Recently, Restoration Robotics launched ARTAS Hair Studio. This state of the art product allows the patient and surgeon plan and produce a simulation of a possible outcome. Although this product has some limitations to the realistic look of the transplanted hair, it does allow for a formal interaction between the surgeon and the patient that spawns more thought into the over- all operative goal and leads to increased numbers of hairs being transplanted.
The most common cause of dissatisfaction of hair transplant patients in my practice and in patients that come to me from other practices is that they didn’t get the thickness that they wanted. The ARTAS Hair Studio allows the patient to “Test Drive” their appearance and modify the operative plan under the guidance of the surgeon. It becomes the surgeon’s ethical and responsible role to provide guidance on safe and age appropriate hairline design, donor capacity, and realistic expectations on social and physiologic downtime. The ARTAS Hair Studio becomes paramount providing a sneak preview to esthetic results that vary with amount of hair.
Put together with a well informed consult discussing preventative hairless measures backed by randomized double-blinded placebo controlled trials, the ARTAS Hair Studio is quickly becoming the standard of care in hair restoration planning and patient education.
ARTAS Hair Studio also integrates directly with the robot and becomes the operative plan for the patient ensuring that the patient is receiving exactly what he is intending to recieve.
For a consultation please call 817-473-2120 or email [email protected]. Skype and other internet-based consultations are available.
Mark A Bishara M.D., P.A. and Paragon Hair Clinics care for patients world-wide.
Dr. Mak A Bishara, M.D. P.A. performs robotic follicular unit graft selection for residents living around Mansfield, Southlake, Dallas, Arlington, Fort Worth, and surrounding the DFW area in North Texas.
How many hairs come out of a graft area?
The number of hair ranges from one hair to four hair for each graft. We have an advantage by using a robot to select only two hair grafts if we need to provide more density. On the other hand single hair grafts are very important for the front of the hairline to get a feathered natural look. We also have the ability to program the robot to only take single hair follicular units.
What % of hairs actually take?
90% of transplanted grafts or better will survive in the recipient site. Much of this is determined by the use of PRP, the use of high potassium based holding solutions, and decreasing the time to transplantation. Limiting our hair transplant sizes the 800 g per session Minimizes the time of out of body and oxidative stress on the follicle.
What is the long term aftercare?
After transplant you may begin to use minoxidil at one week or once the scabs fall out. In the immediate postoperative period, there is a shampoo, conditioner, spray, and copper impregnated guaze pads. These are very important for healing and specifically Helps decrease the downtime from the procedure. I highly recommend the graft site kit and it is available at our office. After the hair transplant several months later you will begin to see your new hair growing. PRP injections would be advisable in your case at 4 weeks and 8 weeks. We would look at your overall hair Results of 10 months and recommend additional transplants in that area if it looks beneficial. You can of course transplant another area after two months allowing the donor site to heal appropriately. There is no long-term of you care needed the transplanted hair. It is your hair and you don’t need to do anything to it to the transplants.
Will I need prp with the transplant?
This is answered above, PRP treatments will provide you with more hair mass. The recommendation is to do this might not only help your transplanted here but more importantly to prevent your natural hair from falling out. As discussed in our consult, there has been no large multi institutional randomized double-blind placebo-controlled trials that have been peer-reviewed to support a statistical significance of hair mass to date. Existing here should go from the flimsy hair to thicker more robust hair and will give Is the appearance of more hair in some individuals.
Should I stop rogaine so you can really see the troubled area in its entirety before transplant?
No, you should not stop rogaine use.
Will I lose the transplanted hair over time since I am diagnosed with hereditary hair loss?
Most likely yes but by using hair laser you will slow your hair loss down.
Is it harder to transplant African American hair? Does it take to the new site as well? Does it take longer? Have you performed any transplants on African Americans?
It is not technically harder to transplant African American hair. The success of hair restoration at the receipt site is acceptable. It does take a little bit longer and yes we have conducted African American hair transplants. AA have acceptable results usually require multiple procedures.
What should I expect during procedure, and what should I expect at home after procedure?
You can expect to come to our office early in the morning take before pictures, have blood drawn, sign consent forms, and be placed in the chair where the nerve block will be performed. You’ll be given antibiotics and a sedative by mouth, next PRP will be injected into the recipient bed followed by recipient site creation. You will then be placed into the robot where we will dissect out a number of grafts that correspond to the number of recipients sites that we created. Then we will place you back into the chair to implant you.
You will rest for two days without increasing your blood pressure and we will follow up with you 2 weeks later on the phone call. Most of the scabs and existing hair connected to the follicle with fall out by seven days. You’ll have some existing scabs. Social downtime is about a week.
We look forward to helping you through your hair restoration journey!
Please give us a call 817-473-2120 or email us at [email protected]
What is a Robotic Hair Transplant?
A robotic hair transplant is a type of hair restoration procedure where donor hair is removed directly from the back and sides of the scalp using robotic control. The specific type of hair transplant where robotic technology is used is called follicular unit extraction (FUE). In FUE, a small, round instrument, or punch, is use to separate individual follicular units (naturally occurring groups of 1-4 hairs) from the surrounding tissue, so that they can be extracted and then implanted into the balding area. This process is very tedious and exacting and when done manually often leads to significant injury to the follicles.
Robotic surgery allows this procedure to be done in a more precise and consistent way, ultimately maximizing the growth of the grafts. In a robotic hair transplant, follicular units are extracted one at a time by the image-guided, computer-driven system called ARTAS, a technology developed by the company Restoration Robotics. At The Paragon Plastic Surgery & Med Spa, all Follicular Unit Extraction (FUE) procedures employ the speed and precision of the robotic system.
How Does the ARTAS Robotic Procedure Differ from Other Hair Transplant Procedures?
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 Hair Transplant 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.
Hair restoration information is available in our office. Please contact us at 817.473.2120 to schedule an appointment. You can also visit our website at www.MarkBisharaMD.com.
Robotic Follicular Unit Extraction in Hair Transplantation
Marc R. Avram, MD,* and Shannon A. Watkins, MD†
BACKGROUND In recent years, there has been a shift toward minimally invasive procedures. In hair trans- plantation surgery, this trend has manifested with the emergence of follicular unit extraction (FUE). Recently, a robot has been introduced for FUE procedures.
OBJECTIVE- To determine the transection rate of a robotic FUE device. In the attached article, the authors discuss the procedure, technical requirements, optimal candidates, advantages, and disadvantages of robotic FUE compared with the standard ellipse.
RESULTS- Optimal candidates for robotic FUE are those with dark hair color who can sit for 45 to 120 minutes and are willing to shave a large area for donor harvesting. The main advantages of robotic FUE compared with the standard ellipse are its minimally invasive nature and the lack of a linear scar.
CONCLUSION- The robot is a new and innovative method for FUE hair transplantation of which hair transplant surgeons should be aware.
Marc R. Avram, MD,* and Shannon A. Watkins, MD†
BACKGROUND In recent years, there has been a shift toward minimally invasive procedures. In hair trans- plantation surgery, this trend has manifested with the emergence of follicular unit extraction (FUE). Recently, a robot has been introduced for FUE procedures.
OBJECTIVE- To determine the transection rate of a robotic FUE device. In the attached article, the authors discuss the procedure, technical requirements, optimal candidates, advantages, and disadvantages of robotic FUE compared with the standard ellipse.
RESULTS- Optimal candidates for robotic FUE are those with dark hair color who can sit for 45 to 120 minutes and are willing to shave a large area for donor harvesting. The main advantages of robotic FUE compared with the standard ellipse are its minimally invasive nature and the lack of a linear scar.
CONCLUSION- The robot is a new and innovative method for FUE hair transplantation of which hair transplant surgeons should be aware.
In the 1990s, hair transplant surgery underwent a revolution in the graft size used for transplantation. From the 1960s into the mid 1990s, 2 to 4 mm grafts containing 10 to 20 hair follicles were the standard graft used in the procedure. In spite of its scientific success, they were often a cosmetic failure because they resulted in a “pluggy” unnatural appearance. In the 1990s, there was a shift toward smaller graft sizes. Currently, the follicular unit, which contains 1 to 4 hair follicles, is the standard graft size used in transplant surgery.1,2 This shift in graft size has allowed patients to consistently grow naturally appearing transplanted hair, as it mimics the natural size of follicular groupings on the scalp1 (Figure 1). In addition, the use of follicular groupings eliminates textural changes and scarring in the recipient area. Large grafts containing 10 to 20 hair follicles required larger recipient sites, which resulted in unnatural “cobblestone” scarring on the scalp. Recipient sites for follicular groupings are less than
In the era of follicular unit transplantation, the only visible scar on the scalp is the linear scar left from the donor ellipse. For the majority of men and women, a linear scar has no short or long- term practical effect. Their existing donor hair will camouflage the scar. A linear scar can create an issue, however, for some patients who wear their hair shorter or want the option of a shorter hairstyle in the future. In addition, there has been an inexorable trend in all surgical procedures toward minimally invasive procedures, which result in less scarring and quicker recovery times.
Donor Harvesting Techniques
Over the past several years, the focus of discussion in the field has begun to shift away from the size of the graft used to transplant hair toward the harvesting method used to obtain the donor grafts. For decades, 2 to 4 mm punch trephines were used to obtain donor hair from the posterior scalp. Typically, the grafts were removed and wounds were allowed to heal by secondary intention. This resulted in widespread “hon- eycomb” scarring (Figure 2). In 1994, the concept of elliptical donor harvesting, also known as strip har- vesting, was introduced and has been the standard method for obtaining donor grafts.3 It is based on the same dermatologic surgery techniques used in removing nevi, skin carcinomas, and cysts. It allows efficient harvesting of hundreds to thousands of fol- licular groupings. As with any cutaneous excision, there is a scar created from removing the donor ellipse. For the majority of patients, this is neither a medical nor a cosmetic issue. For a minority of patients, medical and cosmetic challenges may arise. A small percentage of patients will develop hyper- trophic or broad scars. Others feel limited in the hair styling options because of the donor scar. For these
Over the past several years, the focus of discussion in the field has begun to shift away from the size of the graft used to transplant hair toward the harvesting method used to obtain the donor grafts. For decades, 2 to 4 mm punch trephines were used to obtain donor hair from the posterior scalp. Typically, the grafts were removed and wounds were allowed to heal by secondary intention. This resulted in widespread “hon- eycomb” scarring (Figure 2). In 1994, the concept of elliptical donor harvesting, also known as strip har- vesting, was introduced and has been the standard method for obtaining donor grafts.3 It is based on the same dermatologic surgery techniques used in removing nevi, skin carcinomas, and cysts. It allows efficient harvesting of hundreds to thousands of fol- licular groupings. As with any cutaneous excision, there is a scar created from removing the donor ellipse. For the majority of patients, this is neither a medical nor a cosmetic issue. For a minority of patients, medical and cosmetic challenges may arise. A small percentage of patients will develop hyper- trophic or broad scars. Others feel limited in the hair styling options because of the donor scar. For these
Follicular Unit Extraction Versus Elliptical Donor Harvesting
The concept of follicular unit extraction (FUE) was introduced in the early 21st century and refined over the past decade.4–6 Follicular unit extraction used the same concept of using a steel trephine to harvest donor hair, but instead of being 2 to 4 mm in diameter as was used in the past, the FUE punches range from 0.8 mm to 1.2 mm. This technique is a natural extension of the concept of follicular unit hair transplantation—the utilization of individual follicular groupings in the recipient and donor sites.
Challenges of this technique include the following: increased risk of transection of hair follicles, operator fatigue when harvesting hundreds of follicular groupings, and appropriate spacing of harvested grafts to yield the maximum amount of donor hair without creating the appearance of a depleted donor density.6 Throughout the posterior scalp, the angle of hair growth varies, which presents a challenge to surgeons. Magnification and excellent lighting reduce but do not eliminate the risk of transecting follicles. Compounding this challenge is the need to remove dozens to many hundreds of follicular groupings for each case. Harvesting larger numbers of grafts can result in increased operator fatigue and a higher rate of transected hair follicles. Some experienced sur- geons are able to harvest large numbers of follicular groupings with minimal transections, but others are unable to do so.
The concept of follicular unit extraction (FUE) was introduced in the early 21st century and refined over the past decade.4–6 Follicular unit extraction used the same concept of using a steel trephine to harvest donor hair, but instead of being 2 to 4 mm in diameter as was used in the past, the FUE punches range from 0.8 mm to 1.2 mm. This technique is a natural extension of the concept of follicular unit hair transplantation—the utilization of individual follicular groupings in the recipient and donor sites.
Challenges of this technique include the following: increased risk of transection of hair follicles, operator fatigue when harvesting hundreds of follicular groupings, and appropriate spacing of harvested grafts to yield the maximum amount of donor hair without creating the appearance of a depleted donor density.6 Throughout the posterior scalp, the angle of hair growth varies, which presents a challenge to surgeons. Magnification and excellent lighting reduce but do not eliminate the risk of transecting follicles. Compounding this challenge is the need to remove dozens to many hundreds of follicular groupings for each case. Harvesting larger numbers of grafts can result in increased operator fatigue and a higher rate of transected hair follicles. Some experienced sur- geons are able to harvest large numbers of follicular groupings with minimal transections, but others are unable to do so.
To improve the accuracy and efficiency of FUE, numerous FUE devices have been developed; of which some are motorized, some are suction assisted, and some are single user-directed robotic system. The NeoGraftautomatedhairtransplantsystem,7–9 SAFE (surgically advanced follicular extraction) system,10 and ARTAS Robotic System (Restoration Robotics, Inc, San Jose, CA) are a few of the more well-known FUE devices on the market. In this article, the authors discuss about robotic follicular unit extraction with the robot.
Robotic Follicular Unit Extraction
Technical Aspect
Robotic Follicular Unit Extraction
Technical Aspect
The robotic system was approved by the Food and Drug Administration for hair transplantation in 2011. This robotic device is used to harvest follicular units from the donor region (Figure 3). A 1-mm punch is attached to the robotic arm consisting of a “needle- within-needle”; there is a sharp inner punch sur- rounded by a blunt outer punch. The sharp inner punch creates a shallow 1-mm incision, subsequently, the blunt outer punch spinning at 400 to 800 rpm dissects deeper and separates the follicular units from surrounding tissue. A suction system attached near the punch elevates the follicular unit from the surrounding skin allowing for easier extraction of the graft. A combination of stereoscopic cameras managed by image processing software allows the sharp and blunt punches to identify the precise angle and direction of hair growth. This continuous imaging feedback allows the robot to precisely harvest each follicular grouping. Because of the high level of automation, the robot is able to remove 400 to 600 grafts per hour.11–13 The software requires a minimum distance of 1.6 mm between extracted follicular groupings to minimize risk of overharvesting donor hair. In Table 1, the authors compare strip harvesting with robotic FUE donor harvesting.
See the attached article for more information.
Dr. Bishara’s office locations in Mansfield and Southlake, TX have also added this important step in the Follicular Unit Extraction (FUE) procedure, a step that until now needed to be performed by hand. The goal of the new function is for the robot to automatically obtain the maximum number of donor hairs with the least amount of wounding and the greatest cosmetic benefit for the patient. Dr. Bishara is the only doctor in Texas that offers Graft Site Selection.
How Does it Work?
Using robotic graft selection, the hair restoration surgeon programs the ARTAS robot to harvest follicular units which contain two or more hairs by selectively skipping over the 1-hair units. Using its advanced optical guidance system, the robot orients itself to the scalp by way of special markings on a tensioner, a plastic frame-like device that is positioned on the donor area. The software then rapidly analyzes each graft and selects the appropriate ones for extraction. It then dissects these follicular units from the surrounding scalp tissue.
The Importance of Graft Selection in FUE
In FUE hair transplant procedures, the surgeon wants to harvest as much donor hair as possible while leaving the fewest number of wounds. To minimize the number of wounds, you would want to extract only the units that contain the largest amount of hair. However, smaller grafts of 1-hair are typically needed to create a natural-looking hairline and temples. By selecting and extracting larger grafts first, and then extracting smaller ones only as needed, surgeons can both minimize wounding and harvest an adequate number of follicular units of varying size so as to enhance the cosmetic benefit of the procedure. Smaller grafts can be generated by dividing the larger grafts without increasing the donor wounding.
This News is brought to you courtesy of Dr. Bishara and The Paragon Plastic Surgery & Med Spa
Cosmetic Surgeon Dr. Mark A. Bishara, M.D., serving Fort Worth, Arlington, and the surrounding area.
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