Hair transplantation can be a divided into 4 phases when using the ARTAS robot: 1. Graft Dissection 2. Recipient Site Creation 3. Extraction 4. Implantation
The latest advancement in robotic hair transplantation that has been successfully achieved and FDA cleared is recipient site creation for subsequent manual implantation of the harvested follicles.
ARTAS Site Making
The process begins first by creating a model, site making is preplaned on a tablet computer. The plan is then exported to the computer terminal on the robot.
Next, we create a hairline and can design a pattern or a direction of hair flow. The ARTAS Hair studio allows the physician to preoperatively plan for the distribution of the recipient sides in the most appropriate and artistic hairlines. Preoperative planning avoid mistakes of under filling important areas and over filling less important areas with grafts.
Once the plan is loaded into the robot the patient is positioned as such, a fiducial system is loosely affixed to the patient’s scalp. The patient is mildly sedated and anesthetized with local anesthetic injections.
Finally, the robot creates the preplanned recipient sites designed by the robotic hair transplant surgeon.
For a consultation appointment please call 817-473-2120 or email [email protected]
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At the Paragon Plastic Surgery and Med Spa, we are pleased to offer the most advanced and comprehensive laser treatments available for improving the appearance of your skin and hair. Laser hair therapy is just one of our most popular aesthetic laser treatments, and we are excited to share this technology with our Dallas, Fort Worth, and North Texas patients.
How Laser Hair Growth Works
The Capillus272 uses a special type of laser light that is known to improve circulation and stimulate cellular metabolism within and around the hair follicles of the scalp. Unlike the lasers used for aesthetic skin treatments and tattoo removal, Capillus does not ablate or damage the cells of your skin. Instead, hair restoration is performed with low level lasers that are cool-to-the-touch. Step 1: Dr. Bishara Recommends Capillus
First, Dr. Bishara recommends treatment with the Capillus hair loss laser to reverse the signs of thinning, shedding, or balding. Treatment recommendations vary, but might include 30-minute sessions every other day. Step 2: Laser Therapy Becomes Part of Your Routine
In order to be effective, laser therapy must be incorporated into your daily routine. This is where laser caps like Capillus outshine other treatment options, like in-office domes and laser combs. The wearable and portable design of the Capillus enables comfortable, convenient, and consistent treatment for superior results. Step 3: Hair Follicles Receive Low Level Laser Stimulation
The Capillus272 provides safe exposure to low-level laser light on a regular basis. Exposure is non-invasive and the lasers are cool, creating a hair loss treatment experience with absolutely no pain or discomfort. Step 4: Circulation and Metabolism Improve Across the Scalp
Low level laser therapy (LLLT) is known to improve circulation and cellular metabolism across the scalp. This nourishes hair follicles along the front, top, and sides of the head—even the ones that no longer produce hair. Step 5: Newer, Fuller Hair Grows Naturally
LLLT continues to improve circulation and cellular metabolism, delivering more blood, nutrients, and oxygen to each hair follicle. Over time, consistent use of the Capillus272 has been shown to increase hair growth by up to 51%.*
Benefits of Capillus Laser Cap
Capillus is continually recommended by world-renowned physicians as a safe, proven, and effective method of non-surgical hair restoration. Below are just a few of the benefits offered only by Capillus. Discrete. Capillus272 is a flexible dome-like insert that fits securely within your favorite baseball cap or hat. Simply insert, wear, and enjoy the benefits of laser hair restoration with complete discretion. Portable. Capillus272 is powered by a portable battery pack, enabling you to take your hair loss treatment anywhere. Powerful. With 272 lasers, the Capillus272 is capable of greater energy output than any other available laser cap. Greater output delivers a higher degree of hair follicle stimulation, which can ultimately lead to better results. Effective. In premarketing study for FDA clearance, the Capillus272 demonstrated the ability to effectively promote hair regrowth when compared to a placebo device. On average, patients experienced a 51% increase in hair counts.* Safe. Capillus272 has been cleared by the FDA for the treatment of androgenic alopecia, or hair loss.
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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.
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
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.
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
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.
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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
A recent survey conducted by the International Society of Hair Restoration Surgery (ISHRS) showed that men and women around the world are seeking to correct hair loss while they’re younger rather than putting it off until later in life.
Since the ISHRS starting tracking data on hair restoration in 2004, the extrapolated worldwide volume of surgical hair restoration procedures performed from 2004 to 2012 increased 85 percent. What explains this tremendous increase in people seeking help for hair loss, even during tough economic times? We believe the unprecedented growth and increased popularity in hair restoration over the past decade can be directly attributed to the continual refinements and advances in this type of surgery – together with proven medical therapies – that produce natural-looking, permanent results.
Other key findings of the survey include:
The number of women undergoing hair restoration surgery worldwide increased 20 percent from 2004 to 2012
Patients aged 30 to 49 sought treatment for hair loss more than any other age group
In 2012, ISHRS members chose John Mayer and Sofia Vergara as the celebrities with the best hair
Hair Loss Treatments
We offer a variety of hair loss treatments to suit our patients’ every need and busy lifestyles. Dr. Mark Bishara stays current with the latest in hair restoration technology to offer you the most effective solutions and help you reach your aesthetic goals. With solutions ranging from non-surgical treatments to more in-depth procedures like a hair transplant, you can reverse the effects of hair loss and achieve the look you desire. To learn more about our treatment options, or to set up a consultation with our skilled and experienced hair restoration surgeon. Hair Transplantation
During a hair transplant, hair is redistributed from fuller areas of the head, typically the sides and back of the head, to the balding or thinning areas. These grafts are placed to create a natural appearing result. The new hair follicles act as your normal hair, growing at the same rate as the rest of the area. The procedure can help you achieve a fuller head of hair and the results are permanent.
The ARTAS® Robotic System is a highly advanced surgical device used to harvest follicular unit grafts. It contains infrared cameras as well as state-of-the-art software to provide accurate follicle information for the most precise and efficient hair restoration surgery. ARTAS incorporates a number of elements in its operation, including an image-guided robotic arm and special imaging technologies that co-ordinate together for the purpose of implementing the “follicular unit extraction (FUE)” technique upon the recipient of the system. This procedure is available for both men AND women.
In our practice, we offer patients some of the latest techniques in hair restoration surgery and proven medical treatments that can help men and women permanently restore thinning hair. If you are interested in hair restoration treatments, including ARTAS robotic hair transplants, and the latest treatment options, we would be happy to speak with you or invite you for a consult at our office. Please call our office at (817) 473-2120, visit our website at www.MarkBisharaMD.com.
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