Surgical Hair Restoration

Hair transplant surgery is a procedure in which hair is moved from the back and/or sides of the scalp, where the hair is permanent (donor area), to areas that are thinning or bald on the front, top, or crown of the scalp (recipient area). Once transplanted, the hair will continue to grow for a person’s lifetime.

All modern hair restoration surgeries are based on the concept proposed by Dr. Bernstein, in his 1995 landmark publication “Follicular Transplantation,” that the most natural results are produced when hair is transplanted exclusively as naturally occurring follicular units. Follicular units are tiny bundles of 1 to 4 hairs that occur in all human scalps. It requires significant skill to obtain these units from the donor area and keen aesthetic judgment to make sure they are placed in a way that will maximize the cosmetic impact of the hair restoration procedure. See Aesthetics of Follicular Transplantation.

Types of Procedures

There are two way to obtain follicular units from the permanent donor area of the scalp. In the more traditional method called Follicular Unit Transplantation (FUT), a long, thin strip is removed from the donor area and subsequently dissected into follicular units under special microscopes. In the newer procedure called Follicular Unit Extraction (FUE), follicular units are removed one-by-one directly from the scalp.

Once the follicular units are harvested, the subsequent steps are essentially the same in both FUT and FUE. Hundreds to thousands of sites (needle-sized holes) are made in the recipient area to receive the grafts. After the sites are made, the tiny follicular unit grafts are placed into them – a step that can take several hours or longer.

In both procedures, the follicles will begin producing new hair in 2-3 months and the results of the procedure will be fully grown-in, or “mature,” after about one year. It is the aesthetic arrangement of these individual follicular unit grafts that enables the surgeon to create the most natural results possible.

Read Why Surgical Hair Restoration WorksWhy Surgical Hair Restoration Works

Surgical hair restoration works because hair that originates in the permanent area, or donor area, is not subject to the effects of DHT.

DHT is a hormone that causes hair to become progressively shorter and finer until it eventually disappears — a process called “miniaturization.”

Since the genetic susceptibility to DHT resides in the hair follicle, and not the surrounding skin, a follicle that is moved from the permanent area to a balding area will continue to be resistant to the effects of DHT and will continue to grow.

Candidates for Surgery

In order to be a candidate, four basic criteria should be met. These are to have:

  1. Sufficient hair loss to affect the way you look “now”
  2. Been unresponsive to medical therapy (for those who choose to use medication)
  3. Realistic expectations on what a transplant can accomplish
  4. Enough donor hair supply to satisfy current and future needs

Surgical hair restoration should not be a preventative technique, but rather a treatment once your appearance has changed as a result of your hair loss. These procedures do not prevent the progression of genetic hair loss. Unlike medical therapy, which is used for prevention and is best started early, there are no medical or surgical benefits to having a hair transplant early, other than for cosmetic purposes. In other words, if someone is a candidate for surgery there is never a window that will be lost by waiting.

Read about Candidacy for a Hair Transplant

Follicular Unit Transplantation (FUT)

In Follicular Unit Transplantation (FUT), hair is harvested from the permanent (donor) area in the back and sides of the scalp, by removing a single, thin strip of tissue. The area is then sutured or stapled closed to produce a fine-linear scar. The strip is placed under a series of special stereo-microscopes, where it is dissected into thousands of individual 1-, 2-, 3-, and 4-hair follicular units. These follicular unit grafts are then placed into tiny recipient sites that the surgeon makes in the balding area. This process allows quick healing and leaves no scarring in the transplanted area. Read more in our FUT section. »»

Follicular Unit Extraction (FUE)

In Follicular Unit Extraction (FUE), grafts are removed one-by-one from the back and sides of the scalp using a small, round cutting instrument guided by hand or robotic control. The small holes that remain are left open to heal, which usually takes about one week. There are a variety of punches used for this procedure, each having its advantages and disadvantages, with new ones continually being developed. As in a follicular unit transplant, grafts are placed into tiny recipient sites that the surgeon makes in the balding area. Read more in our Robotic FUE section. »»

Robotic Hair Restoration

Robotic FUE Hair Transplant Surgery
Dr. Bernstein performing Robotic FUE with ARTAS System

Robotic hair transplant techniques are a natural extension of improvements in the technology of Follicular Unit Extraction since its first description by Rassman and Bernstein in 2002. The automation of the standard FUE procedure contributes to the overall improvement of the surgery in a number of ways. The ARTAS® System for FUE, in use at Bernstein Medical, employs an image-guided robot to separate follicular units from the surrounding tissue, allowing for greater precision. Read more in our section on Robotic Hair Transplant procedures. »»

Hair Restoration Photo Journal

In our Photo Journal you can follow the progress of a patient from the planning of the surgery, to the creation of the recipient sites, to the maturation of the results over time. »»

Eyebrow Transplant & Restoration

Eyebrow transplant surgery is similar to other types of surgical hair restoration procedures; however, the special anatomic features of the eyebrow require that special techniques are used to create natural, aesthetically pleasing results in this cosmetically important area.

Eyebrow transplants are used to treat hair loss from a variety of causes. Fortunately, due to the limited amount of hair needed, most patients will have adequate donor hair if they are candidates for this procedure. Read more in the Eyebrow Transplant & Restoration section. »»

Hair Transplant Repair

A variety of hair restoration techniques can be used to correct the appearance of poorly executed transplants, old “plug” procedures, scalp reductions, flaps, or widened donor scars. The main methods involve camouflage or graft removal with re-implantation in smaller units. In a combined repair, both procedures are used to obtain the most natural results. Many patients needing repair have very limited donor reserves, so each step in the repair process must be done with extreme care. Read about corrective methods of hair restoration, and the situations in which each would apply, in the Hair Transplant Repair section. »»

Hair Restoration History, FAQ, and More Information

Surgical hair restoration in the United States began in 1959 with Dr. Orentreich’s famous publication in which he first described the surgical procedure as using large 4-6mm plugs. The procedure has evolved dramatically since that time. Dr. Bernstein’s pioneering research and publications on Follicular Unit Transplantation and Follicular Unit Extraction have revolutionized the field and have led to the modern techniques that are now used by physicians around the world.

Visit our History, FAQ & More Information section for a detailed history of hair transplantation, answers to frequently asked questions about hair restoration, milestones in the development of FUT, a timeline of innovations at Bernstein Medical – Center for Hair Restoration, a glossary of important terms, and much more. »»

Dr. Bernstein Discusses Hair Restoration with Oprah Winfrey and Dr. Mehmet Oz

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