Robotic cosmetic dermatology

Abstract

Science fiction movies have both glorified and vilified robots and their role in human society. While many fields have been revolutionized by robots, such as the automobile industry where manufacturing reliability has increased due to infallible robotic accuracy, medical robots remain in their infancy. Robotic assist devices, such as the da Vinci robot, are guided by human hands to perform urologic and gynecologic surgery through small incisions unable to accommodate human hands. The reduction in skin and organ trauma has shortened recovery times following robotically assisted surgery, but the operating time is usually increased, prolonging anesthesia exposure, and the expense also increased due to the single-use robotic surgical devices. It is anticipated that robotic surgery will increase in the operating room, but do robotics have a role in cosmetic dermatology? This editorial examines the current role of robotics in skin care and visions into the future robotic cosmetic dermatology. The robot and the cosmetic dermatologist/dermatologic surgeon seem to be a complementary match. Dermatologists excel in creative diagnosing of rare conditions from a complex set of symptoms; yet succumb to human infirmities, such as arthritis and fatigue. Robots excel at precision and reproducibility, fluidly executing choreographed movements, yet lack the intelligence for more than following instructions. Taken together, dermatologists and robots are complementary: the physician is the highly training operator directing the robot, and the robot is the reliable and steady extension of the dermatologist's hand. Robotic cosmetic dermatology applications provide intriguing opportunities for improved patient care. Robotics is currently being used for research purposes in the obtaining and analysis of biopsies. Skin biopsy is a common procedure in dermatology for the diagnosis of skin cancer prior to excision and cosmetic reconstruction. For traditional microscope analysis, a 3 mm punch biopsy is submitted providing adequate tissue for embedding and preparation of an H&E slide. Smaller specimens may be lost in processing or present handling problems for the histology technologist. At present, it is possible to robotically slice and examine 30+ specimens from the surface of a 3 mm punch. Robotically excised specimens smaller than 0.25 mm can be obtained from the patient without leaving a scar and obviating the need for a suture closure. Where size counts, the agility of a robotic blade and robotic microtome cannot be matched with human hands. Robotic scarless biopsies will gain increasing importance in cosmetic dermatology. However, we believe that robotic cosmetic dermatology will extend beyond the pure surgical arena into neurotoxin and filler injections. Cosmetic procedures demand precision. Only a robotic hand can deliver precisely 4.37 units of botulinum toxin into one site on the forehead. This exact toxin dosing might allow optimal facial relaxation of the forehead without brow drooping in the challenging patient. It might also allow rapid 1 unit dosing of the entire forehead to achieve a more uniform, natural appearing muscle relaxation. Imagine the ability to inject 0.1 mL of hyaluronic acid over the entire cheek at the identical preprogrammed depth to allow increased dermal hydration for 6 months. This would be the true long-lasting moisturizer! Imagine using a robotic needle so small that it could fit between the nerve endings to deliver the least painful injectable administration possible. The use of robotic injections is just the start. We envision the merger of robotically administered injections with synthetic vision. For example, the dermatologist and the patient would determine where the injections should occur and the robot would be positioned over the patient in the appropriate area. The robot would create a three-dimensional model of the patient's face using stereo cameras and/or laser scanners and present this model to the dermat