Bald Truth Interview: Dr. Bernstein Discusses Importance of Robotic Graft Selection

Dr. Bernstein: Follicular unit graft selection has been one of my pet things with the ARTAS. In fact, before I bought the ARTAS in 2011, researchers [at Restoration Robotics] assured me that follicular unit graft selection would be possible. And so I worked on that for a few years with them. Now I think it's being done routinely in all practices. I should say, hopefully in most practices. Spencer Kobren: Well you know it's being done in your practice. Dr. Bernstein: In our practice, sure. Basically, the concept is very simple. When you do Follicular Unit Extraction (FUE) manually, the doctor automatically goes for the largest follicular units. It's just common sense. You're making a hole, if you make a .9mm or 1mm hole, you want to get as much hair out from that hole as possible. You don't want to get a 1-hair graft from that hole. Especially for teams that are good in microscopic dissection, you can take the larger unit, the 4-hair graft, and divide it up. If you need a 1-hair, you can make it into a 3-hair unit and a 1-hair unit and not have an extra hole. There's a great advantage to that. The robot now can essentially mimic what humans do. They can avoid the 1-hair grafts or even 2-hair grafts if you want, and just go for the largest units. That's a real benefit. Spencer Kobren: That's an amazing benefit, but here's the thing. The new world of FUE, and I'm not talking about what guys were doing 10 years ago, or five years ago, even four years ago. The way the industry is evolving, technicians are doing most of the work. They're not looking for particular graft selection. They're going in there and, in my view, they are decimating these people's scalps. So, the fact that this is being developed by ARTAS and the fact that, obviously, this is something that you've pushed, in the end I think the more people who end up getting the robot, and the more standardized we can make this, the safer it is going to be for the general consumer. Dr. Bernstein: Well certainly, the main advantage of the robot is quality control. There's much more consistency. And as the robot evolves it becomes more and more automated, where there's less and less physician control needed in real-time. At the beginning it was like driving a stick shift, and now it's cruise control. You just have to keep an eye on it and the robot does most of the work and you can program all of these nuances into the robot. It's certainly to the benefit of the patient. The reality is that doctors can do small sessions with good concentration, but when you get to large sessions over and over again most doctors, many start to pass it off to the techs. Then it's catch-as-catch-can, you don't know what the quality of the surgery is going to be. Unfortunately, just like with strip procedures, there's a sale of thousands -- 3,000 or 4,000 graft sessions. It becomes very alluring. But the quality always goes down with very large sessions. And when you're harvesting every single graft, you're not skipping over the 1-hair grafts, it's obviously easier to get bigger numbers. Spencer Kobren: Absolutely. That's what's being sold. Sadly, it's usually younger patients that I'm seeing who are going overseas, or who are going to one of these places like in a strip mall. These companies just buy some sort of machine and they go to town with technicians. It's getting worse. This week there was a FUE conference in Europe. I can tell you this, they're really not focusing much on the ARTAS Robot. These guys are focusing on every other possible method except for the ARTAS. But what's happening is, these doctors are going to these conferences they're learning from other physicians and they're basically training their techs, in my view, to do the work.

• Read more about robotic graft selection
• Read about the advantages of Robotic FUE
• Read about why very large sessions can result in suboptimal results

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