Hair Loss in Women

Hair Restoration Answers

I am an African-American Woman with a Failed Transplant. Should I Have Another Hair Transplant to Correct the First One?

Q: I am an African-American woman who had a unsuccessful hair transplant. Should I have another one? – S ~ Boston, MA

A: A common cause of a failed hair transplant in African Americans is the surgeon missing a diagnosis of primary scarring alopecia. In this case the scalp is literally attacking the transplanted hair and a repeat hair transplant would also not expected to be successful. This condition is recognized by scaling and redness around the follicles and diagnosed by biopsy. The condition is treated medically rather than by surgery. However, if the cause of the failed transplant was poor surgical technique, then a repeat procedure would be warranted as long at the remaining donor supply was adequate. In all cases, a repeat procedure should not be contemplated unless the cause of the failure can be identified and corrected.

Posted by Robert M. Bernstein M.D.

Bernstein Medical In The News

Bernstein Medical Aids ISHRS’s ‘Operation Restore’ in Honor of Hair Loss Awareness Month

August was declared National Hair Loss Awareness Month by the American Academy of Dermatology (AAD) in 2001 in order to raise the public’s awareness of hair loss as a common problem affecting millions of men and women. In appreciation of this cause, Bernstein Medical – Center for Hair Restoration has launched a fundraiser for the International Society of Hair Restoration Surgery‘s (ISHRS) pro bono program, ‘Operation Restore.’ This program provides free hair transplants for those who experience localized hair loss due to trauma or illness.

Raising Awareness of Women’s Hair Loss

Now is the ideal time to bring awareness to women’s hair loss as the stigma of the topic has begun to diminish. Women’s hair loss is now frequently discussed in the media including television programs like the Dr. Oz Show and The Doctors, and in magazines such as Vogue, Cosmopolitan, The Wall Street Journal, New York Magazine, and New York Post.

Background

Androgenetic alopecia (common genetic hair loss) accounts for more than 95% of hair loss in both men and women. While some falsely believe that women do not experience hair loss, about 40 million women in the US alone are affected by hair loss, along with about 60 million men.

Other causes of hair loss include surgical and non-surgical trauma, congenital defects, auto-immune disease, and other medical illnesses. Radiation and cytostatic drugs or other forms of chemotherapy used in cancer treatments also causes hair loss. In cases where hair loss is localized, surgical hair restoration may provide benefit.

Our Cause

We understand the emotional toll hair loss can have on the individuals affected, especially when dealing with their other medical problems. Operation Restore and Bernstein Medical aim to help those who may benefit from hair transplant surgery by assisting in this process and covering expenses.

Dr. Bernstein has worked to advance the techniques of hair restoration and have helped tens of thousands of patients around the world. His pioneering work continues to make hair loss and its treatment more socially acceptable.

Click here to donate to Operation Restore! Bernstein Medical will match all donations made during this fundraising campaign. To qualify for the match, please ensure that you list “Bernstein Medical” in the “This Donation is Being Made on Behalf of:” box. Thank you for your support!

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Bernstein Medical In The News

Dr. Bernstein Notes Increasing Trend of Women Seeking Hair Loss Treatments in New York Post Article

As the taboo of women’s hair loss gradually dissipates, more women than ever are seeking treatment for hair loss caused by stress, pregnancy, genetics, and a variety of other medical conditions and behavioral causes. Dr. Bernstein is quoted in an article in the New York Post identifying the upward trend of women seeking hair loss treatments.

“Approximately 40 percent of women experience some form of hair loss in their lives, and stress is the second biggest cause after genetics,” says Dr. Robert Bernstein, a professor of dermatology at Columbia University and a hair restoration specialist with a Midtown practice. “Over the last five years there had been a 50 percent increase in the number of women coming to our office to seek help.”

The article discussed four women of varying ages who sought treatment for different hair loss conditions. Among the treatments discussed are Rogaine for Women and Laser Therapy.

Read about Women’s Hair Loss
See before and after photos of Female Hair Transplant patients

Posted by Robert M. Bernstein M.D.

Hair Restoration Research

Viviscal May Boost Hair Regrowth

A study published in the December 2015 issue of the Journal of Clinical and Aesthetic Dermatology suggests that Viviscal, an oral supplement designed for women with thinning hair, may promote hair growth. ((Ablon G, Dayan S. A Randomized, Double-blind, Placebo-controlled, Multi-center, Extension Trial Evaluating the Efficacy of a New Oral Supplement in Women with Self-perceived Thinning Hair. J Clin Aesthet Dermatol. 2015 Dec;8(12):15-21.)) The researchers noted a 79 percent increase in healthy, terminal hairs and an almost 12 percent increase in hair diameter in female patients who took the supplement for six months. The evidence suggests that Viviscal may be a useful supplement to current hair restoration treatments, or an alternative treatment in patients not indicated for hair transplant surgery or medical treatment with finasteride.

Background

Viviscal, produced by Lifes2good Inc., out of Chicago, Illinois, was launched in the U.S. in 2008. Its key ingredient is a proprietary mix of powders derived from sustainably-harvested shark and mollusk species. This “amino marine complex,” known as AminoMar C™, is blended with B and C vitamins, and minerals such as calcium, to make Viviscal “Professional Strength.” The active ingredients in the AminoMar complex are glycosaminoglycans (GAGs), a group of long-chain sugar molecules present in many living creatures. GAGs are especially adept at retaining water, and ingesting them may contribute to healthy hair and skin, although it is not clear if taken orally GAGs have any benefit in this regard. According to Viviscal, the beneficial effect on skin and hair of a fish- and protein-heavy diet was first observed in Inuit people in the late 1980s.

Dr. Glynis Ablon and her research team sought to determine if Viviscal “Professional Strength” tablets could successfully treat female hair loss. (The “Professional Strength” blend contains 25mg more of the AminoMar complex than the newer “Extra Strength” variety, as well as a different blend of extracts and additives.) If determined to be a viable treatment, Viviscal could be another option in an otherwise limited market of hair loss products for women. Many women with androgenetic alopecia (common genetic hair loss) are poor candidates for hair transplant surgery. Also, the use of Propecia (finasteride), the most effective hair loss medication available, is not indicated in women due to poor efficacy and the risk of potential side effects.

The Study & Findings

The study observed 40 women, aged 25-66, who self-reported some form of hair loss. An initial densitometry, to determine the progression of hair loss, was conducted on a 4cm² target area of the frontal hairline. This was followed by the random distribution of either Viviscal or a placebo.

At 90 days on Viviscal, the researchers noted a 56% increase in terminal hairs in the target area and 10% increase in mean hair diameter. A nearly insignificant 1% rise was noted in the number of vellus hairs (non-mature or miniaturized hairs). Compared to the placebo group, the Viviscal group had 57% more terminal hairs, a 10% larger hair diameter, and 9% fewer vellus hairs.

At 180 days, compared to baseline, patients on Viviscal showed an almost 80% increase in terminal hairs, a hair diameter increase of 11.67%, and a 14% increase in vellus hairs. Compared to the placebo group at 180 days the Viviscal group had 77% more terminal hairs, an almost 10% larger hair diameter, and slightly more vellus hairs (1.5%).

Limitations of Ablon Study

The main limitation of the study lies in the potential conflict of interest between the researchers and Lifes2good. Dr. Ablon received a grant from Lifes2good as funding for the December 2015 study. In addition, no clear mechanism of action is proposed. Finally, the cause of the volunteer’s hair loss was uncertain and probably represents several different diagnoses further confounding any explanation as to why the supplements might work.

Summary

Viviscal has the potential to supplement current treatments for hair loss or provide an alternative treatment for patients not indicated for hair transplant surgery or medical treatment. It would be especially useful for female patients who have relatively limited treatment options. It may also benefit men who are not good candidates for surgery. While the research findings are compelling, more investigation is necessary into the long-term efficacy of Viviscal and the effects of glycosaminoglycans on the hair growth cycle. Further study should be conducted by independent researchers in order to avoid the perception of a conflict of interest.

Posted by Robert M. Bernstein M.D.

Hair Restoration Research

Viviscal Research Suggests the Treatment Increases Hair Volume, Thickness

A review of research on the efficacy of Viviscal, published in the September 2015 issue of the Journal of Drugs in Dermatology, suggests that the oral supplement may increase hair volume as well as the thickness of healthy, terminal hairs. ((Hornfeldt CS, et al. The Safety and Efficacy of a Sustainable Marine Extract for the Treatment of Thinning Hair: A Summary of New Clinical Research and Results from a Panel Discussion on the Problem of Thinning Hair and Current Treatments. J Drugs Dermatol. 2015 Sep;14(9):s15-22.)) The article presented more than two decades of research on the hair regrowth product and also included a discussion with a roundtable of dermatology and plastic surgery experts.

Both the research review and roundtable discussion point to the benefits of Viviscal, however the article’s conclusions can be questioned due to the appearance of a conflict of interest between the researchers and Lifes2good, Inc., the company that produces Viviscal. Additional independent research needs to determine if Viviscal is a viable and effective hair loss treatment.

Background

Viviscal, was launched in the U.S. in 2008 by Lifes2good Inc., Chicago, Illinois. Its key ingredient is a proprietary mix of powders derived from sustainably-harvested shark and mollusk species. The resulting “amino marine complex,” known as AminoMar C™, is blended with B and C vitamins, and minerals such as calcium to make Viviscal. The active ingredients in the AminoMar complex are called glycosaminoglycans (GAGs), a group of long chain sugar molecules present in many living creatures. GAGs hold water, and ingesting them may contribute to healthy hair and skin – although this is still speculative. According to Viviscal, the beneficial effect on skin and hair of a fish- and protein-heavy diet was first observed in Inuit people in the late 1980s. Viviscal is marketed primarily to women because of the relative dearth of effective hair loss treatments for female patients compared to men.

Review Article

The summary article by Hornfeldt, et al., ((Hornfeldt CS, et al. The Safety and Efficacy of a Sustainable Marine Extract for the Treatment of Thinning Hair: A Summary of New Clinical Research and Results from a Panel Discussion on the Problem of Thinning Hair and Current Treatments. J Drugs Dermatol. 2015 Sep;14(9):s15-22.)) notes that studies dating back to 1992 have suggested that Viviscal may treat hair loss to some degree. ((Lassus A, Eskelinen E, et al. A Comparative Study of a New Food Supplement, ViviScal®, with Fish Extract for the Treatment of Hereditary Androgenic Alopecia in Young Males. J Int Med Res. 1992 Nov;20(6):445-53.)) However, the more recent pivot to testing the supplement in women with thinning hair was pioneered by Dr. Glynis Ablon of the Ablon Skin Institute Research Center, Manhattan Beach, California. In a 2012 pilot study, Dr. Ablon found that Viviscal increased the number of terminal hairs by 211% and 225% after three months and six months, respectively. ((Ablon G. A Double-blind, Placebo-controlled Study Evaluating the Efficacy of an Oral Supplement in Women with Self-perceived Thinning Hair. J Clin Aesthet Dermatol. 2012 Nov;5(11):28-34.)) This was followed by a three month clinical study of women with self-perceived thinning hair; which the author attributed to poor diet, stress, hormones, or abnormal menstruation. In this study, published in early 2015, the mean number of terminal hairs increased by 32%, the count of shed hairs decreased by 39%, and subjects reported a significant increase in quality of life. ((Ablon G. A 3-Month, Randomized, Double-Blind, Placebo-Controlled Study Evaluating the Ability of an Extra-Strength Marine Protein Supplement to Promote Hair Growth and Decrease Shedding in Women with Self-Perceived Thinning Hair. Dermatol Res Pract. 2015; 841570.)) A similar randomized, placebo-controlled study, also led by Dr. Ablon and published in December 2015, found that female patients on Viviscal showed an almost 80% increase in terminal hairs and increase of 11.67% in hair diameter. ((Ablon G, Dayan S. A Randomized, Double-blind, Placebo-controlled, Multi-center, Extension Trial Evaluating the Efficacy of a New Oral Supplement in Women with Self-perceived Thinning Hair. J Clin Aesthet Dermatol. 2015 Dec;8(12):15-21.))

Some additional publications, such as Bloch’s 2014 study, ((Bloch L. Demonstrating the efficacy of a nutraceutical for promoting hair growth using a digital photography technique with posterior image analysis. Submitted for poster presentation at the 2015 World Hair Congress, Miami.)) suggest that Viviscal is effective in increasing patients’ hair volume and thickness. Another study published in 2014 suggests that Viviscal may improve scalp coverage and hair fullness in men with common baldness. ((Pinski KS. Patient satisfaction following the use of a hair fiber filler product to temporarily increase the thickness and fullness of thinning hair. Skinmed. 2014;12(5):278-281.))

In the roundtable discussion, which took place in August 2014, dermatology and plastic surgery physicians discussed findings of several clinical studies and reported a positive inclination to offer Viviscal as a treatment option. ((Hornfeldt CS, et al. The Safety and Efficacy of a Sustainable Marine Extract for the Treatment of Thinning Hair: A Summary of New Clinical Research and Results from a Panel Discussion on the Problem of Thinning Hair and Current Treatments. J Drugs Dermatol. 2015 Sep;14(9):s15-22.))

Limitations of Hornfeldt Review

The main limitation of the Hornfeldt article lies in the potential conflict of interest with the researchers and Lifes2good. Dr. Carl S. Hornfeldt received honoraria fees as a consultant for Lifes2good and his co-author of the review article, Mark Holland, is an employee of Lifes2good. Members of the expert roundtable advised Lifes2good on Viviscal or received an honorarium for their participation.

Summary

Viviscal has the potential to offer a new avenue of treatment for treating hair loss or supplementing current therapies. The review article provides a review of research and presents compelling findings over a span of two decades. However, more research is necessary into the long-term efficacy of Viviscal and the effects of glycosaminoglycans on the hair growth cycle. Also, given the appearance of a conflict of interest between the researchers and Lifes2good, it is particularly important that further research be conducted by independent investigators.

Posted by Robert M. Bernstein M.D.

Bernstein Medical In The News

Treatments for Hair Loss in Women Detailed in Article Featuring Dr. Bernstein

NYCityWoman.com

Dr. Bernstein was interviewed for an article in NYCityWoman.com that ran the gamut of available treatments for hair loss in women. Read below for some select quotes on a wide range of topics related to hair loss in women and treatments for female patients with androgenetic alopecia (common genetic hair loss).

On the fading stigma of hair loss in women:

“Women today are more comfortable talking about their hair loss.”

On indicators of hormone-driven female hair loss:

“It is typical to have a positive family history of hair loss and the presence of miniaturization (short, fine hairs) in the thinning areas.”

On minoxidil for regrowth of thinning hair:

“Rogaine (minoxidil) can increase the quality (length and diameter) of hair that is just starting to thin.”

On the different strengths of Rogaine (minoxidil):

“I generally recommend the 5 percent for women and men. Although it’s sold in separate packages for men and women, the basic ingredients are essentially the same.”

On Rogaine Foam:

“It is an elegant mixture, made for compliance,” says Dr. Bernstein. “It is an aerosolized foam, so it is less irritating than liquid Rogaine, but can be more difficult to get directly on the scalp.”

On LaserComb vs. cap-based Low Level Laser Therapy (LLLT) devices:

“The cap is both easier to use and more effective for very thin hair, due to the greater number of lasers. But for higher-density hair, a laser comb or the LaserBand82 may be more effective, as it’s probably better at getting the laser therapy beam to the scalp.”

On Follicular Unit Transplant (FUT) surgery:

“FUT hair transplants allow many women to have a completely natural hair restoration, producing a dramatic change in their appearance.”

On Robotic FUE hair transplants:

“Robotic FUE allows for unparalleled precision, without any line scars in the donor area and no post-operative limitations on physical activity.”

See before and after photos of some of our female hair transplant patients
Read about the causes, classification, diagnosis and treatment of hair loss in women

Posted by Robert M. Bernstein M.D.

Bernstein Medical In The News

Dr. Bernstein Speaks About Hair Extensions and Traction Alopecia in NYC Website for Women

NYCityWoman.com

Dr. Bernstein was quoted in an article on NYCityWoman.com, where he spoke about the risks associated with popular hair extensions, such as weaves, wefts, and similar clip-in or add-on pieces. Extensions are a stylistic choice that allow women to dramatically change their appearance. However, their frequent use can contribute to a type of hair loss in women called traction alopecia – hair loss around the frontal hairline and temples caused by tight hairstyles pulling on the follicles.

Dr. Bernstein is quoted:

“Hair extensions can create a problem over a long period of time, as constant tugging on the hair follicles compromises their blood supply and may cause permanent thinning,” explains Robert M. Bernstein, M.D., a dermatologist in midtown Manhattan who specializes in hair loss.

Traction alopecia often causes thinning that reverses itself when the hair is worn loose, but if tugging on the hair follicles continues for an extended period of time, the hair loss can be permanent. In patients with permanent hair loss from traction alopecia, a hair transplant can typically restore the hair that is lost from sustained traction. See before and after photos of Patient BOI, Patient NBN, and Patient KAR for examples of women who had their edges restored by hair transplant surgery.

NYCitywoman.com is a website dedicated to lifestyle issues for “women on the right side of 40” — women who are smart, stylish, and eager to embrace new challenges and opportunities.

Read about Traction Alopecia
Read about the Causes of Hair Loss in Women

Before and after photos of women who had surgical hair restoration to repair thin edges:

Patient BOI
Patient NBN
Patient KAR

Posted by Robert M. Bernstein M.D.

Hair Restoration Research

Androgen Treatment May Boost Hair Regrowth in Women

A study published in the British Journal of Dermatology suggests that subcutaneous placement of testosterone pellets may boost hair regrowth in some women. ((Glaser RL, Dimitrakakis C, Messenger AG. Improvement in scalp hair growth in androgen-deficient women treated with testosterone: a questionnaire study. Br J Dermatol. 2012 Feb;166(2):274-8.))

This retrospective analysis examined patients who had androgen deficiency. Of the 285 patients studied, 76 had some degree of hair loss prior to beginning treatment. At one year on testosterone replacement 63% reported an increase in hair regrowth on the scalp.

Traditionally, elevated levels of androgens, such as testosterone, are felt to be the primary cause for common hair loss in both men and women. This is due to the seemingly adverse effect of androgens on hair follicles. This has held true for most men with patterned hair loss in whom DHT-blockers, such as Propecia (finasteride) and Avodart (dutasteride), have proven to be a potent remedy.

Given this, it was surprising that none of the 285 women in the study who had been treated with testosterone reported any hair loss after one year. In fact, of the 76 women who initially reported hair loss before the study, 63% reported positive hair regrowth at one year.

The researchers noted that patients with a “significantly higher body mass index (BMI)” were in the subset of those who did not regrow any hair. This suggests that a higher dose might be needed in some patients. ((Kapp N1, Abitbol JL2, Mathé H2, Scherrer B2, Guillard H2, Gainer E2, Ulmann A2. Effect of body weight and BMI on the efficacy of levonorgestrel emergency contraception. Contraceotion. 2015 Feb;91(2):97-104. doi: 10.1016/j.contraception.2014.11.001. Epub 2014 Nov 8.))^, ((Lopez LM, Grimes DA, Chen M, Otterness C, Westhoff C, Edelman A, Helmerhorst FM. Hormonal contraceptives for contraception in overweight or obese women. Cochrane Database of Systematic Reviews 2013, Issue 4. Art. No.: CD008452. DOI: 10.1002/14651858.CD008452.pub3))^, ((Glasier A, Cameron ST, Blithe D, Scherrer B, Mathe H, Levy D, Gainer E, Ulmann A. Can we identify women at risk of pregnancy despite using emergency contraception? Data from randomized trials of ulipristal acetate and levonorgestrel. Contraception. 2011 Oct;84(4):363-7. doi: 10.1016/j.contraception.2011.02.009. Epub 2011 Apr 2.))

Summary

By correlating higher levels of testosterone with more hair growth and/or retention in women, the study bolsters the idea that hair loss in men and women is caused by different mechanisms. Though not conclusive, the study opens the idea that testosterone implantation can effectively treat hair loss in women.

Posted by Robert M. Bernstein M.D.

Bernstein Medical In The News

Bernstein Medical Patient Writes About Female Hair Loss in Cosmopolitan Magazine

Thinning Hair Nightmare - Cosmopolitan Magazine - January 2014

A patient who visited Dr. Bernstein to learn about her hair loss authored an article on her experiences which appeared in the January 2014 issue of Cosmopolitan Magazine. In an article titled, “Thinning Hair Nightmare,” the patient wrote about her struggle in coping with thinning hair, the taboo of talking about women’s hair loss, and ways in which she attempted to overcome these physical and emotional difficulties.

On visiting Bernstein Medical – Center for Hair Restoration:

I dialed up New York dermatologist and hair transplant surgeon Robert Bernstein, MD — I’d just seen him on Oprah talking about hair loss, so he had to be good — and booked an appointment.

Dr. Bernstein ordered a blood test to rule out common hair loss causes, like thyroid disorders and hormone abnormalities, and he made sure my diet and any medications weren’t to blame. Everything came back normal.

On the diagnosis of hair loss in women:

During a follow-up visit, the doc broke out a densitometer — a crazy flashlight-looking tool that measures the changes in diameter between hair — dove into my mane, resurfacing moments later with a diagnosis: mild androgenetic alopecia, aka female pattern hair loss (FPHL). “It’s the most common type of hair loss in women, affecting perhaps one-third of the adult female population,” he explained. It occurs when a woman’s hair follicles shrink in response to her body’s own hormones.

On the taboo of female hair loss:

In search of solutions, I turned to the blogosphere… While the topic of female hair loss feels taboo, here were thousands of women talking openly — not just about the physicality of the issue but also its psychological toll. […] Whenever any conversation turns to hair, I push myself to talk openly about my issue. I’m determined not to let this condition make me feel ashamed. With more than 30 million U.S. women affected by FPHL, we should find strength in our numbers.

Dr. Bernstein was the featured guest on the Doctor Oz Show, where they discussed women’s hair loss and how the subject is often, unfortunately, considered taboo.

Consultations for female hair loss patients

Video: watch Dr. Bernstein and Dr. Mehmet Oz discuss the taboo of female hair loss

View before & after hair transplant photos of some of our female patients

Posted by Robert M. Bernstein M.D.

Hair Restoration Answers

What is the Incidence of Hair Loss in Adults?

Q: How common is hair loss in adult men and women? — N.F., Bronxville, NY

A: The incidence of androgenetic alopecia (common baldness) is quite high for both men and women. By age 50, 50% of men and 30% of women are affected. By age 70, that increases to 80% of men and 60% of women. Fortunately, in spite of significant thinning, women often preserve their hairline and have a diffuse pattern, so their hair loss can be camouflaged for many years.

Posted by Robert M. Bernstein M.D.

Hair Restoration Answers

What is Female Androgenetic Alopecia?

Q: What is female androgenetic alopecia?

A: Female androgenetic alopecia, also called female pattern hair loss, is caused by the shrinking of susceptible hair follicles in response to normal levels of hormones (androgens). It is the most common type of hair loss in women, affecting perhaps 1/3 of the adult female population. It is seen as a general thinning over the entire scalp, but can also present in a more localized pattern i.e. just limited to the front and top. The condition is characterized by a gradual thinning and shortening (miniaturization) of individual hair follicles, rather than their complete loss and, although the condition tends to be progressive, it rarely leads to complete baldness.

Posted by Robert M. Bernstein M.D.

Hair Restoration Answers

What is Lichen planopilaris?

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

LPP in Male Pattern Alopecia

LPP in Male Pattern Alopecia

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.

Bernstein Medical In The News

Hair Restoration in Women, Dr. Bernstein Featured in ‘New You’ Magazine

Hair Restoration in Women, Dr. Bernstein Featured in 'New You' Magazine

Dr. Bernstein and Bernstein Medical – Center for Hair Restoration were featured in New You magazine’s article “My Hair Lady.” The main topic of the article is hair transplantation in women, however it also touches on hair loss in women, Follicular Unit Transplantation (FUT), medication and other products.

On Bernstein Medical – Center for Hair Restoration:

The Manhattan office of Bob Bernstein, just steps from Park Avenue, is the kind of space that makes successful men feel at home — a good thing for one of the country’s foremost specialists in hair restoration (and the co-author of Hair Loss for Dummies). The layout is part design statement, part science lab, slick with granite, slate, and glass and full of microscopes and high tech gizmos. Among the space’s most noteworthy gadgets is one of only twelve robots in the world programmed to help perform hair transplants, which has a home in Dr. Bernstein’s office.

A female patient of ours discussing the “taboo” of hair transplantation in women:

Sara Lyles, 62, whose hair loss was caused by a styling technique, said that when Dr. Bernstein performed her hair transplant 12 years ago, the subject was taboo. “Women never talked about it, and I was so embarrassed that I avoided all social functions,” she recalls. “I’m African American and I slept in large tight rollers to keep frizzing under control. The traction destroyed my frontal hairline.”

At the time, she would have been mortified if someone found out she had undergone a transplant. “Even my hairdresser had no clue,” she says. “Dr. Bernstein not only gave me my hair back, he gave me my life back.”

Dr. Bernstein on the amazing progress of the hair restoration industry:

As Dr. Bernstein emerges from his operating room, sporting green scrubs and green Nikes that match the room’s tiles, he shakes his head and sighs. “When I went into practice back in the eighties, transplantation was almost barbaric and Rogaine was the only alternative,” he remembers. He marvels at the advances and choices he and others now have to over. “I never would have thought I would be working with robots, lasers, and cloning.”

Posted by Robert M. Bernstein M.D.

Hair Restoration Answers

What is the Origin of the Term DUPA?

Q: What is the Origin of the Term DUPA? — Z.Z., Darien, CT

A: The terms DPA and DUPA were first described by O’tar Norwood in his seminal 1975 publication: Male Pattern Baldness: Classification and Incidence. ((Norwood OT. Male pattern baldness: classification and incidence. So. Med. J 1975;68:1359-1365. Download)) In the paper, Dr. Norwood defined the two terms as:

Diffuse, Unpatterned Alopecia (DUPA). In this type there is a general decrease in the density of hair without any definite pattern, although it is usually more marked over the top and front. This type is common in women.

Diffuse, Patterned Alopecia (DPA). The patterns in this type of hair loss are essentially the same as in more common male pattern baldness, but the areas involved do not become totally bald; the hair only decreases in density. This also occurs in women.

Dr. Norwood’s realization that all hair loss did NOT follow his own Norwood patterns was a great insight, as well as his observation that DUPA was a common pattern in women and uncommon in men. The terms went relatively unnoticed and were not seen again in the medical literature until Drs. Bernstein and Rassman wrote about them again when they were developing Follicular Unit Transplantation. ((Bernstein RM, Rassman WR: Follicular Transplantation: Patient Evaluation and Surgical Planning. Dermatol Surg 1997; 23: 771-84. Download)) The importance of identifying these conditions is that that DUPA (either in men or women) is a relative contra-indication for hair transplantation and, with densitometry, can be readily detected in individuals at a relatively young age. Patients with DPA can be transplanted as if they were early Norwood Class 6’s.

Posted by Robert M. Bernstein M.D.

Bernstein Medical In The News

British Vogue Interviews Dr. Bernstein on Women’s Hair Loss and Female Hair Transplants

Hair transplantation for women is in vogue. As a pioneer in the surgical treatment for female hair loss, Dr. Bernstein was featured in an article in the ‘Beauty’ section of the October 2012 issue of British Vogue.

After describing a visit to Bernstein Medical – Center for Hair Restoration in New York City and giving readers a primer on hair transplant surgery, the article turns to Dr. Bernstein to describe the surge in popularity of the treatment of hair loss in women.

“A quarter of my consults are women. It was 10 per cent five years ago,” says Dr Bernstein. “These improved [hair transplant] techniques work especially well for female hair loss, where it is usually localised patches of thinning that need attention.” And while in the chair, you can even have your eyebrows boosted to Arizona Muse quality, too, if they’ve also taken an ageing hit.

Dr. Bernstein speaks to the difficulty of being a woman suffering from hair loss:

“This is life-changing. Bald men are commonplace, but to have less than a full head of hair for a woman can be isolating. Although there are more tricks women can use to disguise the problem.”

The article also discusses a variety of products and techniques to boost hair volume or camouflage hair loss. Among these are: Kérastase, Nicky Clarke’s ‘Tease Me’ powder, Viviscal Hair Nutrition, laser stimulation, Michaeljohn’s ‘Fine Hair Clinic’, and Touché by Flavien.

Reference
“Hold Onto Your Hair”, Vogue Magazine, October 2012; p375-6.

Posted by Robert M. Bernstein M.D.

Hair Restoration Research

Hair Cloning Study Shows RepliCel’s Efficacy In Increasing Hair Density

RepliCel Life Sciences; a company out of Vancouver, Canada; is studying the use of hair cloning techniques to treat male pattern baldness and hair loss in women.

The study is in progress, but analysis of the 6-month interim results of the first phases has been published. The preliminary results at 6 months show that almost two-thirds of subjects (10 out of 16, or 63%) received a greater than 5% increase in hair density at the injection site. Of that group of 10 subjects, seven of them saw hair density improve by more than 10%. In one subject vellus hair density increased 24.9%, terminal hair density increased 14.5%, overall hair density increased by 19.2%, and cumulative thickness per area increased by 15.4%. There were no significant adverse safety events reported in the first 6 months of the trial.

Phase I/IIa of the RepliCel study involved injecting male and female subjects with their own (autologous) dermal sheath cup cells (DSCC), which were replicated or cloned using RepliCel’s laboratory technology. A preliminary analysis of the safety of the injections, as well as a preliminary analysis of the efficacy of the treatment in growing hair, was announced in May 2012 and presented to the European Hair Research Society in June 2012. Subjects in this part of the study will continue to be monitored for any adverse physical reactions and to assess hair growth at 12 months and 24 months after treatment.

Phase IIb of the study is designed to help the RepliCel researchers formulate the optimal treatment for hair growth. Some of the treatment regimens that will be tested include the use of different concentrations of cells and different treatment schedules, plus the effects of single injections versus repeat injections. The final protocols for Phase IIb are currently being worked out, with the clinical trial expected to begin in late 2012.

Reference:

Lortkipanidze, N. Safety and Efficacy Study of Human Autologous Hair Follicle Cells to Treat Androgenetic Alopecia. In Clinicaltrials.gov. Retrieved July 26, 2012, from http://clinicaltrials.gov/ct2/show/NCT01286649.

Posted by Robert M. Bernstein M.D.

Bernstein Medical In The News

Dr. Schweiger Details Dangers of Hair Extensions

Dr. Schweiger on PIX 11 - Dangers of Hair Extensions

Dr. Schweiger lends his expertise on hair loss in women and cosmetic hair extensions in a segment on PIX 11 television. The interview with Dr. Steve Salvatore focused on the pitfalls of using some types of hair extensions, or using them improperly.

Hair extensions can result in undesirable bald patches caused by traction alopecia, which is hair loss due to a constant tugging on hair follicles.

Read the transcript of the interview below:

Dr. Steve: Dr. Schweiger, there are two types of hair extensions, tell me about those. The permanent and temporary type.

Dr. Schweiger: There are permanent and temporary. The temporary are just that. They are clip-on hair extensions, they’re meant to be used for weddings, special occasions, to test out a new hair style. And they are generally the safer of the hair extensions.

Then there are permanent hair extensions, and there are different types. One permanent type you actually sew into the hair.

Dr. Steve: So you sew it into the existing hair, not the scalp, but the existing hair.

Dr. Schweiger: Exactly, into the hair.

And the other types are either glued or they use metal clamps to put it into the hair and they stay in for anywhere from 1 month to 3 months at a time.

Dr. Steve: So what are the problems that you have with the… I mean, obviously the clip-on ones are probably fine, right? But these other ones, the more permanent ones, what are the problems you run into.

Dr. Schweiger: The main problem that we’re seeing in patients is what’s called traction alopecia. And traction alopecia can come from tight braids or tight hair extensions and it leads to hair loss. Alopecia is just the medical term for hair loss. We’re seeing young patients who are using these products to look better, actually ending up with bald patches and looking worse.

[……]

Dr. Steve: So, obviously you think that the temporary ones are better. What’s the treatment for something like that.

Dr. Schweiger: The first thing, [which] is obvious, is take out the hair extensions. And then go see your doctor to assess the damage. Oftentimes, time will grow back the hair, if not, we can use injections of cortisone. The last line is hair transplant surgery, which a lot of people don’t know is an option. With a hair transplant, we take out a long strip of hair in the back of the scalp, and we dissect it into slivers, then into individual hairs. Then, actually, place them in the balding area to bring back the hair.

Dr. Steve: And the good thing about that is it’s not the old transplants of the past that look like little cornrows. It really does look great. Dr. Schweiger and Chioma, thanks so much for coming. Really appreciate it.

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

Hair Loss Myths Dispelled By Dr. Bernstein and CBS News

CBS News has enlisted the help of Dr. Bernstein in dispelling a series of myths which circulate in the general public about the causes and treatments of hair loss. The feature is titled, Hey, Baldy: 10 Things You Need to Know about Hair Loss.

Horseradish and pigeon droppings. That’s the magic hair-growth potion prescribed by Hippocrates. Alas, there are so many myths about hair loss that folks today are almost as clueless as the father of medicine.

Keep reading as hair loss expert Dr. Robert Bernstein, clinical professor of dermatology at Columbia University, explodes 10 all-too-common follicle fallacies…

Do hair loss genes come from the father’s side or the mother’s? Do bald men just have more testosterone in their system? Do women experience hair loss? Find Dr. Bernstein’s answers to these questions at the CBS News feature.

Visit our hair loss section where Dr. Bernstein debunks more hair loss myths.

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.

Bernstein Medical In The News

A Breakthrough in Hair Cloning

New developments in regenerative medicine, presented at the 18th Annual Scientific Meeting of the International Society for Hair Restoration (ISHRS) this past week, may have opened the possibility that a patient’s hair can be multiplied in his own scalp.

ACell, Inc., a company based in Columbia, Maryland, has developed and refined an Extracellular Matrix (ECM), a natural biological material that can be implanted at the site of an injury or damaged tissue in order to stimulate a unique healing response. The ECM stimulates the body’s own cells to form new tissue specific to that site (a process referred to as “Auto-cloning”).

The ACell MatriStem devices have had some preliminary success in allowing plucked hairs that were placed into recipient sites on the patient’s scalp to grow. Although this is a major breakthrough, significant work remains in order for hair multiplication to become a practical treatment for hair loss in men and women.

It is also anticipated that the regenerative properties of Extracellular Matrix will facilitate the healing of the incision in the donor area after a hair transplant. We are currently offering ACell to all patients undergoing follicular unit transplant procedures at no additional charge.

We are currently studying the use of ACell for scalp hair multiplication as well as the facilitation of wound healing in follicular unit transplantation procedures. We are also treating select patients outside the studies. If you are interested in participating, please give us a call.

Posted by Robert M. Bernstein M.D.

Bernstein Medical In The News

Dr. Bernstein On Dr. Oz Show To Discuss ‘Taboo’ Of Hair Loss In Women

Losing one’s hair can be an uncomfortable topic of conversation for any adult, but, given the importance many women place on their appearance, hair loss in women is an especially taboo subject of conversation. Whether it is a bald patch, diffuse thinning, balding from a medical condition, or scarring from an accident, hair loss can be upsetting or even traumatic for many women.

The good news is that hair restoration pioneers like Dr. Bernstein are bringing the treatment of women’s hair loss out of the cosmetics bag and into the modern era of hair restoration. What a better way of squashing the taboo once and for all than for Dr. Bernstein to appear on national television and confront the issue head-on. Dr. Mehmet Oz invited Dr. Bernstein to appear on his show, the Dr. Oz Show, to discuss the causes and diagnosis of hair loss in women.

As seen in the image above, Dr. Bernstein used a densitometer to evaluate the hair loss of a female member of the audience. The device enables a physician to determine the amount of miniaturization, or genetic thinning, present in the patient’s scalp. Dr. Bernstein also commented on the treatment of hair loss with low level laser therapy (LaserComb).

Dr. Oz and Dr. Bernstein are colleagues at The New York Presbyterian Hospital of Columbia University. They first appeared together on the Oprah Winfrey Show where Dr. Bernstein explained his new hair transplant techniques to Oprah.

See before and after hair transplant photos of some of our female patients.

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 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

Why Is Hair Loss In Women Harder To Treat With A Hair Transplant Than Hair Loss In Men?

Q: Why is hair loss in women harder to treat with hair transplants than hair loss in men?

A: The majority of women present with diffuse hair loss (i.e. thinning all over) rather than the patterned hair loss seen in men (where the hair loss is localized to the front and top of the scalp).

Diffuse thinning presents two problems for a potential hair transplant candidate.

The first is that there is no permanent area where the hair can be taken from. If hair is taken from an area that is thinning, the transplanted hair will continue to thin after the procedure, since moving it doesn’t make it more permanent.

The second problem is that since the areas to be transplanted are thin, rather than completely bald, the existing hair in the area of the hair transplant is at some risk to shedding as a result of the procedure.

When women have a more defined pattern (i.e. more localized thinning on the front part of the scalp with a stable back and sides), they can make excellent candidates for surgery. This pattern occurs in about 20% of women. A small percentage of men have diffuse thinning and are, therefore, poor candidates for a hair restoration surgery as well.

Posted by Robert M. Bernstein M.D.

Hair Restoration Answers

Does Low Level Laser Therapy (LLLT) Affect Hair Loss in Men and Women Differently?

Q: Have there been any studies showing the difference between men and women in their response to laser treatments for hair loss?

A: In the International Journal of Cosmetic Surgery and Aesthetic Dermatology (Vol. 5, Number 2; 2003), a study on low level laser therapy (LLLT) was conducted which indicated that there was a 55% increase of growth (hair count) in the temporal area as well as 64% in the vertex of the female subjects who were treated with LLLT for hair loss. The study also indicated a 74% increase in the hair counts of the male subjects in the temporal area and 120% in the vertex region. These results would initially indicate that LLLT works better in men than in women, but there were four times as many men in this study so the results might be different in a larger test group.

However, even in this notably smaller female group, the tensile strength of the hair increased dramatically over the tensile strength observed in the male subjects after treatment. This would indicate that, at least in this study, there was not only an increased hair count in women, but the tensile strength of that hair was greatly improved as well. This would be initially indicative that LLLT may be found to be more beneficial to women than to men.

It is important to note that this study was published in 2003. Further studies need to be conducted to confirm the initial results and to further elucidate the possible mechanisms of low level laser light therapy in both men and women with alopecia. As important, long term data needs to be accumulated to show the continued efficacy of this treatment. It had been our clinical experience that LLLT is not as effective as one would assume from the results of the initial studies.

Visit the page on Laser Therapy for more information, or read more answers to questions about laser therapy.

Posted by Robert M. Bernstein M.D.

Bernstein Medical In The News

Dr. Schweiger Discusses LaserComb for Hair Loss in Women in Wall Street Journal

Dr. Eric S. Schweiger, an Associate at Bernstein Medical – Center for Hair Restoration, was interviewed recently for an article in the Wall Street Journal.

The article — Can Lasers Stimulate a Hair-Growth Spurt? — discusses the efficacy of the HairMax LaserComb and low level laser therapy (LLLT) and also touches on Dr. Schweiger’s main area of expertise, the diagnosis and treatment of hair loss in women:

Eric S. Schweiger, a clinical instructor of dermatology at Mount Sinai Medical Center in New York, says the LaserComb helps grow hair, but adds that effects are often modest, typically take at least six months and aren’t seen in all patients.

The only home laser device cleared for hair growth by the Food and Drug Administration is the LaserComb, which claims to increase hair growth in men. While used by Dr. Schweiger and others for women, the device isn’t FDA cleared for them; a clinical trial is continuing, the company says.

Read more about low level laser therapy (LLLT) and the HairMax LaserComb. For further reading you can explore the Laser Therapy topic.

Posted by Robert M. Bernstein M.D.

Bernstein Medical In The News

Dr. Bernstein Talks About Hair Loss in Women with New York Times

The New York Times interviewed Dr. Bernstein for a full-length article on hair loss and hair transplant options for women interested in hair restoration. The article – titled, “Tricks and Transplants for Women’s Hair Loss” – covered modern hair transplantation techniques, hair transplant costs, camouflage techniques, and more.

Read below for some excerpts of the article:

Exploring Your Options:

Hairstylists, impressed with how realistic the “new” transplanted hair looks, recommend doctors to clients who are tired of hiding their hair loss with layers or high- and lowlights. “I’ve seen bad jobs,” said Seiji Kitazato, the creative director at Frédéric Fekkai on Fifth Avenue, who refers clients to a few surgeons. “But now you can’t even tell.”

Still, not every woman of the millions who suffer from hair loss is a candidate. Underlying conditions, including anemia and thyroid problems, that are temporary, treatable or affect the scalp rather than the hair, must be dealt with before a transplant can be considered. If a transplant is ruled out, sufferers must rely on wigs, hairpieces or styling tricks.

What’s more, “most medications can cause hair loss, some more frequently than others,” said Dr. Robert M. Bernstein, a clinical professor of dermatology at Columbia University who has a restoration center in Manhattan.

A transplant is an option only for a woman who has a thick enough area of hair from the back and sides to “donate” to a more paltry part of her scalp. But many women don’t experience this kind of localized balding; instead their entire head of hair thins out during menopause or as they age.

Buyer Beware:

So the incentive to treat any and all comers is high. “It’s a big problem,” Dr. Bernstein said. “You shouldn’t go to someone who will give a transplant to anyone who walks in the door.” If your condition is not properly assessed, you could permanently shed more hair after surgery than you gained, he warned, or if the hair transplanted wasn’t stable, “it would disappear.”

Before Hair Transplant Surgery:

If you’re suffering hair loss, see a dermatologist first, not hair transplant surgeons, said Dr. Robert M. Bernstein, a dermatologist in Manhattan who specializes in hair restoration. After determining a cause, dermatologists can offer advice about options from the medical to the surgical. Many women with hair loss try Women’s Rogaine, a solution with 2 percent minoxidil that is applied to the scalp, twice daily. Others prefer Rogaine’s foam for men, because it has 5 percent minodixil, dries quickly and feels less greasy. (But even the women’s formulation warns to discontinue use if facial-hair growth occurs.)

Posted by Robert M. Bernstein M.D.

Hair Restoration Answers

What are the Most Common Causes of Hair Loss in Women?

Q: What are the most common causes of hair loss in women other than genes?

A: The most common causes for localized hair loss in women are traction (due to tight braiding) and alopecia areata (an autoimmune disease that produces smooth round patches of hair loss).

Other than genetic (hereditary) thinning; generalized hair loss is most commonly caused by medications, anemia, and thyroid disease.

Posted by Robert M. Bernstein M.D.

Hair Restoration Answers

Is Female Pattern Hair Loss Common?

Q: How common is female pattern hair loss?

A: It is very common. It affects about 40% of women.

Posted by Robert M. Bernstein M.D.

Hair Restoration Answers

How Do You Treat General Thinning in Women ?

Q: I’ve been losing my hair just around the front of my scalp for years, but now it’s bad enough that I need to wear a wig to hide the top and back. Do you transplant women?

A: If you have thinning in such a broad area, most likely your donor area is also thin and you would not be a good candidate for surgery.

An examination can determine this and also determine if there is some other cause of your hair loss other than genetics.

Posted by Robert M. Bernstein M.D.

Bernstein Medical In The News

Drs. Bernstein, Rassman, Schweiger Release ‘Hair Loss & Replacement For Dummies’

John Wiley & Sons – creators of the hugely-popular For Dummies series of books – published on December 3 the definitive book on hair restoration: Hair Loss & Replacement For Dummies, written by internationally-respected hair transplant pioneers Dr. William R. Rassman and Dr. Robert M. Bernstein with Dr. Eric Schweiger.

Hair Loss & Replacement for Dummies is filled with important information for men and women of virtually all ages anxious to preserve their full head of hair, put the brakes on balding, or explore the safest and most reliable hair replacement techniques currently available. The book offers readers not only the full gamut of modern-day hair-care options but crucial tips on how to avoid unscrupulous hair transplant doctors and potentially harmful products as well.

Topics include:

Getting To Know Your Hair – What Causes Hair Loss; The Devastation Of Hair Loss In Women; Undergoing Hair Restoration Surgery
Splitting Hairs – How Hair Grows; Aging Hair; Hair & Ethnicity, Maintaining Self-Esteem in the Face of Hair Loss;
Taking Better Care Of Your Hair – Washing & Drying Your Hair Correctly; Avoiding Hair Damage; Caring For Childrens’ Hair
Understanding The How & Why Of Hair Loss – Stress & Hair Loss; Environmental Issues; Male Pattern Thinning In Men and Women; Diseases & Disorders That Cause Hair Loss
Creative Techniques For Concealing Hair Loss – A Brief History of “Rugs”; Today’s Toupees
Taking Prescription Medications For Hair Loss – Being Aware of Side Effects
Supplementing Your Diet To Help Slow Hair Loss – Pumping Up Proteins; Minding Your Mineral Intake
Hair Transplant Surgery – Do You Really Need A Hair Transplant; Psychological Considerations; Choosing A Doctor; Possible Complications; Heading Home With A New Head Of Hair!

For further reading see the transcript of an interview with Dr. Bernstein about the book, the original press release, or purchase the book at Amazon.com.

Posted by Robert M. Bernstein M.D.

Hair Restoration Answers

Can a Woman be a Candidate for a Hair Transplant?

Q: I am female and thinning can I be a candidate for a Follicular Unit Hair Transplant?

A: If it turns out that you have female pattern hair loss, you may be a candidate a hair transplant, but would need to be evaluated by a doctor who specializes in surgical hair restoration.

In the evaluation, you should have your degree of hair loss assessed and donor supply measured, using an instrument called a densitometer, to be certain that you have enough permanent donor hair to meet your desired goals. For more information about hair loss in women, please see the Diagnosis of Hair Loss in Women page of the Bernstein Medical – Center for Hair Restoration website.

If you are thinking about your hair loss and would like to be evaluated, go to the physician consult page to schedule a consultation.

Posted by Robert M. Bernstein M.D.

Hair Restoration Answers

Why is there a Different Consultation Fee for Diffuse Thinning versus Patterned Hair Loss?

Q: Why is the consult fee more for diffuse thinning than for a regular visit? — B.F., Altherton, CA

A: Diffuse hair loss, more common in women, can be the result of a number of underlying medical conditions and therefore it usually requires an extended medical evaluation.

If you are a male or female with obvious diffuse thinning from androgenetic alopecia (common baldness), or if you have patterned hair loss where the diagnosis is straightforward, the fee is less because an extensive evaluation is not required.

Please visit our Hair Transplant Costs & Consultation Fees page for more information.

Posted by Robert M. Bernstein M.D.

Hair Restoration Answers

Can Stress Cause Hair Loss or is that a Myth?

Q: I’ve been dealing with daily mental stress for the past few months. I’ve noticed that during that time, I’ve experienced a lot of frontal hair loss and thinning. I thought stress was a myth for causing hair loss. — R.P., Upper East Side, Manhattan

A: Stress may cause temporary shedding, but it generally does not affect the long-term course of genetic hair loss.

It seems that women’s hair is affected by stress more commonly than men’s hair, but the reason is not clear.

Posted by Robert M. Bernstein M.D.

Hair Restoration Answers

Are Women Less Likely to be Candidates for a Hair Transplant?

Q: I heard that a smaller per cent of women are candidates for hair transplants compared to men. Is this true?

A: Yes, that is true. Women more commonly have diffuse hair loss where the thinning is all over the scalp. This means that the donor area (the back and sides of the scalp) are thinning as well.

If the donor area is not stable, then there is no point in doing a hair transplant, since the transplanted hair will continue to fall out. Remember, the transplanted hair is no better than the area where is comes from.

On the other hand, women with stable donor areas can be great candidates for surgical hair restoration. The stability of the donor area can be assessed using a procedure called densitometry and should be part of the hair loss evaluation when you see your physician.

Posted by Robert M. Bernstein M.D.

Hair Restoration Answers

What are Pros and Cons of Laser Therapy at Home vs. Doctor’s Office?

Q: I heard that you can buy a laser for hair loss and use it at home. What are the advantages or disadvantages of doing this?

A: The advantages of home use are convenience and that it is generally less expensive than going to a doctor’s office for treatment.

The main disadvantage of using laser treatments without a doctor’s supervision is that a more effective treatment for hair loss may be available and you may not know about it. By spending time using the laser, the window for a more effective treatment may be missed. A good example is the 20 year old male who has extensive hair loss in his family and is just starting to thin. It is very important for this person to start Propecia (finasteride) as soon as possible, since the long-term benefits of using this medication are well established.

Laser treatment at home, without a prior evaluation by a physician, also risks missing the diagnosis of an underlying medical condition. This can be a particular problem in women where hair loss tends to be diffuse and the cause may not be readily apparent. If the cause of the thinning was due to anemia, thyroid, or ovarian disease, the diagnoses of these treatable conditions might be missed.

Finally, the laser therapy available in a doctor’s office may be significantly more effective than a home unit.

Read more about Laser Therapy for Hair Loss

Posted by Robert M. Bernstein M.D.

Hair Restoration Answers

Can Hair Transplant Treat Hair Loss from Traction Alopecia?

Q: I am a Caucasian female that has experienced hair loss on the sides of my head from the height of the eyebrow to the ear due to traction. The hair loss has been present since my teen years. My job requires me to wear my hair up most of the time. Although I don’t wear it nearly as tight, I seem to continue to lose my hair in the front and on the top of my head. My hair also used to be very thick as a child and is now quite thin. I’m not sure if this is normal or something else is going on, but I am definitely interested in a hair transplant. — M.H., Larchmont, NY

A: It sounds like you are experiencing continued traction alopecia. Unless the underlying cause is corrected (the traction), you can expect to continue to lose your hair. People that have traction alopecia can have thinning even from mild pulling that might not be a problem for others. Once you stop the pulling, it can take up to two years for the hair to return, although there may be permanent hair loss.

Surgical hair restoration is the treatment of choice for permanent hair loss from traction. If you have significant thinning on the sides, you may not be a candidate for hair transplantation since in this procedure we often need to harvest hair from the permanent area in the sides of the scalp as well as the back.

An additional problem (that you allude to) is that you may have underlying female pattern hair loss. This would further complicate the surgical treatment.

A careful examination (including densitometry) can sort these problems out and allow for more specific recommendations.

Posted by Robert M. Bernstein M.D.

Hair Restoration Answers

Can Hair Loss in Women be Caused by Pregnancy, Prozac, or Hyperactive Thyroid?

Q: I had a baby 12 weeks ago and have recently been diagnosed with a hyperactive thyroid, although only slightly. I was also taking Prozac for 7-10 days. I am 27 and have been experiencing a significant amount of hair loss from all over my scalp. What are the chances that this would be permanent?

A: Based upon your history, you have three possible reasons for having a type of hair loss called telogen effluvium; thyroid disease, medication induced (Prozac) and pregnancy.

Telogen effluvium is diagnosed by a hair pull test and observing club hairs under the microscope. It is generally a reversible condition, regardless of the cause. Telogen effluvium most often occurs 2-3 months after the inducing event, so your pregnancy is the most likely cause. Prozac would less likely be the problem since you have only been on it for a short time. Besides causing Telogen effluvium, thyroid disease can also alter your hair characteristics, which can make your hair appear thinner.

Other causes of hair loss, such as genetic female pattern hair alopecia, must be ruled out. Please see the Hair Loss in Women page on the Bernstein Medical – Center for Hair Restoration website for more information.

Posted by Robert M. Bernstein M.D.

Hair Restoration Answers

What are Styling Tips for Thinning Hair?

Q: I am a 45 year old woman and I am beginning to thin on the top of my scalp. I don’t want to use medications and I don’t think that I am quite ready for surgery. Is there anything else I can do? — E.H., Rye, NY

A: There are a number of things that you can do that can make you hair look more full and help disguise the thinning. Lightening ones hair will allow the hair to reflect more light and appear thicker. In lighter-skinned races it will have the additional advantage of decreasing the contrast between the hair and skin and thus the skin will essentially act as a filler between the strands of hair.

Streaking the hair is also helpful to make the hair look thicker. Waving or perming will help as well, as it will give the appearance of more volume. Normally, the hair tends to fall into a natural part where it is the thinnest. If you part your hair in the thickest area (usually the side opposite from where you are used to, or slightly lower on the same side) this will make the hair appear fuller and less see-through.

Finally, there are a number of cosmetic products that can make you look like you have more hair.

Visit the Cosmetics for Hair Loss page on the Bernstein Medical – Center for Hair Restoration website.

Posted by Robert M. Bernstein M.D.

Hair Restoration Answers

Why Should Hair Transplant Doctor Measure Miniaturization in Donor Area Before Transplant?

Q: Why should a doctor measure miniaturization in the donor area before recommending a hair transplant? — E.B., Key West, F.L.

A: Normally, the donor area contains hairs of very uniform diameter (called terminal hairs). In androgenetic hair loss, the action of DHT causes some of these terminal hairs to decrease in diameter and in length until they eventually disappear (a process referred to as “miniaturization“). These changes are seen initially as thinning and eventually lead to complete baldness in the involved areas.

These changes affect the areas that normally bald in genetic hair loss, namely the front and top of the scalp and the crown. However, miniaturization can also affect the donor or permanent regions of the scalp (where the hair is taken from during a hair transplant). If the donor area shows thinning, particularly when a person is young, then a hair transplant will not be successful because the transplanted hair would continue to thin in the new area and eventually disappear. It is important to realize that just because hair is transplanted to another area, that doesn’t make it permanent – it must have been permanent in the area of the scalp it initially came from.

Unfortunately, in its early stages, miniaturization cannot be seen with the naked eye. To detect early miniaturization a doctor must use a densitometer, or an equivalent instrument, that magnifies the surface of the scalp at least 20-30 times. This enables the doctor to see early changes in the diameter of the hairs that are characteristic of miniaturization. If hairs of varying diameter are noted (besides the very fine vellous hairs that normally occur in the scalp), it means that the hair is being affected by DHT and the donor area is not truly permanent.

In this situation, a person should not be scheduled for hair transplantation. If the densitometry reading is not clear, i.e. the changes are subtle and the doctor is not sure, then the decision to have surgery should be postponed. By waiting a few years, it will be easier to tell if the donor area is stable. Having surgery when the donor area is miniaturizing can be a major problem for a patient, since not only will the transplanted hair eventually disappear, but the scar(s) in the donor may eventually become visible. This problem will occur with both follicular unit transplantation (FUT) and follicular unit extraction (FUE).

Posted by Robert M. Bernstein M.D.

Hair Restoration Answers

Can Hair Transplant Treat Diffuse Hair Loss in Women?

Q: My hair loss resembles the grade I female hair loss scale, but none of the male hair loss patterns. It has been relatively stable for the past five years and only recently has it begun to progress further. I began both Propecia and Rogaine two months ago, but the hair loss still continues at the same pace. I’m really worried. Does a hair transplant work in such a diffuse hair loss? — D.D., Park Slope, Brooklyn

A: If your hair loss is diffuse only on top, then a hair transplant will be effective. This condition is called Diffuse Patterned Alopecia or DPA.

If the diffuse pattern of hair loss affects the back and sides as well, then surgical hair restoration should be avoided. In this case (called Diffuse Unpatterned Alopecia or DUPA) the donor area is not permanent and the transplanted hair will continue to thin over time.

Posted by Robert M. Bernstein M.D.

Hair Restoration Answers

Can Hair Transplant Treat Chronic Telogen Effluvium?

Q: I am a 36 year old female who has been diagnosed with Chronic Telogen Effluvium. Although I do not have any bald spots yet my hair is much thinner on both of my temples as well as in the back of my head. Is a hair transplant an option for me or am I just going to shed the new hair as I am shedding my current hair? — R.K., Providence, R.I.

A: Since Chronic Telogen Effluvium is a generalized condition, it is not amenable to correction by a hair transplant. The reason is that there is no stable area to take donor hair from. Chronic TE is generally self-limited, so try to be patient.

Posted by Robert M. Bernstein M.D.

Hair Restoration Answers

Can a Hair Transplant Restore Frontal Hair Loss in Women?

Q: Although I read that women are supposedly protected from hair loss in the frontal hairline by the enzyme aromatase that is exactly where I am losing hair. My hairline has receded and I have developed a widow’s peak. What can be causing this, and how can I fix it? It seems to have been happening gradually for a few years.

A: Less than 10% of female hair loss is in a frontal pattern that is similar to the pattern of genetic hair loss seen in men.

Women with this pattern can often be good candidates for hair transplant surgery, particularly if the donor area is stable. View our Women’s Hair Transplant Gallery for some examples of the kind of results we can achieve for women at Bernstein Medical – Center for Hair Restoration.

Posted by Robert M. Bernstein M.D.

Hair Restoration Answers

Can Hair Loss in Women Come from Hair Dye?

Q: I am a 48 year old woman. Since I have used a new hair dye, I seem to be going bald. Is this possible?

A: Dying hair is a very common practice and hair loss in women who are 48 years old is also very common. The fact that the two have occurred together does not necessarily imply that there is a cause and effect relationship.

Women who are already losing hair often go to a great deal of effort to disguise this fact with dying, bleaching, and perming. These procedures, particularly if too aggressive, or done too frequently, can cause weakening and increased fragility of the hair shaft and increased hair breakage may result. This is more common if the hair is already fine in texture. This breakage is frequently interpreted as “hair loss” and it certainly does result in a significant loss of hair bulk, although the follicle itself is not damaged.

When there is a relationship between hair dye and hair loss in women, it is usually an inflammatory/allergic or irritant reaction. If severe, there may be an actual burn. In these cases, there would be a history of redness and swelling. An inflammatory reaction could cause hair loss but it would be unusual to damage follicles enough to produce scarring – although this occasionally does occur. A scalp biopsy is often helpful to sort out these cases.

Posted by Robert M. Bernstein M.D.

Hair Restoration Answers

What Causes Patch of Hair Loss in Women?

Q: I am a 34 year woman with a patch of hair loss by my temple. I went to the salon to have my hair done and to my surprise my hairdresser told me that I have Alopecia? First time I’d heard of it, my G.P is not very concerned about it but having read so much about it on this site I am becoming a bit concerned. The rest of my hair is healthy any suggestions and diagnosis? — M.V., Williamsburg, Brooklyn

A: “Alopecia” is just a generic term for any kind of hair loss.

It sounds like you have a specific condition called alopecia areata. Alopecia areata is an autoimmune disease that presents with the sudden appearance of well localized bald spot(s) on the scalp or other parts of the body. The underlying skin is always normal.

The treatment is injections with cortisone. Hair transplant surgery is not indicated for this condition.

You should see a dermatologist to confirm the diagnosis and treat.

Other diagnoses to consider are triangular alopecia (which would have been present since childhood) and traction alopecia (that is cased by constant tugging on the hair).

Posted by Robert M. Bernstein M.D.

Hair Restoration Answers

How is Rogaine for Women Different from Men’s Formula? [2020 Update]

Q: What is the difference between Rogaine for men and Rogaine for women? — G.K., Hawthorne, N.Y.

A: Rogaine, the brand name of generic minoxidil, comes in formulations for both men and women. The men’s versions come in a 5% solution and a 5% foam while women’s products are the 5% foam and 2% solution. Of these, the strongest and most effective is the 5% men’s solution. This is due to the inclusion of propylene glycol, which is a vehicle that helps the active ingredient, minoxidil, to more readily penetrate the scalp. As the other products do not contain propylene glycol, they may be slightly less effective.

Instructions for use also differ on the label between the men’s and women’s products. All products (5% men’s solution, 5% men’s foam, 2% women’s solution) recommend twice daily use, except for the 5% women’s foam which recommends once daily application. In reality, a thorough once daily application seems to be nearly as effective as twice daily for all version of topical minoxidil.

While the 5% solution may be stronger, it is more irritating to the scalp and more difficult for some to tolerate. Some people have a sensitivity to the added propylene glycol and will experience redness, burning, itching, and irritation. If this occurs, patients should switch to the 5% foam or 2% solution. We also recommend that patients use enough of the medication when they apply to adequately cover the treatment area of the scalp. Often, this means using 2 or 3 capfuls of foam or 2-3 droppers full of the solution (2-3mL).

It is important to understand, that contrary to the more restrictive package indications, it works in all areas of the scalp where there is thinning. It is not only for use in the crown. Many patients find that evening application allows the full 4-6 hours of contact time necessary for absorption and that the product will dry overnight and no longer look greasy in the morning. Results can appear as early as 3-6 months, but we often advise using minoxidil for a full year before judging its efficacy. As the hair is always cycling and growing, the product will need to be continued daily for ongoing benefit.

Posted by Robert M. Bernstein M.D.

Hair Restoration Answers

Can Women Use Propecia to Treat Hair Loss and Does Their Age Matter?

Q: I have early thinning on the top of my scalp and I was told to use Propecia, but I heard that is was only for men. What do you think? — T.G., Staten Island, NY

A: Women can’t take Propecia during the child-bearing years because, if ingested, it can cause birth defects in male offspring.

In post-menopausal women, where we see the greatest frequency of hair loss, it doesn’t seem to be effective.

In pre-menopausal women who do not plan to become pregnant or who already have children, we are still cautious about using the medication, since there effectiveness has not been proven and its long-term safety in this population has not been tested.

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.

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