Robert M. Bernstein, MD replies to Walter Unger, MD

Hair Transplant Forum Intl. 1997; 7(6): 13-14.

The phenomenon of delayed growth was not “created by the same people who brought us the megasessions as the Holy Grail,” as Dr. Unger states. It was observed and reported by those who perform megasessions and who objectively scrutinize their own work. We also observed that multiple, small hair transplant sessions using large grafts and/or scalp reductions, often did not produce cosmetically acceptable results. This is why we sought to improve on the older, established surgical hair restoration procedures.

I am sure that some cases of “Delayed Growth” result from problems in technique, which still have to be identified and corrected. This was mentioned in our previous writings. It is interesting that that we have observed delayed growth in hair transplantation patients who ultimately produced wonderful results. This is why we think that there is a “growth cycle” issue in some cases. We first noticed the phenomenon in an early patient who had no growth for eight months and then literally exploded with hair. Each time he had a hair transplant surgery the same thing happened and he now has one of the best results we have seen.

I am grateful that hair restoration surgeons are expressing interest (even if only disbelief) in our observations. When we wrote the original “delayed growth article,” we specifically stated that delayed growth referred to situations where the hair did not grow all at once, but regrew in phases over time. It is only rarely that one sees a long period of no-growth preceding active regeneration.

Delayed growth, when it occurs after hair transplants, is often subtle. We know it is occurring because the hair transplantation patient tells us that he feels the stubble of erupting hair, and we can feel and see it as well. This emergence of new growth usually tapers off between 8-12 months after the hair restoration surgery.

We have seen delayed growth in small hair transplant sessions as well as large ones. I am sure that one reason we observe this phenomenon more readily than others is because we now wait at least 8-12 months between sessions – even with small hair replacement procedures. I would think that it would be impossible to appreciate the delayed growth phenomena when multiple hair restoration sessions are performed in the same area only 3-4 months apart.