Robot-assisted hair restoration LA Times Article

[PayDay]

http://www.latimes.com/health/la-he-robotic-surgery-hair-20111017,0,5660320.story

Hair-transplant surgery could become cheaper and more accessible with a new robot that plucks hair follicles from the back and sides of the head so they can be moved to the top and front of a balding pate.

It normally takes eight to nine hours to individually harvest, by hand, the 1,000 follicle clusters needed to build a full mane of hair, according to Dr. James Harris, director of the Hair Sciences Center of Colorado in Denver. Since the surgery is tricky and time-consuming, fewer than 10% of hair-restoration surgeons do it. Most simply remove a whole strip of scalp and separate out the follicles under a microscope. Strip surgery is painful and takes weeks or months to heal versus just a couple of days' healing time and less scarring with individual follicular-unit extraction, Harris says.

The new ARTAS robot decides which follicles to collect and plucks them out as the doctor stands by to check its work. The surgeon can watch from the same room or via a remote monitor.

Harris says the time passes quickly as he watches the robot do its thing: "It's certainly less tedious than doing it by hand. It allows me to think more about the other things I'm going to do with the patient."

The robot halves the surgery time, Harris says, and surgeons can be trained in its use in a couple of days, rather than the two to three years it took him to perfect the by-hand operation.

Harris developed a blade for the drill tip that the machine uses to punch out follicles without damaging them and licensed it to Restoration Robotics Inc. of Mountain View, Calif., the company that makes ARTAS. His office is one of two that tested a prototype of the machine.

Harris was so impressed he became the first hair-restoration specialist to install the ARTAS robot, which was approved by the U.S. Food and Drug Administration last year. He and his fellow testers have already put more than 350 heads under the machine's care, with no complications, he says.

Since collecting follicles one by one directly from the scalp is so time-consuming and difficult, physicians that do it charge $5,000 to $10,000, Harris says. The robot cost $200,000, but because it saves him time, Harris offers patients a discount if they let ARTAS do the follicle extraction.

—Amber Dance

[John P. Cole, MD]

I really don't understand why the data on follicle extraction is so inaccurate in these reports regarding robotic extractions.

Extraction rates vary by physician and technique. There are many physicians who can extract over 1000 grafts in one hour by a variety of techniques.

it does not take years to become proficient in manual FUE. It takes no more than one week for a physician with good hands. Many physicians are able to extract grafts well by the second day when done manually. With some mechanical devices including mine, which is not available at this time, you can become proficient in 2 or 3 minutes.

Transection rates vary by physician and technique, as well. The robot is better than some physicians and worse than others.

The robot has trouble differentiating grafts containing more than one hair so it tends to select grafts containing fewer hairs per graft even though it uses a larger 1.2 mm punch.

In Alaska, over 40% of the physicians in the audience offered FUE. i have no idea where the 10% of all physicians came from. In 2008 over 10% of all hair restoration surgery procedures were done by FUE (mostly manual techniques).

i think the robot has a place in hair transplant surgery. It offers a better transection rate than many physicians can achieve. It is also going to be faster than many physicians. Still, it is much slower than many physicians and much slower than some.

i think we should see accurate data when a physician promotes a tool they have an financial interest in. Otherwise, i think it really damages their credibility.

[James Harris, MD]

ARTAS Article in LA Times

The data in the article are estimates as we have no survey data to provide the accuracy that we would like. The recent 2011 practice survey of the ISHRS did not inquire about the percentage of physicians performing FUE and certainly did not ask about rates of extraction. I am basing the estimate on discussions I have had with several hundred physicians. More importantly the point I was trying to make is that very few physicians offer FUE as a primary treatment in their practice even when their websites promote them as FUE experts; the fact is that they use FUE as a marketing tool rather than a treatment modality for a multitude of reasons.

In my discussions with them I have found out that in they are not extracting at acceptable rates because they do not have the opportunity or the desire to train and practice. In spite of your imagination there are not many physicians producing 1000 grafts an hour and it certainly isn’t happening after a week of experience and your assertion of proficiency in 2-3 minutes is a stretch.

Your claim that the robot may be faster than some surgeons and slower than others is absolutely true. But so what? Your tone is one of incrimination and the point and you are trying to make is meaningless as some physicians are faster than others in any procedure. What does your comment have to do with the application of any technique and specifically what does it have to do with the introduction of new technology that will benefit many doctors and the patients that decide to go to them?

In addressing your inaccuracies, there is absolutely no “tendency” for the robot to select grafts with fewer hairs, in fact the opposite is true. The size of the punch creating the incision around the target graft is 1 mm, not 1.2 mm. I do not receive royalties or payments of any sort based robot sales, my lectures or discussions with physicians.

The article was intended to let the potential patient know of a new technology that may enhance their clinical results in the hands of the right surgeon.

[fitness-man]

I have my consultation with Dr. Harris Nov 16th.

I plan on getting James Harris with the ARTAS robot transplant next year. Assuming I am a good candidate for the process. The numbers he quoted me were right within my budget.

Hopefully his time schedule for a transplant is better than his consultation time schedule 2ish months +

[John P. Cole, MD]

There has been a plethora of knowledge available regarding extraction rates and transection rates for years. Rather than accept this data or mention it in any of your marketing message, you have chosen to simply ignore it, while perpetuating the claims that you have the fastest equipment on the market. You have done this for many years in marketing your safe system.

Yes there are some very good physicians who can produce well over 1000 graft extractions in an hour. Some may be based on burst rates, but many can cut this many in one hour. Others may average 400 to 500 per hour, but that's still much better if you produce a lower transection rate and more hair per graft because the patient gets more hair and a better value to what really bothers them, their hair loss. The fact that you ignore these physicians is completely understood. You seem to ignore other physicians as a rule of thumb.

You are cutting with a 1.2 mm punch. You are not communicating with an idiot or someone who does not perform FUE. You are communicating with someone who understands it far better than you do and to someone who has done far more FUE procedures than you will probably ever perform. A 1.2 mm punch would average more hair per graft, if the Robot did not select grafts with fewer hairs per graft. The Robot cannot discern grafts containing more hair in many instances due to limitations in the equipment. The reason you are cutting with a larger punch is to reduce the transection rate of the grafts.

Frankly, I really don’t care if you receive royalties or just a boost to your ego. What I do care about is your failure to recognize the limitations of some equipment, the advantages of other equipment, and the abilities of many physicians using a variety of different techniques. I can still recall when you felt that you did not need depth control or a variation in punch sizes. Even the depth of your safe system has decreased significantly from your original 5 mm depth. Over time even the most stubborn people catch on through a variety of means.
I’m not incriminating the Robot. It’s going to offer FUE options to many patients in the hands of physicians, who would otherwise not be able to offer FUE for a variety of reasons. I’m very much pro FUE and very much anti-strip.
What I’m doing is lecturing you. I’m lecturing because your message is meant to market the Robot while failing to inform patients that there are also some very good alternatives with proven results and documented safety records that exceed the capacity of the Robot in it’s present form. Rather, you are quoted that typically takes 8 to 9 hours to harvest 1000 follicle clusters by hand. That is simply ridiculous. Also, over 10% of hair restoration surgery procedures in the 2008 ISHRS practice census were FUE cases. This number did not go down during the time the Robot was not commercially available.
It is my opinion that someone who does not accurately quote the literature does place his or her credibility into question.

There are very good hair transplant surgeons, who are quite quick and pick things up quickly. There are others, who cannot pick things up as quickly and may never be good at FUE. Furthermore, if you are not committed to FUE, you may never be as good at it as those who practice it every day. With proper instrumentation, you can pick it up quickly, and if you have good hand eye coordination with outstanding instrumentation, along with proper teaching you can be very good in a short period of time. Perhaps over time, the Robot can make significant strides, but for now, the Robot cannot match the potential available from other modalities to perform FUE.

I do think that it is great that we have an alternative option for FUE that fits the budget of many people. That’s one potential clear advantage in favor of the Robot for many patients. The difference is that you will average fewer hairs per graft and risk a higher transection rate. It really does not matter if it takes you longer to get the Robot transplant performed than other methods available. Eventually, I’m sure they will figure out how to improve that, as well.

[amadeus]

I love this forum! Where else can you see two of the best FUE surgeons in the world having an open debate? I’m very interested in learning more about this robot and personally think that it looks like a positive step for HT surgery. Cool stuff! I wonder what Spencer Kobren thinks about it?

[PayDay]

On Sunday’s radio show Spencer mentioned that they are streaming a live surgery with the robot this Friday on the TBT website. Is is going to be a call in show, so we can ask Dr. Harris questions? The last one was pretty cool, but I'm really looking forward to seeing how this thing works. Dr. Harris do you know if we can call in to talk to you live or will we have to type our questions in the chat room?

[PayDay]

Hair Transplant Pioneer To Use Robotic ARTAS System For FUE Hair Transplantation

http://www.sfgate.com/cgi-bin/article.cgi?f=/g/a/2011/10/24/prweb8884530.DTL

Dr. Robert M. Bernstein - pioneer of the follicular unit transplantation (FUT) and follicular unit extraction (FUE) hair transplant procedures - will become the first hair restoration physician on the East Coast to employ the robotic ARTAS™ System for FUE hair transplantation.

New York, NY (PRWEB) October 24, 2011

Robert M. Bernstein, M.D., F.A.A.D., world-renowned pioneer of the Follicular Unit Transplantation (FUT) and Follicular Unit Extraction (FUE) hair transplant techniques and founder of Bernstein Medical - Center for Hair Restoration, will become the first hair transplant surgeon on the East Coast to use the robotic ARTAS System for Hair Restoration.

Dr. Bernstein, a Clinical Professor of Dermatology at Columbia University in New York, said that he is excited to incorporate the image-guided robotic system into his FUE procedures. "The ARTAS System is a ground-breaking technology for hair transplantation that will provide significant benefits to our patients," said Dr. Bernstein. "From the accuracy of follicular unit graft extraction to the automation of what is normally a labor and skill intensive procedure, the outcome is better hair restoration results and faster, more comfortable procedures."

The ARTAS System for Hair Restoration, developed by Restoration Robotics, Inc., overcomes some of the human limitations in performing FUE hair transplant procedures. Greater accuracy in extracting follicular unit grafts, combined with the sharp/blunt extraction technique, allows for graft removal with less damage to the graft and greater preservation of its protective tissues. A lower rate of damage increases the probability that the grafts will survive the transplant process, leading to better results. The automation of what is a technically challenging and physically demanding process for the physician when performed manually, contributes to a shorter procedure and a decreased need for local anesthetic.

By utilizing the latest and most effective advancements in hair transplantation technology, Dr. Bernstein, a New York native, is extending his record as a true pioneer in the field of hair restoration. His landmark medical publications on follicular unit transplantation (FUT) and follicular unit extraction (FUE) revolutionized the field and provide the foundation for techniques in use by surgeons across five continents. His medical practice has been devoted exclusively to the treatment of hair loss since 1995 and he now performs both restorative and corrective procedures at his state-of-the-art hair restoration facility in mid-town Manhattan.

Dr. Bernstein has appeared on a wide variety of notable media programs and publications. Some of these include: The Oprah Winfrey Show, The Dr. Oz Show, The Today Show, Good Morning America, ABC News, CBS News, Fox News, National Public Radio, New York Times, Men's Health Magazine, GQ Magazine, Univision, Telemundo, "O" the Oprah Magazine, and more. He is co-author of Hair Loss & Replacement for Dummies and The Patient's Guide to Hair Restoration. He has been selected as one of NY Magazine's "Best Doctors in New York" for 12 consecutive years.

For more information, contact Ethan Oringel at 212-826-2400 or visit www.bernsteinmedical.com.

About Bernstein Medical - Center for Hair Restoration:

Bernstein Medical - Center for Hair Restoration is a state-of-the-art facility and international referral center located in midtown Manhattan, New York City. The center is dedicated to the diagnosis and treatment of hair loss in men and women. Hair transplant surgery and hair transplant repair surgery are performed using the follicular unit transplant (FUT) and follicular unit extraction (FUE) techniques that Dr. Bernstein pioneered and detailed through his many medical publications. Patients of Bernstein Medical - Center for Hair Restoration receive a thorough medical diagnostic evaluation and comprehensive discussion of their treatment options. When surgical treatment is indicated, it is performed with meticulous attention to detail, personal attention, and long-term follow-up.

[charity]

I love this forum! Where else can you see two of the best FUE surgeons in the world having an open debate? I’m very interested in learning more about this robot and personally think that it looks like a positive step for HT surgery. Cool stuff! I wonder what Spencer Kobren thinks about it?

yes it is really great to listen to two of the best bicker back and forth about their techniques. The bottom line is still the costs. I filled out a consultation and had several conversations with Dr. Coles office. In my initial conversations with them I told them I was really in desperate times and I need a lot of repair work and had very limited funds.
here's what i was told
**3000-3500** grafts to restore your frontal third. You are not the ideal candidate for full hair restoration. I would like more information about your previous procedures as well. You can start with a test procedure of **500** BHT to the crown.
Please let me know if you have any questions regarding the information. The prices are as followed:
CIT Shaven: $8 per graft - 2000 grafts per day. The back of head will be shaved to the scalp with a zero guard clipper (the whole back of head) and above ears. If you have prior scarring, it will be visible until hair grows out.
CIT Non Shaven: $10 per graft - 1500 grafts per day. Hair must be at least 2-2.5 inches in length (This technique requires Dr. Cole to cut one at a time individual follicular units.)
*Other BHT procedures including chest, legs, stomach, arms…are all $12 per graft.
* PRP Therapy - $850 Micro needling is $160
*Acell, PRP and Thrombin combo $1200

So I basically said no thanks to their 40000.00 estimate. And mind you that is not even for a full head of hair!!

I think Dr.Cole is a little threatened by the challenge of competing with the future of automation, realizing this may eventually cut into his cash cow.
Who the hell makes 40000.00 in 2 days??!?!

I am all for the automation process and the thought of having realistic prices especially people who have suffered for years with horrible scarring or primitive procedures. This proceedure sounds outstanding and would love to hear more and see some results of the donor area after removal. Also to know if its possible to remove the hair from the chest, back, etc.

[amadeus]

That’s very pricy. These doctors make a lot of money but one thing Spencer Kobren says all the time when people bring this up on his show is that people will pay what the market will bear. It’s the law of economics he says, and he’s right. It’s not fair, but I guess there are plenty of well off guys who will pay these outrageous prices. I’m not one of them and am hoping that this robot will eventually help to drive down the cost to maybe 5 dollars per graft like regular hair transplants. Spencer if you are reading this please discuss this on Friday’s live hair transplant show.
Dr. Cole does seem a bit threatened by this robot, but I probably would feel the same way if I spent my life trying to improve hair transplants only to have the rug pulled out from under me by new technology. He’s only human like the rest of us. I still think he’s one of the best at FUE but so is Harris and now that I read that Dr. Bernstein is going to be using this robot, I can't help but think that it might me the best way to do FUE.

[charity]

That’s very pricy. These doctors make a lot of money but one thing Spencer Kobren says all the time when people bring this up on his show is that people will pay what the market will bear. It’s the law of economics he says, and he’s right. It’s not fair, but I guess there are plenty of well off guys who will pay these outrageous prices. I’m not one of them and am hoping that this robot will eventually help to drive down the cost to maybe 5 dollars per graft like regular hair transplants. Spencer if you are reading this please discuss this on Friday’s live hair transplant show.
Dr. Cole does seem a bit threatened by this robot, but I probably would feel the same way if I spent my life trying to improve hair transplants only to have the rug pulled out from under me by new technology. He’s only human like the rest of us. I still think he’s one of the best at FUE but so is Harris and now that I read that Dr. Bernstein is going to be using this robot, I can't help but think that it might me the best way to do FUE.

I agree Dr. Cole has a right to feel threatened. And I 100% agree that Dr.Cole is probably tops in the industry. that is the reason i sought him out to begin with. I know he hears my type of story a million times a year. I guess I was hoping for a humane side instead of a clinical reply. However keeping your prices out of reach also opens the door for people to capitalize on more cost effective means. If Coles prices where within reason( and let's face it he sets the bar in this category) the odds are that this technology would not even be needed. So in the end who's fault is it??

[PayDay]

Ziering Medical is Second Practice to Offer Revolutionary ARTAS System to Patients in

The plot thickens

http://www.marketwatch.com/story/ziering-medical-is-second-practice-to-offer-revolutionary-artas-system-to-patients-in-united-states-2011-10-17

LOS ANGELES, Oct 17, 2011 (BUSINESS WIRE) -- Ziering Medical Worldwide, a private practice dedicated exclusively to the specialty of hair restoration, today announced that they will be the first to bring the ground-breaking ARTAS(TM) System to Los Angeles. The ARTAS System is the first and only FDA cleared, physician controlled, interactive, computer assisted technology that allows safe and effective follicular unit extraction (FUE). The ARTAS System was developed in close collaboration with several leading hair restoration physicians to enable minimally invasive harvesting of hair follicles.

"My entire practice is committed to helping patients with various degrees of hair loss and providing them with state-of-the-art options that are very safe and effective," commented Craig L. Ziering, D.O., FAOCD, Founder and Medical Director for Ziering Medical Worldwide. "The ARTAS System is an excellent solution to hair loss that is less invasive, offers a quicker recovery time and natural permanent results."

"The ARTAS System adds to Ziering Medical's tradition of offering break-through treatments for hair loss for the benefit of patients," said Jim McCollum, President and Chief Executive Officer, Restoration Robotics, Inc. "We are proud to have him as the first adopter to the LA market."

Hair Loss By The Numbers

According to the International Society of Hair Restoration Surgery (ISHRS)(1), at least 35 million men in the United States are affected by male pattern baldness or androgenetic alopecia. By age 50, approximately 50% of men will experience some degree of appreciable hair loss. Approximately one in four men suffer from male pattern baldness (MPB), which has psychological, professional and social consequences for these patients, such as:

-- 68% of men feel helpless about their hair loss

-- 73% of balding men feel they are less attractive than they were when they had hair(2)

-- 77% of balding men would feel very or somewhat concerned if they were in their 20s, just starting their career and experiencing hair loss(3)

Hair restoration moves healthy, functioning follicles to the areas of the patient's scalp most impacted by baldness for more dramatic results. New hair continues to grow over the course of a full year, resulting in a gradual change in the patient's appearance over time. Hair restoration is the only permanent solution for hair loss.

About Ziering Medical Worldwide

Headquartered in Los Angeles, California, Ziering Medical Worldwide serves as the industry leader for hair restoration and transplants with numerous upscale surgery centers and consult destinations. Internationally recognized for his leadership and contributions to new innovations and studies in hair restoration, Dr. Ziering has practiced exclusively in his field for over 20 years. Dr. Ziering and his team of professionals have worked with world famous clientele and appeared on "Extreme Makeover," "The Today Show," and many cosmetic medicine programs. Learn more about Ziering Medical's continuing advancements in microsurgical technology as well as numerous non-surgical options for hair restoration at www.zieringmedical.com .

About Restoration Robotics

Restoration Robotics, Inc., a privately held medical device company, is dedicated to revolutionizing the field of hair transplantation by developing and commercializing its state-of-the-art image-guided ARTAS(TM) System. This interactive, computer assisted system uses image guided technology to enhance the quality of hair follicle harvesting for the benefit of physicians and their patients. To learn more about the ARTAS System and its unique technology, visit www.artashair.com . To learn more about hair loss and restoration, please visit the International Society of Hair Restoration Surgeons (ISHRS) at www.ishrs.org .

(1) International Society of Hair Restoration Surgeons (ISHRS) website. http://www.ishrs.org/hair-loss/hair-loss-male.htm . Accessed April 11, 2011. (2) Journal of the American Academy of Dermatology (3) ISHRS 2006 Consumer Hair Loss Survey

[gillenator]

How very thankful we all can be for the many improved strides in HT surgery methodology espcially now that we have so many options for patients today that let's face it, we did not have even 5 years ago. You both have your place in your own methodologies and instrumentation whether they be by robotic or not. It really comes down to each individual patient and his/her needs as defined by their goals.

I am also seeing more and more repair patients regain some level of social independence freeing some of them of the psychological barriers from past HT surgery procedures. Let's not lose sight of that.

That is what this is all about and let's rather be encouraged by the obvious improvements in robotic technology from Dr. Harris and others. I am seeing more and more IAHRS and ISHRS physicians adoting this robotic tooling in their own practices and even the more as we speak. I am especially encouraged by the range and total control over the robotic device as the seperate FU extractions are made. It's very similiar to the potential control in the robotic devices an urologist uses when various sized kidney stones are extracted. Stones as small as .5 mm with very precise movements. Obviously they also employ the use of a monitor so they can make any needed adjustments as they guide their instrument at and through the point of extraction.

With time, and as Dr. Cole pointed out, more and more improvements will be made in the industry and hopefully the transection rate can be reduced to nearly zero! We are sincerely behind you Dr. Harris!

Thank you again gentlemen for your passion.

[charity]

can the ARTAS do body hair FUE's?

[topcat]

Most clinics don’t offer FUE because they simply do not have the necessary skill to offer it without damaging the patient. They also realize that they simple cannot make much profit spending their whole day working on one patient even if they had the skill. Of course not being able to offer FUE leaves them at a distinct disadvantage so I’m sure they are chomping at the bit.

To suggest this robot is for the benefit of the patient is nonsense in my opinion. If my figures are correct more than $63M+ has been raised in attempt to bring this robot to market. These investors have one goal in mind at that is to realize a hefty return.

Most patients that have had a FUE procedure or are familiar with it know that a 1mm punch is too large and usually ends up in visible scarring. How exactly does this benefit the patient? Are patients made aware that skilled doctors are using punches that are .75-.85 in size? Are patients made aware that a 1mm punch covers a square area that is 80% larger? Does that matter in the clinics opinion? This industry always seems to think it’s quite ethical to leave out information if the patient doesn’t ask.

With the limited extraction area will overharvesting become of concern for clinics concerned only with numbers? The suggestion that FUE can be learned in 2-3 minutes I find to be absurd.