DERMATOLOGIC SURGERY

Characteristics of robotically harvested hairfollicles in Koreans

Jung Won Shin, MD,a Soon Hyo Kwon, MD,a Sung Ae Kim, MD, PhD,a Joo Yong Kim, MD,b

Jung Im Na, MD, PhD,a Kyoung Chan Park, MD, PhD,a and Chang Hun Huh, MD, PhDa

Seongnam-si and Seoul, Republic of Korea

From

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Background: Recently, an automated robotic hair restoration device was developed and is increasinglybeing used for hair restoration.

Objective: We sought to analyze the hair follicles of Korean patients that were harvested by a hairrestoration robotic device.

Methods: Data were reviewed from a total of 22 patients who underwent robotic follicular unit (FU)extraction hair restoration surgery at Seoul National University Bundang Hospital. Hair follicles collectedfrom 3 grids in the central parts of the safe donor zone of each patient were analyzed.

Results: The total number of harvested FUs was 5213, and the total number of collected FUs was 4955. Theaverage yield was 95.1% 6 3.5%. Among the 12,017 harvested hairs, 590 hairs were transected and theaverage transection rate was 4.91% 6 2.9%. FUs of double hairs made up the majority of harvested FUs(44.1%), followed by triple hairs (31.9%). The transection rate increases in FUs that contain multiple hairs.

Limitations: A relatively small sample size and lack of comparative study with conventional FU extractionmodalities are limitations.

Conclusions: The robotic system qualifies for use in hair restoration surgery. It efficiently harvests not onlysingle hairs but multiple hairs as well. ( J Am Acad Dermatol http://dx.doi.org/10.1016/j.jaad.2014.07.058.)

Key words: androgenetic alopecia; follicular unit extraction; hair restoration surgery; robot; transectionrate.

Abbreviations used:

FDA: Food and Drug AdministrationFU: follicular unitFUE: follicular unit extraction

Hair is considered a major aspect of appear-ance, and consequently, hair restorationsurgery for androgenetic alopecia has

become an increasingly common procedure. The 2main harvesting techniques for hair restorationsurgery are follicular unit (FU) strip surgery and FUextraction (FUE). FU strip surgery produces grafts byexcision of a linear strip of donor scalp with subse-quent dissection to obtain individual FUs.1,2 FUE is aharvesting method that extracts individual FUs usingsmall and precise punches.3 FUE has recently gainedpopularity because it offers many advantages overthe strip method, such as the absence of linear

the Department of Dermatology, Seoul National University

ndang Hospital, Seongnam-si,a and Mojerim Hair Clinic,

oul.b

ing sources: None.

licts of interest: None declared.

pted for publication July 29, 2014.

int requests: Chang Hun Huh, MD, PhD, Department of

ermatology, Seoul National University Bundang Hospital,

scarring on the donor tissue, less pain, and shorterrecovery time for the patient.4 Furthermore, by usingthe FUE method, the exact number of hairs neededfor hair transplantation can be harvested. However,FUE is still a time-consuming, technically difficult,and labor-intensive procedure for surgeons. An

300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do

463-707, Korea. E-mail: chhuh@snu.ac.kr.

Published online September 13, 2014.

0190-9622/$36.00

� 2014 by the American Academy of Dermatology, Inc. Published

by Elsevier Inc. This is an open access article under the CC BY-NC-

ND license (http://creativecommons.org/licenses/by-nc-nd/3.0/).

http://dx.doi.org/10.1016/j.jaad.2014.07.058

1

J AM ACAD DERMATOL2 Shin et al

automated robotic hair restoration device was deve-loped recently and received US Food and DrugAdministration (FDA) 510(k) clearance on April 11,2011. To date, there have been no published clinicaldata in peer-reviewed scientific journals using thisrobotic system toour knowledge. In the current study,the authors analyzed hair follicles harvested by the

CAPSULE SUMMARY

d Strip surgery and follicular unitextraction are 2 main harvestingtechniques in hair restoration.

d The newly developed robotic deviceharvests multiple hairs with high yieldsand low transection rates.

d The robot harvests hairs efficiently,without the strip surgery’s linear scar ortime-consuming process of follicular unitextraction.

robot for hair restoration sur-gery in Korean patients.

METHODSRobot system

The ARTAS robotic system(Restoration Robotics Inc,San Jose, CA) is an interac-tive, computer-assisted, andphysician-controlled roboticsystem used for the FUE har-vest. The robot systemextracts individual FUs, oneat a time, directly from apatient’s safe donor area.The system is composed of

a cart with a 6-axis articulated robotic arm (Fig 1, A).A needle mechanism is affixed to the end of therobotic arm to separate FUs from the scalp. Theneedle mechanism also houses stereo cameras andforce sensors that guide the dissection and providesafety measures in real time. A specialized chair isused to position and stabilize the patient’s head andbody during the procedure.

The dissection system uses a needle-in-needleconfiguration in which a sharp bi-beveled needle(inner needle) is concentrically arranged within ablunt outer punch (Fig 1, B). A skin tensioner isintegral to the dissection process (Fig 1, C ). During adissection, the inner needle makes a shallow scoringincision of 1 mm in diameter around the selected FU.The outer punch, which spins at between 400 and800 rotations per minute, dilates the scoring incisionand dissects deeper into the skin to separate the FUfrom the surrounding tissue. A suction systemelevates the FU above the skin and thereby easesthe extraction process. Stereo cameras and an imageprocessing system are able to identify FUs on thescalp and precisely measure and calculate the anglesand direction of each FU within its field of view.Imaging feedback allows the robot to dynamicallytrack and harvest each hair even in the presenceof motion caused by the patient’s breathing andincidental head movements.

The details of the robotic procedure are asfollows. The patient’s hair in the donor area is shaveddown to about 1 mm in length to reveal the FUs to beharvested. The surgeon injects a local anesthetic to

numb the donor area. A tensioning device is placedover the area to be harvested to provide consistentskin tension. Optical targets are then established bythe imaging system to guide the robot back and forthover the donor area as it dissects the follicles. Oncethe system is ready, the physician and assistant caninitiate the dissection process. Generally, the robot

determines directions androtations per minute of theneedle, and targets folliclesto be extracted in a randompattern. However, the sur-geons can optimize thedissection parameters, suchas depths of the inner needleand outer punch anddistance between harvestattempts, using a handheldremote control and a com-puter monitor. The surgeonsalso can choose follicles tobe extracted or skipped inmanual mode. After extract-

ing FUs, the surgeon makes slits in the recipient areaand the extracted follicles are inserted in the slits afterproper processing. The patients are instructed totake oral antibiotics 2 hours before the surgeryand for 3 days after the surgery for prophylaxis.The patients are also instructed to take oralacetaminophen and methylprednisolone to reducepain and swelling until 3 days after procedure.

For this study, the ARTAS software, Version 4.8.2(Restoration Robotics Inc) was used for harvestinghair follicles. We used the classic skin tensionerfor this study: each dissection area (grid) definedby the classic skin tensioner is approximately3.53 3.5 cm2. The surgeon followed the distribution,direction, angle, and rotations-per-minute parame-ters, which were set automatically by the robot.The surgeon adjusted the depth of the innerneedle and outer punch, and exercised the optionof overriding the FU selection of the roboticsystem. To eliminate interoperator variability, thecorresponding author conducted all of thesurgeries and collected all of the analyzed hairfollicles. The distance between harvested FUs wasset to 1.9 mm.

PatientsA total of 22 patients who underwent robotic-

assisted hair restoration surgery from September2012 to March 2013 at Seoul National UniversityBundang Hospital with the robotic system wereincluded in the current study. Medical records ofthe patients were reviewed after surgery.

Fig 1. ARTAS robotic system (Restoration Robotics Inc, San Jose, CA). A, The system iscomposed of a cart with an articulated robotic arm and a specialized chair. B, Dissection systemwith a needle-in-needle configuration in which a sharp bi-beveled needle (inner needle) isconcentrically arranged within a blunt outer punch. C, A classic tensioner. (Printed withpermission from Restoration Robotics Inc.)

Table I. Demographics and clinical data of each patient

No. Sex Age, y Diagnosis

No. of samples from 3 grids

Punches FUs Hairs Transected hairs TR, % Yield, %

1 M 32 AGA 262 246 515 33 6.4 93.92 M 47 AGA 252 237 726 90 12.4 94.13 M 28 AGA 248 223 508 25 4.9 89.94 M 53 AGA 222 209 524 3 0.6 94.15 M 37 AGA 242 235 640 15 2.3 97.16 M 27 AGA 231 201 534 12 2.3 87.07 M 55 AGA 225 195 435 19 4.4 86.78 F 52 FTB 270 249 656 28 4.3 92.29 M 59 AGA 197 192 397 20 5.0 97.510 M 76 AGA 252 246 567 16 2.8 97.611 M 56 AGA 228 221 539 4 0.7 96.912 M 63 AGA 201 199 495 31 6.3 99.013 M 48 AGA 187 180 358 26 7.3 96.314 M 42 AGA 246 244 605 13 2.2 99.215 M 46 AGA 247 240 683 46 6.7 97.216 M 58 AGA 248 242 549 33 6.0 97.617 M 52 AGA 281 278 644 46 7.1 98.918 M 51 AGA 273 261 684 12 1.8 95.619 M 32 AGA 201 195 470 7 1.5 97.020 M 53 AGA 268 256 539 46 8.5 95.521 M 59 AGA 198 188 426 24 5.6 95.022 M 60 AGA 234 218 523 41 7.8 93.2Total 5213 4955 12,017 590 4.9 95.1

AGA, Androgenetic alopecia; F, female; FTB, female-type baldness; FU, follicular unit; M, male; TR, transection ratio.

J AM ACAD DERMATOL Shin et al 3

EvaluationTypically, between 12 and 14 skin tensioner

applications (grids) were required to harvest 1000FU grafts. The superior border of the grids was setbetween the right and left reflection of the externalear and scalp. Hair follicles were collected from 3grids (upper center, lower center, left lateral) to avoidvariation between subjects, and were analyzed. Thissampling method was performed on every patientand was meant to represent the harvest performance

on the upper occiput, lower occiput, and lateralocciput regions of the scalp. As mentioned before,every follicle was collected by a single surgeon, andthe follicles were analyzed under a microscope by 2independent nurses. Yield was defined as the ratio ofthe number of collected implantable FUs to thenumber of total punches attempted. Transectionrate was defined as the ratio of the number of hairsthat are accidentally cut and damaged during theprocedure to total hair count. In subanalysis, the

Fig 2. The number of hairs in a robot-harvested follicularunit (FU ). Fig 3. Transection rate according to the number of hairs in

a follicular unit (FU ).

J AM ACAD DERMATOL4 Shin et al

multiplicity of FUs and the relationship betweenmultiplicity and transection rate was assessed.

RESULTSThe mean age of patients was 49.4 6 12.3 years.

In all, 21 patients were male with androgeneticalopecia, and 1 patient was female with female-typebaldness. The total number of attempted harvests forthe entire study, including all 3 grids for each patient,was 5213, and the total FU grafts generated was 4955.The average yield was 95.1% 6 3.5%. Of the 12,017harvestedhairswith the FUs, 590hairswere transectedand the average transection rate was 4.9%6 2.9%. Ofthe harvested hairs, 1244 (10.4%) were telogen hairsand 146 (1.2%)were vellus hairs. The average numberof FUs per grid was 75.1 6 9.1, and the average haircount per grid was 182.1 6 32.6. Information forindividual patients is presented in Table I.

The number of hairs in a robot-harvested FUranged from 1 to 7, with an average of 2.4. As shownin Fig 2, of 4955 FUs, the majority were thosecontaining 2-hair grafts (2187 FUs, 44.1%) followedby 3-hair grafts (1583 FUs, 31.9%). In all, 649 weresingle-hair grafts (13.1%) and 445 were 4-hair grafts(9.0%). In all, 82 were 5-hair grafts (1.7%) and only 9were grafts of 6 hairs and above (0.2%). A total of10.1% of robot-harvested FUs were partially or totallytransected. Transection shows a tendency to correlatewith multiplicity of hairs; 29.2% of quintuple hairfollicles were transected, whereas only 4.8% ofsingle-hair grafts resulted in transection (Fig 3).

No significant side effects or complications weredetected during or after the surgery. There were nocases of infection or excessive scarring, and nopatient reported severe pain.

DISCUSSIONOriginal FUEwas performedmanually using large

(4-mm) handheld punches.5,6 The size of the punch

was gradually decreased to improve cosmeticoutcome and survival of grafts. However, the hand-held punches failed to gain universal acceptancebecause the procedure took too long to perform andwas so laborious that the total number of hairfollicles transplanted in a single surgical sessionwas limited. Although motorized punch deviceshave been introduced recently, FUE is still a time-consuming, exhausting, and technically challengingjob for surgeons and furthermore has a long learningcurve. The FDA-cleared computer-assisted roboticsystem is used for the FUE harvest. It was developedto overcome some of the disadvantages of FUE.

In the current study, hair follicles collected from 3grids in the central part of each patient’s head wereanalyzed. The calculated yield was 95.1%. Some ofthe missing follicles had been drawn into themachine by the suction system, and others wereuncollectable and remained attached to the scalpbecause of inadequate dissection. The transectionrate by the robotic system in our study was 4.9%. Inother studies conducted in the United States7 andJapan,8 the average transection rates were 8.0% and5.9%, respectively. We attribute these differences tothe variability of a patient’s hair profile (eg, waviness,thickness, color) and the surgeon’s minute control ofthe depth of punches. For example, we set thedefault puncture depth deeper (2.8-2.9 mm) thanother studies (2.1-2.2 mm) (personal communica-tion, James Harris, MD, Hair Sciences Center, Denver,CO, August 23, 2011). A comparison of the currentstudy to these other 2 studies is presented in Table II.

The robot was also able to harvest FU grafts withmultiple hair follicles. Two-hair grafts were themajority of harvested FUs (44.1%), followed bytriple-hair grafts (31.9%). The average number ofhairs in a harvested FUwas 2.4, which is similar to theUS study. This means that the robot harvesting

Table II. Comparison of data from 3 studies using ARTAS robotic system*

Wasserbauer7 (United States) Kasai et al8 (Japan) Current study

Study size, no.Patients 33 42 22FU samples 9062 33,516 4955

Characteristics of subjectsAge, y 29-59 22-70 27-76Sex 33 Male 40 Male and 2 female 21 Male and 1 femaleHair texture Straight or wavy Straight Straight

Transection rate 8.0% 5.9% 4.9%Range (6.1%-10.9%) (2.0%-12.0%) (0.6%-12.4%)No. of hairs/graft 2.4 N/A 2.4

FU, Follicular unit; N/A, not available.

*Restoration Robotics Inc, San Jose, CA.

J AM ACAD DERMATOL Shin et al 5

procedure is quite efficient for multiple hairs as well.However, we should keep in mind that transectionrate tended to increase according to the number ofhairs within an FU; 29.2% of 5-hair grafts weretransected partially or totally, whereas only 4.8% ofsingle-hair grafts were transected.

There were no significant complications experi-enced during or after the surgery, such as infection orsevere pain. There were also no side effects suchas serious scarring or development of excessivecontiguous holes.

Currently, strip surgery is still the most commonlyperformed hair restoration procedure by hairsurgeons.5 However, FUE is expected to becomemore popular following current trends thatprioritize minimizing invasiveness. The roboticsystem remedies some of the major disadvantagesof FUE by saving the surgeon time and labor, andreducing the learning curve.

The literatures include a few references about thetime required for manual FUE. FUE operation timevaries according to the surgeon’s skill, total FUsneeded, and the method of FUE used. In somearticles, the authors reported the time needed formanual FUE ranged from 14.2 to 36 minutes toharvest 100 FUs,9-11 which is significantly longer thanour experience with robotic-assisted FUE, which is6 to 9 minutes per 100 FUs.

The cost of this robotic system varies widelyworldwide because of country-specific tariffs andtaxes. In the United States, the system may costover USD $265,000, depending on the productconfiguration.

To our knowledge, this is the first assessment ofrobot-harvested hair follicles. We believe these datawill be beneficial for hair restoration surgeons,

especially current users of the robotic system.Further investigations are still necessary, includingstudies using a larger sample size and longer-termfollow-ups, to fully understand the transection rate ofrobotically harvests FUs. Furthermore, because thisis a noncontrolled retrospective study, a comparativestudy with conventional FUE, mechanical handengine, or mechanical pump should be conducted.

REFERENCES

1. Bernstein R, Rassman W. Follicular transplantation: patient

evaluation and surgical planning. Dermatol Surg 1997;23:

771-847.

2. Bernstein R, Rassman W. The aesthetics of follicular

transplantation. Dermatol Surg 1997;23:785-99.

3. Rassman W, Berstein R, McClellan R, Jones R, Worton E,

Uyttendaele H. Follicular unit extraction: minimally invasive

surgery for hair transplantation. Dermatol Surg 2002;28:720-8.

4. Harris J. Follicular unit extraction. Facial Plast Surg Clin North

Am 2013;21:375-84.

5. Williams K. Current practices and controversies in cosmetic

hair restoration. Dermatol Surg 2013;39:797-801.

6. Unger W. Hair transplantation. 1st ed. New York: Marcel

Dekker; 1976.

7. Wasserbauer S. Robotic assisted harvest of follicular units:

Abstract book of 19th annual scientific meeting of Interna-

tional Society of Hair Restoration Surgery; September 14-18,

2011; Anchorage, AK. pp. 252-6.

8. Kasai K, Haruyama I, Aikawa Y, Saito K. Advantages and

disadvantages of FUE using ARTAS system form Japanese:

Abstract book of 21st annual scientific meeting of Interna-

tional Society of Hair Restoration Surgery; October 23-26,

2013; San Francisco (CA). pp. 387-8.

9. Bernstein R, Rassman W, Anderson K. Follicular unit extraction

mega sessions: evolution of a technique. Hair Transplant

Forum Int 2004;14:97-9.

10. Dua A, Dua K. Follicular unit extraction hair transplant. J Cutan

Aesthet Surg 2010;3:76-81.

11. Onda M, Igawa HH, Inoue K, Tanino R. Novel technique of

follicular unit extraction hair transplantation with a powered

punching device. Dermatol Surg 2008;34:1683-8.

Introduction

The ARTAS® Robotic System facilitates hair restoration surgery through minimally invasive follicular unit harvesting. Patient benefits include; precise graft harvesting, minimal post-op discomfort and no linear donor scar. By preserving the natural appearance of the donor area, it allows patients to wear shorter hairstyles without detecting the wound scars. This is an important goal for many persons seeking surgical hair restoration. 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. 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.

Case Study

The patient is a 46-year old white Caucasian male with Norwood Stage 5A Male Pattern Baldness. He has dark brown, straight hair of medium-fine caliber and a donor density of 2.1hairs/mm2. His skin color is Fitzpatrick Type III. (Photo 1)

The patient underwent harvesting with the ARTAS Robotic System using features available with the new software version 7.0 (2014). The following tools helped to preserve the natural appearance of the donor area.

Features include: • 19g Needle for Dissection: This leaves a smaller surface wound (0.9mm) and minimizes scarring. Smaller

sites heal more rapidly.• “No F1s” Software Algorithm: A new intelligent software algorithm that preferentially harvests follicular units

containing multiple hairs (F2 or more). This maximizes the amount of hair follicles which are harvested per graft.

• Minimum Distance Between Harvest Sites: An intelligent algorithm that controls the minimum distance between harvests sites. The minimum distance was increased from 1.7mm to 2.0mm and accommodates decreasing hair density as the dissection progressed from the occipital scalp to the sides of the head. It also enables a blending or “feathering” effect between harvested and non-harvested zones making the harvesting less noticeable.

• Intuitive Controls: This gives the user the ability to make adjustments in real-time, allowing the physician to adapt to changes in the characteristics specific to each patient’s donor area.

The patient had 2,540 harvests to obtain a total of 2,768 grafts for implantation (Photo 2). The average number of hairs per follicular unit was 2.6 and the harvest yield was 95.2% prior to splitting the grafts to obtain more 1-hair follicular units. Post-operative care of the donor area consisted of gentle washing and applying ointment (Bacitracin®, AQUAPHOR®) for 7 days to keep the donor area moist to facilitate healing.

During the third post-operative month, the patient returned to the clinic to undergo an examination of his donor area and an evaluation of the visibility of wound scars. His donor area hair was gradually shortened to

OCTOBER, 2014

ARTAS® Robotic System provides a comprehensive suite of tools to minimize donor area scarring following hair transplantation

Robert M. Bernstein, MDBernstein Medical - Center for Hair RestorationNew York, New York

James A. Harris, MD, FACSHair Sciences Center of ColoradoDenver, Colorado

different lengths in order to see how short he could wear his hair before scarring from the harvest sites was detectable. The hair lengths were: 1. #2 Clippers 6mm (Photo 3) 2. #1 Clippers 3mm (Photo 4) 3. Close cut using the Wahl Peanut Clippers 1.5mm (Photo 5) 4. Shaved down to skin (Photo 6)

Even when the hair was shaved down to skin, the detectability of the wound scars was extremely low. The harvest zones blended, or transitioned, into the un-harvested areas so that there were no detectible changes in hair density as one progressed from one region of the scalp to another.

ARTAS® Robotic System Provides Minimized Donor Area Scarring

Conclusion

The ARTAS® Robotic System provides a comprehensive suite of tools to minimize the detectability of wound scars post-surgery and maintain the natural appearance of the donor area.

The ARTAS® System from Restoration Robotics is indicated for harvesting hair follicles from the scalp in men diagnosed with androgenic alopecia (male pattern hair loss) who have black or brown straight hair. The ARTAS System is intended to assist physicians in identifying and extracting hair follicular units from the scalp during hair transplantation.

© 2014 Restoration Robotics, Inc. All Rights Reserved. Restoration Robotics, ARTAS and the stylized logos are among the trademarks and/or registered trademarks of Restoration Robotics Inc.

Photo 1, Pre-operative

Photo 3, Shaved with #2 clipper 6mm

Photo 5, Shaved with peanut clippers 1.5mm

Photo 4, Shaved with #1 clipper 3mm

Photo 6, Shaved to the skin

Photo 2, Day 2 following the ARTAS procedure

Three Months Post-procedure

Immediately Post-procedure

Photos courtersy of Bernstein Medical - Center for Hair Restoration

MK-134 Rev. A

Experience the Future of Hair Transplantation

The ARTAS® Robotic System with the ARTAS Hair Studio® Technology and Recipient Site Making

ARTAS Hair Studio

Harvesting

Recipient Site Making

The OpportunityTO MEET AN UNTAPPED MARKET

* American Academy of Dermatology, www.aad.org** International Society of Hair Restoration Surgeons, 2013 Practice Census

50 MillionBaldness

U.S. Men Suffer From Hereditary

20~40Years Old

Majority of Patients Are Between

Annually**39%Minimally Invasive Hair Transplants Growing At

310,000+

Worldwide*

Hair Transplantation Procedures Are Performed Annually

“With the ARTAS® Robotic System, I am confident that I am employing the most advanced technology to treat my patients. Restoration Robotics has also given me strong marketing support, which has elevated my clinic to be recognized as an international center for hair transplantation.” Dr. Eduardo Lopez Bran - Clinica Imema, Spain

Photos courtesy of the Hair Sciences Center of Colorado, James A. Harris, MD, FACS

Robotic PrecisionTO DELIVER EXCEPTIONAL PATIENT OUTCOMES

Minimally Invasive Dissection• Delivers robust intact grafts

• Preserves the natural look of the patient’s donor area

• Patented blunt dissection technique produces

minimal scarring and healthy grafts

Image-Guided Robotic Alignment• Digital mapping provides precise and consistent graft dissection,

unparalleled to manual techniques

• Robotic arm can approach follicular units at the appropriate angle to

control needle alignment

High Definition User Interface• Rapid, micron-level targeting accuracy

• Determines hair angles, orientation and direction

unable to be seen with the human eye

• Monitors and updates parameters of each follicular

unit 60 times a second

HARVESTING LEGEND

Completed Harvest

Future Harvest

Current Harvest

Donor Area Comparison – Strip vs ARTAS ARTAS Donor Area

Donor Area AnalysisIntelligent algorithms identify and select only the best hairs for harvesting

• Consistent results

• Uniformly harvested donor area

Post-ARTAS Robotic ProcedureNon ARTAS Post-Strip Surgery Pre-procedure 9 months Post-ARTAS

“Once I take my patients through the ARTAS Hair Studio consultation, they overwhelmingly want to have Recipient Site Making as part of the ARTAS procedure.” Dr. David Berman - MD Medical Director, Berman Skin Institute

PROTECTING PRE-EXISTING HEALTHY HAIR

Recipient Site Making using intelligent algorithms• Avoids damaging pre-existing healthy hair

• Creates natural site distribution

• Eliminates human fatigue with consistent and reproducible results

The minimally invasive procedure that patients demand• No incisions or sutures

• Preserves the natural look of the donor area

• Rapid recovery

The First and Only robotic hair transplant system• Image-guided robotic alignment for graft

harvesting and Recipient Site Making

• High resolution digital mapping provides unparalleled visual details of the

treatment area

ARTAS Hair Studio® Advanced 3D modeling tool that transforms your patient’s consultation• An interactive individualized photograph-

based tool

• Illustrate your aesthetic vision to your patient

A Powerful CombinationTO DRIVE PRACTICE GROWTH

ARTAS Hair Studio®

ENGAGE, EDUCATE AND MOTIVATE PATIENTS

Recipient Site MakingPROTECTING PRE-EXISTING HEALTHY HAIR

The ARTAS Hair Studio® Technology is a 3D photograph-based simulation of the patient’s potential results that helps to set realistic patient expectations. During the patient consultation, you will design a personalized cosmetic plan with the patient’s input. ARTAS Hair Studio allows you to illustrate different options by using the available preset tools that shows you various graft counts and hair distribution. This simulation tool helps to enhance patient education and increase the patient’s confidence regarding procedural outcomes.

Preset Comb Styles Customization Tools

Design Options

• Treatment design is delivered to the robot for execution under physician control

• Site Making creates the ideal aesthetic hair pattern for the optimal outcome

• Physician-controlled dissection parameters: hair angles, depth and direction

• Avoids damaging patient’s pre-existing healthy hair using a series of algorithms that evaluates specific hair characteristics

Dissection Parameters

Recipient Sites Created

Visualization of Healthy HairsSITE MAKING LEGEND

Number of Grafts

Hair Length

Hair Color

Recipient Site Making - 12 days Post-ARTAS

Incision Depth Setting

Density Setting Average Elevation Angle

Hair Caliber Setting

Unsurpassed SupportWE PARTNER WITH YOU TO ENSURE YOUR SUCCESS

Clinical SupportThorough clinical training to develop a high level of proficiency

• Hands-on product training

• Develop staff efficiency and workflow

• Exceptional clinical case support

On-Site Technical Service and Support• Responsive in-office service by Restoration Robotics Field Service Engineers

Practice DevelopmentSkilled team of experienced Practice Development Specialists

• Consultation on new patient marketing and database mining

• Extensive in-office marketing support

• Staff training on the entire process, from patient consultation to closing

Driving Patient Acquisition

“From the first step of the contract to the last step of training, Restoration Robotics provided absolutely phenomenal support.”Dr. Ken Williams - The Irvine Institute of Medicine & Cosmetic Surgery

“ARTAS search advertising has led to a significant rise in patients asking for the robotic procedure.”Dr. Mark Bishara - Bishara Cosmetic Surgery and Hair Restoration

“I have an amazing hairline and feel confident again. I could not be happier with the results” - Jeff, Actual Patient

Donor Area

Before ARTAS9 Months Post-ARTAS

Photos courtesy of the Hair Sciences Center of Colorado, James A. Harris, MD, FACS

© 2015 Restoration Robotics, Inc. All Rights Reserved. Restoration Robotics, ARTAS, ARTAS Hair Studio, and the stylized logos are among the trademarks and/or registered trademarks of Restoration Robotics Inc.

The ARTAS® System is indicated for harvesting hair follicles from the scalp of men diagnosed with androgenic alopecia (male pattern hair loss) who

have black or brown straight hair. It is also indicated for creating recipient sites for subsequent manual implementation of the harvested follicles.

MK-100 Rev B

Results* Donor Area

Photos courtesy of Dr. Yates Hair Science, William D. Yates, MD

BEFORE ARTAS 14 MONTHS POST-ARTAS

Photos courtesy of Dr. Yates Hair Science, William D. Yates, MD

BEFORE ARTAS 10 MONTHS POST-ARTAS

Photos courtesy of Dr. Yates Hair Science, William D. Yates, MD

BEFORE ARTAS 11 MONTHS POST-ARTAS

Photos courtesy of New Horizons Center for Cosmetic Surgery, Gregory A. Turowski, MD

BEFORE ARTAS 10 MONTHS POST-ARTAS

Photos courtesy of the Hair Sciences Center of Colorado, James A. Harris, MD, FACSBEFORE ARTAS 10 MONTHS POST-ARTAS

888.963.8923 ContactUs@RestorationRobotics.comwww.restorationrobotics.com128 Baytech Drive | San Jose, CA 95134

For more information, contact an ARTAS representative today.

BEFORE ARTAS

3 MONTHS POST-ARTAS

Photos courtesy of Bernstein Medical - Center for Hair Restoration Robert M. Bernstein, MD

Photos courtesy of the Hair Sciences Center of Colorado, James A. Harris, MD, FACS

BEFORE ARTAS

10 DAYS POST-ARTAS

* Actual results may vary

CORPORATE OVERVIEW

Restoration Robotics, Inc., (San Jose, CA) is a privately held global medical device company dedicated to transforming the field of hair restoration. The company produces the ARTAS® System*, the first and only computer- assisted, physician- controlled system to harvest follicular units directly from the scalp. Restoration Robotics has unique expertise in machine vision, image guidance, visual servicing and robotics, as well as developing intuitive interfaces to manage these technologies. The company is located in the heart of the high- technology center of Silicon Valley.

Restoration Robotics 2015 Media Kit

PRODUCT OVERVIEW - The ARTAS® System for Hair Restoration

The ARTAS® System enables physicians to harvest viable follicular units in a minimally invasive procedure. Using sophisticated imaging technology and precision robotics, the ARTAS® System dissects follicular units accurately and consistently, thousands of times in a single session. A proprietary dissection system and intelligent algorithms help physicians retain the natural appearance of the patient’s donor area. Using the ARTAS® system, hair restoration is minimally invasive, virtually pain free and leaves no linear scar unlike previous hair restoration methods.

Benefits of the ARTAS® System:

• The ONLY physician- controlled robotic hair transplant system

• Image- guided graft harvesting and recipient site making

• Intelligent algorithms select the most viable hair for harvesting

• Personally customize patient consultations using ARTAS Hair Studio® - an Advanced 3D modeling that simulates patients hair results using an interactive individualized photograph- based tool

• Minimally invasive procedure with no incisions or sutures with rapid recovery

*The ARTAS® System has received FDA 510(k) clearance and CE Marking certification.

Physician Experience

“ Restoration Robotics has helped me meet the increasing patient demand for a minimally invasive procedure, with no linear scar. With the ARTAS Robotic System, I am confident that I am employing the most advanced technology to treat my patients.”

Dr. Eduardo Lopez Bran, Clinica imema, Spain

GROWTH AND OPPORTUNITY

Restoration Robotics 2015 Media Kit

WORLDWIDEACCORDING TO ISHRSQUICK FACTS

1 July 2013 Practice Census Results. International Society of Hair Restoration Surgery, prepared by Relevant Research, Inc., Chicago, IL1-2 % of Hair Restoration procedure change between 2004 to 2012.3 American hair loss association.

THE NUMBER HAIRRESTORATION PATIENTSTREATED WORLDWIDE IN 20121

“The TOTAL MARKET SIZEfor hair restoration surgery[WORLDWIDE] has increased47.9% since 2008 from$1.3 billion USD in 2008to $1.9 billion USD in2012.”1

USA Worldwide

72.1%27.9%

FAST GROW WORLDWIDE VOLUME OF SURGICAL HAIRRESTORATION PROCEDURES

104%Australia

397%Asia

94%Europe

740%Africa/

Middle East

OVER ONE BILLIONBALDING PEOPLEIN THE WORLD3

- Dr. Mark Bishara on Technology Review at “Hair transplant surgery Embraces Robotic Technology”

ARTAS® System provides a very safe manner of extracting healthy grafts that require little to not rimming before they are implanted. Enhance graft success as well as reduces the technical staff required. The mean number of surgical assistants required for one hair transplant procedure using other means is 4.5.

2

PATIENT EXPERIENCE

Restoration Robotics 2015 Media Kit

“The procedure is virtually pain free compared to the strip method and my recovery time was phenomenal. I was back to work the next day and to regular activities within a couple of days. I felt great immediately afterwards. I couldn’t have had a better procedure done.” –Vincent

“When I was trying to figure out what to do about my hair loss I definitely didn’t want to do the old style procedure of taking a strip of scalp and it getting sutured, and then being out of commission for weeks. Hair plugs I didn’t want to do because it was invasive and didn’t look natural. Then I found ARTAS, which was much less invasive. It looked natural and great. You couldn’t tell I had anything done.” - Jeff

ARTAS PATIENT RESULTS

MEDIA CONTACT

RESTORATION ROBOTICS: Lina Leon | Linal@restorationrobotics.com International Sales and Marketing Managerwww.restorationrobotics.comwww.ARTAShair.com MK-305 Rev A.

Before ARTAS1 Before ARTAS1 Before ARTAS2

24 months after ARTAS 9 months after ARTAS 10 months after ARTAS

1 Photos courtesy of Dr. Yates Hair Science William D. Yates, MD

2 Photos courtesy of New Horizons Center for Cosmetic Surgery Gregory A. Turowski, MD