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Hair Restoration Answers

What is Lichen planopilaris?

Q: What is Lichen planopilaris? — G.S., Pleasantville, NY

A: Lichen planopilaris (LPP) is a distinct variant of cicatricial (scarring) alopecia, a group of uncommon disorders which destroy the hair follicles and replace them with scar tissue. LPP is considered to have an autoimmune cause. In this condition, the body’s immune system attacks the hair follicles causing scarring and permanent hair loss. Clinically, LPP is characterized by the increased spacing of full thickness terminal hairs (due to follicular destruction) with associated redness around the follicles, scaling and areas of scarred scalp. In contrast, in androgenetic alopecia (AGA) or common baldness, one sees smaller, finer hairs (miniaturization) and non-inflamed, non-scarred scalp. Complicating the picture is that LPP and AGA can occur at the same time – particularly since the latter condition (common baldness) is so prevalent in the population (see photo). And LPP can involve the frontal area of the scalp, mimicking the pattern of common genetic hair loss. Interestingly, the condition is more common in women than in men.

For those considering a hair transplant, ruling out a diagnosis of LPP is particularly important as transplanted hair will often be rejected in patients with LPP. In common baldness, the disease resides in the follicles (i.e., a genetic sensitivity of the follicles to DHT). Since the donor hair follicles remain healthy, even when transplanted to a new location, we call common baldness donor dominant. It is the reason why hair transplantation works in persons with common baldness. In contrast, LPP is a recipient dominant condition. This means that the problem is in the recipient area skin, so if healthy hair is transplanted into an area affected by LPP the hair may be lost.

Because it is so important to rule out suspected LPP when considering a hair transplant and because it is often hard to make a definitive diagnosis on the physical exam alone, a scalp biopsy is often recommended when the diagnosis of LPP is being considered by your doctor. A scalp biopsy is a simple five minute office procedure, performed under local anesthesia. Generally one suture is used for the biopsy site and it heals with a barely detectable mark. It takes about a week to get the results. The biopsy can usually give the doctor a definitive answer on the presence or absence of LPP and guide further therapy. If the biopsy is negative, a hair transplant may be considered. If the biopsy shows lichen planopilaris, then medical therapy would be indicated.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

What Does Hair Transplant Procedure Do To Existing Hair?

Q: What does the hair transplantation process do to your existing hair? — R.V., London, UK

A: When we perform hair transplant surgery, we transplant into an area that is either bald or has some existing hair. The hair that is existing is undergoing a process called miniaturization. What this means is that the hairs are continuing to decrease in size – both in diameter and in length. When we perform a hair transplant, we don’t transplant around the existing miniaturized hair on your scalp, we transplant through it. And the reason why we do that is because the miniaturized hair, the fine hair that is being affected by DHT, is eventually going to disappear, so you don’t want there to be any gaps.

So the question is, does the hair transplant actually destroy the existing hair? The answer is that it doesn’t destroy, but it can “shock” it. In other words, creating recipient sites (that the grafts are placed into) will temporarily alter the local circulation of the scalp and this can cause some of the hair in the area to be shed. The reason why hair may be shed is that hair is naturally cyclical. In other words, hair is normally growing, shedding, and then regrowing again. When you stress the scalp, the growing hair may be shed prematurely, but then it regrows.

If you think about the process of electrolysis, it makes sense that you don’t damage follicles from making recipient sites during a hair transplant procedure. In electrolysis used to treat unwanted hair, you stick a needle in the follicle, and you turn on an electric current. And you burn it. And then what happens to the hair? It usually comes back and you need to do it a few more times, even though we are applying an electric current via a needle placed directly in the follicle. So it makes sense that by just inserting a fine needle – the tool commonly used to make a hair transplant site – into the skin, one would not destroy hair follicles. However, the cumulative effect of making hundreds or thousands of recipient sites does shock the follicles and, as a result, some may shed their hair.

It can occur with general anesthesia – when the scalp is not even touched – and it can occur with oral medications, from pregnancy, or after psychological stress. So if you have hair restoration surgery and there is shedding, and it takes six months to a year for the transplanted hair to grow in, during this time hair transplant patient will experience some thinning. Since miniaturized hair is going to eventually disappear anyway, some of the miniaturized hair that is shed may not return. But if it is healthy hair, and it is shed, it will grow back. And, of course, the transplanted hair will be growing in as well during this time.

I am often asked to describe how much can be expected to be shed. The answer is that it is an amount that is often noticeable by the patient, but not noticeable by anyone else.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

What is the Difference Between NeoGraft and ARTAS Robotic System for FUE Hair Transplant Surgery?

Q: What is the main difference between NeoGraft and the ARTAS™ robotic system? — H.T., Staten Island, NY

A: The Neograft device is basically a powered FUE tool. It is still done by hand and therefore risks operator induced errors and damage to hair follicles. The ARTAS System, made by Restoration Robotics, uses electronic image-based tracking capabilities to map the individual follicular units. It does so to determine the optimal approach for automated graft harvesting. The robotic harvesting device produces consistently high quality grafts and low dissection rates.

For more information on these systems, visit the Follicular Unit Extraction (FUE) section or read Dr. Bernstein’s answers to questions on Robotics.

Read about Robotic FUE Hair Transplantation

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Can Dandruff Or Nizoral Cause Hair Loss?

Q: Can dandruff cause hair loss? I have a lot of dandruff and use the Nizoral Shampoo for it. And can the Nizoral be a reason I am losing my hair? — K.P., Suffern, NY

A: Dandruff (the medical term is seborrhea) does not cause hair loss as it is a condition that involves scaling and redness on the surface of the scalp and does not involve the growth parts of the hair follicle that lie deeper in the skin. Although Nizoral is an ineffective treatment for hair loss (it is sometimes prescribed for this) it will not cause hair loss.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Is Nizoral An Effective Hair Loss Medication?

Q: I use Nizoral for my dandruff. Does it work for hair loss too? — M.D., Danbury, CT

A: The active ingredient in Nizoral is Ketoconazole. This medication, originally developed to treat fungus infections, has slight anti-androgen action. It is supposed to work in hair loss by inhibiting the action of DHT on hair follicles. Although, in theory, it should be useful for androgenetic hair loss, there have not been conclusive scientific studies to show that it works to treat balding when used as a topical application for balding.

Posted by Robert M. Bernstein M.D.
Bernstein Medical In The News

CBS Program on Hair Transplantation, Hair Loss Features Interview With Dr. Bernstein

Dr. Bernstein on CBS - Eye on NY

Dr. Bernstein was interviewed by Dana Tyler, host of the television program “Eye on New York” on CBS, for the show that aired on April 17th. The wide-ranging interview was the feature in a 9-minute segment on hair transplantation and hair loss.

Below is a partial transcript from the interview.

Hair Loss – Men vs. Women:

DT: How big a problem is it, men versus women? We heard the statistics but is it worse for one group or the other?

RB: It seems to be worse in women emotionally. Statistically it’s obviously more common in men, but the pattern is very different. When men lose their hair they lose it mostly in the front. And they can start in two different patterns. One is in the temples and in the crown or it can just go front to back. That’s called patterned hair loss and it’s pretty obvious. Women have a more diffuse pattern so it would be many years before you even notice it.

DT: What about the influence we hear, if it’s your mother’s father or your mother’s grandfather was bald then therefore, men, you will be. Is there any truth to that?

RB: Like many myths there is a little bit to it. There is a slight predominance coming from the mother’s side of the family. There is something called an androgen receptor gene, that has been found on the X chromosome, which accounts for the slight difference between inheritance from the mother’s side versus the father’s side. But most of the genetics is on the regular chromosomes, called the autosomal chromosomes, which is the same from both sides. So you can get it from either your mother or your father or your uncles or grandparents.

Early Hair Loss:

DT: Age-wise. Are there certain times – I mean, we talked about earlier in the 30s, but some young men it happens earlier.

RB: It seems that when people start to lose their hair early, it has a tendency to be much more severe. So the people who start to thin around 16, 17 usually become very bald. Time is usually on your side if you have hair into your 30s and 40s, [it’s] more likely you’ll have a full head of hair.

Hair Loss in Women:

DT: Speaking about women and the reasons behind women’s hair loss. A little different than for men.

RB: It’s genetic, as with men for the most part, but there are two different systems. Where in men it’s related to androgens directly, which causes the front-to-back pattern, in women they have another enzyme pathway which kind of evens it out and keeps their hairline longer. Also, because women have a tendency to thin all over, their genetic hair loss can be mimicked by other things, such as diseases that cause hair shedding or thinning — so anemia, thyroid disease, medications such as birth control pills — all those things can also contribute to hair loss, and it seems that those factors are much more common in women than in men.

DT: And then in trying to determine if a woman is going through that, because there are more factors is it hard to figure out why there is the hair loss?

RB: It’s a little bit more difficult [in women]. The main thing that you do is to look at the hair diameters. In genetic hair loss the hairs have different diameters. In [conditions] like anemia, or where there is shedding on medication, the hair comes out at its root. Where people think of hair loss as losing hair, most of hair loss is thinning because the hairs are actually thinner in diameter.

Preventing Hair Loss:

DT: Preventing baldness… is there anything that can be done?

RB: There are… But it’s not what you think. It’s not hats and combs.

DT: Fertilizing your head. (laughs)

RB: There are two medications, main medicines. One is Propecia, or the generic term is called finasteride, and what that does is it blocks DHT. And DHT is what causes these hair follicles to gradually miniaturize, or get smaller, and disappear. And the other is Rogaine, which actually stimulates hair follicles directly. Unfortunately, Propecia can’t be used in women because it can cause birth defects during child bearing years and it can also stimulate breast tissue, but it is very effective in men.

DT: So what does a woman do?

RB: Well, Rogaine will help a little bit. Lasers can help a little bit, perhaps not as much as the initial studies have suggested. And then, once you’ve lost your hair, surgical options are available.

Hair Transplantation:

DT: Hair transplants. I know that’s a complicated procedure. And Dr. Max [Gomez] was talking about the art of it, too, when you’re finding someone. Tell me a little bit more…

RB: The main thing in hair transplants is really to determine who is a good candidate. And the interesting thing is that because of the pattern of [hair loss] in men, men usually have a very permanent area on the back and sides of the scalp. So when you move that to the front and top, it will continue to grow. Because women’s hair loss is more diffuse, the back and sides are not always stable. So, when you’re trying to decide if a woman is a good candidate, you have to make sure that the hair, where you get it from, is going to last their lifetime. And only a small percentage of women are really good candidates for that transplant.

The Future of Hair Restoration – Medications & Cloning:

DT: What about the future? Are you optimistic about new options on the horizon?

RB: First of all, new medications are coming out. Latisse is a medication that can grow eyelashes. And we’ve just started studying it in eyebrow hair, and it seems to grow eyebrows as well. There are studies to see if you can grow hair on the scalp. And it certainly will, it’s just whether it’s practical and how well it works. It probably will be of some benefit.

DT: There always is progress, right?

RB: Right. And then [there are] hair transplants where we can take individual follicles rather than having to take a long thin strip, although that still seems to give you the best volume. And then we’re trying to multiply hair. In other words, the limitation of transplants is always that we don’t have [as much] hair as we’d like. So we’re working on cloning. We’re working on multiplying hair that can actually be plucked from the scalp. So that [the original hair] will regenerate, and you then can get the plucked hair to grow into new hair follicles.

For more interviews with Dr. Bernstein, and other media appearances, visit our Bernstein Medical “In The News” section.

Posted by Robert M. Bernstein M.D.
Bernstein Medical In The News

Press Release: Hair Transplant Pioneer Studies Hair Cloning, Hair Restoration Procedures Using ACell’s Extracellular Matrix

Robert M. Bernstein, M.D., F.A.A.D., Renowned Hair Transplant Surgeon and Founder of Bernstein Medical – Center for Hair Restoration in New York, is Studying Four Applications of ACell MatriStem™ Extracellular Matrix in a Type of Hair Cloning, Called Hair Multiplication, as well as in Current Hair Restoration Procedures.

New York, NY (PRWEB) March 15, 2011 – Robert M. Bernstein, M.D., F.A.A.D., Clinical Professor of Dermatology at Columbia University in New York and founder of Bernstein Medical – Center for Hair Restoration, has been granted approval by the Western Institutional Review Board (WIRB) to study four different applications of the ACell MatriStem extracellular matrix (ECM) in hair restoration.

Hair Cloning with ACell MatriStemHair Cloningwith ACell MatriStem

Two of the studies include its use in a type of hair cloning, called hair multiplication, where plucked hairs and transected follicular units are induced to generate new hair-producing follicles. The other two areas of study include evaluating the use of the ECM in current hair transplant procedures to enhance hair growth and facilitate wound healing.

Approval by the WIRB allows the researchers to conduct double-blinded, bilateral controlled studies. Controlled studies are the best way to increase the objectivity of the research and insure the validity of the results.

“The medical research we are performing is important because it may lead to hair multiplication as a way to increase a person’s supply of donor hair. In this way, patients would no longer be limited in the amount of hair which can be used in a hair restoration procedure,” said Dr. Bernstein. “Additionally, in the near-term, the extracellular matrix may be able to improve the cosmetic benefit of current hair transplant procedures. We are simultaneously pushing the boundaries of hair cloning methods and follicular unit transplantation.”

Hair multiplication, a variation of what is popularly known as hair cloning, is a procedure where partial hair follicles are stimulated to form whole follicles. These parts can either be from hairs derived from plucking or from follicles which have been purposely cut into sections. Generally, damaged follicular units will stop growing hairs. However, there is anecdotal evidence that an extracellular matrix applied to partial follicles may stimulate whole follicles to grow and, when applied to wounds, may stimulate the body’s cells to heal the damaged tissue.

This new medical research also attempts to show that ACell can improve the healing of wounds created when follicular units are harvested for hair transplant surgery. Currently, in follicular unit hair transplant procedures, a linear scar results when a surgeon incises the patient’s scalp to harvest follicular units. Occasionally, this scar can be stretched, resulting in a less-than favorable cosmetic result. If ECM can induce the wound to heal more completely, the linear scar may be improved. The extracellular matrix may also benefit general hair growth in hair transplantation in that the sites where hair is transplanted, called recipient sites, can be primed with ECM to encourage healthy growth of the hair follicle.

Dr. Bernstein is known world-wide for pioneering the hair restoration procedures of follicular unit transplantation (FUT) and follicular unit extraction (FUE). Follicular units are the naturally-occurring groups of one to four hair follicles which make up scalp hair. These tiny structures are the components which are transplanted in follicular unit hair transplants.

While hair cloning has been of great interest to hair restoration physicians and sufferers of common genetic hair loss, the method by which this can be achieved has yet to be determined. The use of ACell’s extracellular matrix to generate follicles is a promising development in achieving this elusive goal. In addition to the longer term implications of using ECM in hair multiplication, its impact on hair restoration will be more immediate if it can be proven effective when used in current FUT procedures.

About Dr. Robert M. Bernstein:

Dr. Bernstein is a certified dermatologist and pioneer in the field of hair transplant surgery. His landmark medical publications have revolutionized hair transplantation and provide the foundation for techniques used by hair transplant surgeons across five continents. He is respected for his honest and ethical assessment of a patient’s treatment options, exceptional surgical skills, and keen aesthetic sense in hair transplantation. In addition to his many medical publications, Dr. Bernstein has appeared as a hair loss or hair transplantation expert on The Oprah Winfrey Show, The Dr. Oz Show, Good Morning America, The Today Show, The Discovery Channel, CBS News, Fox News, and National Public Radio; and he has been interviewed for articles in GQ Magazine, Men’s Health, Vogue, the New York Times, and others.

About Bernstein Medical – Center for Hair Restoration:

Bernstein Medical – Center for Hair Restoration is a state-of-the-art hair restoration facility and international referral center, located in midtown Manhattan, New York City. The center is dedicated to the diagnosis and treatment of hair loss in men and women. Hair transplant surgery, hair repair surgery, and eyebrow transplant surgery are performed using the follicular unit transplant (FUT) and follicular unit extraction (FUE) surgical hair restoration techniques.

Contact Bernstein Medical – Center for Hair Restoration:

If you are a journalist and would like to discuss this press release, please email us or call us today (212-826-2400) to schedule an appointment to speak with Dr. Bernstein.

View the press release at PRWeb.

Posted by Robert M. Bernstein M.D.
Bernstein Medical In The News

Hair Loss Articles Feature Dr. Schweiger

Dr. Eric S. Schweiger - Associate at Bernstein Medical - Center for Hair RestorationDr. Eric S. Schweiger, board-certified dermatologist, is quoted in a few recent articles on the effects of chemotherapy on hair, genetic testing for hair loss, and protecting a balding scalp from the sun.

“Coping with Chemo-Induced Hair Loss” was published in a recent issue of Energy Times, a publication focused on wellness and nutrition. Dr. Schweiger commented on the way hair follicles can react to chemotherapy treatment for cancer patients:

Expect changes like “chemo curl.” Eric Schweiger, MD, explains that chemo shocks rapidly dividing cells like hair follicles in the scalp, causing the hair loss. “When the follicles grow again, the shock sometimes changes how they grow, temporarily resulting in a different hair texture and color, which eventually normalizes,” explains Schweiger.

In the article, “Genetic Testing to Predict Hair Loss,” published on HairLoss.com, Dr. Schweiger and Dr. Bernstein discussed the efficacy of genetic tests for hair loss:

[Dr. Schweiger] explains, “I think the test has probably identified a predictor of hair loss but not the only predictor. There is science behind the test and some published research studies; however, the longitudinal, larger studies have not been done, because this testing procedure is just too new.” Dr. Robert Bernstein, M.D., director at Bernstein Medical Center, agrees and adds, “These tests focus on one particular dominant gene, but what is becoming apparent is that hair loss is a complex genetic condition most likely involving several different genes.” He further notes that age, stress, hormone levels, disease and many other factors also are at play in determining factors for hair loss. “Just because a person has the genes for baldness, it doesn’t mean the trait will manifest itself. The truth is the cause and effect have not been proven and differ from person to person, and the association is not anywhere near 100 percent.”

[…]

“Right now, we predict future hair loss based on follicle miniaturization, using advanced microscopic equipment,” says Dr. Schweiger, “and I advise a man to do this at around age 25. If someone presents with more than 25 percent miniaturization, then it’s time to start a hair loss prevention regimen.”

Lastly, Dr. Schweiger contributed featured commentary to an article on HairLoss.com on a topic of importance to those suffering from hair loss, namely, protecting your scalp from the dangerous radiation given off by the sun. In “When You Lose Your Hair, Protect Your Scalp,” Dr. Schweiger encourages bald or balding individuals to take important steps to protect their scalps:

…if you notice your hair thinning or you have baldness of any kind for any reason, it’s important to protect your scalp from sun damage, precancer and skin cancer,” says Dr. Eric Schweiger, M.D., a board-certified dermatologist and hair transplant surgeon at Bernstein Medical — Center for Hair Restoration in New York City. That’s because 100 percent of the surface area on top of your head directly faces the sun’s burning rays when the sun is strongest, between 10 a.m. and 2 p.m. “In general, a mild sunburn on your scalp won’t harm your hair follicles. But any exposure that causes blistering can cause scarring and pre-cancer cells, which will harm hair follicles permanently, so you need to take special care of your scalp when exposed to the sun, even for only a few minutes,” explains Schweiger.

Set up a hair loss consultation with one of our board certified physicians.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Does Sebum Cause Hair Loss By Blocking Pores On Scalp?

Q: I have been on finasteride for about 7 months. After my latest haircut I can see that my scalp is shiny. I read that is from sebum buildup and it can cause a layer that clogs the growth of hair. I was wondering if this is true and, if so, how can it be treated? — T.C., Philadelphia, PA

A: It is not true. Hair loss is caused by the miniaturizing effects of DHT on the hair follicle, not by blocked pores.

For more on this topic, view our pages on the causes of hair loss in men or the causes of hair loss in women.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

What are the Obstacles to Hair Cloning Using Plucked Hairs?

Q: What are the possible obstacles that you see with hair cloning using the plucking technique? — D.E., Boston, MA

A: Plucked hair does not contain that much epithelial tissue, so we do not yet know what the success of the procedure will be. Plucked hairs will most likely grow into individual hair follicles that are not follicular units and therefore, will not have completely the natural (full) look of two and three hair grafts. This limitation may be circumvented, however, by placing several hairs in one recipient site. It is possible that the sebaceous gland may not fully develop, so the cloned hair may not have the full luster of a transplanted hair.

The most important concern is that, since the follicle is made, in part, by recipient cells that may be androgen sensitive, the plucked hair derived follicles may not be permanent. It is possible, that since all the components of a normal hair may not be present, the cloned hair may only survive for one hair cycle.

Since the ACell extracellular matrix is derived from porcine (pig) tissue, the procedure may not be appropriate if you are Kosher or allergic to pork. Of course, we do not know what other obstacles may arise since this technique is so new –- or even if the ones mentioned above will really be obstacles at all -– only time will tell.

Follow the latest in Hair Cloning Research

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

What is ACell for Hair Cloning?

Q: I’ve read about some recent advances in hair cloning techniques with ACell. How does this work? — C.A., Stamford, CT

A: We, and several other groups, are engaged in studies using ACell MatriStem, a porcine extracellular matrix (ECM), to induce hair follicles to multiply in the patient’s own scalp (in vivo). This process differs from what people normally think of when speaking about cloning, namely producing populations of genetically identical cells, organs, or even individuals, in a test tube (in vitro).

In the current studies, a part of a hair follicle is implanted into the scalp in an extracellular matrix (ACell MatriStem), with the goal of inducing a complete follicle to form.

The concept is that if a small enough part of the donor follicle is removed, it will completely regenerate. Then, ACell MatriStem will induce the new hair fragment, implanted into the recipient site on the top of the scalp, to produce a new follicle –- thus we get two hairs from one. In one model being tested, hair is literally plucked from the scalp carrying with it enough genetic tissue to grow a new hair.

For more information, view our ACell page in the Hair Cloning section.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Why Am I Losing Hair Despite Taking Avodart For Hair Loss?

Q: I am currently taking Avodart and have done so for around 8 months. Last night I had a significant loss of hair after taking a shower, nothing like I have ever seen before and found it very distressing. Can you tell me if this is hair loss or could it be something known as shedding and could you please tell me what is the difference between hair loss and hair shedding? — M.S., New York, NY

A: Hair loss is a very general term that can refer loss of hair for any reason. Genetic hair loss is caused by the effects of DHT on hair follicles that result in miniaturization -– i.e. a slowly progressive change in hair diameter that starts with visible thinning and that may gradually end in complete baldness. Hair shedding is more sudden where hair falls out due to a rapid shift of hair from its growth phase into the resting phase. The medical term for this is telogen effluvium. This process is usually reversible when the offending problem is stopped. It can be due to stress, medication, or other issues. You should see a dermatologist to figure out which process is going on. Dutasteride can cause some shedding when it first starts to work, but it would be unusual to do this after being on treatment for eight months.

Read more about the Causes of Hair Loss in Men, view our Hair Loss Glossary, or read more about Avodart Hair Loss Medication.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

What Length Is Hair After Transplant?

Q: Is transplanted hair the same length as existing hair? — G.E., Buckinghamshire, UK

A: The hair is first clipped to about 1-mm before it is transplanted. The transplanted hair will look like stubble for the first few weeks after the hair restoration procedure. It is then shed and the newly transplanted follicles go into a resting phase for about two months.

At about 10 weeks after the hair transplant, the follicles will gradually start to produce new hair. They start out as fine hair and then gradually increase in thickness and in length. The process takes about 6 months, with full growth about one year after the hair restoration procedure.

For a more detailed overview of what to watch for in the days, weeks, and months after a hair transplant, view our After Hair Transplant Surgery page.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Cutting Up 5mg Finasteride Tablets

Q: Hey doc, you told me to cut up 5mg finasteride into four parts. Why not five, so that it will be equal to Propecia which is 1mg? — H.F., Eastchester, NY

A: For several reasons:

1) you will lose some of the medication in the cutting process,
2) the generic dose can be slightly less than the brand, and
3) it is too difficult to cut into five parts – four is hard enough.

Note that due to the fact that finasteride stays in the hair follicle for a long time, the pieces do not have to be in four equal parts.

Posted by Robert M. Bernstein M.D.
Hair Restoration Research

Dr. Christiano at Columbia University Identifies APCDD1, A Newly Discovered Gene Associated With Hair Loss

Dr. Angela Christiano of Columbia University in New York and a team of scientific researchers have identified a new gene involved in hair growth. Their discovery may affect the direction of future research for hair loss and the diagnosis and ultimate prevention of male pattern baldness.

The condition which leads to thinning hair is called hereditary hypotrichosis simplex. Through the study of families in Pakistan and Italy who suffer from this condition, the team was able to identify a mutation of the APCDD1 gene located in chromosome 18. This chromosome has been linked to other causes of hair loss.

According to Dr. Christiano, “The identification of this gene underlying hereditary hypotrichosis simplex has afforded us an opportunity to gain insight into the process of hair follicle miniaturization, which is most commonly observed in male pattern hair loss or androgenetic alopecia.”

The mutation of the APCDD1 gene inhibits the Wnt signaling pathway. Although this recently discovered gene does not explain the complex process of male pattern baldness, the importance of this discovery lies in the Wnt signaling that the gene directs, has now been shown to control hair growth in humans, as well as in mice.

Reference: Nature 464, 1043-1047 (15 April 2010) | doi:10.1038/nature08875;

Posted by Robert M. Bernstein M.D.
Bernstein Medical In The News

O, The Oprah Magazine Discusses Hair Loss In Women, Female Hair Transplants With Dr. Bernstein

O, The Oprah Magazine - March 2010O, The Oprah Magazine featured hair loss in women in the beauty section of their March 2010 issue.

Dr. Bernstein was consulted for the article:

Hair transplant: A possibility if your hair loss is concentrated in specific areas. Hair follicles (in groups of up to four) are surgically removed from an area on your scalp where growth is dense and then implanted in the thinning patches. Since female hair loss is often diffuse, only about 20 percent of female patients with thinning hair are candidates, says Robert Bernstein, MD, a New York City dermatologist who specializes in these surgeries. (The price tag can run from $3,000 to $15,000.)

In October 2008 Dr. Bernstein appeared on the Oprah Winfrey Show, where he spoke with Oprah and Dr. Mehmet Oz about hair transplantation and gave a live demonstration featuring the hair transplant results of one of his patients.

Watch a video clip of Dr. Bernstein and Oprah discussion hair transplantation.

Read the full article at Oprah.com.

Reference:
“The Truth About Hair Loss,” “O” – Oprah Magazine, March 2010; p90.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Is Hair Cloning Technique Using ACell a Breakthrough?

Q: I just read a press release saying that researchers have developed a successful technique to clone hair by using a wound healing powder. To paraphrase, the press release says:

MatriStem MicroMatrix, a product of regenerative medicine, ACell, Inc., is a wound healing powder that promotes healing and tissue growth and has now proven to help regenerate hair in the donor and recipient regions of hair transplant patients. While intended to heal ulcers and burns, Gary Hitzig, M.D. and Jerry Cooley, M.D., have found that its properties offer a broader scope of treatment, including hair cloning. “We’ve made amazing breakthroughs using MatriStem as a hair cloning tool,” said Dr. Hitzig. “We’ve been able to multiply the number of hair follicles growing in the recipient area, and as an added benefit are seeing faster hair growth. This new hair cloning technique also makes hair transplantation surgery less invasive.”

Is this new technique really a breakthrough in hair cloning? And if so, when can we start cloning hair?

A: It appears from preliminary studies that plucked hairs stimulated by ACell are in some cases able to regenerate new hair. Because the hair is placed into the recipient area and is partially derived from cells in the dermis, it is not yet clear whether the hair will be effected by androgens over time or if it will continue to bald.

The research so far is promising and a number of doctors are doing research in this area, including Dr. Schweiger and myself at Bernstein Medical – Center for Hair Restoration.

For more on the topic, visit our Hair Cloning section, our page on ACell extracellular matrix devices, and answers to questions on Hair Cloning.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Why Does A Hair Transplant Work?

Q: Why does a hair transplant grow – why doesn’t the transplanted hair fall out? — J.F., Redding, C.T.

A: Hair transplants work because hair removed from the permanent zone in the back and sides of the scalp continues to grow when transplanted to the balding area in the front or top of one’s head. The reason is that the genetic predisposition for hair to fall out resides in the hair follicle itself, rather than in the scalp — this idea is called Donor Dominance. This predisposition is an inherited sensitivity to the effects of DHT, which causes affected hair to decrease in diameter and in length and eventually disappear — a process called “miniaturization.” When DHT resistant hair from the back of the scalp is transplanted to the top, it will continue to be resistant to DHT in its new location and grow normally.

Read more about Miniaturization
Read about the Causes of Hair Loss in Men

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

What is Hair Transplant Graft Depth and How Long After Transplant can Grafts be Dislodged?

Q: How far into the scalp are the grafts placed and is the follicle far enough into the scalp that it will not be damaged? I have heard that the critical time to not touch your scalp is the first 2-3 weeks after the procedure. — M.G., Hillsborough, C.A.

A: The growth part of the follicle is 3-4mm into the scalp. Grafts can be dislodged the first 10 days, so you need to be careful not to scrub your scalp during this period. After that, the grafts are permanent. At 2-3 weeks they can’t be dislodged, even by vigorous scrubbing.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

After a Hair Transplant What are the Effects of DHT on Donor Hair?

Q: Hi! I wanted to ask if after hair restoration surgery the transplanted hair will eventually fall out? Because the surgery is to restore hair mainly for people with genetic hair loss which results from DHT, won’t the DHT make the new follicles implanted fall out as well? — B.C., Stamford, C.T.

A: Hair loss is due to the action of DHT (a byproduct of testosterone) on hair follicles that cause them to shrink and eventually disappear (the process is called miniaturization). The follicles on the back and sides of the scalp are not sensitive to DHT and therefore don’t bald (miniaturize).

When you transplant hair from the back and sides to the bald area on the front or top of the scalp the hair follicles maintain their original characteristics (their resistance to DHT) and therefore they will continue to grow.

Read about Miniaturization

Posted by Robert M. Bernstein M.D.
Hair Restoration Research

Laminin-511 Stimulates Dermal Papilla for New Hair Growth

Jing Gao, Mindy C. DeRouen, Chih-Hsin Chen, Michael Nguyen, et. al.
Genes & Development 22:2111-2124, 2008

The growth of a hair follicle from its developmental cell stage to a hair bearing follicle is through an interactive process between epidermal cells and those of the dermal papilla. It was found that Laminin-511 is instrumental in facilitating this process.

It has been felt that the extra-cellular protein Laminin is critical to both adhesion and the signaling process in hair development; however, the mechanism is not fully understood.

Through this study, it was shown that the signaling pathways introduced by the administration of noggin and sonic hedgehog alone were insufficient to develop a hair follicle. When Laminin-511 protein was introduced to the tissue culture, the dermal papilla developed. When the protein was inhibited, hair follicle growth again ceased. This information supports prior studies suggesting that Laminin is critical in the early stages of follicle cell development and is required for continued follicle development and growth.

This study reaffirms in vitro and in vivo studies in mice, the importance of Laminin-511 in the formation of dermal papilla to promote the development of more organized dermal papilla cells and the hair follicle development. It also suggests that there is a reciprocal mechanism between the signaling pathways of noggin and sonic hedgehog with Laminin-511.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Hair Transplant Using Shedded Hair?

Q: Can a hair transplant be done using the hair which has fallen out? — G.O., Gramercy, N.Y.

A: A hair transplant is really a misnomer, since it is the follicle (or root) that is transplanted not the hair itself – although the transplanted follicle usually contains a hair.

Hair, like fingernails, are dead and cannot grow once detached from the root.

Posted by Robert M. Bernstein M.D.
Bernstein Medical In The News

Dr. Bernstein Discusses Hair Transplantation and Densitometry in PRWeb Podcast

Dr. Bernstein took part in a PRWeb podcast about hair transplantation in June 2007. Stream the discussion below or read the transcript:

Announcer: PRWebPodcast.com, visiting with newsmakers and industry experts.

Mario: This is Mario from PRWeb, and today it is a real pleasure to have with us Robert M. Bernstein, M.D. Dr. Bernstein is Associate Clinical Professor of Dermatology at Columbia University, and founder of New York City‑based Bernstein Medical – Center for Hair Restoration. Dr. Bernstein, it’s a pleasure to have you here on PRWeb.

Dr. Bernstein: Nice to be speaking with you.

Mario: Give us some understanding, sir, of your practice, the Bernstein Medical – Center for Hair Restoration. How long have you been around, where you guys are located, what is it you do there, please?

Dr. Bernstein: Bernstein Medical has evolved over the last ten years. It was set it up to do a specific procedure that I pioneered called “follicular unit hair transplantation.”

In this procedure, we dissect out hair follicles from the back of the scalp, exactly the way they grow in nature, so we are now able to perform hair transplants that essentially mimic nature.

This procedure is used by doctors around the world in hair restoration procedures. Our NY Hair Transplant Center is in midtown Manhattan and has been specifically designed for performing this hair transplantation technique.

Mario: You recently co‑authored an article, Dr. Bernstein, that appeared in the “Medical Journal of the International Society of Hair Restoration Surgery”. Now, you are well read and interviewed all over. This must be a bit exciting, something that was positive for you and your clinic. Tell us about the article, what it touched on, and some of the things that would be important for our listeners.

Dr. Bernstein: It sure was very exciting. The hair transplantation procedure has been around for many years, but a lot of it has been too much of an art and not enough of a science. What we’ve found is that doctors sometimes make these very general judgments about how bald the patient is going to become, how much hair they may need for the hair transplant or for the restoration.

We’ve found that by using a procedure called “densitometry”, where the hair is looked at under high magnification, we are able to get much more specific and useful information, both on the extent of how much someone is going to lose their hair, and also whether they are going to be a good candidate for hair restoration surgery.

One of the things that we’ve found is that when people start to thin, the hair first changes diameter before it’s lost, and this change in diameter may not necessarily be seen by the naked eye or be observed by another person.

But if you clip the hair very short and look at the base of the hair follicles under very high power, 30X magnification, you can actually see these very subtle, early changes, and these changes will anticipate future hair loss.

When we’re trying to decide whether a person should have hair transplant surgery, we can actually look at the donor area in the back and sides of the head, and see how stable these areas are. For example, someone that is becoming very bald, if the back and sides of their head show no change in the hair diameter, or no miniaturization, then we know that they may have very good hair for hair transplants; where a person with a similar degree of hair loss, whose sides and back are not stable, may not be a good hair transplantation candidate.

In a sense, by being able to measure things now, we’re able to have a much better sense of whether people are going to become very bald, possibly the rate of change of their hair loss, and then if they do need surgery, such as a hair transplant, we’re able to give much more specific information about what actually might be done.

Mario: We’re speaking to Dr. Robert M. Bernstein, M.D., an Associate Clinical Professor of Dermatology at Columbia University, and founder of New York‑based Bernstein Center for Hair Restoration.

Dr. Bernstein, give us some contact information where we can learn more about your services, and be able to end up taking advantage of them.

Dr. Bernstein: The best information can be found on our web site. The web address is www.BernsteinMedical.com.

Mario: Dr. Bernstein, it’s been a pleasure having you here on PRWeb podcasting with us. The best of luck to you, and congratulations again for that article in the “Medical Journal of the International Society of Hair Restoration Surgery.”

Dr. Bernstein: Thanks a lot, nice talking to you.

Announcer: Produced by PRWeb, the online visibility company.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

How Does the Laser Therapy (LLLT) Hair Loss Treatment Work?

Q: I heard about the laser comb and other lasers for hair loss, how do they work?

A: Low Level Laser Therapy (LLLT) is based on the scientific principle of photobiotherapy. Photobiotherapy occurs when laser light, absorbed by cells, causes stimulation of cell metabolism and improved blood flow.

Although the exact mechanism by which lasers promote hair growth is still unknown, they appear to stimulate the follicles on the scalp by increasing energy production and partially reversing the miniaturization process leading to thicker hair shafts and a fuller look.

Read more about Laser Therapy for Hair Loss

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Do You Use Sutures or Staples in an FUT Hair Transplant?

Q: Can you please comment on the use of sutures verses staples in hair restoration procedures? — S.S., Prospect Park, NY

A: Sutures are great on non-hair bearing skin and allow perfect approximation of the wound edges, but on the scalp they can cause damage to hair follicles below the skin’s surface. The reason is that a running (continuous) suture traps hair follicles and when the skin swells (as it normally does after hair transplants) the trapped follicles can strangulate and die.

Since staples are placed individually – about ½ cm apart – they don’t strangle the tissue. This allows the blood supply to flow freely to the wound edge permitting the blood’s oxygen to reach the follicles in the stapled area and minimizing the risk of any hair loss. The unimpeded blood flow also facilitates wound healing and can sometimes result in a finer scar, particularly in a tight scalp.

For these reasons, we now use staples in most of our hair transplants.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

How Do You Treat Hair Loss from Pseudopelade or Scarring Hair Loss on the Scalp?

Q: I am suffering from Pseudopelade for four years now. I have lost a lot of hair & there are big bald patches on the top of my scalp that are difficult to hide. Is there any hair transplant surgery or follicle transplant surgery possible in my case, or anything else I can do? — T.L., Boston, MA

A: In general, hair transplantation does not work for Pseudopelade (a localized area of scarring hair loss on the top of the scalp) since the condition is recipient dominant rather than donor dominant.

With a donor dominant condition, such as androgenetic hair loss, the tendency to have the condition, or be resistant to it, is located in the hair follicle and moves with the hair follicle when the follicle is transplanted to a new area. Therefore, in androgenetic alopecia, healthy permanent hair taken from the donor area in the back of the scalp will continue to grow in the a new location in the balding part of the scalp.

In a recipient dominant condition, such as Pseudopelade, the problem is in the skin, so if you perform a hair transplant into an affected area of skin, the transplanted hair will become affected by the same process and be lost.

The disease process can often be slowed down with anti-inflammatory agents, such as corticosteriods, applied or injected locally and the bald area can be camouflaged with cosmetics specially made for use on the scalp. See the Cosmetic Camouflage Products page on the Bernstein Medical – Center for Hair Restoration website.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

After Hair Transplant, What Happens if Transplanted Area is Injured?

Q: I am a patient of yours who had a hair transplantation procedure done mostly in the crown area and in the front about seven months ago. The hair is just starting to come in nicely and is starting to fill in the bald spots. Yesterday I carelessly banged the top of my head against a beam in my attic and cut a nice gash in, you guessed it, a transplanted area. I’d say that the cut is about a good inch. My wife works for a doctor who is certified in facial plastic surgery and I had him suture up the gash. He did not cut any hair, but it took 4 stitches to close the wound. I’m worried about the impact on the transplanted area. Just when it was starting to come in nice I now have a bald spot that I suspect is going to stay as a result of the accident. Please advise. — V.F., Fort Lee, N.J.

A: There is not much you can do at this time. Depending upon the doctor’s suturing techniques; you may or may not have permanent hair loss from the trauma and subsequent suturing. The problem is that if the sutures are placed too far from the wound edge they can strangulate hair follicles, particularly if there is any swelling. Hair loss may be temporary, but if it is permanent, it should be minimal. Additional grafts can be added at your next hair restoration procedure to cover any area of hair loss and the scar from the injury, if it is visible.

Posted by Robert M. Bernstein M.D.
Hair Restoration Research

U.K. Invests in Hair Cloning Research

The British government has awarded Intercytex a grant to automate the production of their new hair regeneration therapy. Intercytex is a cell therapy company that develops products to restore and regenerate skin and hair. Intercytex has partnered with a private company, The Automation Partnership (TAP), to develop an automated manufacturing process for their novel hair multiplication treatment.

The hair multiplication product, ICX-TRC, has been submitted as a hair regeneration therapy that uses cells cloned from one’s own scalp. It is intended for the treatment of male pattern baldness (androgenetic alopecia) and female pattern hair loss. The key researcher, biochemist Dr. Paul Kemp, founder of Intercytex, is developing the hair multiplication treatment at their Manchester facility. This investment in hair cloning research is spearheaded by UK Science Minister, Lord Sainsbury.

The government grant will be used mainly to develop a robotic system specifically designed to support the commercial-scale production of their hair cloning product ICX-TRC, at a scale that can handle a large number of people. The company is currently in Phase II clinical testing.

How Intercytex’s Hair Cloning Product Works

Intercytex’s method of hair regeneration involves removing a slice of the scalp, complete with hairs and follicles, from the back of the head. Hair follicles from this area are most resistant to typical hereditary baldness. The sample is taken to a laboratory where the hair producing dermal papilla (DP) cells are extracted and multiplied in flasks. After eight weeks, the DP cells should have cloned into millions of hair cells.

To complete the hair cloning process, the new cells are injected back into the patient’s scalp under a local anesthetic. These cultured cells should then develop into brand new hair follicles.

Intercytex

Intercytex is a 6-year-old company with its main office is in Cambridge, UK and has a clinical production facility and research and development laboratories in Manchester, UK. Additional laboratories are located in Boston, Massachusetts. TAP, founded in 1988, is a private company with headquarters near Cambridge, UK. Intercytex is publicly traded on the London Stock exchange (LSE: ICX).

Additional information about this hair cloning product can be found at www.intercytex.com.

Posted by Robert M. Bernstein M.D.
Bernstein Medical In The News

Hair Transplant Society Names Dr. Bernstein ‘Pioneer of the Month’

The International Society of Hair Restoration Surgery (ISHRS) has named Dr. Bernstein the ‘Pioneer of the Month’ in their official publication, the Hair Transplant Forum International.

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

Pioneer of the Month – Robert M. Bernstein, MDThe 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.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Is Hair Loss Treatment with Avodart Safe?

Q: My friend is taking Avodart, he bought it over the internet. Is it safe to take? — T.G., Denver, Colorado

A: Avodart (dutasteride 0.5mg) was approved by the FDA for the treatment of prostate enlargement in men in 2002. Avodart has not been approved for the treatment of androgenetic hair loss, although physicians can use an approved medication in ways other than for which it was specifically approved. That said, the use of dutasteride certainly requires a doctor’s supervision.

Like finasteride (the active ingredient in Proscar and Propecia), dutasteride blocks the enzyme 5-alpha reductase that converts testosterone to DHT (DHT is a key hormone that causes hair loss). However, unlike finasteride, which only inhibits the Type I form of the enzyme, dutasteride inhibits both the Type I and Type II forms. This combined effect lowers circulating DHT more with dutasteride than with finasteride, but also increases the incidence of its side effects.

The Type II form of the enzyme (blocked by finasteride) is found predominantly in the hair follicle. The Type I form of the enzyme has been found in the scalp and sebaceous glands, and many other parts of the body, but its exact role in hair growth has not been determined. It is felt that dutasteride’s ability to dramatically lower serum levels of DHT is what makes it a more potent medication in hair loss.

When considering the safety of dutasteride, one should consider the following:

  • It acts on other parts of the body besides the hair follicle.
  • Unlike finasteride, where families that had a deficiency of the Type II 5-alpha reductase enzyme were followed for years without any adverse effects, there is no natural biologic model to show the safety of dutasteride.
  • Dutasteride has been approved for prostate enlargement in an older male population. It is not approved for hair loss and, in fact, the clinical trials for hair loss were discontinued, so there is no safety data for its use in younger patients. There is a greater incidence of sexual side effects with dutasteride compared to finasteride.
  • The 1/2 life of dutasteride is 5 weeks compared to 6-8 hours for finasteride. Serum concentrations of dutasteride are detectable up to 4-6 months after discontinuation of treatment.
Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Can I Have a Hair Transplant if My Scalp is Tight from Prior Surgery?

Q: What can be done if I want to have a hair transplant and my scalp is very tight from prior surgeries? — R.R., Long Island, N.Y.

A: Follicular Unit Extraction is ideal in very tight scalps, provided that there is enough hair to extract without leaving the donor area too thin and provided that the follicles are not too distorted from the scarring.

With strip harvesting, undermining techniques may be helpful to close the wound edges once the strip is removed.

In undermining, the surgeon uses either a sharp instrument (scalpel) or blunt instrument (the dull edge of scissors) to separate the upper layers of the scalp (dermis and epidermis) from the lower part of the scalp (fascia). The hair transplant surgeon accomplishes this by spreading apart the fat layer of the skin or by cutting through scar tissue.

Undermining allows the upper layers of skin to literally slide over the lower layers and can significantly increase the ability to close a tight wound. However, if not done carefully, it may increase the risk of bleeding and injury to nerves and occasionally may damage hair follicles.

Undermining is usually used with a layered closure where the deeper tissues are brought together first with a layer of absorbable sutures before the surface of the skin is sutured closed with sutures that are removed.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Which Gives More Donor Hair: FUT or FUE Hair Transplant?

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? — D.D., Highland Park, T.X.

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.

Read about Follicular Unit Extraction (FUE)

Read about Follicular Unit Transplantation (FUT)

Posted by Robert M. Bernstein M.D.
Bernstein Medical In The News

New Instrument for Follicular Unit Extraction Introduced By Drs. Bernstein and Rassman

PRESS RELEASE

World renown hair transplant surgeon introduces a new surgical tool that improves the way hair transplantation can be performed.

New York, NY March 21, 2006

Follicular Unit Extraction (FUE) InstrumentIn a new article appearing on the cover of Hair Transplant Forum International, the official publication of The International Society of Hair Transplant Surgeons (ISHRS), pioneering hair transplant surgeon Robert M. Bernstein MD, along with his colleague Dr. William R. Rassman, recently revealed details about a “New Instrumentation for Three-Step Follicular Unit Extraction.”

Dr. Bernstein is known throughout the world of medicine as author of the landmark publication; “Follicular Transplantation” which described a new hair replacement transplant technique in which he was able to transplant hair exactly as it grows – in naturally occurring groups called follicular units. That paper, together with two dozen other major publications, has revolutionized the way hair transplants are now performed – moving away from “doll’s hair” like plugs and into the realm of natural, undetectable hair patterns.

Follicular Unit Extraction (FUE) is a further refinement of this technique where follicular units are literally removed, one-by-one, directly from the scalp. In the traditional procedure, a strip of tissue is removed from the back of the head and placed under a microscope in order to remove the follicles.

The latest FUE instrument design is based upon Dr. J. A. Harris’ concept of using a blunt tool to prevent damage to hair follicles during extraction. The new device improves on the old method by re-conceiving the shape of the tool’s edge in order to minimize injury to hair follicles. “Our new instrument is made in the shape of a cylindrical tube with a bull-nosed edge. This allows us to capture the entire follicular unit (naturally groups of 1-4 hairs) without damage to the hair bulbs.” We also found that the incidence of buried grafts decreased significantly with the new instrument from about 9% to 1.8% with this new device” said Dr. Bernstein from his Center for Hair Restoration in New York.

In a recent study conducted by Leever Research Services, it is estimated that over 360,000 patients sought help from doctors for their hair loss last year. With ground-breaking work by surgeons like Robert M. Bernstein M.D., the impressive aesthetic results from new hair transplantation techniques are helping men and women who suffer from baldness to get a renewed outlook on their lives.

Posted by Robert M. Bernstein M.D.
Hair Restoration Research

Summary: Hope Grows For Bald Baby Boomers

Dr. Bernstein summarizes an article on hair cloning in The Plain Dealer:

An English based company called Intercytex has claimed some success in its research on hair cloning with its first testing in humans. This technique is similar to the one initially proposed by Dr. Colin Jahoda and published in 1999. (Download the article )

The idea is that certain cells (called fibroblasts) found at the bottom of hair follicles can be separated from the follicles after they have been removed from the scalp, and then be used to form new follicles.

The way this works is as follows: a few hair follicles at the permanent area from the back of the scalp (the area that does not bald) are removed. In a lab, the germinative cells at the base of the follicle are dissected off and placed in a Petri dish. They are then incubated in a special medium and allowed to multiply thousands of times.

These cultured cells are then injected into the balding area of the scalp where they induce complete hair follicles to form. In contrast to traditional hair transplants, where the doctor is limited by the patient’s finite donor supply and hair is literally just moved around (from the back to the front), in hair cloning, there will be an actual increase in the total number of hairs on a person’s head.

Initial testing involved seven male volunteers that were suffering from androgenetic alopecia (common baldness). After the process, five of them showed an increased amount of hair. Fortunately, there were no complications, such as skin inflammation or tissue rejection. However, the test area was small and volunteers only grew a little hair.

Towards the middle of next year, additional patients will be tested using a greater number of cloned cells, so that a larger area of the scalp could be covered. The researchers speculate that this new cloning technology may be on the market in as soon as five years.

The researchers speculate that in the distant future, traditional hair transplants may not be needed at all. Instead, as patients start to thin, they could come to the clinic on a regular basis for injections of their own cells to stimulate the growth of new follicles and stop the impending balding – a sort of hair maintenance.

Reference: The Plain Dealer, Tuesday, November 15, 2005. “Hope grows for bald baby boomers,” Malcolm Ritter, Associated Press.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

After Hair Transplant, What is a Normal Amount of Shedding?

Q: I had a hair transplant two weeks ago and I just started noticing that some grafts were in my baseball cap at the end of the day. Am I losing the transplant and what can I do to keep this from happening? – Weston, C.T.

A: The follicles are firmly fixed in the scalp 10 days following the hair transplant. Hair is shed from the follicle beginning the second week after the procedure. This is perfectly normal and does not represent any loss of grafts.

What you are seeing is the root sheath that is shed along with the hair shaft. This looks like a little bulb, but is not the growth part of the follicle and should not be a cause for concern.

Two weeks following the hair transplant you may shower and shampoo your scalp as you normally did before the procedure without any risk of losing grafts.

Posted by Robert M. Bernstein M.D.
Bernstein Medical In The News

Dr. Bernstein Presents at ISHRS 13th Annual Scientific Meeting in Sydney, Australia

PRESS RELEASE

Dr. Bernstein - Presenting on Hair Transplantation in Sydney, AustraliaSome of the world’s most renown hair transplant surgeons gathered this month to hear about the latest cutting edge methods in surgical hair restoration. Speakers included Robert M. Bernstein. M.D. founder of Bernstein Medical – Center for Hair Restoration, New York, NY

The International Society of Hair Restoration Surgery (ISHRS) recently held their 13th annual scientific meeting. A broad range of topics were explored including; the most recent research in cloning, the latest proven medical therapies to prevent hair loss, and the newest concepts in the harvesting of donor hair follicles used for transplanting. The event was capped off with a live hair transplant surgery workshop.

As the largest non-profit voluntary organization comprised of over 650 hair restoration physicians, the ISHRS is the first international society created to promote continuing quality improvement and education for professionals in the field of surgical hair restoration.

The purpose of the annual event is to bring together the world’s best minds in hair restoration surgery for an interchange of ideas, knowledge and experience. The meeting is aimed at enhancing, to the highest possible level, the skills and artistry of the members.

One of this years exciting presentations was given by Robert M. Bernstein M.D., Associate Clinical Professor of Dermatology at the College of Physicians and Surgeons of Columbia University in New York. Dr. Bernstein is recognized world wide for his pioneering work in Follicular Unit Extraction (FUE) and Follicular Unit Transplantation (FUT), considered to be the state-of-the-art in surgical hair restoration techniques.

Dr. Bernstein introduced a new instrument for FUE that enables hair to be removed directly from the back of the scalp without the need for a linear incision. The instrument increases ones ability to remove the hair in its naturally occurring groups with minimal damage. According to Dr. Bernstein, “FUE has been most useful for camouflaging the scars produced by hair transplants performed with older techniques.”

The International Society of Hair Restoration Surgery brought together a lively collection of panels led by doctors who were well-known and highly-respected professionals from the surgical hair restoration industry. Doctors such as Robert M. Bernstein M.D. shared their expertise in order to cover the issues and advances in medical and surgical hair restoration and the latest research developments in the field. The intention being better treatment and treatment options for patients.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

What Did Dr. Jahoda’s Hair Cloning Research Show?

Q: I have heard that Dr. Jahoda was able to clone hair. Is that true? — M.T., Cincinnati, OH

A: Possibly the most interesting work related to cloning hair was done by Colon Jahoda in England over a decade ago. Dr. Jahoda’s work is significant because he identified an inducer cell — i.e. fibroblasts in the outer portion of the hair follicle (the outer root sheath) — that can stimulate the skin to produce new hair. It is well known that fibroblasts, unlike many other tissue cells, are relatively easy to culture.

Theoretically, a patient’s fibroblasts could be removed from the sheaths of just a few follicles and then cultured to produce thousands of follicles. These fibroblasts could then be injected back into the scalp to induce thousands of new hair follicles to grow.

In the study, fibroblasts from a man were injected into the forearm of genetically unrelated women. The cross-gender aspect of his experiment has received much publicity and is potentially of great importance to burn victims, but has little relevance to hair transplantation for male pattern baldness. Patients would probably benefit most from using their own cultured fibroblasts for the best match.

So far this important single study has not been reproduced.

Read about the latest in Hair Cloning Research

Posted by Robert M. Bernstein M.D.
Hair Restoration Research

Hedgehog Signaling Pathway Could Yield Hair Growth, Hair Loss Treatment

Dr. Bernstein summarizes an article in the Journal of the National Cancer Institute:

Curis, Inc., a drug development company, has published data showing the effectiveness of a proprietary Hedgehog pathway activator to stimulate hair growth in adult mice. The study shows that a topically applied small molecule agonist of the Hedgehog signaling pathway can stimulate hair follicles to pass from the resting stage to the growth stage of the hair cycle. The Hedgehog agonist produces no other noticeable short or long-term changes in the skin of the mice.

This study also demonstrated that the Hedgehog agonist is active in human scalp in vitro as measured by Hedgehog pathway gene expression. The results suggest that topical application of a Hedgehog agonist could be effective in treating hair loss conditions, including male and female pattern genetic hair loss.

Preliminary results were presented at the American Academy of Dermatology (AAD) in February 2005. This work was based on a study in 2001 by Sato et. Al. who showed that the Sonic hedgehog gene is involved in the initiation of hair growth in mice.

Reference: Sato N., Leopold PL, Crystal, RG. Effect of Adenovirus-Mediated Expression of Sonic Hedgehog Gene on Hair Regrowth in Mice With Chemotherapy-Induced Alopecia. Journal of the National Cancer Institute, 2001, Vol. 93, No. 24.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

How Long Should I Wait Before Having a Second Hair Transplant?

Q: If a second hair transplant is performed before the first had a chance to grow could the second procedure destroy the follicles from the first? — B.M., Upper East Side, NYC

A: Hair from the second hair transplant session would not damage the follicles transplanted in the first session, even if follicular unit grafts were transplanted in exactly the same spot as in the first session.

The reason to wait until the hair grows in, however, is so that you can better plan the subsequent hair restoration procedure. If two follicular units are placed on top of each other or very close together, you will essentially be creating a mini-graft and the results will not look natural.

We advise waiting at least 8 months between sessions with 10-12 months being ideal so that the grafts of the second session can be evenly distributed among the grafts of the first.

The extra few months not only allow the surgeon to identify all of the previously transplanted grafts, but enables him to get a sense of the “look” of the first session (i.e. the wave, the density, and how the patient will ultimately want to comb his newly transplanted hair). This is very useful in guiding the placement of grafts in the second session to maximize its cosmetic benefit.

Read more about a second transplant
See before after hair transplant photos of patients who had a second procedure

Posted by Robert M. Bernstein M.D.
Bernstein Medical In The News

Hair Loss in Women the Topic in Dr. Bernstein ‘Early Show’ Interview

The highly-rated CBS television program “The Early Show” interviewed Dr. Bernstein as part of a three-part series on hair loss in women. View a clip of the video here:

Watch the video at YouTube or go to the Bernstein Medical YouTube Channel to see more videos on hair loss in women and other hair restoration topics.

Read the full transcript here:

Julie Chen: There are many treatments available for serious hair loss including surgical options like hair transplants. That may sound scary, but for one woman, it was the answer she’d been waiting for.

Narrator: Marian Malloy is used to being in control. As the duty manager for an international terminal at Newark Airport, it’s her job. But Marian wasn’t always so self-confident. Due to a condition called alopecia areata, Marian began losing her hair back in college.

Marian Malloy: I was on my own for the very first time and I was learning about life and learning about my hair loss. And it just devastated me. So I started out picking out methods to improve my hairline. Initially, I went to a dermatologists who put me on a prescription of injections, actually. I would go over weekly and he injected my head, and I got results, but I also started growing facial hair, which wasn’t something that I wanted. After that, I decided to start with the Rogaine and once again I saw results, but Rogaine was something that I had to do every day for the rest of my life, and I just didn’t want to be that dependent on a medication.

Narrator: Marian continued to search for an acceptable treatment to her condition, even trying hair plugs, until she heard about Dr. Robert Bernstein’s new method of Follicular Unit Transplantation, or in layman’s terms, a hair transplant.

Marian Malloy: I wasn’t scared at all. I was desperate, so that overrode everything.

Julie Chen: Marian Malloy is here along with her hair transplant surgeon, Dr. Robert Bernstein, to help us look at some of the medical options that are available to women suffering from this affliction.

Good morning to both of you.

Dr. Bernstein: Good morning.

Marian Malloy: Good morning.

Julie Chen: Marian, thank you for speaking out about this very private problem. How has your life changed since getting the hair transplant?

Marian Malloy: Well, I just feel better about my appearance, and appearance is very important to me in my line of work. I just feel a lot better and I think I look better. My hairline looks better.

Julie Chen: Boost in the self-confidence department?

Marian Malloy: Actually, yes.

Julie Chen: And your friends and family see a difference in it?

Marian Malloy: You know, my friends and family really didn’t notice a difference before, and they thought I was crazy for harping on it the way that I did.

Julie Chen: But if you see it, that’s all that —

Marian Malloy: And it was all about me. It’s not about my family and friends. It’s about how I feel.

Julie Chen: Right.

Marian Malloy: Yes.

Julie Chen: Dr. Bernstein, I want to go through all the options that are available for women, but what is the difference between female and male hair loss option-wise. What can we do to treat it?

Dr. Bernstein: The main difference medically is that women have hair loss often from hormonal changes and it’s due to an imbalance between progesterones and estrogens. That equilibrium can be reestablished with medication. Often birth control pills can do that.

Julie Chen: So that’s one option.

Dr. Bernstein: One option. For the most common cause of hair loss, genetic hair loss, Minoxidil can be used for both men and women, but the most effective medication for men, Propecia, can’t be used in women. And the reason –

Julie Chen: Why not?

Dr. Bernstein: The reason is that it causes birth defects if taken during pregnancy and postmenopausally it doesn’t seem to work.

Julie Chen: Oh, okay. So talk to me about Minoxidil, also known as Rogaine .Just as successful for women as in men?

Dr. Bernstein: It seems to be similarly successful, but the success rate is not very good, and one of the problems with its use in women is that you can get hair at the hairline on the forehead. So the usefulness is a little bit limited.

Julie Chen: So is it promoting hair growth if it does work, the Rogaine, or is it just making your existing hair grow in thicker? I’ve heard both.

Dr. Bernstein: It actually stimulates the growth of existing hair.

Julie Chen: Okay so you got to be really careful topically what you touch after you’re rubbing it into your scalp.

Dr. Bernstein: Yes.

Julie Chen: Another option is topical Cortisone and Cortisone injection.

Dr. Bernstein: Yes many people think that Cortisone can be used for genetic hair loss or common hair loss and it really can’t. It’s a good treatment for specific types of diseases, the most common one is alopecia areata. In that condition, the body actually fights off its own hair follicles. And then the Cortisone is used to suppress the immune system and actually allows the body to permit the hair to grow back.

Julie Chen: Now, Marian tried these options that we’re talking about. You weren’t satisfied, so you had a hair transplant.

Marian Malloy: Yes.

Julie Chen: Describe exactly what you did for Marian.

Dr. Bernstein: In the past, hair transplantation was not a good option for women because hair was transplanted in little clumps. With Follicular Unit Transplantation, we can now transplant hair exactly the way it grows, which is in little tiny bundles of one to four hairs. With Marian we took a strip from the back of her head, in other words, right from the back of the scalp where you can’t see it.

Julie Chen: Where there’s more hair?

Dr. Bernstein: Yes, we remove that strip and place it under a microscope and dissect out the individual follicular units – the hair is transplanted exactly the way it grows in nature. And that hair is then put in needle-poke incisions all along the hairline, and because the grafts are so small, you can actually mimic the swirls and the change in hair direction exactly the way the hair grows naturally.

Julie Chen: And it stays?

Dr. Bernstein: Yes, it stays. We make a very snug fit between the graft and the needle-poke incision. And so it really holds on to the grafts well. In fact, the patients can shower the next morning.

Julie Chen: The next morning? Marian, what was your experience like having this hair transplant? No problems since?

Marian Malloy: No problems, absolutely no problems.

Julie Chen: Did insurance cover any of this?

Marian Malloy: No, absolutely not.

Julie Chen: How costly is this?

Dr. Bernstein: The average procedure is about $7,000.

Julie Chen: And it’s one procedure and you’re done?

Dr. Bernstein: Usually one to two procedures.

Julie Chen: $7,000 a pop. Well, you found it was worth your money, is that right, Marian?

Marian Malloy: Absolutely, yes.

Julie Chen: Dr. Bernstein, Marian Malloy, thank you both for coming on the show talking about this.

Posted by Robert M. Bernstein M.D.
Bernstein Medical In The News

Follicular Hair Transplantation Makes Splash After Bernstein Introduces Procedure To American Academy of Dermatology

Cosmetic Surgery Times features Dr. Bernstein’s presentation to the 55th annual meeting of the American Academy of Dermatology in their April 1997 issue.

The article entitled, “Follicular Transplants Mimic Natural Hair Growth Patterns,” describes Dr. Bernstein’s introduction of his new procedure, Follicular Unit Transplantation, to the academy as well as the keys to making the technique successful. Find the complete article below:

Form Follows Function: Follicular Transplants Mimic Natural Hair Growth Patterns

By Neil Osterweil
Contributing Editor

SAN FRANCISCO – In recent years, many hair replacement surgeons have adopted the modem architecture philosophy that “less is more,” moving from the use of hair plugs, to split grafts, to minigrafts and, finally, micrografts. But at least one hair transplant specialist contends that a more appropriate architectural dictum is “form follows function.”

In other words, the surgeon should let the technique fit the head, and not the other way around, suggested Robert M. Bernstein, MD, at the 55th annual meeting of the American Academy of Dermatology.

Dr. Bernstein is an assistant clinical professor of dermatology at the College of Physicians and Surgeons, Columbia University in New York. He described his “follicular transplantation” technique in a meeting presentation and in an interview with COSMETIC SURGERY TIMES.

Natural Hair Groups Used

Dr. Robert M. Bernstein“Hair doesn’t grow singly it grows in naturally occurring groups of from one to four hairs. In follicular transplantation, we use these naturally occurring groups as the unit of the transplant,” he told CST.

The typical follicular unit consists of one to four terminal hairs, one or two vellus hairs, sebaceous glands, subcutaneous fat and a band of collagen which circumscribes and defines the unit. In the follicular transplant technique, the follicular unit is carefully dissected and removed, and then the intervening skin is discarded. This enables the donor site to be small, allowing implantation through a small needle poke. Because trauma to the recipient sites is minimal, the entire procedure can be performed at one time. Dr. Bernstein and colleagues have implanted as many as 3,900 follicular units in a single, 1 day session.

Keys to the follicular transplant technique are:

• Identify the patient’s natural hair groupings and isolate the individual follicular units – Hair groupings are assessed with an instrument called a densitometer, and the average size of a person’s groups can be easily calculated. This information is critical in the planning of the transplant. The density of hairs in an individual measured as the number of hairs per square millimeter of skin is quite variable, but the density of follicular units is relatively constant within individual races.

Most people of Caucasian ancestry have a density of approximately one group per millimeter; people of Asian and African descent tend to have slightly less dense growth patterns, although the characteristics of the person’s hair (such as wavy or wiry hair), can give a full appearance even with low density.

If a patient has an average hair density of two, he will receive mostly two hair implants, with some one-hair and three hair implants mixed in. “If you try to make the groups larger than they occur naturally, they will look pluggy. If you try to make them smaller than they naturally occur, they’re not going to grow as well, because each group is actually a little biologic machine that makes the hair — it’s an anatomic unit. If you break it up it just doesn’t grow as well,” Dr. Bernstein observed.

Form Follows Function: Follicular Transplants Mimic Natural Hair Growth Patterns
A 38-year old man with a Norwood Class 5A/6 hair loss pattern undergoes a single procedure of 2,500 follicular implants. The result 11 months later. (Photos courtesy of Robert M. Bernstein, MD)

• Harvest meticulously – The acquisition and preparation of grafts must be carefully performed to ensure success for this demanding technique. Highly trained, skilled assistants are essential to the success of the procedure. Dr. Bernstein noted that he uses a highly trained team of up to 10 assistants to produce the implants for a single case. “The assistants, who range from medical technicians to registered nurses, are such an integral part of the procedure that they must become expert in their specific tasks for the surgery to be successful.” The physician must be able to skillfully harvest the donor strip and must be able to make accurate judgments about the size of grafts intra-operatively and adjust the technique accordingly. Dissection and placing of the follicular units is the most labor intensive part of the procedure.

• Design the recipient area well – The recipient sites are carefully distributed so that a natural looking pattern is maintained throughout the recipient area. An important consideration for this stage of the procedure is to “frame the face and spare the crown” so those facial features are kept in correct proportion. A common mistake in hair replacement, said Dr. Bernstein, is to create a hairline that is too high thereby elongating the forehead and accentuating, rather than minimizing, the patient’s baldness. It is also important to avoid or eliminate contrast between the implants and surrounding skin by creating a soft transition zone of single hairs and to have the hair emerge from the scalp at natural angles.

Procedure Lowers Cost

Although the procedure is highly labor intensive, it can actually be less expensive than conventional hair replacement surgery, because it can be performed in a single, but lengthy, session.

“It is also much more efficient and conserves donor hair much better than conventional hair transplants. Every time you make an incision in the person’s scalp you waste some hair and make the remaining hair more difficult to remove. Accessing the donor area just once or twice will increase the total amount of hair that is available for the transplant,” Dr. Bernstein told CST.

“In the very near future, the procedure will be improved and made more affordable with automated instruments that will enable the surgeon to make sites and implant the hair in a single motion. This will also decrease the possibility of injury to the implants by reducing handling and keeping the grafts uniformly cool and moist. It is possible that someday hair follicles may be cloned to provide a virtually unlimited supply of custom follicular units, but until then the finite nature of a person’s donor supply must be respected,” concluded the doctor.

Posted by Robert M. Bernstein M.D.



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