A: All of the patients that appear on the Bernstein Medical website were operated on by me personally. My own staff assisted me in these procedures.

I worked with Dr. Rassman at NHI from 1995 to 2004. Photos of patients that I operated on during this period may therefore also appear on the NHI website.

Below is the article that appeared in the publication announcing Dr. Bernstein as the recipient of the honor. Dr. Bernstein is also a member of the society.

Hair Transplant Forum International
September-October 2006

Pioneer of the Month – Robert M. Bernstein, MD
by Jerry E. Cooley, MD Charlotte, North Carolina

The term “follicular unit transplantation” (FUT) has become so firmly embedded in our consciousness that we often consider it synonymous with hair transplantation in general. Surgeons new to the field may be unaware of its origin and how the concept evolved. In the 1980s, many separate clinics were developing total micrografting techniques to improve the naturalness of hair transplantation. In 1988, Dr. Bobby Limmer began developing a technique consisting of single strip harvesting with stereomicroscopic dissection of the hair follicles within the strip, which he published in 1994.

After observing histologic sections of scalp biopsies, dermatopathologist Dr. John Headington coined the term “follicular unit” in 1984 to describe the naturally occurring anatomic groupings of hair follicles. In 1995, a surgeon just entering the field of hair transplantation became aware of these natural “follicular units” and came to believe that they should be the building blocks for all hair transplants. His name was Bob Bernstein.

From 1995 to 2000, Bob and his colleague Dr. Bill Rassman articulated the rationale and benefits of FUT in dozens of publications and numerous lectures. Doubtlessly, Bob’s extraordinary effort advocating FUT in public forums during that time was critical to FUT’s rapid evolution and acceptance among surgeons.

Bob was born in New York City and raised on Long Island, New York. For college, Bob headed south to Tulane University in New Orleans. Next, he went to medical school in Newark at the University of Medicine and Dentistry of New Jersey. He then went on to a residency in dermatology at Albert Einstein College of Medicine, where he served as chief resident.

Bob performed some punch grafting procedures in residency and a few more when he started his cosmetically focused dermatology practice in 1982. Not liking the results, he didn’t perform another transplant for 12 years. In the summer of 1994, Bob saw a patient of Dr. Ron Shapiro for a dermatologic problem. Impressed with the results of the surgery, Bob began speaking with Ron about the changes in the field. Ron encouraged him to attend the next ISHRS meeting in Toronto, which he did. While there, he saw several of Dr. Rassman’s patients presented and was greatly impressed.

Soon after, he was in Bill’s office observing micrograft “megasessions.” One of the things that caught Bob’s attention was Bill’s use of the “densitometer” to quantify the patients’ hair density. Bob noticed that the hair surprisingly grew in small groups. Bill half jokingly told Bob that he should give up his dermatology practice and go into hair restoration and invited him back for a second visit. On the 5-hour plane ride to Los Angeles, Bob thought about the potential of only transplanting those small groups he saw with the densitometer, and wrote the outline of a paper entitled, “Follicular Transplantation” (published that same year). The second visit with Bill confirmed his interest in hair transplants and, in particular, developing this idea of FUT. He quickly transferred his dermatology practice to a colleague and joined Bill’s group, the New Hair Institute (NHI).

Over the next 10 years, Bob authored and coauthored over 50 papers on FUT addressing issues such as quantifying various aspects of FUs among patients, racial variations, graft sorting, as well as hairline aesthetics, corrective techniques, the use of special absorbable sutures, and FUE and its instrumentation. One of the concepts he emphasized was the recognition of Diffuse Patterned Alopecia (DPA) and Diffuse Unpatterned Alopecia (DUPA), which were originally described by Dr. O’Tar Norwood. Bob helped raise awareness that patients with DUPA and low donor density are not surgical candidates. For all of his many contributions to the field, Bob was awarded the 2001 Platinum Follicle Award.

Branching out in other directions, Bob decided to go to business school and received his MBA from Columbia University in 2004. He did this to learn how to better streamline the day-long hair transplant sessions and improve general management of his growing staff. In 2005, Bob formed his own practice, Bernstein Medical – Center for Hair Restoration. Looking to the future, Bob says, “I am excited about the accelerated rate of technical changes to the hair transplant procedure. This is due to an increasing number of really clever minds that have entered the field. Almost every aspect of the surgery is being tweaked and improved upon. It goes without saying that cloning will be the next really big thing—but I think it will take longer to develop than some are promising.” On the down side, he notes, “A concern I have is that, as hair transplant practices grow into big franchises with large marketing campaigns, many people are being directed toward surgery rather than being treated as patients with hair loss in need of an accurate diagnosis, medical treatment, emotional support, and surgery only when appropriate.”

Bob met his wife, Shizuka, who was born in Tokyo, when she was opening a dance studio in the East Village section of New York. She now owns a day spa in midtown Manhattan. Bob has three children; two are in college: Michael, 22, is studying mixed martial arts and foreign language; Taijiro, 21, is majoring in theoretical math. His daughter, Nikita, 12, is in 7th grade and plays on the basketball team. In addition to going to Nikita’s games, Bob enjoys skiing, piano, chess, basketball, philosophy, and music history.

A: The Merck data showed that over 90% of patients had peak response at 1 year and this has been my experience as well.

Most patients show the most dramatic response between 6 to 12 months with some getting additional benefit up to two years. Prior to 6 months, the results are quite variable and there may even be a net loss due to shedding during this period, as the Propecia stimulates a new anagen cycle.

If one is planning to go on Propecia before a hair transplant to minimize any shedding from the surgery and to prevent future hair loss, one should start the medication at least one month prior to the procedure.

If one wants to use Propecia for the purpose of possibly avoiding hair restoration surgery, then one needs to wait at least a year to see if there will be enough regrowth.

Finally, if one is younger (i.e. in the 23-25 age range) one should be on Propecia for at least two years to give it every possible chance of working and see its maximum benefit before considering a hair transplant.

View the segment, which includes footage of Dr. Bernstein speaking about hair transplantation and performing a transplant procedure, below:

Watch the video at YouTube or go to the Bernstein Medical – Center for Hair Restoration YouTube channel to see more videos on hair transplantation and hair transplant repair.

Read the full transcript of the segment here:

These days, more and more men who want to compete in the marketplace are seeking cosmetic surgery because they see it as giving them a competitive advantage.

With over 35 million American men affected by hair loss, it’s not surprising that hair restoration ranks high on the list of most popular procedures, generating two billion dollars in revenue each year.

Forty two year-old New York composer Ken Gold started losing his hair 20 years ago.

Ken Gold: In your 20s, you know, everyone is more image-conscious and you don’t want to lose your hair in your 20s.

Ken is not alone. 20% of men in their 20s experience hair loss. In their 30s, the odds jump to 30%, and by the time a man is in his 50s, there is a 50% chance he will be losing some hair.

Ken Gold: Once you’ve lost your hair, you look older. And you don’t want to be 22 and look 35, you know?

Determined to stay youthful, Ken investigated his options and decided to undergo a series of hair transplant procedures beginning in 1981.

Ken Gold: One of the guys I was doing business with, he had a very thick full head of hair. And he said, “Well, I’ve got a hair transplant,” and I was just astonished.

But after five years and four painful, expensive procedures, Ken still didn’t have the full head of hair he wanted.

Ken Gold: My head was a mess. You only had to lift up the hair in the back and you could see what they call the Swiss cheese scalp, just this huge massive scar tissue with little round holes, you know.

Dr. Bernstein: When hair transplants were first started, they thought in order to get enough fullness, you had to move the hair in large clumps, and that’s traditionally known as plugs. And much of our practice is still devoted to hair transplant repair.

Ken despaired of ever finding the solution to his problem until he found the New Hair Institute in Fort Lee, New Jersey.

Dr. Bernstein: When I first saw Ken in 1995. He still had the traditional plugs, and I would say on a scale of one to ten, he was maybe a seven, with ten being the worst. We performed a procedure called follicular unit transplantation where hair is transplanted in exactly the way it grows in nature, which are little tiny groups of one to four hairs.

Ken Gold: After the first surgery I was just ecstatic because I was actually able to look at myself in the mirror.

Almost 20 years and $40,000 later, Ken has finally achieved the natural-looking hair he wanted. But there are alternatives to hair transplant surgery.

Dr. Bernstein: Probably the best thing to do if you’re noticing hair loss is to have a diagnosis of male pattern hair loss to make sure there is not some other treatable condition, and then to use a medication, such as Propecia, which actually can prevent hair loss if it is taken early enough.

But Ken Gold is convinced he’s found the right solution for him.

Ken Gold: I’m very happy now. I wasn’t happy five years ago. When I look in the mirror now, I see someone with hair and I’m able to comb it back and say, yeah, this looks okay.

HEALTH MATTERS COLUMN

Even IF they don’t talk much about it, just about all the guys he knows are taking medication for their thinning hair, said Steve, a retail manager in his early 30s from Suffolk County, NY. He would be too, but he had side effects right away. He’s had consultations for hair transplants, but that won’t work either because of the pattern of his balding.

So he’s using a protein product that makes his hair look fuller, changed his diet to include leafy green vegetables, gone to two psychics for help. And, he said, he’s biding his time, waiting for new hair restoration medications or for hair cloning to hit the marketplace.

“In the ’90s, everything’s about looks,” said Steve, who asked that his last name be kept confidential. “No one wants to give up their youth.” All the effort to find a hair restoration solution is worth it, he said, “because losing my hair bothers me a lot.”

Sure, hair loss isn’t crippling or life-threatening. But to hear people’s tales, it’s traumatic, depressing and embarrassing.

Yet, you’re more likely to get a snicker than a hug for your pains, said Spencer Kobren, 34, a Manhattan consumer activist and author of “The Bald Truth,” (Pocket Books, 1998, $6.99.) There may be few open arms to comfort you, he said, but there are plenty of extended hands to take your trust and your money.

Kobren should know. He has spent several years testing out hair loss products and talking to the experts about his own hair loss, which began at 22. Now he serves as a sounding board and clearinghouse for the good news and the bad about hair loss and its treatments on a syndicated radio show, aired locally on WEVD /1050 AM on Sunday nights.

“You feel like you’re losing a part of yourself. You see your appearance deteriorate, often rapidly and drastically,” he said. You become vulnerable to promises and pitches, but don’t be swayed by them, said Kobren, who now has a full head of hair. Instead, do a lot of research. The wrong hair restoration products or treatments may not only fail to grow hair, they can make matters a lot worse. For example, he said he gets thousands of letters and e-mails about botched hair transplants that leave men scarred, poorer and balder.

According to Kobren, about $7 billion is spent by consumers annually on finding solutions to hair loss. There are about 50 million men who are balding, with at least 20 percent starting in their 20s. Most have male-pattern baldness, genetically linked and triggered by the action of a hormone called dihydrotestosterone (DHT).

Hair loss is not just a guy thing, though. Plenty of women — about 20 million — have varying degrees of it too. Hair loss is finally getting recognition as a women’s health problem, said Maggie Greenwood- Robinson, whose book, “Hair Savers for Women” (Three Rivers), is due next spring. Kobren’s “The Truth About Women’s Hair Loss,” (Contemporary) will be out in January. “There are more options than ever before for women with hair loss,” said Greenwood-Robinson, and they shouldn’t give up.

But they do have to be cautious. The diagnosis and treatment for men and women is very different, said Dr. Robert M. Bernstein, assistant professor of dermatology at Columbia College of Physicians arid Surgeons and medical director of the New Hair Institute in Manhattan and Fort Lee, N.J.

“Women usually have a diffuse type of hair loss with thinning all over,” he said, “while men generally lose hair on the front and top and keep a permanent zone on the back and sides.” Female baldness can also be due to DHT, but many women lose hair because of anemia, gynecological issues, thyroid disorders or stress, among other reasons. You don’t want to waste your efforts on hair restoration products when what you need is more iron or different birth control pills. “A medical evaluation is extremely important to rule out underlying medical conditions,” said Bernstein.

The treatment of hair loss is an increasingly complicated decision for both men arid women, but at least there is more information than ever to help you ask the right questions. Web sites include www. thebaldtruth.org and www.regrowth.com. Bernstein’s practice has a Web site at www. newhair.com and a detailed book called “The Patient’s Guide to Hair Restoration.”

Your hair restoration options include:

Medication: Finasteride (brand name Propecia), taken orally by prescription. Available for under two years, Propecia is for men only and causes side effects in about 2 percent of them. It has been shown to stop hair loss in about 87 percent of users and new growth in about half. It’s not for women, because it can cause birth defects if a woman is pregnant, and if she’s past child-bearing age, it doesn’t seem to work.

Minoxidil: (brand name Rogaine), used topically. It can be used by both men and women and appears to slow down the rate of hair loss, but not to prevent balding in the long haul. Any effect from either of these hair restoration medications stops when you no longer use them.

Hair transplant surgery: for men and women. Bernstein has pioneered a state-of-the-art technique called follicular unit transplantation, a precise method using hair-follicle groupings that result in a more natural growth of hair and doesn’t leave scars.

Removing grafts of skin from your head and placing them in balding spots is clearly an art as well as a science. Besides being a good candidate for surgical hair restoration, you need to find a dermatologist with a lot of experience performing hair transplant surgery. Expect to ask many questions, learn the risks, see pictures of other patients and meet them in person.