Q: I thought that FUE extraction is performed in a way that it cannot be detected. Therefore, it is best to distribute the pattern evenly starting from the safe zone and fading out on the sides. The ARTAS results often show a smaller extraction area and harder edges (no transition from extraction to non-extraction area). Does this lead to a higher risk to detect the surgery? — H.K. ~ Chicago, I.L.
A: Feathering of the extraction zone in FUE is a technique where the distance between the extractions gradually increases as one reaches the border of the extracted zone. When this technique should be used depends upon the short- and long-term goals of the patient. If the patient’s main goal of the FUE procedure is to wear their hair very short, then the technique of feathering and rounding the edges to have a less distinct border is appropriate, as this will decrease the visibility of the harvested area.
However, if a person does not wear his hair very short (nor plans to) and maximizing the donor supply is paramount, then a more organized pattern, with less feathering, will give a greater long-term yield and a more even distribution. The reason is that the healing of FUE wounds distorts adjacent follicular units making subsequent extraction in the same regions more difficult and increases the risk of transection. For this reason, in subsequent procedures we generally prefer to harvest in new areas. If we need to harvest more hair from the same area, we rarely go back more than once.
When one feathers extensively in the donor area, this utilizes a larger surface area of the scalp with less graft yield, so it may become necessary to go back over the same area to obtain additional grafts, often multiple times. This risks increased transection and an uneven, mottled appearance to the donor area.
If a person wears his hair very short, then feathering is critical (even though it makes subsequent extraction more problematic). It is very easy to feather and round edges with the ARTAS robot, but we make the decision to do so based upon the specific needs and goals of the patient.
Q: Is it true that manual FUE hair transplant procedures are better than robotic hair transplants because the physician can adjust and feel the follicle when extracting? — M.H. ~ Great Neck, N.Y.
A: The ARTAS robot is a physician controlled, computerized device that uses a three-dimensional optical system to isolate follicular units from the back of the scalp in a hair transplant. The robotic system assists the physician in the extraction of grafts with precision and speed. Although there is some advantage to having “human feel” for the tissue, this is far outweighed by the fact that repetitive procedures performed manually thousands of times lead to operator fatigue and result in increased transection and damage to grafts. With the ARTAS robotic system, the quality of the first and the last graft harvested will be the same.
Read about advantages of the ARTAS Robot over manual FUE procedures
Q: I have read that the ARTAS System works best on straight black hair. Is this an option for gray hair? How about wavy or curly hair? – P.W., Fort Lee, NJ
A: The ARTAS robotic system can be used in patients with any hair color although in order for the robot to visualize white hair (or very light blond hair) the hair must be dyed. Curly hair is also not a problem as the donor hair in a robotic procedure is shaved to approximately 1 mm in length so a wave or curl is eliminated. In patients of African descent, where the hair below the surface of the skin may be curved, a slightly larger punch can be used. we have patients dye their hair the evening before or the day of the procedure. For convenience, only the hair in the donor area (back and sides) where the robot will be doing the harvesting needs to be dyed.
In patients who prefer not to shave or dye the entire back and sides of the scalp, we can perform the ARTAS robotic FUE using the long-hair technique. With this technique, you will grow your hair on the back and sides of the scalp a bit longer so it can cover the harvested area. On the day of the procedure, we will lift up the hair, clip a long thin band of donor hair and then extract follicular units from this limited region of the scalp. After the procedure, you can simply comb down your hair to cover the donor zone. The area that has been harvested (and possibly dyed depending on your hair color) will not be visible.
- Read about the ARTAS Robotic System
- Read about dying white hair in advance of Robotic FUE
- Read about the long-hair Robotic FUE technique
Q: How are specifications for making recipient sites inputted into the ARTAS® robot? — A.F., Queens, NY
A: At the outset of the procedure, the physician sits at a computer terminal that is connected to the ARTAS Robot and enters the specifications directly into the robot’s software. Variables programmed in this manner include the number of recipient sites, density of sites, angle that the hair will extrude from the skin, depth of recipient sites, and the minimum distance away from existing hair follicles that a site can be created.
- Read about Robotic Hair Transplants
- Read about the ARTAS Robotic System
- More details on Robotic Recipient Site Creation
Q: Will the ARTAS robot result in a lower cost for an FUE hair transplant? — F.K., Ditmars Boulevard, NY
A: Robotic FUE may cost slightly more per graft than a typical manual FUE procedure due to the greater expense of this new technology. At Bernstein Medical, we use the ARTAS Robotic System for all Follicular Unit Extraction (FUE) procedures.
Q: How does the ARTAS System avoid damaging hair follicles in the balding area during recipient site creation? — R.K., Brooklyn, NY
A: The ARTAS robot‘s optical guidance system enables it to accurately create recipient sites in areas of thinning hair without damaging existing hair follicles. During the recipient site creation process, the robot uses its advanced image-guided optical system to scan the surface of the skin, locate existing hair follicles in the recipient area, and then create recipient sites at a specified distance from these existing hairs.
The ARTAS robot carries out this process rapidly, accurately, and consistently according to the physician’s programmed specifications. Thanks to the microscopic precision of the image-guided technology, the robotic hair transplant system can avoid injury to follicles that can result when Follicular Unit Extraction (FUE) is performed using manual techniques.
- Read about Robotic Hair Transplants
- Read about the ARTAS Robotic System
- More details on Robotic Recipient Site Creation
Q: Why is using the robot to create recipient sites useful in a hair transplant? — S.K., Jersey City, NJ
A: The ARTAS® Robotic Hair Transplant system eliminates the inconsistencies inherent in creating large numbers of recipient sites by hand. The robot can create sites at a rate of up to 2,000 per hour. Although there is more set-up time compared to sites made manually, once the physician specifies the parameters such as punch depth, punch angle, and site direction, recipient site creation is precise and rapid.
One of the benefits of robotic site creation is that the distribution of grafts over a fixed area of the scalp can be exact. For example, if one wants to transplant 1,000 grafts evenly over 50cm2 of area, this can be done with great precision and with uniform site spacing. In addition, the physician can vary the densities in select regions of the scalp and the robot will adjust the densities in other areas so that the total number of sites remains the same.
Another benefit of the new technology is that the robot can be programmed to avoid existing hair and select which specific hair diameters to avoid. The robot is programmed to keep a specified distance from the existing hair to ensure that the resident follicles will not be damaged and that the distribution of new hair is even and natural. This computerized mechanism appears to be more accurate than what can be done by hand and, importantly, does not sacrifice speed in the process.
Q: How do recipient sites get made in Robotic FUE? And how does the robot know where to create the sites? — K.K., Bergen County, NJ
A: In performing recipient site creation, the ARTAS Robotic Hair Transplant system automates another part of the hair transplant process that is repetitive and prone to human error. In robotic site creation, the physician first designs the hair restoration and then specifies the angle of hair elevation, hair direction, site depth, average density, and total number of the recipient site incisions. The robot then creates the sites according to these specifications.
During site creation, the robot automatically uses its image-guided technology to avoid hairs of a certain diameter (specified by the doctor). The robot creates sites at a minimum distance from hairs of the specified diameter (the distance is also specified by the physician) and will do so randomly throughout the areas where the hair is finer or the scalp is bald. With this important feature, the new distribution of sites can be made to complement the distribution of existing hair. Observation of the ARTAS System suggests that it performs recipient site creation with greater precision and consistency than can be accomplished manually.
Q: What is the main difference between hair transplants using the robot versus other procedures? — M.P., Flatiron, NY
A: There are two basic types of hair transplant procedures, Follicular Unit Transplantation (FUT or strip surgery) and Follicular Unit Extraction (FUE).
In FUT, donor hair is harvested by removing a long thin strip from the back of the scalp. Individual follicular units are then obtained from this strip using stereo-microscopic dissection. In FUE, individual follicular units are harvested directly from the donor area using a sharp, round cutting instrument.
The ARTAS Robotic System performs the follicular unit isolation step of an FUE procedure and can also create recipient sites according to specifications determined by the hair restoration surgeon. In performing each of these steps, the robot uses its image-guided technology to locate the next target and position the cutting instrument, and it does so with precision and speed that cannot be accomplished using manual FUE techniques or instruments.
Q: I have been reading about Robotic FUE and have seen some photos on your website of you operating the ARTAS robot using what looks like a remote control. What is that thing and how does it control the robot? — C.B., Greenwich, CT
Dr. Bernstein Operating the ARTAS FUE Robot
A: The ARTAS robot uses a dual operating system when performing follicular unit extraction. One station consists of a desktop computer adjacent to the robot. This station is used to establish the basic parameters of the transplant such as the spacing of grafts, the angle and depth of the harvest, which size follicular units will be targeted, and a host of other important variables.
The hand-held pendant is used by the operator situated next to the patient. The remote has more limited options – the main ones being depth adjustment and to immediately suspend the action of the robot. Many of the parameters are determined automatically by the robot’s computer to maximize the accuracy of the harvesting. The robot also makes real-time adjustments to these variables during the hair restoration procedure.
The physician sets the parameters at the computer monitor and, once the settings are determined, he/she sets the tensioner grid on the patient’s scalp. The tensioner determines where the grafts will be harvested. The grid is moved approximately every 130 harvests. The robot can be operated at the computer terminal and through a mobile pendant. The physician often alternates with a trained assistant between that station and using the pendant.
Besides the involvement in the operation of the robot, there are many other important physician-dependent steps to the hair transplant including the planning and design of the procedure, and recipient site creation. Other steps, such as the microscopic sorting and trimming of harvested follicular unit grafts and graft placement, are often performed by trained staff, but require the physician’s close supervision.
Q: How does the ARTAS robot control the depth of the incision in Robotic FUE? — B.V., Old Greenwich, CT
A: The ARTAS robotic system is equipped with advanced sensors that determine the precise depth of the sharp and blunt needles used both in the graft harvesting step and for recipient site creation. The robot automatically adjusts to the precise depth needed for the non-traumatic extraction of the grafts. The tip of the punching mechanism contains depth markings so that the physician can visually override the punch when he wants to fine-tune its action. While monitoring the procedure in real time, if it is observed that the punches are too superficial or too deep, punch depth can be modified using the robot’s computer system.
The physician can also use the ARTAS system to precisely control the depth of recipient sites. As with harvesting, the robot automatically adjusts the depth based on parameters set by the physician and the doctor can then make further adjustments, in real-time, during the procedure.
Q: Does Follicular Unit Extraction performed by a robot hurt more than regular FUE? — R.T., Greenwich, CT
A: As with manual FUE, robotic FUE hair transplantation is an outpatient procedure performed under long-acting local anesthesia – a combination of lidocaine and bupivacaine. After the initial injections, the patient does not experience any pain or discomfort.
Before starting local anesthesia, we give most patients oral valium and intra-muscular midazolam (a very fast acting sedative that is very relaxing). While some patients doze off at the beginning of the procedure, others prefer to watch TV, a film, or just chat.
Local anesthesia generally wears off after 4-5 hours, so for transplant sessions lasting longer than this, we will give more anesthesia before the first wears off. With Robotic FUE, there is no discomfort once the procedure is completed and the anesthesia wears off. This is in stark contrast to an FUT strip procedure which can be uncomfortable in the donor area for days to weeks.
Q: How many follicles can you transplant with robotic FUE compared to manual FUE? — R.V., Upper West Side, N.Y.
A: We can extract the same number of follicles robotically as we can manually.
That said, the goal of any hair transplant procedure is not to transplant as many hair follicles as possible but rather to achieve the best possible cosmetic result given your degree of hair loss and the number of hair follicles available in your donor area.
While there is no difference between robotic and manual FUE in terms of the number of follicles that each procedure can extract, robotic FUE does have the following advantages over manual FUE:
- During the follicular unit extraction (or harvesting) phase of a hair transplant, there is less chance of damaging follicular units using a robot vs. a hand held device (e.g., Neograft), because the robot is more accurate. This means more grafts survive after transplant.
- Robotic graft harvesting times are shorter than manual, e.g., while on average if a physician could manually extract 200-300 grafts per hour, the same physician could robotically extract up to 500-1000 grafts per hour ((Chang, H.H. Robotics, artificial intelligence, and the future of hair transplantation. Prime Dermatology, July/August 2014.)). This means a shorter procedure time for the patient.
Read more about the advantages of Robotic FUE.
Q: I am 26 years old and have been suffering from hair loss for 8 years. I have been on Propecia (finasteride) and Rogaine (minoxidil) during those years. Unfortunately my hair loss has continued to progress aggressively. I am of half African and Caucasian descent, and my hair is curly. I understand that there are certain limitations on having hair transplants before you are 35, however I do not mind having another transplant in a few years, if necessary. — A.L., Rye, N.Y.
A: Although it is possible to have a hair transplant to the crown using robotic FUE in African American patients, given your young age and that you state your hair loss is progressing aggressively while on Propecia and Minoxidil, it is likely not a good decision to have surgery at this time.
The reason is that as your hair loss surrounding the crown expands over time, it may look unnatural to have hair transplanted solely to the crown region.
At your age, it is best to take Propecia (finasteride) and Rogaine (minoxidil), and if a transplant is indicated, to start at your frontal hairline and top of your scalp, the areas that will be most important cosmetically long-term.
Q: I’ve heard that your ARTAS hair transplant robot can now create the recipient site in a hair transplant procedure. Has it been done on humans or is it still in an experimental phase, and if so can you tell if it looks as natural as when the surgeon does it? — P.S., Miami, Fl
A: In February 2014 we introduced new technology that allows the ARTAS Robotic System to assist the surgeon in recipient site creation. We are now using the ARTAS robot to make recipient sites in select hair transplant procedures. If designed and programmed properly by the doctor, robotic assisted recipient site creation can produce a hair transplant result that is as natural as when the surgeon does it by hand.
Q: I have read a bit about the ARTAS robot and how it uses an “image-guided” system, but what does that mean? And how is the robot’s imaging system different than a human surgeon viewing the grafts with the naked eye? — S.V., Middle Village, N.Y.
A: That is a great question and it gets to one of the key benefits of the robotic hair transplant system: its accuracy. When a surgeon is performing FUE using manual techniques, they must wear a headset that magnifies the scalp so they can see the follicular units more clearly than with the naked eye. The surgeon must visually and mentally process subtle nuances of the skin and follicular units for every one of the hundreds or thousands of units that are extracted. The ARTAS robot magnifies the surface of the skin in much the same way, but to a much greater extent. In addition, it is not subject to the limitations of the human eye, or human hand, and it is not subject to human error. The surgeon may not have exact hand-eye coordination. The surgeon may be concentrating on one aspect of the extraction, say following the angle of the hair, but might ignore another important aspect of the follicle, say its depth in the skin or its orientation. And, of course, the surgeon tires, both physically and mentally, from performing the hundreds or thousands of repetitive motions.
The robot’s image-guided system, on the other hand, does not experience these limitations. The robot magnifies the skin, detects each follicular unit and the nuances of the skin/hair characteristics, and then extracts that follicular unit with precision. When the imaging system detects changes to the skin, this new information is fed into the computer in real-time and the system adjusts automatically based on this feedback as it continues to harvest grafts. There is no distracting the robot, and the robot will not forget, or ignore, key variables in the extraction. The robot can extract thousands of follicular units without tiring from repetition or slowing down the extraction.
Based on my own practical experience using the robot, it is clear that the robot’s ability to estimate the position of the follicles under the skin and to extract it with precision is superior to manual techniques. Having used the ARTAS system for over three years, and having helped make improvements to the device since the first iteration, I have seen robotic technology substantially improve the outcome for my patients.
Display: ARTAS Robot Image-Guided System
Q: Is robotic FUE different in the number of follicular unit grafts one can extract compared to manual FUE? — R.V., Stamford, CT
A: We can extract (and transplant) the same number of follicular unit grafts robotically as we can manually?
The goal of a hair transplant is not to simply transplant as many grafts as possible but to achieve the best possible cosmetic result given the number of hair follicles in your donor reserve. Remember, this is always a limited supply.
While there is no difference between robotic and manual FUE in terms of the number of follicular unit grafts that each can extract, robotic FUE does differ from manual FUE in several important ways.
First, there is generally less transection of the hair follicles with robotic FUE, since the method is more precise. This enables us to obtain follicular units with less trauma to the grafts.
Second, while the robot is not necessarily faster than the human surgeon, the robot is much more consistent since, unlike the human surgeon, it never fatigues and the accuracy is maintained throughout the entire procedure.
Read more about Robotic Hair Transplant
Q: I understand that in robotic hair transplantation, a robot performs the extraction part of the FUE procedure. What’s the outlook on the robot doing more of the hair transplant procedure? — B.B., Greenwich, CT
A: Currently, the ARTAS® Robotic System is a technology for extracting grafts. This is the most difficult part of a follicular unit extraction procedure, but it is only one part.
There are two other major parts to the FUE procedure: one part is the creation of recipient sites (in our practice, we create the recipient sites first, so that once we harvest the grafts, we can immediately place them into the scalp), and the other part is graft placement.
Recipient site creation involves more than merely making holes in the recipient area. It involves making decisions on hairline design, graft distribution, hair direction, recipient site size and depth. When done manually, the surgeon first designs the new hairline so that the hair transplant will look as natural as possible, particularly as the person ages. Next, the surgeon will demarcate the extent of the area to be transplanted and decide on the graft distribution (i.e., how much hair will be placed in each part of the scalp) and will then prepare a “recipient site” in the part of the scalp that has lost hair. The surgeon will then manually create incisions in the recipient site into which the follicular units will be placed.
On February 8, 2014, Dr. Bernstein unveiled “recipient site” creation capabilities of the hair transplant robot. These new capabilities allow the doctor to import a hairline design and other markings that have been made on the patient’s scalp directly into the robot. The robot then maps the design onto a precise 3-D model of the patient’s head. The physician can then program the proper distribution, direction and depth of the future recipient sites and the robot then creates the sites according to the physician’s specifications.
Graft placement, the last step, is perhaps the most challenging to automate. Engineers are currently working to design and build the capacity to automate the placement of extracted follicular units into recipient site incisions. Done manually, it requires significant hand-eye coordination and a very slow learning curve. For the hair transplant robot, it will be a significant challenge with development taking several years or more.
Read more about Robotic Hair Transplant
Q: Does transplanted hair grow faster after robotic FUE? — P.P., Flatiron, NY
A: There is no difference in the rate of growth between manual FUE verses robotic FUE. However, with Robotic FUE, the actual growth should be better due to less transection, i.e., less damage to follicles during the harvest.
In general, one can expect transplanted hair to start to grow within two to five months with the transplanted hair taking on its final appearance after approximately one year.
Q: I’ve heard that robotic-assisted FUE is better than manual FUE, but what exactly is the main advantage of Robotic FUE? — N.K., Bergen County, NJ
A: Robotic FUE is a significant improvement over other FUE techniques for a number of reasons. The accuracy and ability of a robot to perform countless repetitive motions are key reasons why robotic techniques are an improvement over manual techniques.
In a manual procedure, the skill and speed of a physician are under constant stress, as he or she must follow the angle and depth of the hair precisely hundreds to thousands of times. This task is almost impossible for even the best surgeons to perform without risking harm to the integrity of the follicles. Entering the skin at the wrong angle risks transecting or cutting the follicles and may render them useless for transplantation. Making too shallow an incision can also damage follicles, as the important base of the follicle can become sheared off when it is subsequently extracted.
The robot is engineered to avoid these problems, and so the number of viable grafts that the robot extracts is increased. As a result, the likelihood of the success of the transplant is greater using the robotic system.
Read more about Robotic Hair Transplant
Q: I’ve heard it takes the artistry of the surgeon to create a natural looking hair transplant. How do you do this with a robot? — S.S., Shanghai, China
A: I currently create the recipient sites by hand using different size needles. They determine the angle, direction and distribution of the grafts, and these three variables determine the aesthetic aspects of the hair transplant.
However, I am working with Restoration Robotics to have the ARTAS System create recipient sites and we are currently beta-testing this technology. The robot can now make very precise recipient sites. The ability of the robot to mimic the art of the surgeon is in the works, and we expect it to be ready in the fall of 2014.
In this new robotic-assisted process, the surgeon designs the hairline and delineates the area to be transplanted directly on the patient’s scalp. The surgeon then photographs the patient’s scalp and feeds the photograph into the robot’s computer to create a digital 3-D image. The doctor, in order to have the robot mimic what he would do by hand, can then manipulate various parameters, such as hair angle, direction and density.
Read more about Recipient Site Creation in a Robotic Hair Transplant
Q: Why does the ARTAS® Robotic System only do FUE, not FUT? — V.Z., Chicago, Illinois
A: Currently the robot is only used for harvesting grafts from the donor area. In FUE, the doctor punches out hundreds to thousands of individual follicular units from the back and sides of the scalp by hand using a small round instrument called a punch. The punch has to be held at exactly the right angle, with just the right pressure applied, stopped at a precise depth and, during this time, rotated (or spun mechanically) without changing the alignment.
As one can imagine, this exhaustingly tedious process can best be done using the precision of a robotic device.
In FUT, the harvesting is done by a surgeon using a scalpel to make a long incision in the back of the scalp. It only takes a few minutes. The harvested strip is removed and then placed under dissecting microscopes where the individual follicular units are isolated. This dissection, thus far, can only be done by hand. There is no robotic technology available to do this.
Harvesting the donor hair, of course, is only one part of a hair transplant. The other steps, recipient site creation (making the holes that the grafts are placed into) and actually placing the grafts into those sites are similar in both FUE and FUT.
It is anticipated that robotic site creation will be available in the fall of 2014 and robotic graft placement, the third and final step, about two years after that. At that time, the robot will be able to perform the entire FUE procedure and the last two parts of the FUT procedure.
Of course, the robot doesn’t do the surgery alone. The physician must input all the information regarding the design and planning of the procedure and closely monitor each step of the robotic process. Unlike automating industrial production, the human scalp has great variability, so there is no one formula that will be appropriate for every patient. Physician skill and involvement is just as important in robotic hair transplantation as it is with every other type of surgical hair restoration procedure.
Q: Is it true that hair transplants can now be done totally by a robot? — M.S., Los Angeles, California
A: The ARTAS Robotic System, developed by Restoration Robotics, is the most advanced technology for extracting grafts (the first and most difficult step in a Follicular Unit Extraction procedure), but it cannot yet do the entire hair transplant procedure, nor can it work without the supervision of the hair restoration surgeon.
Currently, the ARTAS System assists the surgeon in performing the first part of an FUE hair transplant (i.e., the extraction phase) with greater precision and consistency than can be done by hand. Engineers and researchers are currently developing the ARTAS to do the remainder of the procedure as well, i.e., making recipient sites in parts of the scalp that have lost hair and then implanting the harvested grafts into these sites.
The next step, recipient site creation, will be available in the latter half of 2014. Dr. Bernstein is already testing a beta version of this new technology. We anticipate that within two years, under the supervision of the surgeon, the ARTAS robot will be performing most of the FUE hair transplant procedure.
Q: I heard that for someone who has had several strip procedures, the ARTAS robot for FUE does not work because it is programmed to work with “textbook male pattern baldness”, which I no longer have. I thought the scars from previous procedures, as well as the large amount of already transplanted hair, might throw off the robot’s programming (it wouldn’t quite know what to do). But if I am wrong about this then the robot may in fact be the best approach for me. Please advise. — N.C., Paris, France
A: When performing robotic hair transplants on patients with prior surgery, I program the robot to avoid scarred areas – just as we would do visually when performing manual FUE.
Q: I am an African-American man with tight curly hair. Will the FUE robot be able to work on curly hair? — E.O., Manhattan, N.Y.
A: Yes, the ARTAS robot for FUE can be adapted for African-American hair when performing follicular unit extraction. We use a punch that is 0.1mm wider in diameter than the instrument used for Caucasians. It allows us to incorporate the slightly larger volume of tissue that results from the curved hair and enables us to accomplish the hair transplant with less in jury to follicles than if a smaller instrument were used.
See before & after hair transplant photos of patients with curly hair
Read about Robotic Hair Transplantation
Q: I read your post that the ARTAS robot doesn’t work well in patients who want FUE but have blond hair. I have dark skin and hair, does that present a problem for the machine? — J.S., London, England, U.K.
A: The ARTAS Robot performs follicular unit extraction just as well with blond hair as dark hair, but not white hair. It is simple to just to dye the white donor hair prior to the hair transplant procedure. This donor hair will be clipped very short the morning of surgery removed anyway, so it will not present too much of a cosmetic issue.
See before & after hair transplant photos organized by hair character
Q: Can the ARTAS Robot FUE hair transplant be performed on blonds? I heard it only works on dark-haired individuals? — T.W., Jersey City, NJ
A: Correct, robotic FUE doesn’t work well on light-blond or white hair -– but it is easy to dye the hair prior to surgery, and this will solve the problem. We generally advise patients to dye their hair two to three days prior to the procedure so that any residue of the dying still on the scalp can be washed off.
Read more about Robotic FUE Hair Transplantation
Q: I wanted to find out about the difference between what Dr. Bernstein does with his robotic system versus NeoGraft. — G.M., Newark, NJ
A: The ARTAS robotic system, used at Bernstein Medical, has robotic control, video imaging and uses a blunt dissection technique. This allows for very precise extraction of follicular units from the donor area with minimal transection. The Neograft machine for FUE is a manually operated machine which uses sharp edge dissection. Because it relies on manual controls rather than robotics, it is less accurate and the cutting tip causes more graft injury. The precision of the robot allows the grafts to be harvested with less trauma and will thus result in better growth. In my opinion, these differences are very significant.
Read more about the differences between the ARTAS Robot and Neograft
Q: Is robotic FUE hair transplantation more expensive than traditional Follicular Unit Extraction? — K.M., Wayne, NJ
A: In our practice, we charge the same per graft for both procedures. However, there is a slightly higher minimum fee for robotic FUE procedures. See our Hair Transplant Costs & Consultation Fees page.
Q: Does the robotic hair transplant system do the whole operation or does the doctor do any of it? — B.W., Brooklyn, NY
A: The ARTAS robot only performs a small part of the FUE procedure, although it is an important one. FUE comprises four basic steps:
- Isolation of follicular units from the surrounding skin
- Removal of follicular units from the scalp
- Making recipient sites
- Placing grafts into these sites
The robot only performs the first step, follicular unit isolation.
Even in this first step, however, physician control is extremely important, as the doctor must determine the precise depth to which both the sharp and blunt dissection are set. They must also make constant adjustments to the angle that aligns the instrument with the graft.
The ARTAS robotic system gets all of its cues from the surface of the skin, so that it can place the target follicular unit in the exact center of the cutting field of the robotic tip. It can also align the tip parallel with the emergent hairs. However, the angle of the hair as it emerges from the scalp is slightly different than the angle below the skin and the doctor needs to tell the robot what this angle is. Fortunately, the robotic imaging system provides the doctor with the information he needs to make this determination.
Read about Robotic Hair Transplantation.
Q: Is Robotic FUE faster than traditional FUE hair transplants? — F.W., Hoboken, NJ
A: Yes. Although, the speed of removal per graft is about the same, the actual procedure time is shortened when using the robotic device. The ARTAS robotic FUE system has a longer set-up time, but this is more than offset by the fact that the robot doesn’t “tire” during longer procedures.
For more information, visit the page on Robotic FUE Hair Transplantation or read answers to questions on Robotic FUE.
Q: How many different kinds of robotic devices are there? — T.R., Boca Raton, FL
A: There is only one, the robot called the ARTAS System for FUE, made by Restoration Robotics. The Neograft machine, occasionally confused with a robotic device, is actually a hand-held instrument that is not robotically controlled and lacks image-based tracking. It is, therefore, not capable of eliminating the operator error and variability of hand operated devices and does not decrease the damage to follicles, called transection, inherent in manual techniques.
Read more about Robotic FUE hair transplantation.
Q: Does Robotic FUE leave any scars? — T.B, White Plains, NY
A: Robotic FUE leaves the same tiny, white scars in the donor area produced by manual Follicular Unit Extraction.
Q: What is the main difference between NeoGraft and the ARTAS™ robotic system? — H.T., Staten Island, NY
A: The Neograft device is basically a powered FUE tool. It is still done by hand and therefore risks operator induced errors and damage to hair follicles. The ARTAS System, made by Restoration Robotics, uses electronic image-based tracking capabilities to map the individual follicular units. It does so to determine the optimal approach for automated graft harvesting. The robotic harvesting device produces consistently high quality grafts and low dissection rates.
For more information on these systems, visit the Follicular Unit Extraction (FUE) section or read Dr. Bernstein’s answers to questions on Robotics.
Read about Robotic FUE Hair Transplantation
Q: With the ARTAS™ robotic system for FUE hair transplantation, by Restoration Robotics, what part of the FUE hair transplant procedure can actually be done by the robot? — A.M., Los Angeles, CA
A: The ARTAS System is a computer-guided method of harvesting follicular units in the donor area during Follicular Unit Extraction (FUE). The initial phase of FUE, where the follicles are selected, scored and separated from the surrounding scalp is done by the ARTAS System. All other phases of the procedure including; actual follicular unit graft removal from the scalp, hairline design, recipient site creation and placement of the grafts into the balding scalp are done by the surgical team.
In the near future, improvements in the ARTAS System should allow it to be able to actually extract the separated grafts from the scalp. Eventually, the engineers hope to be able to increase the capability of the system so that it can create recipient sites and implant the extracted grafts into them.
Read about Robotic FUE Hair Transplantation
Q: How does the ARTAS™ robotic hair transplant system actually work? — J.N., Fort Lee, NJ
A: The ARTAS System for Follicular Unit Extraction (FUE) combines several features including an interactive, image-guided robotic arm, special imaging technologies, small skin punches of two different sizes, and a computer monitor. After the system is positioned over the patient’s donor area of the scalp, ARTAS is capable of identifying and isolating follicular units from the surrounding scalp.
After the robotic arm is aligned with the follicular unit, a sharp 1-mm punch is used to cut through the upper part of the skin (the epidermis and upper dermis).
Immediately following this, a duller, 1.3mm punch is used to separate the deeper part of the follicular unit from the remainder of the dermis and subcutaneous fat. Once separated by the robot, the follicular units are manually removed from the scalp and stored until they are implanted into the patient’s recipient area.
Read about robotic FUE hair transplantation
Q: What does the ARTAS™ robotic system for Follicular Unit Extraction (FUE) actually do? — E.J., Plainsboro, NJ
A: The ARTAS robotic system for hair restoration is a computer assisted system, made by a company called Restoration Robotics, that utilizes image-guided robotics to increase the quality of the hair follicles harvested during FUE. It aids in the initial part of the FUE hair transplant procedure where follicular units are separated from the surrounding tissue. The system is operated under direct physician supervision.
Read about robotic FUE hair transplantation
Q: When was the ARTAS robot for FUE approved for use in hair transplantation? — J.B., Jersey City, NJ
A: Restoration Robotics’ ARTAS System for robotic follicular unit harvesting, received 510K clearance by the Food and Drug Administration (FDA) on April 14, 2011. The indication is for “harvesting hair follicles from the scalp in men diagnosed with androgenetic alopecia (male pattern hair loss) with black or brown straight hair.”
Read about robotic FUE hair transplantation
Q: What is Restoration Robotics? — L.N., East Brunswick, NJ
A: Restoration Robotics is a medical device company, based in Mountain View, California, that has developed a computerized instrument to assist in the graft extraction phase of follicular unit extraction (FUE) hair transplant procedures. Their patented device, called “ARTAS,” is an image-guided system for FUE. Their website is: www.restorationrobotics.com.
Read about robotic FUE hair transplantation
Q: I have read your page on robotics in hair restoration and am interested in learning more. Are there any updates in the development of the system you mentioned? — W.T., London, UK
A: Restoration Robotics, Inc. — based in Mountain View, CA — has spent the last few years developing and testing a robotic hair transplant device for follicular unit extraction (FUE). The ARTAS™ robot system has recently received 510(k) approval from the Food and Drug Administration, meaning that the company may now begin marketing the system for use in hair restoration clinics.
The FDA classifies the device as a “computer assisted hair harvesting system” and describes it as being used to identify and extract follicular units and to help the surgeon do the same during hair transplantation.
The ARTAS™ robot consists of a computer assisted station with needle mechanism, force sensor, robotic arm, and video imaging system. The software that runs the instrument helps the surgeon target follicular units for extraction and also uses stereoscopic video images to guide the needle mechanism and robotic arm.
We will update you as more information becomes available about the ARTAS™ system and Restoration Robotics.
See a photo of the ARTAS robot and stay on top of developments by visiting our Robotic Hair Transplantation page
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