Follicular Unit Extraction

Attendee: When would you use follicular unit extraction?

Dr. Bernstein: As we discussed before, the strip harvesting technique in follicular unit hair transplantation will give more hair. It is overall a better procedure. We would consider FUE if someone shaves the hair on the back and sides very, very close, if the scalp is too tight for strip harvesting and for repairs of donor scars.

Attendee: Like shaving your head too?

Dr. Bernstein: If you consider shaving your head, you probably should do this before contemplating hair restoration. When one has hair transplant surgery, the purpose is to have the appearance of more hair. If you want to shave it off, I would offer that you are really not ready for the procedure. Remember, follicular unit extraction is also going to leave little dots – tiny white scars.

Attendee: Now, where would you see the dots? Would you take the hair from all over?

Dr. Bernstein: Yes. We take it from all over, as long as it is in the permanent zone. But that is actually the reason why a strip is superior. Because when you take a strip, you’re taking all the hair in the mid-portion of the permanent zone, you are not just picking away at it. So it’s an extremely efficient hair transplantation procedure. There’s a band here that’s dead center of the permanent hair. That is all used in FUT and the area is then sutured closed.

When you extract, you’re not removing bald skin. You’re just taking the hair out. So if you take all the hair away, you’re going to be left with a big bald area. So you can only take a portion of that away which is why you are so limited.

So what you have to do is to start to go lower or higher in the donor area, but that hair is not necessarily permanent at the margins of this zone. So that’s why it’s so much more efficient to do the strip. So we can do extraction, but usually people that are young, really the people that want extraction, are the people that are losing their hair at a young age and therefore are likely to become very bald. And to maximize the transplanted hair one should really use a strip. So the best thing is to delay hair transplant surgery on those people until they decide how they really want to wear their hair.


Shampooing, Shedding and Androgenetic Alopecia

Attendee: I know when I wash my hair, I’m afraid to touch the top because every time I touch the top it falls out. If you look at your hand every day when you’re washing your head, you start freaking out.

Dr. Bernstein: Washing doesn’t cause hair loss at all. What happens is that when people are afraid to wash, afraid to brush their hair, afraid of combing, afraid to vigorously shampoo or shampoo less often, the hair that would normally be removed, just accumulates on the scalp. When the person finally does shampoo, more appears to fall out because it has been sitting up there for days. The patient, however, says, ah-ha, look, see all the hair. Now they wait ten days. And then they comb their hair after ten days and say, ah-ha, now look there is even more hair….. and it just continues. So the less frequently you do it, the more you see it at any one time. But it doesn’t affect the rate of hair loss.

Now, this is an important concept. In male pattern hair loss, what did we say is the cause of the hair loss? The cause is the progressive shrinking of hair shaft length and diameter – what we call shortening of the cell cycle. The hair doesn’t grow as long. In genetic hair loss, hair is not growing, rather than falling out at a faster rate. To stress this point, let me say it again, “Male pattern hair loss (or androgenetic hair loss) is not caused by hair falling out; it is caused by hair not growing back with the same thickness or length.”

So the fact that you see hair in the tub is a good sign – as long as it is not excessive. It means there is hair to fall out. Remember, it is not the falling out, but the fact that the hair is not growing back that’s the process of hair loss. And it’s not over one cycle. It’s very gradual as normal hair is replaced with the smaller and smaller hair.

With hair loss from pregnancy or from taking birth control pills, there you see actual shedding. Genetic hair loss in men is not a process of your hair falling out. It’s a process of the hair not growing back. So seeing hair on the comb is actually a good sign. It should not be a concern.


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