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- The Notable Articles Project: Revisiting the Articles That Helped Shape the Specialty
Synopsis: The traditional order for the steps of a hair transplant sur gery has been to first perform donor harvesting then make sites and place grafts. Hair transplant surgery can often be a long procedure, and one goal of many teams is to find ways to decrease the length of the procedure to improve the patient experience, decrease the physical strain on the team, and specifically decrease the out-of-body time of the grafts to improve graft survival.
Read: - Innovations In Robotic Hair Restoration
Bernstein RM, Wolfeld MBSynopsis: With the latest version of the ARTAS platform, 9x, Restoration Robotics has designed a faster and more accurate system for hair transplantation. The improved accuracy of harvesting and shortened procedure time increases graft viability, while smaller needles reduce scarring and allow patients to wear shorter hairstyles. Many of the changes in this upgrade have been made as a response to specific physician feedback.
Read: - Advances in Robotic FUE
Bernstein RM, Wolfeld MBSynopsis: Since the publication of “What’s New in Robotic Hair Transplantation” (Hair Transplant Forum Int’l. 2017; 27(3):100-101), there have been important improvements to the robotic system in both its incision and recipient site creation capabilities. These advances fall into four overlapping categories:increased speed, increased accuracy, increased functionality, and improved artificial intelligence (AI). The overlap occurs since improvements in functionality, accuracy, and AI can also increase the overall speed of the procedure. A faster procedure decreases the time grafts are outside the body and allows the physician to perform larger cases without placing additional oxidative stress on the follicles.
Read: - Commentary on Redefining the “E” in FUE: Excision = Incision + Extraction
Bernstein RM, Rassman WRSynopsis:There has been a change in the nomenclature of the FUE procedure. It will not be called Follicular Unit Excision, describing the two main components of an FUE procedure, incision (separatioin of the follicle from the tissue) and extraction (the removal of the follicular unit from the scalp once it is separated). Drs. Robert M. Bernstein and William R. Rassman’s commentary explains the importance of this change in terminology.
Read: - Innovation and Quality in Hair Restoration Surgery
Bernstein RM. Innovation and Quality in Hair Restoration Surgery. Hair Transplant Forum Intl. 2017; 27(5): 187.Synopsis: Hair restoration has advanced dramatically in the past 25 years, most recently with the growing popularity of FUE. The challenge of FUE is that the grafts are more fragile compared to the follicular units generated in traditional FUT/strip procedures. Innovations such as the ARTAS Robot and other devices attempt to address this problem. With the increasing participation of ISHRS members – now 1,200 strong – progression in this field should continue at an accelerating pace.
Read: - What’s New in Robotic Hair Transplantation
Bernstein RM, Wolfeld MB, Krejci J. What’s New in Robotic Hair Transplantation. Hair Transplant Forum Intl. 2017; 27(3): 100:101.Synopsis: Since the introduction of robotic FUE technology over five years ago, there have been numerous upgrades to the system. The current paper describes the most recent advances. These include a more user-friendly interface, the ability to select for larger follicular units, greater range-of-motion of the robotic arm, improved methods for stabilizing the scalp and newly designed needles for more accurate harvesting.
Read: - Robotic Follicular Unit Graft Selection
Bernstein RM, Wolfeld MB: Robotic follicular unit graft selection. Dermatologic Surgery 2016; 42(6): 710-14.Synopsis: The current robotic system harvests follicular unit grafts in a random manner. A new capability of the ARTAS robot is to select follicular units based on the number of hairs they contain, in order to increase the hair/wound yield. This bilateral controlled study of 24 patients was designed to evaluate this functionality. Results showed that, compared to random follicular unit harvesting, robotic follicular unit graft selection produced more hairs per harvest attempt (2.60 vs. 2.22) and more hairs per graft (2.72 vs. 2.44). The clinical benefit was statistically significant at p<.01.
Read: - Long-Hair Robotic FUE
Bernstein RM. Long-Hair Robotic FUE. Restoration Robotics White Paper. May 2015.Synopsis: A limitation of FUE procedures is the short-term cosmetic problem of clipping the entire donor area in the back and sides of the scalp. The long-hair robotic technique avoids this problem by harvesting through a broad band of clipped hair that is covered with longer hair combed down over the harvested area. This technique enables the physician to harvest relatively large amounts of donor hair without shaving the patient’s entire scalp.
Read: - Commentary on Robotic FUE in Hair Transplantation
Bernstein RM: Commentary on Robotic Follicular Unit Extraction in Hair Transplantation. Dermatol Surg 2015;41(2):279.Synopsis: In their excellent article, “Robotic Follicular Unit Extraction in Hair Transplantation,” Avram and Watkin give a review of the salient aspects of the newly evolving field of robotic hair transplantation. As the authors state, the appeal of robotic FUE is part of the “inexorable trend” toward minimally invasive surgical procedures. As with any new technology, it is up to the practicing physician to make sure that it is used appropriately and to the maximum benefit of our patients.
Read: - ARTAS Robotic System Provides Minimized Donor Area Scarring
Bernstein RM. ARTAS Robotic System provides a comprehensive suite of tools to minimize donor area scarring following hair transplantation. Restoration Robotics White Paper. September 2014.Synopsis: The ARTAS® Robotic System provides a unique, comprehensive suite of tools that physicians can use to minimize donor area scarring and offer the patient greater styling options post-surgery. Factors that influence scarring in the donor area include: dissection punch size, density of harvest sites, distribution of the harvest sites, total number of sites, and the ‘blending in’ of harvest zones with un-harvested areas.
Read: - Robotic Recipient Site Creation in Hair Transplantation
Bernstein RM, Wolfeld MB, Zingaretti G. Robotic recipient site creation in hair transplantation. Hair Transplant Forum Intl. 2014; 24(3): 95-97.Synopsis: The initial application of the ARTAS® robotic system (robot), released in the fall of 2011, was the separation of follicular units from the surrounding scalp tissue, the first step in a follicular unit extraction procedure. Subsequent steps in FUE include removal of the follicular unit grafts from the donor scalp, site creation, and graft placement. With its new hardware and software capabilities, the robot can now perform one more step in this process, making recipient sites. Preliminary observations suggest that it can accomplish this function with greater precision and consistency than when performed manually.
Read: - Current Status of Surgery In Dermatology: Hair Transplantation
Hanke CW, et.al. Current status of surgery in dermatology. Bernstein RM. Section on Hair Transplantation. J Am Acad Dermatol. 2013 Dec;69(6): 20-22.Synopsis: Every few decades, the American Academy of Dermatology publishes a comprehensive survey of the state of dermatology and dermatologic surgery. Dr. Bernstein was asked to contribute to this historical overview. The paper describes important developments in the field of hair restoration surgery over a period of more than twenty years. Dr. Bernstein’s pioneering articles on FUT and FUE are highlighted as key advances in the field, along with contributions by more than a dozen dermatologists. The section on hair transplantation includes a look towards the future with mentions of both robotic graft harvesting and the promise, and challenges, of hair cloning techniques.
Read: - Age and the Donor Zone in FU Hair Transplants
Bernstein RM. Controversies: Age and the donor zone in FU hair transplants. Hair Transplant Forum International 2013; 23(3): 91-92.Synopsis: When considering Follicular Unit Transplantation (FUT) and Follicular Unit Extraction (FUE) procedures, a person’s age and the ability to assess the permanence of the donor area are important variables in determining surgical candidacy. This FUT case study examines the importance of these variables in the patient evaluation.
Read: - Robotic Hair Transplants
Bernstein RM. Robotic Hair Transplants. The Link 2013; 5: 6-7.Synopsis: A major advance in Follicular Unit Extraction is the introduction of a robotically controlled, image guided system to remove intact follicular units directly from the scalp. The robotic device increases the accuracy of graft harvesting, which in turn minimizes damage to hair follicles and reduces harvesting time. Each of these factors potentially contributes to increased graft survival. The technology also enables FUE to be performed on a wider variety of patients. This paper discusses this new robotic technology.
Read: - Integrating Robotic FUE into a Hair Transplant Practice
Bernstein RM. Integrating Robotic FUE into a hair transplant practice. Hair Transplant Forum Intl. 2012; 22(6): 228-229.Synopsis: In addition to acquiring a robotic device, performing FUE hair transplant procedures using a robotic image-guided system requires special surgical facilities, staff training, and modification of the FUE procedure itself. This paper reviews some of the key elements that go into successful implementation of R-FUE into a physician’s practice.
Read: - Pre-Making Recipient Sites in FUE and R-FUE Procedures
Bernstein RM, Rassman WR. Pre-making recipient sites to increase graft survival in manual and robotic FUE procedures. Hair Transplant Forum Intl. 2012; 22(4): 128-130.Synopsis: In FUT procedures, once the donor strip is removed, follicular unit dissection and graft insertion can be performed simultaneously. In FUE procedures, graft extraction must be completed before placement can begin, increasing the time grafts are out of the body and subjecting them to hypoxic injury. Waiting for recipient sites to be made adds to this time. These authors suggest creating recipient sites prior to extraction to decrease the time the grafts are outside the body. Other potential advantages of pre-making recipient sites are discussed.
Read: - Bimatoprost for the Treatment of Thinning Eyebrows
Schweiger ES, Pinchover L, Bernstein RM. Topical Bimatoprost for the Treatment of Eyebrow Hypotrichosis. J Drugs Dermatol. 2012;11(1): 106-108.Synopsis: Topical bimatoprost was FDA approved in December 2008 for the treatment of eyelash hypotrichosis (thinning eyelashes). Since its approval, there has been interest in its “off label” for hair growth in other areas, such as the scalp or eyebrows, but there has yet to be published scientific evidence to support this use. We report one of the first cases of significant eyebrow hair growth in a patient after use of topical bimatoprost for eyebrow hypotrichosis.
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The following is a list of Dr. Bernstein's medical publications on Follicular Unit Transplantation, Follicular Unit Extraction, Robotic Hair Transplants, and other hair restoration topics.
The publications are listed from the most recent down to the first publications.
