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


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 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
Hair Restoration Answers

How Does Platelet Rich Plasma (PRP) Treat Androgenic Alopecia?

April 13th, 2015

Q: How does PRP therapy for hair loss work?

A: In theory, platelet rich plasma (PRP) stimulates the growth of hair follicles by reversing the hair miniaturization (thinning hair) process seen in androgenic alopecia (common baldness).

While it is not exactly known how PRP reverses miniaturization, researchers do have a few ideas. First, PRP may counteract miniaturization by prolonging the growth (anagen) phase of hair follicle.1 Second, PRP has been observed to increase the number of stem cells in hair follicles. This is known to help protect a hair follicle from apoptosis, a natural process of programmed cell death. Researchers think that this anti-apoptotic effect could stimulate new hair growth.2 Finally, PRP treatment has been observed to promote growth of new blood vessels around treated hair follicles. Researchers have suggested that this could also stimulate new hair growth.3

In sum, a number of factors may come into play to effect new hair growth during treatment with platelet rich plasma. Research is ongoing to further clarify the specific mechanisms involved.

Read about the latest research into PRP therapy for hair loss

Read more in our section on Platelet Rich Plasma

References:
  1. Z. J. Li, H.-I. Choi, D.-K. Choi et al., “Autologous platelet-rich plasma: a potential therapeutic tool for promoting hair growth.” Dermatologic Surgery, vol. 38, no. 7, part 11, pp. 1040–1046, 2012. []
  2. Takikawa M, Nakamura S, Nakamura S, et al. “Enhanced effect of platelet-rich plasma containing a new carrier on hair growth.” Dermatol Surg. 2011 Dec;37(12):1721-9. []
  3. L. Mecklenburg, D. J. Tobin, S.Muller-Rover, et al. “Active hair growth (anagen) is associated with angiogenesis.” Journal of Investigative Dermatology, vol. 114, no. 5, pp. 909–916, 2000. []

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Posted on April 13th, 2015 at 8:31 am
Hair Restoration Answers

Why is Robotic Recipient Site Creation an Advantage?

April 9th, 2015

Q: Why is using the robot to create recipient sites useful in a hair transplant?

A: The ARTAS Robotic Hair Transplant system eliminates the inconsistencies inherent in creating large numbers of recipient sites by hand. The robot can create sites at a rate of up to 2,000 per hour. Although there is more set-up time compared to sites made manually, once the physician specifies the parameters such as punch depth, punch angle, and site direction, recipient site creation is precise and rapid.

One of the benefits of robotic site creation is that the distribution of grafts over a fixed area of the scalp can be exact. For example, if one wants to transplant 1,000 grafts evenly over 50cm2 of area, this can be done with great precision and with uniform site spacing. In addition, the physician can vary the densities in select regions of the scalp and the robot will adjust the densities in other areas so that the total number of sites remains the same.

Another benefit of the new technology is that the robot can be programmed to avoid existing hair and select which specific hair diameters to avoid. The robot is programmed to keep a specified distance from the existing hair to ensure that the resident follicles will not be damaged and that the distribution of new hair is even and natural. This computerized mechanism appears to be more accurate than what can be done by hand and, importantly, does not sacrifice speed in the process.

Read more about Robotic Recipient Site Creation

Read about Robotic Hair Transplantation


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Posted by Robert M. Bernstein M.D. on April 9th, 2015 at 1:15 pm
Hair Restoration Answers

How Does the ARTAS Robotic System Make Recipient Sites in a Hair Transplant?

April 6th, 2015

Q: How do recipient sites get made in Robotic FUE? And how does the robot know where to create the sites?

A: In performing recipient site creation, the ARTAS Robotic Hair Transplant system automates another part of the hair transplant process that is repetitive and prone to human error. In robotic site creation, the physician first designs the hair restoration and then specifies the angle of hair elevation, hair direction, site depth, average density, and total number of the recipient site incisions. The robot then creates the sites according to these specifications.

During site creation, the robot automatically uses its image-guided technology to avoid hairs of a certain diameter (specified by the doctor). The robot creates sites at a minimum distance from hairs of the specified diameter (the distance is also specified by the physician) and will do so randomly throughout the areas where the hair is finer or the scalp is bald. With this important feature, the new distribution of sites can be made to complement the distribution of existing hair. Observation of the ARTAS System suggests that it performs recipient site creation with greater precision and consistency than can be accomplished manually.

Read details on our Robotic Recipient Site Creation page

Read our Robotic Hair Transplant FAQ


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Posted by Robert M. Bernstein M.D. on April 6th, 2015 at 8:35 am
Hair Restoration Answers

How Does Robotic FUE Differ from Other Hair Transplant Procedures?

April 3rd, 2015

Q: What is the main difference between hair transplants using the robot versus other procedures?

A: There are two basic types of hair transplant procedures, Follicular Unit Transplantation (FUT or strip surgery) and Follicular Unit Extraction (FUE). In FUT, donor hair is harvested by removing a long thin strip from the back of the scalp. Individual follicular units are then obtained from this strip using stereo-microscopic dissection. In FUE, individual follicular units are harvested directly from the donor area using a sharp, round cutting instrument. The ARTAS Robotic System performs the follicular unit isolation step of an FUE procedure and can also create recipient sites according to specifications determined by the hair restoration surgeon. In performing each of these steps, the robot uses its image-guided technology to locate the next target and position the cutting instrument, and it does so with precision and speed that cannot be accomplished using manual FUE techniques or instruments.

Read more about the ARTAS Robotic System

Read the Robotic Hair Transplant FAQ


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Posted by Robert M. Bernstein M.D. on April 3rd, 2015 at 12:56 pm
Hair Restoration Answers

Does Propecia Work for Life or Does it Stop Working Over Time?

April 2nd, 2015

Q: Can Propecia (finasteride) completely halt androgenic alopecia for the duration of your lifetime, or does it just slow down the progression of androgenic alopecia?

A: In many patients we have found finasteride to hold on to a patient’s hair for at least 15 years. We don’t have much longer data than that since it was approved for hair loss in 1998. Although finasteride will usually continue to work as long as you take it, it may lose some of its efficacy over time. Generally after about 5 years we may notice that the patient’s hair is starting to thin again and we will increase the dose slightly. It is important to understand that even if someone thins on finasteride it doesn’t mean the medicine is not working, because they might have thinned much more without it. To my knowledge, there are no studies that have looked at the effects of finasteride for such an extended period of time.

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

Read more about Propecia (finasteride)


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Posted on April 2nd, 2015 at 4:59 pm
Hair Restoration Answers

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

April 1st, 2015

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 at 11:37 am
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

Q: How does laser therapy work?

A: 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


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