New Hair Transplantation Technology Opens Path to the Future
In recent years, surgical hair transplantation has been going through a significant but quiet revolution. Follicular Unit Hair Transplantation, the standard strip excision method that is still widely used, and the more minimally invasive Follicular Unit Extraction (FUE) approaches are being challenged by a technology from Restoration Robotics, Inc. (San Jose, Calif.), that automates the grafting process with more precision than is possible using manual FUE techniques. Lately, this company has signaled that this new approach to hair restoration is catching on by announcing new features for its ARTAS Robotic system as well as a new marketing / outreach program to help physicians attract and retain new patients.
The ARTAS Robotic System Heralds a Paradigm Shift in Hair Restoration Procedures
By Jeffrey Frentzen, Executive Editor
The ARTAS Robotic System employs a minimally invasive dissection punch process using an image- guided robotic arm. The system harvests follicular units from the patient’s donor area, exceeding manual FUE in terms of precision, control, reproducibility and efficiency, as well as eradicates the problem of physician fatigue.
The ARTAS easy-to-learn, programmable and automated robotics-based approach frees the practitioner to focus on the artistry of the procedure, as well as leave patients with virtually no scarring and minimal downtime after the work is done.
“There is no doubt that the ARTAS system is precipitating a paradigm shift,” expressed Mark A. Bishara, M.D., a cosmetic surgeon based in Mansfield, Tex. “For physicians and in particularly hair transplant surgeons who are only doing the strip based procedure and do not really do FUE, from hitting the ground they will be much more efficient at using a robot than if they would try to go back and learn to fine tune the eye-to-hand coordination type of skill necessary for doing manual procedures. The ARTAS system is definitely going to fulfill different voids in various practices.”
Increasingly, cosmetic surgeons and dermatologists are investigating the ARTAS Robotic System, noted Tim Parkyn, Senior Marketing Manager at Restoration Robotics. “They see the technology not only from the aspect of what they can do for the patient but also how they can adopt this into their practice. It is something they can learn and master in a decent amount of time, whereas the older techniques of hair transplantation are much more difficult to master.”
As with the introduction of any transformative technology the physician community takes its time to assess its value and potential for bringing in new patients. In the case of the ARTAS Robotic System, however, that time has come, according to Dr. Bishara. “I had a mixed practice of both cosmetic surgery and reconstructive surgery, along with hair restoration where we did around 50% strip procedures and 50% of FUE,” he said. “There is no doubt that with the results we’re achieving now with the robot, with the density and the overall hair maps, it is certainly acceptable to forego having a strip taken out of the back of your head. And that’s coming from somebody who did the manual transplantation procedure for several years before purchasing the robot.”
According to Gregory A. Turowski, M.D., Ph.D., F.A.C.S., a plastic surgeon in Skokie, Ill., the ARTAS system eases the tediousness of manual approaches and also dramatically speeds up the overall procedure. “I had used some FUE systems before, but they were manual systems and they require a lot of experience and concentration for long periods of time, and they were relatively slow,” he expressed. “The main advantages of using the ARTAS system is that it’s faster than doing transplantation manually, even for an experienced person. It doesn’t require a steep learning curve. One can become quite proficient compared with other approaches to FUE. More than that, I think it improves the quality of the grafts. The grafts are more consistently not denuded and not stripped from the surrounding tissue. This combination of features has us using the robotic system more than the manual technologies.”
Herbert S. Feinberg, M.D., a dermatologist in Englewood, N.J., said he implemented the ARTAS Robotic System in his practice in order to speed up the FUE process. “I found manual FUE too tedious. The ARTAS robot allowed me to perform FUE with more competencies that I could ever achieve manually. Certainly, it’s less physically demanding. I have now transplanted a number of patients who had traditional FUT or strip procedures in the past. All of them said they preferred the robotic transplant and they would never go back to a strip procedure if they needed more work in the future.”
In order to help physicians retain those patients and attracting new ones, Restoration Robotics has recently started to roll out a new Internet-based advertising and social media-based marketing and patient outreach program. “Hair transplantation is a unique market space,” said Mr. Parkyn. “Unlike the behavior of female patients that regularly return to their aesthetic physician, the typical male is not going to ask friends about where they go for hair transplantation. Identifying and marketing to these men, and getting our message in front of them can be a challenging task. A lot of men have certainly heard about hair transplantation, but they might not believe that it works.”
When people start noticing their hair loss, one of the key places they go for information are the online search engines, added Mr. Parkyn. “With this program, anyone searching online for any information in this category will find our information at the top of the search results page, encouraging them to response or look up a doctor to see. We can see expanding into other media as we go forward including banner ads and inbound marketing, as well as informational videos and infographics and trying to take a lot of the mystery out of hair transplantation. This kind of education will hopefully convince both men and women to seek out hair transplantation with one of the physicians that use the ARTAS system. We look to empower our physicians with this kind of information so that they can then take it out to the market.”
Any time industry comes out with a new technology that is relatively new to the consumer, the manufacturer bares a large majority of the burden to educate via public awareness and other campaigns. “Restoration Robotics has done exactly that,” noted Dr. Bishara. “The company has been getting the word out about the robotic technology. They’ve used cooperative advertisement agreements for more of the grassroots efforts, and also have taken on a large scale Google AdWords campaign for advertising the system and the procedure. So many times, industry will focus just on the providers and leave it up to them to educate patients and the public on new techniques and technologies. However, Restoration Robotics is taking the lead in this case, picking up the flag for practices that need marketing help in order to accomplish the goals of public outreach and letting them keep my marketing dollars.”
The company’s patient marketing program is a necessary component for practice success, noted Dr. Feinberg. “The materials provided by Restoration Robotics were well thought out and professionally presented. Most important to me was their focus on Internet presence. While most of my patients were referred from traditional sources, such as patient, doctor and barber referrals, the Internet has been the go to medium for most people seeking information about robotic transplants. For example, most of my consults have come to me via the Internet, such as the ARTAS website.”
Unless a physician already has the kind of extensive funds and access to an existing public relations firm or marketer, “You will need all the help you can get when you’re starting up something that’s so new, unique and somewhat mysterious to most people,” added Dr. Feinberg.  “Today, to make yourself visible in what’s become a quite competitive environment you need professional assistance.”
One result of the company’s outreach would be to reel in physician naysayers, as more consumers learn about the ARTAS Robotic System and approach those physicians with questions about it. “These physicians will be compelled to start buying into the concept of non-manual grafting,” noted Dr. Bishara. “When you look at the naysayers you can scratch the surface and find out that there is usually some other type of fear motivating them to behave like that. This new technology needs to be truly embraced. Whenever you see such see such drastic game changing take place in medicine and other fields, as well, it induces a lot of fear. For instance, surgeons that are in different parts of their career and are not willing to switch over, and they feel that their craft is being lost or that all of their life’s efforts have gone by the wayside. They feel like they’re being replaced by something newer and better. But history has taught us that those that have been courageous enough to be early adopters, and embrace new things and new technology, and opening want to be at the forefront of change and participate in that change, are those that usually end up being laureates in the field.”
Dr. Turowski agreed that the ARTAS Robotic System confronts the hair restoration surgeon with a radically new procedure and technology, “It makes sense that at first people would be somewhat skeptical. And though public awareness is a key to the success of this system, public perception and physician acceptance has also changed during the past several months for one other important reason,” he said. “After two and a half years of doing the procedure, I and I’m sure others have demonstrated excellent results. We have the data and the before and afters to show to prospective patients to show that the procedure not only works but works well.”
In addition to offering global marketing support for practices, Restoration Robotics has also announced the ARTAS Hair Studio (AHS), which will improve the functionality of the robotic system by incorporating a new tablet-based interface that physicians can use in both patient consultations and in programming aspects of the hair restoration procedure.
The AHS allows physicians to use the tablet to create an onscreen photorealistic model of the patient’s head, explained Mr. Parkyn. “You can spin that head around in any direction and see it from any angle. The physician would literally draw the transplant, adjusting for lines, different levels of density in different areas of the head, etc.,” he stated. “We see it as an interactive tool, with which a physician can sit down with a patient and try out different simulations of what the patient’s hair transplant will look like. It allows the patient and the physician to explore and experiment and look at which way they want or need to go. Eventually that information can be fed to the robot, which would then perform a lot of the procedure based on the design the physician and patient have agreed upon.”
The new product will provide the patient with insight into what a hair restoration procedure can offer, noted Dr. Bishara. “In addition, the AHS turns out to be a great pre-op planning device. Physicians will be able to easily predict the amount of grafts needed for a certain operation. It is a good integrated approach as well as a good sales tool during the consult. It should not extend the time of the consult, but rather it does provide good information that is accurate.
For Dr. Feinberg, “The new AHS impressed me enough to put in my order.  Anything that can enhance a procedure that is working so well now can only have a positive effect,” he expressed. “The robotic system is very high-tech and that has been a strong selling point for many of my patients. Any improvement can only create more interest and acceptance from and by patients. Also, for the ‘techie’ doctor — and I speak as one of that species — these enhancements can be very stimulating and certainly a lot of fun.”
The result of the company’s effort, in part, will be that the public’s perception of hair transplantation will move from older approaches to the automated robotic FUE method. “There are some patients that definitely benefit from the strip procedures,” noted Dr. Turowski, “but in my opinion if you have a choice of leaving a large scar on a patient’s skull versus no scar — or a nearly invisible little scars — it is a pretty simple choice.”
Bringing along the skeptics in the medical community will happen, as well, because of good patient outcomes and the kind of next-generational improvements in the technology represented by the ARTAS system.
“Every surgeon who has one will tell you why they have it, and the people that don’t have one are going to tell you why they don’t have one,” said Dr. Bishara. “They’ll give you an excuse on why they haven’t purchased one. The fact remains is that it’s worth making the switch to next generation. I think technology that a few years ago may have sounded very futuristic and unreal will become the new standard. Then, we will wonder how we could have lived without it.”
The thought process of arriving at that point varies depending upon the physician’s orientation, Dr. Bishara added. “For surgeons that have been doing hair and only do hair, increasing productivity and clinical outcomes using this system can be beneficial and even allow them to expand their aesthetic offerings. Those who embrace the new and explore the ARTAS system may ultimately be free to offer a wider scope of cosmetic surgery and other procedures, which can expand their business.”
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The low- level laser therapy treatment is also known as “The Cold Laser”. The laser light generated by low-powered (cold) lasers has recently come into use as a non-surgical hair restoration treatment for patten hair loss.
Laser Hair Therapy is a non-chemical and non-invasive treatment being used around the United States of hair loss.  Like other treatments (such as Propecia and Minoxidil) some patients tend to respond better than others.  Laser therapy has been proven to have the best results when combined with other medical therapies such as Propecia, minoxidil or finasteride.  Patients that have more hair tend to have better results.  Men and women both are seeing great hair response to these treatments.

“Once viewed with skepticism by some in the medical community, low-level laser therapy has since proven itself to be a safe
and highly effective treatment for male and female pattern hair loss.” Dr. Alan J. Bauman
Many patients experience significant improvement and report benefits such as:

  • Reduction of excessive hair loss
  • Improvement of hair shaft quality
  • Repair of damaged hair follicles
  • Thicker, easier-to-manage hair
  • Reduction of excess oil production in the scalp
  • Relief from itchy scalp symptoms

Low Level Light Therapy is a great treatment that can be used also have a hair transplant.  The treatment cost is $3500 for 48 treatments.  Please call our office for more information at (817) 473-2120 or visit our website at

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ARTAS Hair Studio™ Preview
Regarding FUE hair transplantation, Dr. Bernstein describes the recipient site creation process in detail. He explains why, in FUE procedures, the recipient sites are created before the follicular unit grafts are extracted from the donor area. “Pre-making” recipient sites is a key improvement to the FUE procedure that Dr. Bernstein was the first to describe in medical literature. It is beneficial in several ways, the most important of which include reducing the overall time grafts are out of the body and creating a “fertile bed” for the follicular unit grafts. Both of these processes contribute to increased graft survival.
At the 2nd ARTAS User Group Meeting in February 2014, Dr. Bernstein introduced hardware and software technology by which the ARTAS Robotic System can create recipient sites in an FUE hair transplant. The addition of the recipient site creation capability to the robot, which until now was used solely to extract follicular units, brings the system closer to performing all critical aspects of a hair transplant procedure.
In using the updated ARTAS robot, the doctor takes photographs of the patient which are fed into the robot’s computer system. The ARTAS™ Hair Studio converts the photos into a 3-D model of the patient. This model can be manipulated and saved for use in the patient’s procedure. The physician then designs the recipient site incisions in order to create the most natural looking hair transplant. During the procedure, the robot uses its guidance technology to avoid existing hairs while creating up to 1,500 recipient sites per hour. The automation of recipient site creation improves a procedure that, with manual tools, can be physically demanding and prone to human error.
The recipient site creation capability will be available for the ARTAS Robotic Hair Transplant System in the fall of 2014.
The final step of a robotic hair transplant will be the automated insertion of follicular units into recipient sites created by the ARTAS. This step is likely 2 or more years away from use in a hair restoration clinic.
On the advancement, Dr. Bernstein said: “This development is a crucial step towards a robotic system that can perform every aspect of a hair transplant. A great deal of credit goes to the engineers of Restoration Robotics who have worked to make automated recipient site creation a reality. I am proud that this work not only improves hair transplants for patients, but adds to the increasingly important trend of using robotic technology in medicine.”
The ARTAS Robotic System, developed by Restoration Robotics, is currently in use by hair restoration physicians around the world to automate the extraction of grafts of skin and hair called follicular units.. Follicular units, which are natural groupings of one to four hair follicles, form the biological basis of the modern hair transplant procedure. Once extracted from the back of the patient’s scalp, the follicular unit grafts are then inserted into recipient sites in the balding area of the scalp where they grow hairs that are immune to the effects of common hair loss.
This is exciting news to the hair restoration industry and for patients interested in hair restoration.  For more information on Robotic Hair Restoration in the Texas area, please contact Dr. Mark Bishara’s office at (817) 473-2120 or visit our website at

The older, traditional form of hair transplantation is called Follicular Unit Transplantation (FUT), or more commonly, “strip” surgery. In a “strip” surgery, the surgeon uses a scalpel to remove a large piece of scalp from the back of the head. This process requires stitches or staples to close the wound. The strip of scalp is given to a group of technicians who then manually dissect each individual follicular unit. These dissected follicular units are transplanted into the scalp by the surgical team. The recovery period for this procedure is significant, typically several weeks. In addition, patients may experience numbness, scalp tightness or lingering pain. More importantly, the risk of leaving a noticeable linear scar on the back of the head is unacceptable to many patients.

Donor Area Comparison

The “Strip” method:  a strip of scalp from your donor area is cut out with a scalpel, and the strip is completely removed from the head.  The donor area is pulled together and stitched close to the wound.  This method leaves a visible scar.
ARTAS Robotic method: the hair is removed individually by the robot and no cutting or stitches are needed.  The scalp retains the natural appearance with no linear scar.
Strip Method Post Procedure:                     ARTAS Method- 1 Week Post Procedure:

For the very latest technology in hair restoration, Dr. Bishara uses the ARTAS System. This interactive, computer assisted equipment employs image guidance to enhance the quality of hair follicle harvesting. ARTAS is the first hair transplant robot to improve the most challenging aspects of Follicular Unit Extraction (FUE). It received clearance from the Food & Drug Administration (FDA) for use in April 2011.  Please contact our office for more information at (817) 473-2120 or visit our website at
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Plastic surgeons are seeing more patients who wish to undergo facial surgery, suggesting social media-posted selfies may be inspiring more Americans to consider plastic surgery.
The growing trend of taking selfies – a type of self-portrait photograph, typically taken at arm’s length with a hand-held digital camera or camera phone – and posting them on Facebook, Twitter,  Snapchat, and Instagram, has been attributed to the increase in nose jobs and other reconstructive facial procedures.
Dr. Edward Farrior, President of the AAFPRS who conducted the research that posed these assertions, states in CBS News:

“Social platforms like Instagram, Snapchat and the iPhone app, which are solely image based, force patients to hold a microscope up to their own image and often look at it with more self-critical eye than ever before. These images are often the first impressions young people put out there to prospective friends, romantic interests and employers, and our patients want to put their best face forward.”

According to an annual survey conducted by the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) of a select group of the organization’s 2,700 members revealed one in three plastic surgeons reported seeing an increase in requests for facial procedures by patients who wanted to look better online.

Between 2012 and 2013 they saw a 10 percent rise in nose jobs, a seven percent rise in hair transplants and a six percent rise in eyelid surgery, says the NY Daily News. In addition, 58 percent of the doctors surveyed noted having a growing number of patients under 30 seeking out services – in part because of social media images like selfies.
Nose jobs (rhinoplasty) are the most popular elective surgical procedure conducted among those in the under 35 crowd – accounting for 90 percent of women, and 86 percent of men respectfully. And while women account for nearly 80 percent of plastic surgeries for face and eye lifts, men are becoming more determined to keep their hair and combat wrinkles.
This information is brought to you courtesy of Dr. Mark Bishara and The Paragon Plastic Surgery & Med Spa in Mansfield and Southlake, TX
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