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

Dr. Robert M. Bernstein: We just came back from the Chicago meeting, our annual meeting of the ISHRS. It was really interesting, they gave some statistics on the field of hair restoration. Spencer Kobren: Yeah. RB: It turns out that over the last two years, there has been about a 28% increase in people performing hair transplantation. In hair transplantation worldwide, there was about 400,000 procedures. SK: Now we're talking, we're talking all of surgical hair restoration? RB: Hair transplantation. SK: Hair transplantation. Yeah. RB: In the old days there used to be a lot of different kinds of procedures, now it's basically hair transplants. The thing that's most interesting is that follicular unit extraction (FUE) is now 50% of all procedures. SK: Which is pretty amazing. RB: So from the census that they have - which is from 2004, versus the census in 2002 - FUE had increased 50%, 51%. At the time of the last census, it was about 48%. Now it's 50% of all procedures worldwide. SK: Which is pretty significant. Now are we seeing more procedures, and I know that there's no doubt here in the U.S. that everyone is now starting to, at the very least, incorporate FUE into their practices to some degree? When you're dealing with Europe and Asia, I mean, no one is doing (FUT) strip anymore. It's all FUE all the time. RB: Well, correct, especially with the new guys. When people are starting their practices, virtually everyone is just doing FUE. SK: You've actually had the opportunity to do tremendous trial and error in your practice over the years. And you've gravitated towards robotic hair transplant surgery. When people ask me about that and I try to explain, listen, Dr. Bernstein is one of the most conservative physicians in this field. There's a reason why he's going in that direction. So why don't we talk about that? RB: Well, I always take offense at the word conservative. [Laughter] I like to say "the most appropriate." SK: Yes. Actually yeah, that's probably a better term. You're right. RB: That said, yeah I think that with extraction, we struggled for years trying to get the procedure right. It's a very, very difficult procedure. It requires hand-eye coordination that's obviously repetitive over thousands of times. And of anything that we do in hair, FUE lends itself most to robotics. The ideal is just getting the technology. It's very, very complicated. The company that makes the robot, Restoration Robotics, has been around now for about twelve years. They've been working on this technology. When I first saw the technology in 2011, I was all over it. And I thought, whoa, this is incredible. At that time, it was really in a very raw state compared to the way it is now. But in any event... where it is now... is that it really is a tool that's really, in my opinion, consistently superior than most people can do by hand. SK: Why do you think there's so much resistance, still? Why do you think? Besides the obvious, the barrier to entry, the cost of the device, the fact that there's a lot of guys out there who maybe have been doing FUE for a while, who have kind of branded their own form of FUE? So there's some concerns there. Besides that, what would the real resistance be? RB: I think that there are two things. I think one is very legitimate, and one is perhaps not. I think the legitimate thing is that the robot in its inception was not the greatest instrument. The recipient sites were too big, it randomly harvested grafts (it couldn't select grafts), the optical system was much different in the old days, it was much slower. The RPMs were different. The tensioner that we used to stabilize the scalp wasn't working that well. I mean there are thousands of upgrades that have occurred over the last four years. I mean, it has been unbelievable. The interface was very difficult to work with. It's technology. Now all those things have been worked out. Now the company's moved on to the next thing, recipient site making. In harvesting grafts, the actual extraction has been perfected. I think a lot of the early machines weren't that good. And I think a lot of the perception has been around people's initial experience.

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