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


Hair Restoration Answers

How are PRP Treatments Different at Bernstein Medical?

April 28th, 2016

Q: How are PRP treatments for hair loss different at Bernstein Medical? — Huntington, N.Y.

A: There are three reasons Platelet Rich Plasma (PRP) treatments are different at Bernstein Medical from other facilities. First, we use the Emcyte Pure PRP System, the most sophisticated system for the preparation of Platelet Rich Plasma. Second, by using a double centrifuge technique, we generate the optimal concentration of growth factors in PRP. Third, and most important, we have the knowledge to know when PRP is appropriate and the skill to inject the proper quantity of PRP at just the right depth to achieve the desired result — a skill that cannot be overstated.

Read more about PRP
Read our PRP for Hair Loss FAQ


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Posted on April 28th, 2016 at 2:13 pm
Hair Restoration Answers

Can I Have PRP During a Hair Transplant?

March 24th, 2016

Q: Do you administer PRP (Platelet Rich Plasma) during a hair transplant? — R.W., Manhattan, NY

A: The wounds created in the hair transplant procedure (recipient site creation) promote blood platelet migration and the activation of growth factors making PRP therapy unnecessary for the actual surgery. That said, doctors may wish to use PRP for areas of the scalp that are thinning, but were not addressed by the hair transplant. An example might be using PRP for the crown if the doctor only transplanted hair to the front part of the scalp.


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Posted by Robert M. Bernstein M.D. on March 24th, 2016 at 12:04 pm
Hair Restoration Answers

What Problems Can Arise from Transplanting the Crown Too Early?

March 17th, 2016

Q: What is the problem with transplanting the crown too early? — P.L., Newark, NJ

A: If a person’s hair loss continues – which is almost always the case – the crown will expand and leave the transplanted area isolated, i.e. looking like a pony-tail. The surgeon can perform additional hair transplant procedures to re-connect the transplanted area to the fringe, but, as one can see from the photo below, this is a large area that can require a lot of hair. It is often impossible to determine when a person is young if the donor supply will be adequate. If there is not enough donor hair, then the island of hair may remain isolated. Most importantly, it uses up a lot of hair that might be better transplanted to the front and top of the scalp – areas that are far more important cosmetically.

Patient who visited us who had an early crown transplant

The front and top of the scalp are more important to one’s appearance than the crown, and these areas should be the first priority when planning hair restoration surgery.

As an exception, if a person has a family history of baldness limited to the crown, even at an advanced age, and the person in question is following this pattern, then earlier treatment of the crown may be considered.

Lastly, if you do treat the crown in a younger person, or one with whom the extent of hair loss is uncertain, the crown should be transplanted with light coverage only. That way a limited amount of hair will be used up in this area and there will be enough left over for the more cosmetically significant top and front of the scalp.

For a complete review of this topic please read: Follicular Transplantation: Patient Evaluation and Surgical Planning. Dermatol Surg 1997; 23: 771-84. A copy in PDF format, and other hair transplant publications, can be downloaded at the Bernstein Medical – Center for Hair Restoration Medical Publications page.

View the Crown (Vertex) topic, the Age topic or see posts tagged with Early Hair Loss for further reading.

View Before and After Photos of some of our crown hair transplant patients

Read about candidacy for a hair transplant in young patients


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Posted by Robert M. Bernstein M.D. on March 17th, 2016 at 8:16 am
Hair Restoration Answers

Can Resistance Training Accelerate Hair Loss?

January 26th, 2016

Q: I have read several articles on the internet which suggest that resistance training can accelerate male pattern baldness. Is there any truth in this?

A: Anything that raises androgen levels in your body can potentially accelerate hair loss. That said, I suggest that you should exercise as you normally would. As long as you don’t take drugs to enhance your workout, the effects should be minimal.

Read about Hair Loss in Men
Read about the Treatment of Hair Loss in Men


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Posted by Robert M. Bernstein M.D. on January 26th, 2016 at 5:39 pm
Hair Restoration Answers

How are Recipient Sites Programmed into the ARTAS Robot?

December 18th, 2015

Q: How are specifications for making recipient sites inputted into the ARTAS® robot? — A.F., Queens, NY

A: At the outset of the procedure, the physician sits at a computer terminal that is connected to the ARTAS Robot and enters the specifications directly into the robot’s software. Variables programmed in this manner include: the number of recipient sites, density of sites, angle that the hair will extrude from the skin, depth of recipient sites, and the minimum distance away from existing hair follicles that a site can be created.

Read about Robotic Hair Transplants
Read about the ARTAS Robotic System
More details on Robotic Recipient Site Creation


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Posted by Robert M. Bernstein M.D. on December 18th, 2015 at 9:00 am
Hair Restoration Answers

Will Robotic FUE Reduce the Cost Per Graft for FUE Procedures?

December 17th, 2015

Q: Will the ARTAS robot result in a lower cost for an FUE hair transplant?

A: Robotic FUE may cost slightly more per graft than a typical manual FUE procedure due to the greater expense of this new technology. At Bernstein Medical, we use the ARTAS Robotic System for all Follicular Unit Extraction (FUE) procedures.

Read about Robotic Hair Transplants


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Posted by Robert M. Bernstein M.D. on December 17th, 2015 at 8:07 am
Hair Restoration Answers

How Does the ARTAS Robot Avoid Transection of Hair Follicles During Recipient Site Creation?

December 16th, 2015

Q: How does the ARTAS System avoid damaging hair follicles in the balding area during recipient site creation? — R.K., Brooklyn, NY

A: The ARTAS robot‘s optical guidance system enables it to accurately create recipient sites in areas of thinning hair without damaging existing hair follicles. During the recipient site creation process, the robot uses its advanced image-guided optical system to scan the surface of the skin, locate existing hair follicles in the recipient area, and then create recipient sites at a specified distance from these existing hairs.

The ARTAS robot carries out this process rapidly, accurately, and consistently according to the physician’s programmed specifications. Thanks to the microscopic precision of the image-guided technology, the robotic hair transplant system can avoid injury to follicles that can result when Follicular Unit Extraction (FUE) is performed using manual techniques.

Read about Robotic Hair Transplants
Read about the ARTAS Robotic System
More details on Robotic Recipient Site Creation


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Posted by Robert M. Bernstein M.D. on December 16th, 2015 at 8:41 am
Hair Restoration Answers

What Is Your Opinion on Doctors Performing Only FUT or Only FUE?

June 22nd, 2015

Q: It seems that some doctors offer only FUT and others only FUE. What is your opinion on that?

A: Both FUT and FUE are excellent techniques, but have different indications. To deliver the best care for our patients, hair restoration physicians should have expertise in both procedures, and they should offer both in their practices.

The main advantage of FUT is that it typically (but not always) gives the highest yield of hair. Therefore, when the patient’s primary goal is to achieve maximum fullness, FUT should be performed. There are many well described reasons for this, including the precision of stereo-microscopic dissection and the ability to efficiently harvest from a more select area of the donor zone, but these are beyond the scope of this brief commentary.

The main advantage of FUE is no linear scar. Therefore, when the patient’s primary goal is to be able to wear his hair very short, FUE should be performed. FUE is also indicated when there is an increased risk of a widened scar or when scalp laxity does not permit a strip excision. The patient may sometimes chose FUE simply to avoid the stigma of a linear donor scar.

There are situations in which both procedures are useful in the same patient. For example, FUT may first be used to maximize yield, but then, after several sessions, the scalp may become too tight to continue to perform FUT, or the donor scar may become wider than anticipated. In the former case, the physician can switch to FUE to obtain additional grafts; in the latter case FUE may be used to camouflage the scar of the FUT procedure.

It is tempting to see the world in black and white, and it is easiest to learn and train one’s staff in just one hair transplant technique — but medicine is never so simple. Developments over the past twenty years have given us two excellent hair restoration procedures. We should offer our patients both.

Read about FUE Pros and Cons


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Posted by Robert M. Bernstein M.D. on June 22nd, 2015 at 3:08 pm
Hair Restoration Answers

Does Hair Loss Treatment with Propecia Work in Older Patients?

June 20th, 2015

Q: Hi. I am 52 years old and wish to know if Propecia will work for my age. I have started losing some hair a couple of years ago and it’s thinning out. Thank you very much for your help.

A: Propecia (Finasteride 1 mg) can hold on to hair at any age, but works best to re-grow hair in those who are younger.

The reason is that finasteride works to reverse miniaturization (the thinning and shortening of hairs due to DHT). Younger patients, with early hair loss, generally have more hair in the early stages of miniaturization where the changes are readily reversible.

Older patients are more likely have more advanced miniaturization or areas that are totally bald and will thus not regrow with medical therapy.

Read more about Propecia »»


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Posted by Robert M. Bernstein M.D. on June 20th, 2015 at 2:40 pm
Hair Restoration Answers

What is Platelet-Rich Plasma (PRP) and How Does It Promote Hair Growth?

June 17th, 2015

Q: I’ve heard a lot about platelet-rich plasma (PRP). What is platelet-rich plasma, and how does it promote hair growth?

A: To begin, first let’s define a few basic terms: blood plasma, platelets and PRP

What Is Blood Plasma?

Blood plasma holds the blood cells in a liquid suspension. Blood plasma makes up about 55% of the body’s total blood volume. There are three basic types of blood cells: red blood cells (that carry oxygen), white blood cells (that have immune functions to help fight infection) and platelets (that facilitate coagulation, wound healing and repair).

What is a Platelet?

A platelet is a type of white blood cell containing approximately 50 to 80 tiny encapsulated structures called alpha-granules. Each alpha-granule contains a high number of growth factors, many playing a fundamental role in healing following tissue damage.[1] Many of these platelets are also known to regulate the growth cycle of hair follicles.[2]

Platelets are formed in the bone marrow and circulate throughout the bloodstream in a concentration of approximately 140,000 to 400,000 platelets/mm3.

What is Platelet-Rich Plasma?

Derived from a patient’s own blood plasma, platelet rich plasma is concentrated blood plasma which contains approximately five times the number of platelets and growth factors normally found in the blood.

How Does Platelet-Rich Plasma Work to Promote New Hair Growth?

Studies that have looked at the therapeutic effects of PRP on hair loss have found that it promotes hair survival and hair growth in both laboratory studies[3] and human clinical trials, but exactly how PRP promotes new hair growth isn’t clear. Researchers have suggested a few possible mechanisms.

In a recent pilot study[4] that found that PRP injections resulted in noticeable improvement in both males and females with androgenetic alopecia, researchers suggested that PRP may have stimulated hair growth by prolonging the anagen (growth) phase of the hair follicle.

In another study[5] that showed PRP promoted hair growth in males with alopecia, researchers suggested that PRP may have protected the hair follicles against one of the possible main mechanisms of pattern hair loss: the death of dermal papilla cells in the hair follicle.[6] The death of these cells leads to a gradual shrinking and eventual disappearance of the hair shaft, a process called miniaturization.

Other studies have observed that PRP seems to promote the growth of new blood vessels around treated hair follicles. Because of this, researchers have suggested that the growth of new blood vessels may be helping to stimulate new hair growth.[7]

In sum, while published studies so far suggest that PRP therapy is a safe and effective treatment option for male and female androgenetic alopecia, there is still a need for more extensive studies to better understand the mechanism by which PRP treatments promote hair growth.

Platelet Rich Plasma (PRP) FAQ

See the PRP Treatment Steps

Read about the latest research into PRP therapy for hair loss

Read more in our section on Platelet Rich Plasma

References:
  1. Eppley BL, Pietrzak WS, and Blanton M. Platelet-Rich Plasma: A Review of Biology and Applications in Plastic Surgery. Plastic and Reconstructive Surgery, 2006. []
  2. Itami S, Kurata S, Takayasu S. Androgen induction of follicular epithelial cell growth is mediated via insulin-like growth factor-I from dermal papilla cells. Biochem Biophys Res Commun. 1995; 212: 988–94. []
  3. Li ZJ, Choi HI, Choi DK et al. Autologous platelet-rich plasma: a potential therapeutic tool for promoting hair growth. Dermatol Surg 2012; 38: 1040–6. []
  4. Schiavone G, Raskovic D, Greco J, Abeni D. Platelet-rich plasma for androgenetic alopecia: a pilot study. Dermatol Surg. 2014; 40(9): 1010-9. []
  5. Cervelli V, Garcovich S, Bielli A, Cervelli G, Curcio BC, Scioli MG, Orlandi A and Gentile P. The effect of autologous activated platelet rich plasma (AA-PRP) injection on pattern hair loss: clinical and histomorphometric evaluation. BioMed Research International 2014; 1-9 []
  6. Whiting DA. Possible mechanisms of miniaturization during androgenetic alopecia or pattern hair loss. J Am Acad Dermatol. 2001 Sep;45(3 Suppl):S81-6. []
  7. L. Mecklenburg, D. J. Tobin, S.Muller-Rover, et al. “Active hair growth, anagen, is associated with angiogenesis.” Journal of Investigative Dermatology 2000, 114:5; 909–916. []

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Posted by Robert M. Bernstein M.D. on June 17th, 2015 at 12:35 pm
Hair Restoration Answers

Which Platelet Rich Plasma (PRP) System Do You Use?

June 11th, 2015

Q: I have seen some talk about different forms of platelet rich plasma (PRP). Which is the best system for preparing PRP for hair loss? Which are you using?

A: We use the Emcyte Pure PRP system. It is a double centrifuge system that I think is the best.

Platelet Rich Plasma (PRP) FAQ
See the PRP Treatment Slideshow


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Posted by Robert M. Bernstein M.D. on June 11th, 2015 at 4:45 pm
Hair Restoration Answers

Can I Have Platelet Rich Plasma Therapy Instead of Hair Transplant Surgery?

June 11th, 2015

Q: It was recommended by the doctor that I have a hair transplant. Can I do platelet rich plasma (PRP) instead?

A: PRP will generally be inadequate for patients who are candidates for a hair transplant. PRP works to reverse miniaturization (thinning hair) as do other medical treatments (Propecia, Rogaine, LLLT). Unfortunately, medical treatments do not grow hair back once it has been lost.

Platelet Rich Plasma (PRP) FAQ

See the PRP Treatment Steps


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Posted by Robert M. Bernstein M.D. on June 11th, 2015 at 4:31 pm
Hair Restoration Answers

Does Platelet Rich Plasma (PRP) Therapy For Hair Loss Involve Surgery?

June 10th, 2015

Q: How is platelet rich plasma therapy for hair loss performed? Does it involve surgery?

A: Platelet rich plasma (PRP) therapy for hair loss is performed during a simple office visit, takes about 30-45 minutes, and does NOT involve surgery.

The first step in PRP treatment for hair loss involves drawing a patient’s blood into a syringe.

Next we use a double-centrifuge platelet concentration system (the Emcyte Pure PRP system) to separate and then concentrate platelet-rich plasma from the blood.

The last step involves transferring the platelet-rich plasma into a syringe and then injecting the plasma directly into the patient’s scalp.

After the treatment, some patients may experience very temporary soreness and/or swelling, but many patients will experience nothing.

After the initial treatment, patients will typically receive two more treatments at 6 week intervals. After that, they will receive additional treatments every 3 months over the course of the first year. After the first year, patients will receive treatments approximately every 6 months.

Platelet Rich Plasma (PRP) FAQ

See the PRP Treatment Steps

Read about the latest research into PRP therapy for hair loss

Read more in our section on Platelet Rich Plasma


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Posted by Robert M. Bernstein M.D. on June 10th, 2015 at 3:33 pm
Hair Restoration Answers

Are There Any Side Effects or Safety Concerns in Using PRP to Treat Hair Loss?

April 20th, 2015

Q: I’ve heard about using platelet rich plasma (PRP) therapy to treat hair loss. Are there any potential serious side effects that I should be aware of?

A: PRP is a therapy that has been used since 1987 to help promote the healing of hard tissue (bone, joints) and soft tissue (skin). To date, there have been no reported major side effects.[1]

Only a handful of published studies have tested PRP’s effectiveness and safety in treating hair loss; however, none of those studies have reported serious side effects.[2],[3],[4],[5],[6],[7]

This lack of any reported major side effects coupled with the fact that PRP is obtained from a patient’s own blood makes doctors relatively confident that PRP treatments are safe for hair loss.[8]

All this said, researchers are continuing to evaluate both the efficacy and the safety of PRP therapy for the treatment of male and female pattern baldness.

Read about the latest research into PRP therapy for hair loss

Read more in our section on Platelet Rich Plasma

References:
  1. Hall MP, et al “Platelet-rich Plasma: Current Concepts and Application in Sports Medicine” J Am Acad Orthop Surg, Vol 17, No 10, October 2009, 602-608. []
  2. Kang JS1, Zheng Z, Choi MJ, Lee SH, Kim DY, Cho SB. The effect of CD34+ cell-containing autologous platelet-rich plasma injection on pattern hair loss: a preliminary study. J Eur Acad Dermatol Venereol. 2012 Jan;28(1):72-9 []
  3. 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 []
  4. Khatu S.S, More Y.E, Gokhale N.R, Chavhan D.C, Bendsure N. Platelet-rich plasma in androgenic alopecia: myth or an effective tool. J Cutan Aesthet Surg. 2014 Apr;7(2):107-10. []
  5. 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. []
  6. Takikawa M, Nakamura S, Nakamura S, Ishirara M, Kishimoto S, Sasaki K, Yanagibayashi S, Azuma R, Yamamoto N, Kiyosawa T. Enhanced effect of platelet-rich plasma containing a new carrier on hair growth.Dermatol Surg. 2011 Dec;37(12):1721-9 []
  7. Trink A, Sorbellini E, Bezzola P, Rodella L, Rezzani R, Ramot Y, Rinaldi F. A randomized, double-blind, placebo- and active-controlled, half-head study to evaluate the effects of platelet-rich plasma on alopecia areata. Br J Dermatol. 2013 Sep;169(3):690-4. []
  8. Platelet-rich plasma: Clarifying the issues. The American Academy of Orthopaedic Surgeons website, www.aaos.org, September 2010. []

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Posted by Robert M. Bernstein M.D. on April 20th, 2015 at 9:21 am
Hair Restoration Answers

Does Finasteride Need to be Taken Every Day?

April 13th, 2015

Q: Does finasteride need to be taken every day?

A: Finasteride (Propecia) is a competitive inhibitor of Type II, 5 alpha-reductase (5AR is the enzyme that converts Testosterone to DHT which then causes hair to miniaturize and eventually be lost). Finasteride is 100x times more selective in inhibiting the Type II enzyme (present in hair follicles) than the Type I enzyme (present in other body tissues). The turnover (T1/2) of the finasteride/5AR Type II complex is 30 days and the finasteride/5AR Type I complex is 15 days. This explains why finasteride does not need to be taken every day and why, after stopping finasteride, the effects may take a month or longer to begin to dissappear.

Read about the first comprehensive study to investigate Propecia’s long term efficacy

Read more about Propecia (finasteride)


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Posted by Robert M. Bernstein M.D. on April 13th, 2015 at 3:29 pm


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