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The following are excerpts from the Question and Answer segments of Dr. Bernstein’s Open House Seminars.



HAIR TRANSPLANTATION SEMINAR: PART 10

Scalp Laxity

Attendee: How does a tight scalp affect hair transplants?

Dr. Bernstein: There are two components to having a loose scalp. The first is having elastic or stretchable skin. This is not much benefit for the hair transplant. The other is having more redundant or more mobile skin. This is very helpful in surgical hair restoration. If you have a loose scalp due to redundant tissue, you essentially have more hair.

Now, we used to think that a loose scalp was only important with a strip. Obviously, if you’re taking out a strip and the scalp is loose it is easier to close, but it’s actually more complicated than that. A loose scalp, instead of just being more stretchable, can also be more redundant – you have extra scalp. So you have extra hair to remove.

Now, if you have a very tight scalp because it’s not redundant, because you don’t have extra scalp, then it’s bad both for a strip and for a follicular unit extraction. Remember, the big constraint in FUE is that you often don’t have enough hair. So someone who has a tight scalp just doesn’t have a lot of hair.

Now, another corollary to that is we used to think that people with very loose scalps healed with the finest scars. It kind of makes sense. It turns out that it’s possibly just the opposite. And I wrote a paper on this many years ago called “The Scalp Laxity Paradox.” The reason is, if you think about it, why does someone have a loose scalp? Because it’s really stretchable, it doesn’t hold together well. So after you sew the edges back together, it’s going to re-stretch. So people with loose scalps often have the worse scars.

Now, someone with a tight scalp, why is it tight? It is tight because it doesn’t move, because it stays in place. So people with tight scalps usually heal with the best scars as long as you plan the hair transplant surgery right, plan the surgery so that the strip is narrow enough to easily close.

And so this is an interesting twist on scalp laxity. We had our first insights into this taking care of a hair restoration patient with a disease called Ehlers-Danlos syndrome – a condition where the collagen is not formed well. And the person healed with a wide scar although we thought he would heal beautifully because his scalp was so loose.

Attendee: My scalp tingles a bit, it feels kind of funny. What does this mean?

Dr. Bernstein: In early hair loss sometimes there’s a little bit of a tingling in the scalp, a little bit of a sensation, nobody really knows what causes it. Maybe there’s a touch of inflammation associated with androgenetic alopecia. The people that are having male pattern hair loss and I guess female hair loss, as well experience this kind of sensitivity or tingling on the scalp, not infrequently.

Attendee: Can medications such as Propecia work once a follicle dies?

Dr. Bernstein: Once a follicle is completely miniaturized, only a hair transplantation procedure will get the hair back. At some point there will be cloning, but this technology is still a ways off.


Dr. Bernstein’s Hair Loss

Attendee: How come you didn’t have a hair transplant yourself?

Dr. Bernstein: That’s a fair question. Everybody asks me that. I am actually not a good candidate. My dad is very, very bald. In fact, his sides are extremely thin and my sides are getting there. So I don’t have really stable donor hair. So even if I had a hair transplant, my transplant would be really thin and ratty. My kids kid me when I cut my hair. They say that my hair doesn’t fall on to the floor. It kind of sticks to my clothes – it is so fine and static. So I don’t have enough donor hair to be a good candidate.


Density

Attendee: How thick will my hair be after the hair transplant?

Dr. Bernstein: I like to describe what hair transplants do, by what they don’t do. It doesn’t keep you warm and it doesn’t keep the sun off your head. It doesn’t keep you from getting a sun burn. And I think that that’s a good analogy because it’s not a magical procedure. We’re just moving hair, not creating new hair, but we’re moving it in a way that makes the patient look better – often dramatically better.

So we’re changing the distribution to make it look better without actually adding total hair volume. And that’s why it is more difficult to treat a younger person who’s complaining of decreased hair volume when the hair is actually distributed nicely.


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