visit our Photo Consult page and submit the form.

If you can read Japanese, download the article here.

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ARTAS at Bernstein Medical

You don’t have to be interested in a hair transplant to appreciate the advanced technology in the ARTAS system for robotic FUE. That is why the technology and media website “All Things D” has featured the image-guided hair restoration robot in an article titled, “All I Want for Christmas is a Robot Hair Transplant.”

The article gives the reader an overview of the system and why it is beneficial. Dr. Bernstein provided some insight for the piece, particularly regarding the reduction of human error that can occur in long procedures. The article also notes that, as of the date of publication, there are only four ARTAS robotic systems in use in the United States. The system in use at Bernstein Medical is the only one on the East Coast.

For a more detailed description of the system, how it works, and its benefits please visit our section on Robotic Hair Transplantation.

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ARTAS at Bernstein Medical - Center for Hair Restoration
Dr. Bernstein and Staff with ARTAS System

We are pleased to announce that robotic FUE is now available at Bernstein Medical – Center for Hair Restoration. This is a major advance in FUE technology.

The ARTAS system for hair restoration allows us to more effectively isolate follicular unit grafts from the donor area of the scalp without causing damage to individual follicles, a problem that has been a limitation of manual FUE techniques. Many other important parts of the FUE procedure will still be performed by the physician and team, including actual removal of the follicular units from the scalp, recipient site creation, and graft placement. The aesthetic elements that give a hair transplant a natural-looking result will still be in the hands of the physician. Read more about the benefits of robotic hair transplantation.

We are proud of the cutting-edge work we do in our state-of-the-art medical facility and are excited as we take FUE hair transplantation to the next level.

View our press release about the ARTAS system at Bernstein Medical.

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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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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.

Read more about developments in Robotic FUE

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