Dr. Bernstein answers frequently asked questions about hair transplantation, hair loss, and medical treatment for hair loss.


Hair Restoration Answers

Can Platelet Rich Plasma (PRP) Effectively Treat Genetic Hair Loss?

April 1st, 2015 (12 hours ago)

Q: I have read conflicting reports on the use of PRP to treat hair loss. What is your assessment? Does it work?

A: Two recent studies published in 2014 have presented preliminary evidence that platelet rich plasma (PRP) therapy may stop or reverse genetic hair loss (androgenetic alopecia) in both males and females.

The first study, published in the medical journal Dermatologic Surgery, found at least some improvement in male and female patients with androgenetic alopecia. This study concluded that 47% of those patients experienced at least moderate to very good improvement,1 a level that the researchers defined as “clinically important.” Because this was just a pilot study without a control group, the authors could not reliably claim that PRP was effective in treating hair loss.

A second study, published in the journal BioMed Research International, concluded that treatments of platelet-rich plasma stimulated hair growth in men with pattern hair loss.2 In this clinical study, the researchers found a statistically significant increase in both hair density and terminal hairs.

While more comprehensive testing needs to be done, these studies provide preliminary evidence that platelet rich plasma therapy may stimulate hair growth in patients with male or female pattern baldness.

Read more about Platelet Rich Plasma (PRP)

Read our PRP FAQ for answers to common questions

References:
  1. Schiavone G, Raskovic D, Greco J, Abeni D. Platelet-rich plasma for androgenetic alopecia: a pilot study. Dermatol Surg. 2014 Sep; 40(9):1010-9 []
  2. V. Cervelli, S. Garcovich, A. Bielli, G. Cervelli, B. C. Curcio, M. G. Scioli, A. Orlandi, P. Gentile. “The effect of autologous activated platelet rich plasma (AA-PRP) injection on pattern hair loss: clinical and histomorphometric evaluation,” BioMed Research International Volume 2014. []

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Posted by Robert M. Bernstein M.D. on April 1st, 2015 (12 hours ago) at 11:37 am (12 hours ago)
Hair Restoration Answers

How Does a Hair Transplant Surgeon Operate the ARTAS Robot for FUE?

March 11th, 2015

Q: I have been reading about Robotic FUE and have seen some photos on your website of you operating the ARTAS robot using what looks like a remote control. What is that thing and how does it control the robot?

Dr. Bernstein Operating the ARTAS FUE Robot
Dr. Bernstein Operating the ARTAS FUE Robot

A: The ARTAS robot uses a dual operating system when performing follicular unit extraction. One station consists of a desktop computer adjacent to the robot. This station is used to establish the basic parameters of the transplant such as the spacing of grafts, the angle and depth of the harvest, which size follicular units will be targeted, and a host of other important variables.

The hand-held pendant is used by the operator situated next to the patient. The remote has more limited options – the main ones being depth adjustment and to immediately suspend the action of the robot. Many of the parameters are determined automatically by the robot’s computer to maximize the accuracy of the harvesting. The robot also makes real-time adjustments to these variables during the hair restoration procedure.

The physician sets the parameters at the computer monitor and, once the settings are determined, he/she sets the tensioner grid on the patient’s scalp. The tensioner determines where the grafts will be harvested. The grid is moved approximately every 130 harvests. The robot can be operated at the computer terminal and through a mobile pendant. The physician often alternates with a trained assistant between that station and using the pendant.

Besides the involvement in the operation of the robot, there are many other important physician-dependent steps to the hair transplant including the planning and design of the procedure, and recipient site creation. Other steps, such as the microscopic sorting and trimming of harvested follicular unit grafts and graft placement, are often performed by trained staff, but require the physician’s close supervision.

Read about Robotic Hair Transplantation

Read articles about Robotic FUE


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Posted by Robert M. Bernstein M.D. on March 11th, 2015 at 9:41 am
Hair Restoration Answers

How Does the ARTAS System, or the Surgeon, Determine the Depth of the Incision, and Can it be Adjusted During Surgery?

February 13th, 2015

Q: How does the ARTAS robot control the depth of the incision in Robotic FUE?

A: The ARTAS robotic system is equipped with advanced sensors that determine the precise depth of the sharp and blunt needles used both in the graft harvesting step and for recipient site creation. The robot automatically adjusts to the precise depth needed for the non-traumatic extraction of the grafts. The tip of the punching mechanism contains depth markings so that the physician can visually override the punch when he wants to fine-tune its action. While monitoring the procedure in real time, if it is observed that the punches are too superficial or too deep, punch depth can be modified using the robot’s computer system.

The physician can also use the ARTAS system to precisely control the depth of recipient sites. As with harvesting, the robot automatically adjusts the depth based on parameters set by the physician and the doctor can then make further adjustments, in real-time, during the procedure.

Click here to read more about Robotic Hair Transplantation


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Posted by Robert M. Bernstein M.D. on February 13th, 2015 at 4:51 pm
Hair Restoration Answers

Can a Hair Transplant Treat an African-American Woman with Scarring (Cicatricial) Alopecia?

January 13th, 2015

Q: I’m a 42 year old African-American woman and I’m losing hair on the crown of my head. Would I be a good candidate for a hair transplant?

A: Hair loss in the crown of an African American female can have several different etiologies, so the first thing to do is to make the right diagnosis. The most common causes of hair loss are androgenic alopecia (AGA) and scarring alopecia, also called ‘Central Centrifugal Cicatricial Alopecia,’ or CCCA. A biopsy is often useful to differentiate these two causes of hair loss when the diagnosis is unclear. A biopsy can also identify other, but less common, causes of crown hair loss.

AGA presents with a history of gradual thinning in the front and/or top of the scalp, a relative preservation of the frontal hairline, a positive family history of hair loss and the presence of miniaturization in the thinning areas. Miniaturization, the progressive decrease of the hair shaft’s diameter and length in response to hormones, can be identified using a hand-held device called a densitometer. If the diagnosis is AGA, then a hair transplant can be very successful provided there is enough donor hair.

CCCA presents as a progressive form of scarring alopecia that occurs almost exclusively in African American women. The onset of CCCA is very slow, typically developing over the course of years. CCCA starts near the vertex or top of the scalp and spreads in an outward direction. The involved area is usually smooth and shiny with decreased hair density.

Central Centrifugal Cicatricial Alopecia is diagnosed with a scalp biopsy performed in the area of hair loss. Those patients with CCCA are generally not candidates for a hair transplant procedure since the body may reject the transplanted hair. This condition is better treated with oral and injectable anti-inflammatory medications. Surgical treatment for cosmetic benefit may be an option in some cases after the disease has been inactive for many years.

Click here to read more about Scarring Alopecias


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Posted on January 13th, 2015 at 2:18 pm
Hair Restoration Answers

Is a Robotic FUE Hair Transplant Painful?

January 9th, 2015

Q: Does Follicular Unit Extraction performed by a robot hurt more than regular FUE? — R.T., Greenwich, CT

A: As with manual FUE, robotic FUE hair transplantation is an outpatient procedure performed under long-acting local anesthesia – a combination of lidocaine and bupivacaine. After the initial injections, the patient does not experience any pain or discomfort.

Before starting local anesthesia, we give most patients oral valium and intra-muscular midazolam (a very fast acting sedative that is very relaxing). While some patients doze off at the beginning of the procedure, others prefer to watch TV, a film, or just chat.

Local anesthesia generally wears off after 4-5 hours, so for transplant sessions lasting longer than this, we will give more anesthesia before the first wears off. With Robotic FUE, there is no discomfort once the procedure is completed and the anesthesia wears off. This is in stark contrast to an FUT strip procedure which can be uncomfortable in the donor area for days to weeks.


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Posted by Robert M. Bernstein M.D. on January 9th, 2015 at 8:40 am
Hair Restoration Answers

Can I Play Contact Sports Right After a FUE Procedure?

December 29th, 2014

Q: Can I play a contact sport, like football, right after having a FUE procedure?

A: I performed a study (“Graft Anchoring in Hair Transplantation,” Dermatologic Surgery 2006; 32: 198-204) to answer a simple question, one that patients ask all the time: at what point are transplanted grafts so securely anchored in the scalp that they cannot be dislodged?

In the study, it was found that after 10 days the transplanted grafts become a permanent part of the body such that no amount of scrubbing or combing can dislodge them. So, while there are generally no limitations on strenuous exercise after a FUE procedure, we recommend waiting at least 10 days before playing any contact sport, like football, as the grafts could be dislodged if vigorously rubbed.

To learn more, see After Your Hair Transplant Surgery


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Posted by Robert M. Bernstein M.D. on December 29th, 2014 at 12:47 pm
Hair Restoration Answers

How does Laser Therapy (LLLT) Actually Work to Grow Hair?

December 29th, 2014

The actual mechanism by which Low Level Laser Therapy (LLLT) stimulates hair growth (i.e., increases the anagen phase of the hair cycle) is still unknown. Possible mechanisms include the following:

  1. Stimulating the production of various growth factors (insulin-GF, vascular endothelial-GF, fibroblast-GF)
  2. Dilating the blood vessels of the hair follicles
  3. Increasing the production of ATP (molecular energy) in the cells through its effects on mitochondria.

Learn more about Laser Therapy


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Posted by Robert M. Bernstein M.D. on December 29th, 2014 at 11:31 am
Hair Restoration Answers

How Many Hair Transplants Will I Need?

November 17th, 2014

The first session of a hair transplant should be designed as a stand-alone procedure with the following three goals:

  1. Establishing a permanent frame to the face by creating, or reinforcing, the frontal hairline.
  2. Providing coverage to the thinning, or bald, areas of the scalp with the hair transplant extending at least to the vertex transition point.
  3. Adding sufficient density so that the result will look natural.

Achieving all of these goals will allow the first procedure to stand on its own.

Because of this, many people feel one hair transplant is sufficient.

Reasons for Second Hair Transplant

While the first session of a hair transplant is designed to stand on its own, there are several reasons why one would want a second hair transplant, such as increasing the density in a previously transplanted area; refining the hairline created in the first transplant; focusing on increased crown coverage, when appropriate; or addressing further hair loss that’s occurred after the first transplant.

Because of this last reason, addressing further hair loss, careful patient evaluation and surgical planning is needed to take into account your donor reserve and the likely extent of any future balding in the planning of your first transplant session.

Wait at least 10 to 12 months Before Getting a Second Hair Transplant

If a second transplant is warranted, patients are advised to wait at least 10 to 12 months after the first transplant before considering a second. This is because over the course of the first year, the first transplanted hairs have grown in and the progressive increase in a hair’s diameter, texture and length can markedly change the look of the hair restoration — this may influence the way a patient wants to groom his/her hair, and only after the hair has reached styling length can the patient and physician make the best aesthetic judgments regarding the placement of additional grafts.

For patients having an FUT (strip) procedure, another reason to delay a second hair transplant session for this time period is that scalp laxity will continue to improve making the donor hair easier to harvest.

You can view our Hair Transplant Photos by the number of sessions each patient has had:


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Posted by Robert M. Bernstein M.D. on November 17th, 2014 at 11:55 am
Hair Restoration Answers

Is Propecia and/or Rogaine Mandatory after a Hair Transplant?

November 3rd, 2014

Q: I’ve heard that using Propecia and/or Rogaine is a good idea after having a hair transplant, but are they mandatory?

A: Neither finasteride (brand name: Propecia) nor minoxidil (brand name: Rogaine) will have any effect on transplanted hair. That said, while you don’t need them to protect your transplanted hair, you will likely have original hair interspersed among your transplanted hair that will continue to thin and fall out over time. This vulnerable hair can be protected by finasteride which has been shown to reduce future hair loss significantly; additionally, you can add Rogaine for extra benefit.

However, with Propecia, you should only use it if you can commit to it long-term because it takes up to a full year to see any effect. With Rogaine, you should only use it if you can commit to using it continually and regularly – you should not stop and start it.


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Posted by Robert M. Bernstein M.D. on November 3rd, 2014 at 12:37 pm
Hair Restoration Answers

How Many Follicles Can You Transplant With Robotic FUE?

November 3rd, 2014

Q: How many follicles can you transplant with robotic FUE compared to manual FUE?

A: We can extract the same number of follicles robotically as we can manually.

That said, the goal of any hair transplant procedure is not to transplant as many hair follicles as possible but rather to achieve the best possible cosmetic result given your degree of hair loss and the number of hair follicles available in your donor area.

While there is no difference between robotic and manual FUE in terms of the number of follicles that each procedure can extract, robotic FUE does have the following advantages over manual FUE:

  • During the follicular unit extraction (or harvesting) phase of a hair transplant, there is less chance of damaging follicular units using a robot vs. a hand held device (e.g., Neograft), because the robot is more accurate. This means more grafts survive after transplant.
  • Robotic graft harvesting times are shorter than manual, e.g., while on average if a physician could manually extract 200-300 grafts per hour, the same physician could robotically extract up to 500-1000 grafts per hour1. This means a shorter procedure time for the patient.

Read more about the advantages of Robotic FUE.

References:
  1. Chang, H.H. Robotics, artificial intelligence, and the future of hair transplantation. Prime Dermatology, July/August 2014. []

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Posted by Robert M. Bernstein M.D. on November 3rd, 2014 at 12:26 pm
Hair Restoration Answers

Is it Possible To Have a Robotic FUE Hair Transplant on the Crown Area with African Hair at 26 Years of Age?

September 29th, 2014

Q: I am 26 years old and have been suffering from hair loss for 8 years. I have been on Propecia (finasteride) and Rogaine (minoxidil) during those years. Unfortunately my hair loss has continued to progress aggressively. I am of half African and Caucasian descent, and my hair is curly. I understand that there are certain limitations on having hair transplants before you are 35, however I do not mind having another transplant in a few years, if necessary.

A: Although it is possible to have a hair transplant to the crown using robotic FUE in African American patients, given your young age and that you state your hair loss is progressing aggressively while on Propecia and Minoxidil, it is likely not a good decision to have surgery at this time.

The reason is that as your hair loss surrounding the crown expands over time, it may look unnatural to have hair transplanted solely to the crown region.

At your age, it is best to take Propecia (finasteride) and Rogaine (minoxidil), and if a transplant is indicated, to start at your frontal hairline and top of your scalp, the areas that will be most important cosmetically long-term.


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Posted on September 29th, 2014 at 3:15 pm
Hair Restoration Answers

Can a Robot Making a Recipient Area Create a Natural Looking Hair Transplant?

September 17th, 2014

Q: I’ve heard that your ARTAS hair transplant robot can now create the recipient site in a hair transplant procedure. Has it been done on humans or is it still in an experimental phase, and if so can you tell if it looks as natural as when the surgeon does it?

A: In February 2014 we introduced new technology that allows the ARTAS Robotic System to assist the surgeon in recipient site creation. We are now using the ARTAS robot to make recipient sites in select hair transplant procedures. If designed and programmed properly by the doctor, robotic assisted recipient site creation can produce a hair transplant result that is as natural as when the surgeon does it by hand.


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Posted by Robert M. Bernstein M.D. on September 17th, 2014 at 5:13 pm
Hair Restoration Answers

Is FUE Scarless Surgery?

September 15th, 2014

Q: I heard FUE is a scarless surgery. Is this true using any of the current FUE methods (ARTAS robot, Neograft, manual FUE)?

A: All hair transplant procedures, follicular unit transplantation (FUT) and follicular unit extraction (FUE), leave scars. FUT produces a linear scar at the back of the scalp that may be visible if you keep your hair short. FUE, on the other hand, leaves small dot scars at the back of the scalp that are not visible if you keep your hair short. These tiny scars will happen regardless of which FUE method is used, i.e., ARTAS robot, SAFE system, Neograft, or manual FUE. Some physicians who use the Neograft method advertise that there is no scarring involved when using the Neograft; however, this is not true: however, this is not true: there is some scarring associated with all FUE methods that increases with the total number of grafts harvested.


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Posted by Robert M. Bernstein M.D. on September 15th, 2014 at 2:05 pm
Hair Restoration Answers

How Does the ARTAS Robot’s Image-Guided System Work?

July 18th, 2014

Q: I have read a bit about the ARTAS robot and how it uses an “image-guided” system, but what does that mean? And how is the robot’s imaging system different than a human surgeon viewing the grafts with the naked eye?

A: That is a great question and it gets to one of the key benefits of the robotic hair transplant system: its accuracy. When a surgeon is performing FUE using manual techniques, they must wear a headset that magnifies the scalp so they can see the follicular units more clearly than with the naked eye. The surgeon must visually and mentally process subtle nuances of the skin and follicular units for every one of the hundreds or thousands of units that are extracted. The ARTAS robot magnifies the surface of the skin in much the same way, but to a much greater extent. In addition, it is not subject to the limitations of the human eye, or human hand, and it is not subject to human error. The surgeon may not have exact hand-eye coordination. The surgeon may be concentrating on one aspect of the extraction, say following the angle of the hair, but might ignore another important aspect of the follicle, say its depth in the skin or its orientation. And, of course, the surgeon tires, both physically and mentally, from performing the hundreds or thousands of repetitive motions.

The robot’s image-guided system, on the other hand, does not experience these limitations. The robot magnifies the skin, detects each follicular unit and the nuances of the skin/hair characteristics, and then extracts that follicular unit with precision. When the imaging system detects changes to the skin, this new information is fed into the computer in real-time and the system adjusts automatically based on this feedback as it continues to harvest grafts. There is no distracting the robot, and the robot will not forget, or ignore, key variables in the extraction. The robot can extract thousands of follicular units without tiring from repetition or slowing down the extraction.

Based on my own practical experience using the robot, it is clear that the robot’s ability to estimate the position of the follicles under the skin and to extract it with precision is superior to manual techniques. Having used the ARTAS system for over three years, and having helped make improvements to the device since the first iteration, I have seen robotic technology substantially improve the outcome for my patients.

Video Display of the ARTAS Robot Image-Guided System




Display: ARTAS Robot Image-Guided System



Read more about the ARTAS Robot and how it works


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Posted by Robert M. Bernstein M.D. on July 18th, 2014 at 8:49 am
Hair Restoration Answers

Do Propecia (Finasteride) and Rogaine (Minoxidil) Work on Front of the Scalp?

July 10th, 2014

Q: I have done a lot of research over the past year including seeing a dermatologist and receiving consultation from a surgeon. Both recommended Propecia and Rogaine, however my confidence in their advice was lost when I researched these products and read online that they do not work on the front of the scalp to improve my receding hairline, only to regrow hair in the crown area. Can you settle the issue once and for all? Do Propecia and Rogaine work on the front of the scalp? Can they improve my receding hairline?

A: Both Propecia and Minoxidil definitely can work in the front of the scalp as long as there is some hair in the area. Although their mechanisms of action are different, both Propecia (finasteride) and Rogaine (minoxidil) act to thicken miniaturized hair regardless of where it is on the scalp. In fact, there are published data (Leyden et. al., JAAD, 1999) demonstrating this improvement with finasteride in a controlled clinical trial of men with frontal hair loss.

The source of the confusion on this topic is the fact that the FDA limited the application of the drugs to the crown on the package inserts for both Propecia and Rogaine. The FDA did this because Upjohn (the company that introduced Rogaine) and Merck (Propecia) only tested the medications on the crown in the clinical trials. Logically, the fact that DHT causes frontal hair loss and Propecia works by blocking DHT gives a reasonable explanation for the efficacy of the drug on the front of the scalp. Also, a side effect of the use of minoxidil is facial hair, so how could it not also work on the front of the scalp? It is regrettable that some doctors and many patients think that these medications won’t work on the front of the scalp. Unfortunately, many hair restoration surgeons have done little to educate the public and dispel this myth.

To reiterate, yes, both of these medications can work on the front of the scalp to prevent hair loss and thicken a thinning hairline. However, it is important to note that neither of these medications can grow hair on a totally bald scalp or lower an existing hairline. Hair follicles must exist for the medications to work. It is also important to stress that the best results come from using both finasteride and minoxidil together.

Visit Bernstein Medical for a hair loss consult with one of our board certified physicians

Watch videos of Dr. Bernstein discussing the topic of hair loss medication


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Posted by Robert M. Bernstein M.D. on July 10th, 2014 at 8:00 am


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