Hair Transplant, Hair Restoration & Repair
110 East 55th Street, New York, NY
Telephone: 212.826.2400
Robert M. Bernstein, MD has been selected as one of New York Magazine’s “Best Doctors” for the seventh year in a row.
This special annual issue in New York Magazine, June 13, 2006, presents the findings of Castle Connolly Medical Ltd., publishers of the guidebook, Top Doctors: New York Metro Area.
Dr. Bernstein is the only hair restoration surgeon honored to be included in this list of prominent physicians for seven consecutive years.
Q: I have read that some doctors perform something called a trichophytic closure. What is this?
A: A trichophytic closure is a way to minimize the appearance of the donor scar in a hair transplant using a strip incision.
The technique entails cutting the off the top of one of the wound edges and suturing it so that the hair from that edge grows through the scar. Either wound edge can be trimmed in the technique, but removing part of the upper edge is most common.
Q: I recently turned 22 and have been on Propecia for about 2.5 years. The amount of hair that de-miniaturized with daily 1 mg peaked about a year ago and I have seen steady thinning since. I feel that I am too young for a hair transplant. My question is whether or not an increase in dosage of Propecia is indicated here or if I should seek other options entirely?
A: At 22 years old, I would increase the dose of Propecia before considering hair restoration surgery. However, it is important to realize that there is no scientific evidence that increasing the dose will have any additional effects. There are published data by Roberts et al in the JAAD in 1999 demonstrating that 5 mg is no better than 1 mg from controlled clinical trials.
I usually increase the dose when someone has been on the same dose of medication for about three years, although there is no good data on how exactly to increase the dose, or that it will actually make a difference.
For this purpose, I generally use finasteride in the form of Proscar 5mg every other day (or Proscar 1/2 pill every day).
If you break up the pills, be mindful of the potential risk to pregnant women from handling crushed tablets.
Q: I have read about something called “tumescent anesthesia” but didn’t understand what it is. What exactly is it?
A: Tumescent techniques were first popularized in liposuction surgery where large quantities of fluid containing adrenalin were injected into the person’s fat layer to decrease bleeding before the fat was literally sucked out of the body. Bleeding was minimized because the epinephrine (adrenaline) constricted blood vessels and the fluid compressed the blood flow in the smallest blood vessels called capillaries.
The technique allowed small liposuction procedures to be performed safely in as an out-patient procedure. In surgical hair restoration, low concentrations of anesthetic fluid and adrenaline are injected into the fat layer in the back of the scalp.
In a hair transplant, besides decreasing the bleeding, the fluid makes the skin more rigid so that the incision can me more easily made without cutting hair follicles. It also helps the doctor avoid damage to the deeper blood vessels and nerves in the scalp.
Q: I am Norwood Class 6 and have read about both Follicular Unit Extraction (FUE) and Follicular Unit Transplantation (FUT). Which will give me more hair?
A: In general, FUT will give you more hair since, in FUT, the best hair from the mid-portion of the permanent zone of the scalp (also called the “sweet spot”) can be utilized in the hair transplant.
With FUE, since only the hair follicles are extracted and not the surrounding bald skin, if too much hair is removed, the donor area will begin to look thin as hair is removed. This will limit the amount of hair that can be harvested.
Although in FUE additional areas of the scalp can be utilized to some degree, this will generally not compensate for the inability to access all of the hair in the mid-permanent zone and the total amount available for the hair restoration will be less.
Disclaimer: The purpose of the Hair Transplant Blog is to provide the public with general information on hair restoration. Information provided on this site should not be used for medical diagnosis and/or treatment.
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