It is estimated by the American Hair Loss Association that two-thirds of all men will experience appreciable hair loss by the time they're 35. And while previous hair restoration procedures have included topical ointments, prescription medication, and even lasers, the newest technology to address hair loss is Follicular Unit Extraction (FUE). This method of hair restoration, which was previously done with devices such as Neograft, may have just been streamlined and improved with the addition of a robotic system called ARTAS.
According to pioneer in FUE hair transplantation and renowned hair transplant surgeon, Dr. Robert M. Bernstein of Bernstein Medical - Center For Hair Restoration in New York, "Modern hair transplantation includes Follicular Unit Transplantation (FUT) and Follicular Unit Extraction (FUE). The FUE procedure is ideal for younger patients where there is more concern about not having a linear scar so they can have the option of keeping their hair very short. The limitations of FUE has been that when you try to punch out the follicular units, the punch has to be perfectly lined up with the hair follicles. As you can imagine, when you're doing thousands of these in one procedure, it's very difficult to get each one exactly right and lined up."
Which is where the ARTAS robotic system steps in - by actually lining up the cutting instrument with the follicular unit, it successfully extracts the follicular unit by going dead center, reducing any damage to the follicle itself. By using a 2-step punch system delivered by an image-guided robotic arm, the ARTAS system first delivers a miniscule sharp punch that initially scores the skin. Immediately following the first punch is a dull punch that is slightly larger, which actually separates the follicular unit from the surrounding tissue.
As Dr. Bernstein explains, the Follicular Unit Extraction system is a 4-step procedure:
- Separation of the follicular units from the surrounding tissue
- Actual extraction of follicular units (done manually with forceps)
- Creation of the recipient's new site (making the holes in which the grafted follicular units will be placed)
- Actual implantation of the grafted of the grafted follicular units
"Of the four steps, the ARTAS robotic system is actually only doing the first step: separating the follicular units from the surrounding scalp, it doesn't even actually remove them," describes Dr. Bernstein, "The rest of the steps are still done manually. Eventually, the robot will perform all four steps but that's probably at least five years off."
The key to a successful hair transplantation may lie within the extraction of the follicular units. "A one punch system that only uses a sharp punch to cut the whole follicular unit will cut the skin but you risk cutting the bulb or the roots of the follicle," states Dr. Bernstein, "Whereas if you use the sharp punch first to just break the skin and then use the duller punch to go around the follicular units, you can extract them without causing the damage that single sharp punch might cause."
Benefits of the ARTAS system for the patient may include a better hair transplant. "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 have 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.
Other benefits may include speed and accuracy: performing FUE manually can become tedious when you have to remove follicular units of just 3-4 single hairs at a time. The procedure typically lasts over several hours with the doctor taking breaks. Dr. Bernstein says, "With ARTAS, you can extract between 500-700 grafts an hour, which is significantly greater than what the average doctor could do."
The ARTAS system has been extensively tested in trials with no adverse reactions. The robot is programmed so if the patient moves, the robot retracts and pulls away from the patient. Dr. Bernstein remarks, "It's actually very safe, ARTAS also limits the amount of pressure on the punch when it's cutting into the skin."
The ARTAS system, created by California based Restoration Robotics, was only recently presented to physicians in September 2011. Dr. Bernstein believes this to be the wave of the hair restoration future, "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. Obviously you want the best procedure for your patients and as such, this will eventually supplant other methods of performing hair restoration."
For more information on hair restoration, hair transplants or the FUE procedure using the ARTAS robotic system, please contact Dr. Robert Bernstein.