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Robotic Hair Transplants & Hair Restoration
Flagship: 110 East 55th Street, New York, NY
212-826-2400 - [email protected]
Bernstein Medical - Center for Hair Restoration
Dr. Bernstein and Dr. Shaver answer frequently asked questions about hair transplantation, hair loss, and medical treatment for hair loss.
Hair Restoration Answers

Does Surgeon Determine Angle of Hair In Hair Transplant?

July 1st, 2013

Q: I notice that some patients end up with hair that seems to stand straight up while others have hair that flows to one side or the other. Does the angle at which you place the follicles in the scalp ultimately determine how the hair will lie? Is there some artistic talent needed when placing these follicles so that patients end up with hair that lies flat or sticks straight up? What determines this? Do we have control over it? — H.B., Fort Lauderdale, F.L.

A: Great question. You are correct, the angle of the recipient sites largely determines the hair direction. Hair should be planted the way it grows (i.e., in a forward and horizontal direction at the frontal hairline.) It is extremely important that it is transplanted that way to look natural. The body will alter the angle a bit as it heals, usually elevating it slightly and re-creating any prior wave (yes, waves are determined by the scalp, rather than by the hair follicles per se). In a properly performed hair transplant, a straight-up appearance should be due to grooming, it should not have been a result of the actual procedure. Hair should never be transplanted perpendicular to the scalp. I discussed these important concepts way back in my 1997 paper “The Aesthetics of Follicular Transplantation“.

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Hair Restoration Answers

After Hair Transplant Is There Shock Hair Loss In Donor Area?

April 23rd, 2013

Q: I have seen through forums that a hair transplant gives severe shock loss in the donor zone (especially behind ears) after the surgery. Doctors say it is temporary and can last about six months or more. Frankly, do you believe in this? Will the donor shocked hair recover? — M.D., Darien, C.T.

A: It depends if you are speaking about follicular unit hair transplantation using strip harvesting (FUT) or Follicular Unit Extraction (FUE). With FUT, it is extremely uncommon to have any shock hair loss in the donor area. This could occur if the hair transplant procedure was done improperly, i.e. the donor area was closed too tightly. In this case, some hair loss may be permanent. This is one of the reasons that very large hair transplant sessions are unwise. Shock hair loss in FUE is more common, but is generally not significant and should eventually recover completely.

That said, some shock hair loss in the recipient area is quite common with either hair restoration procedure (FUT or FUE). This is particularly the case if there is a lot of existing miniaturized hair (hair that is starting to thin) in the transplanted area.

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Hair Restoration Answers

What is the Incidence of Hair Loss in Adults?

April 5th, 2013

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.

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Hair Restoration Answers

Can Andro Gel Cause Hair Loss?

March 29th, 2013

Q: The last few months my friend and I experimented with andro gel thinking it would make our T levels go up and make our work outs better. We got the andro gel online with no prescription (which I know is really stupid on our behalf). The past couple of months I have been experienced a lot of acne and hair loss. I went to the doctor and confessed and said what I did, and he was very disappointed and lectured me on how dangerous it was and stupid on my behalf – which I totally agree. He told me the rise in testosterone from andro gel contributed to the acceleration of hair thinning and acne. I had mild hair loss prior but the andro gel seem to have accelerated it. The doctor put me on Propecia and gave me some acne cream for the acne. He said the Propecia will undo some of the damage it did for the hair. In your experience, can Propecia reverse some of the damage? I am 28 years old.

A: Your doctor is giving you the right course of action. Testosterone supplements can accelerate hair loss, particularly in those with underlying genetic hair loss. Finasteride 1mg (Propecia) should help you to grow your hair back. You may also want to consider using minoxidil (Rogaine) in addition.

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Hair Restoration Answers

What is Female Androgenetic Alopecia?

March 25th, 2013

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.

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Hair Restoration Answers

Can You Program the FUE Robot To Avoid Scars?

March 21st, 2013

Q: I heard that for someone who has had several strip procedures, the ARTAS robot for FUE does not work because it is programmed to work with “textbook male pattern baldness”, which I no longer have. I thought the scars from previous procedures, as well as the large amount of already transplanted hair, might throw off the robot’s programming (it wouldn’t quite know what to do). But if I am wrong about this then the robot may in fact be the best approach for me. Please advise. — N.C., Paris, France

A: When performing robotic hair transplants on patients with prior surgery, I program the robot to avoid scarred areas – just as we would do visually when performing manual FUE.

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Hair Restoration Answers

Will I Need Multiple FUE Hair Transplants Over Time?

March 18th, 2013

Q: I’ve noticed from the chatter on blogs, that it is not uncommon for men to go through multiple FUE procedures over 10+ year time-frame. It seems to be that after the initial FUE procedure to address moderate hair loss, the patient continues their natural balding to where they must undergo another FUE procedure in order to get back to their desired look. I’m almost 33 and while I take Propecia, my hair loss has been very gradual since I was about 26. I still have what many would consider a full head of hair, although very thin and with noticeable loss at my temples and crown. I’d always thought that a hair transplant would be a “1 and done” procedure, and now I’m concerned that if I do an FUE procedure now to replace what’s been already lost, I’ll just have to revisit a subsequent FUE down the line. Are ongoing FUEs simply part of the hair maintenance that a patient needs to accept about hair restoration process? — A.A., New Hyde Park, N.Y.

A: Your concerns are correct and would apply to any hair transplant procedure; FUT or FUE. That is why it is best not to begin hair restoration surgery too early.

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Hair Restoration Answers

Is Propecia Persistent Side Effects Study Reported in the Media Flawed?

March 15th, 2013

Q: As a Propecia user, I was alarmed when I read headlines last year about a new study indicating very high rates of depression and erectile dysfunction caused by Propecia, with symptoms persisting even after the drug was stopped. However, when I read the articles, this “study” appeared to be survey of 61 men who had taken Propecia and already reported sexual problems who were then asked about symptoms of depression. These rates of depression were compared to a small survey of men who had hair loss but had never taken Propecia.

Anyone with a basic understanding of statistics would know such a survey was deeply flawed. First, it is a textbook example of a bad data sample — to get sound results you have to start with an unbiased and random group of people who took the drug, not a self-selected group of men already suffering symptoms. The study also confuses correlation with causation — because these men are suffering from ED or depression does not necessarily mean it was caused by the drug. Am I missing something here, or did the media just report these “findings” with no scrutiny on what was actually studied? — Jonathan, Brooklyn, NY

A: Jonathan, I think you’re right on the mark. The way the study was conducted raises a lot of concern about the accuracy of the findings. It is really important that additional data is obtained in a controlled way, as this will be most useful for physicians in advising patients. I addressed concern on these reports last year. The issue of persistent sexual dysfunction as a side-effect of finasteride (Post-Finasteride Syndrome) is an on-going issue that we take very seriously. I sit on the International Society of Hair Restoration Surgery (ISHRS) Task Force on Finasteride Adverse Events, so this is an issue that we watch very closely.

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Hair Restoration Answers

Why Recommend FUT Not FUE If I Have No Linear Scar?

March 1st, 2013

Q: If I have no linear scar and I can exercise right away, why would you ever recommend FUT instead of FUE? — H.T., Dover, M.A.

A: I advise FUT because the grafts are of better quality (less transaction and more support tissue surrounding the follicle) and because more hair can be obtained from the mid-portion of the permanent zone –- which is where the hair is the best quality and most permanent. For the majority of patients a linear scar buried in the donor hair is not an issue. Each patient has to weigh the pros and cons of each procedure when making a decision.

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