Drs. Berman and Zimmerman can transplant one hair at a time without any linear cut on the back of the scalp. This follicular unit extraction (FUE) technique can be done by hand, or by automated robotic device. Our state of the art center is one of three in the world with this new, stereoscopic, 3D video image-guided robotic technology.
Dr. Berman/Dr. Canales Publication on Robotic-Assisted Hair Transplantation

Follicular Unit Hair Transplantation
About Benefits Alternatives How Does It Work? Who is a candidate? What Can I Expect? Safety & Side Effects Recovery Time Does it Hurt? Before Treatment Instructions After Treatment Instructions Who Performs the Treatments?

Follicular Unit Hair Transplantation is a medical procedure which redistributes your naturally growing hair. Hair which is growing in great density on the back of your head can be moved to areas where there is a shortage or thinning of the hair, such as the balding areas in front or on top of the scalp. Because of the abundance of hair on the back of the scalp, removing some hair from this area does not cause any cosmetic problems. Additionally, these hairs are genetically programmed to grow throughout your lifetime, thus transplanting them to the balding area permits them to grow permanently.

• Permanent
• Natural
• Undetectable
• 1-3 hair micrografts avoid the old pluggy, dolls head appearance
• Avoids the needs for temporary solutions such as wigs, hair pieces
• Improves male and female pattern loss of hair
• Thicker hair
• Reduction of bald spots
• For both men and women
• Affordable
• Artistically-designed hairlines

Propecia, Rogaine, Hair Pieces, Wigs, and Hair Extensions

The following will lead you through a typical hair transplantation procedure.

While the patient watches a video, your surgeon anesthetizes the back of the scalp and harvests a strip of hair-bearing skin. The strip is meticulously dissected down to individual grafts; some grafts containing 1 hair follicle each (one hair follicular unit), while others contain 2 or 3 hair follicles each (two or three hair follicular units).

Next, the surgeon follows the pre-designed graft placement, planting the smallest single-hair grafts into the frontal hairline to give a purposeful, somewhat random and natural distribution of hair. The 2-to-3 hair grafts are placed behind this hairline to fill in and enhance hair density. The surgeon takes into consideration the pattern of expected change of hairline and future hair loss, so that the transplanted hairs, now permanent, will sit naturally as the pre-destined baldness pattern of the non-transplanted hair evolves.

Further, in an attempt to create the desired distribution of future gray hairs, the surgeon will assess present day coloration and mix or separate follicles that may gray in order to preserve the desired, natural appearance as the patient ages. Our surgeons have published articles on hair transplantation in medical journals and remains acutely aware of the subtle nuances that go into the "good transplant."

Not everyone is a candidate for hair transplantation. At your initial consultation, your surgeon will examine the density of hair on the back of the scalp in order to determine if there is enough hair for transplantation to the balding area. Multiple sessions may be required for optimal benefit, and patients should have realistic expectations prior to undergoing hair transplantation, or any other cosmetic procedure.

Hair transplantation can naturally and permanently correct thinning hair. Though hair transplantation has been performed since the 1950's, technological advances in recent years have substantially enhanced cosmetic outcomes. Recent advances have transformed hair transplantation into the most commonly performed cosmetic procedures for men in the United States.

One may not be aware of the staggering number of people who have had a hair transplant, as a good hair transplant is not noticeable. Certainly, most everyone has seen a bad transplant, perhaps one that was done with large plugs, resulting in a pluggy, dolls head, or corn stalk effect. These poor outcomes were due to older techniques using large, round punch devices to remove 15-20 hairs per graft.

Today, Dr. Berman and his staff move only one to three hairs at a time, placing them each in tiny slits in the skin, eliminating any possibility of creating a pluggy appearance. Because these results are superior to the older techniques, Dr. Berman exclusively relies on this "Follicular Unit" approach, as opposed to the old punch graft technique, still used by others. Today, our well trained team can move thousands of hairs per session, creating natural results.

The specific risks and the suitability of these procedures for a given individual can be determined only at the time of consultation. All surgical procedures have some degree of risk. Minor complications that do not affect the outcome occur occasionally. Major complications are unusual.

Patients can shampoo new hair one day following the procedure. Sutures from back of head are removed in seven days. Transplanted hairs will fall out within two months, followed by regrowth of new hair. The final appearance may not be noted for up to one year.

Most patients are awake during the procedure and may infrequently feel some slight discomfort.

Wash hair; avoid blood thinners such as aspirin, Motrin, ibuprofen, etc.

Most patients can shampoo their hair in 24 hours. Avoid strenuous exercise and blood thinners after the procedure for about 1 week.

Our physicians are assisted by registered nurses, physician assistants and medical assistants when performing this procedure.

Propecia
About Benefits Alternatives How Does It Work? Who is a candidate? What Can I Expect? Safety & Side Effects Recovery Time Does it Hurt? Before Treatment Instructions After Treatment Instructions Who Writes for this Prescription?

The most common form of balding is male pattern hair loss, representing close to 95% of all hair loss cases. Mild to moderate male pattern hair loss affects about half of men by age 50. This type of hair loss results in a receding hairline and/or balding at the crown. It is due to heredity, from either the mother's or father's side of the family, and is dependent on hormones. Propecia is the first and only FDA-approved pill proven to treat male pattern hair loss on the vertex (top of head) and anterior mid-scalp area in men.

• Propecia can slow the loss of hair in men
• Propecia can increase hair growth in men

Follicular Unit Hair Transplantation
Rogaine Solution

The causes of hair loss are not well defined; however, researchers have found that men with male pattern hair loss have increased levels of DHT in the balding area of their scalps. DHT is one of many male hormones in the body. DHT is developmentally important early in a man's life; however, it appears to be a cause of hair loss as men get older. DHT shrinks the hair follicle until it no longer produces visible hair.

Human hair normally follows a cycle of growth, falling out, and new growth. But increased levels of DHT are believed to contribute to the shortening of the growth phase, and a shortening of the time it takes for the hair to fall out. This results in thinning of the hair on the scalp.

Science has found a way to affect DHT with a prescription taken once a day in tablet form: Propecia. Finasteride, the active ingredient in Propecia blocks the formation of DHT and, in this way, appears to interrupt a key factor in the development of inherited male pattern hair loss in men. Propecia has been proven to effectively lower DHT in the scalp.

Men with male pattern baldness may be candidates. Women and children are not candidates for Propecia.

The fact is, for most men, Propecia works. Most men reported an increase in the amount of hair, a decrease in hair loss, and an improvement in appearance. The results of two years of clinical testing* showed favorable results for the vast majority of men on Propecia.

• 5 of 6 men kept the amount of hair they had (vs. 28% with a sugar pill)
• 2 of 3 men regrew some hair (vs. 7% with a sugar pill)
• 80% were rated improved by doctors (vs. 47% with sugar pill)

*Based on vertex studies at two years of men aged 18 to 41 with mild to moderate hair loss. There is no evidence that Propecia works for receding hairlines at the temples. Take Propecia daily and you could see results in as little as three months. If you stop taking Propecia, however, your results will gradually go away over 12 months. And if it has not worked in 12 months, it is unlikely to be of benefit. Propecia is available by prescription only, so the best thing to do is talk to our medical staff for more information.

Clinical tests showed Propecia was very well tolerated. Only a very small number of men had sexual side effects, with each occurring in less than 2% of men. They included less desire for sex, difficulty in achieving an erection, and a decrease in the amount of semen. When the men who had these side effects stopped taking Propecia, the side effects went away. Propecia is for men only. Women who are or may potentially be pregnant must not use Propecia because of the risk that the active ingredient may cause a specific kind of birth defect. Likewise, women should avoid handling tablets that are crushed or broken. Propecia tablets are coated to prevent contact with the active ingredient during normal handling.

None.

No. This is a medication take orally.

See prescribing provider for more information.

See prescribing provider for more information.

Our physicians and Physician Assistants

New robotic hair transplant pioneered at the Berman Skin Institute. Our state of the art center was the first to start testing robotic hair transplantation on patients five years ago. Now, having completed the large FDA clinical research trial, we are pleased to announce that at last we can now offer this novel technology to most patients. The robot painlessly plucks out one hair follicle at a time without the need for a linear cut on the scalp.

Published Research Paper

New! ARTAS™ Robotic Assisted Hair Transplantation
About Benefits Alternatives How Does It Work? Who is a candidate? What Can I Expect? Safety & Side Effects Recovery Time Does it Hurt? Before Treatment Instructions After Treatment Instructions Who Performs the Treatments?

Dr. Berman is excited to announce that robotic-assisted hair transplant surgery is finally here! Dr. Berman has led the research team for five years as principal investigator for the ARTAS™ robot by Restoration Robotics, Inc. "FDA approval is finally here" according to Dr. David Berman of the Berman Skin Institute in Palo Alto, Walnut Creek and San Francisco. "This technology permits physicians to extract tiny hair grafts, each containing one, two or more hairs from the back of the scalp, precisely and relatively non-invasively compared to the more traditional strip harvesting technique of hair transplantation. " The Restoration Robotics ARTAS™ robot utilizes the Follicular Unit Extraction (FUE) technique of using a tiny 1 mm punch device to extract hairs from the donor area for implantation to areas in need of more density. For a number of years, FUE has been attempted to be performed by hand, however transection of the hair follicles is very high, especially in untrained hands. Further, this has been a very slow and tedious procedure when compared to the more traditional strip harvesting technique, making it a difficult surgery for both patient and physician. "With 3 D real time video imaging and sophisticated software, the robotic-assisted approach is able to precisely extract hairs from the back of the head for implantation elsewhere. Not only does this eliminate the need for a linear cut or scar on the back of the scalp, it also increases the donor area; strip harvesting techniques are inherently limiting as the surgeon must close the wound with stitches. If the strip is too big or if the patient has had multiple procedures, it is often very hard to stretch the skin together with the strip harvesting approach" says Dr. Berman. "Now, we can even take a multiplicity of grafts from around old linear hair transplant scars without the concern of wound closure. Too often, I have patients who desire even more hair after strip harvesting treatments which cannot be done any further with that technique as the surgeon wouldn't be able to close the wound. These patients do extremely well with the robotic approach as there is almost no limit to the amount of hair we can harvest . We could even take hair from other parts of the body for transplantation to the head. This is being done right now by hand using the FUE approach, and surely it is just a matter of time before the robot harvests from body areas as well".

Dr. Berman has been at the forefront of hair transplant research for over twenty years. He was the first surgeon to start investigating the robotic approach with Restoration Robotics, Inc and remains committed to staying on the cutting edge of technology.

If you are interested in learning more about brand new ARTAS™ robotic-assisted hair transplantation procedure, please feel free to send us your photos. Please also tell us your history of hair rejuvenation treatments, a brief history of your medical conditions, and how we can best serve your needs.

Please send to:
David Berman, MD
900 Welch Road, Suite 300
Palo Alto, CA 94304

After receiving your photos, we may be even able to perform a live video telemedicine phone call, one on one with the doctor which can facilitate our understanding of your concerns, even without you having to fly in from out of state, or drive in from a far away distance.

We look forward to helping you achieve your goals of self improvement.

This is a photo of shaved area of back of scalp from patient that hair robotic harvesting one year prior. Note tiny dotted scars that will be virtually invisible once his hair is regrown in this donor area

• No linear incision
• No linear scar
• Increased accuracy of graft placement at proper angles and orientation
• Increased graft survival
• Less labor/medical staff requirements
• Increased accuracy of graft harvesting
• Faster healing time
• Expanding the donor area to include areas remote from the scalp, such as the chest or back
• Reduced duration of the procedure
• Reduced recovery time

Follicular Unit Transplantation
Follicular Unit Extraction, by manual technique

Targeting Follicular Units:  The medical staff sees a magnified stereo-view of the scalp.  The software digitizes this view.  Complex imaging algorithms compute angles, orientation, location of follicular units on the scalp as well as follicular unit type (1,2,3) – this is the basis for accurate targeting. Additionally, stereoscopic video images guide the movement of the needle mechanism and robotic arm.  This function is known as visual servoing.
Two punches, an inner and outer, arranged concentrically: The inner punch is sharp and has a 1mm internal diameter castellated edge that  makes a   shallow incision in skin of 1-3mm.  The outer punch is blunt, with an internal diameter of 1.37mm.  The Outer punch enters the scalp through the incision made by the inner punch.  It spins or oscillates into the scalp while bluntly dissecting 7-8mm into the skin around the follicle.  Donor area hair is cropped to 1mm length.  Lidocaine is injected into the skin of the scalp to numb the area.  Tension is applied to scalp using a specially designed retractor.  Patient is in the semi-prone position in our specialized chair.  Camera system scans the patient’s scalp and identifies groups of 1-3 hairs (follicular units, FUs).  System automatically targets FUs for harvesting based on medical staff input.  The process is semi-automated: it can automatically target  5, 10, 15, or more follicular units sequentially; additionally, the system periodically prompts the medical staff user for input.

Only patients with darker hair colors can undergo the ARTAS™ Robotic-assisted hair transplantation procedure. Currently the video imaging software on the device has a more difficult time targeting grey and blonde colored hairs.

Patients undergo this relatively non-invasive procedure and can expect to usually see more hair growing in about 3-6 months. Often patients don't see the fullest hair growth until 8-12 months or more after the procedure.

• Inherently safe design:  Stereo cameras measure the distance between the needle and the scalp at every frame, and the robot moves based on the camera measurements
• Redundant safety devices:  Hard stops, Force Sensor, Emergency stop buttons, and medical staff overrides
• The specific risks and the suitability of this procedure for a given individual can be determined only at the time of consultation.

Patients go back to work the next day.  Since there are no stitches needed, patients may even return to vigorous athletic activity within a few days.

A local injection of topical anesthetics makes this procedure safe and comfortable without the need for sedative medications.

Wash hair; avoid blood thinners such as aspirin, Motrin, ibuprofen, etc.

Apply polysporin antibiotic ointment to the donor area twice a day.  Patients may shampoo the scalp within one to two days, but avoid rubbing the recipient area for about one week.

Our physicians are assisted by registered nurses, physician assistants and medical assistants when performing this procedure.