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Bernstein Medical - Center for Hair Restoration
Dr. Bernstein answers frequently asked questions about hair transplantation, hair loss, and medical treatment for hair loss.
Hair Restoration Answers

What Is Your Opinion on Doctors Performing Only FUT or Only FUE?

June 22nd, 2015

Q: It seems that some doctors offer only FUT and others only FUE. What is your opinion on that? — D.E., Portland, M.E.

A: Both FUT and FUE are excellent techniques, but have different indications. To deliver the best care for our patients, hair restoration physicians should have expertise in both procedures, and they should offer both in their practices.

Update: I have expanded the answer to this question in a new Answers post.

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Hair Restoration Answers

Does Propecia Work in Older Patients?

June 20th, 2015

Q: Hi. I am 52 years old and wish to know if Propecia will work for people my age. I have started losing some hair a couple of years ago and it’s thinning out. Thank you very much for your help. — K.E., Boca Raton, FL

A: Propecia (Finasteride 1 mg) can hold on to hair at any age, but works best to re-grow hair in those who are younger.

The reason is that finasteride works to reverse miniaturization (the thinning and shortening of hairs due to DHT). Younger patients, with early hair loss, generally have more hair in the early stages of miniaturization where the changes are readily reversible.

Older patients are more likely have more advanced miniaturization or areas that are totally bald and will thus not regrow with medical therapy.

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Hair Restoration Answers

What is Platelet-Rich Plasma (PRP) and How Does It Promote Hair Growth?

June 17th, 2015

Q: I’ve heard a lot about platelet-rich plasma (PRP). What is platelet-rich plasma, and how does it promote hair growth? — A.V., Scarsdale, NY

A: To begin, first let’s define a few basic terms: blood plasma, platelets and PRP

What Is Blood Plasma?

Blood plasma holds the blood cells in a liquid suspension. Blood plasma makes up about 55% of the body’s total blood volume. There are three basic types of blood cells: red blood cells (that carry oxygen), white blood cells (that have immune functions to help fight infection) and platelets (that facilitate coagulation, wound healing and repair).

What is a Platelet?

A platelet is a type of white blood cell containing approximately 50 to 80 tiny encapsulated structures called alpha-granules. Each alpha-granule contains a high number of growth factors, many playing a fundamental role in healing following tissue damage.[1] Many of these platelets are also known to regulate the growth cycle of hair follicles.[2]

Platelets are formed in the bone marrow and circulate throughout the bloodstream in a concentration of approximately 140,000 to 400,000 platelets/mm3.

What is Platelet-Rich Plasma?

Derived from a patient’s own blood plasma, platelet rich plasma is concentrated blood plasma which contains approximately five times the number of platelets and growth factors normally found in the blood.

How Does Platelet-Rich Plasma Work to Promote New Hair Growth?

Studies that have looked at the therapeutic effects of PRP on hair loss have found that it promotes hair survival and hair growth in both laboratory studies[3] and human clinical trials, but exactly how PRP promotes new hair growth isn’t clear. Researchers have suggested a few possible mechanisms.

In a recent pilot study[4] that found that PRP injections resulted in noticeable improvement in both males and females with androgenetic alopecia, researchers suggested that PRP may have stimulated hair growth by prolonging the anagen (growth) phase of the hair follicle.

In another study[5] that showed PRP promoted hair growth in males with alopecia, researchers suggested that PRP may have protected the hair follicles against one of the possible main mechanisms of pattern hair loss: the death of dermal papilla cells in the hair follicle.[6] The death of these cells leads to a gradual shrinking and eventual disappearance of the hair shaft, a process called miniaturization.

Other studies have observed that PRP seems to promote the growth of new blood vessels around treated hair follicles. Because of this, researchers have suggested that the growth of new blood vessels may be helping to stimulate new hair growth.[7]

In sum, while published studies so far suggest that PRP therapy is a safe and effective treatment option for male and female androgenetic alopecia, there is still a need for more extensive studies to better understand the mechanism by which PRP treatments promote hair growth.

References:
  1. Eppley BL, Pietrzak WS, and Blanton M. Platelet-Rich Plasma: A Review of Biology and Applications in Plastic Surgery. Plastic and Reconstructive Surgery, 2006. []
  2. Itami S, Kurata S, Takayasu S. Androgen induction of follicular epithelial cell growth is mediated via insulin-like growth factor-I from dermal papilla cells. Biochem Biophys Res Commun. 1995; 212: 988–94. []
  3. Li ZJ, Choi HI, Choi DK et al. Autologous platelet-rich plasma: a potential therapeutic tool for promoting hair growth. Dermatol Surg 2012; 38: 1040–6. []
  4. Schiavone G, Raskovic D, Greco J, Abeni D. Platelet-rich plasma for androgenetic alopecia: a pilot study. Dermatol Surg. 2014; 40(9): 1010-9. []
  5. Cervelli V, Garcovich S, Bielli A, Cervelli G, Curcio BC, Scioli MG, Orlandi A and Gentile P. The effect of autologous activated platelet rich plasma (AA-PRP) injection on pattern hair loss: clinical and histomorphometric evaluation. BioMed Research International 2014; 1-9 []
  6. Whiting DA. Possible mechanisms of miniaturization during androgenetic alopecia or pattern hair loss. J Am Acad Dermatol. 2001 Sep;45(3 Suppl):S81-6. []
  7. L. Mecklenburg, D. J. Tobin, S.Muller-Rover, et al. “Active hair growth, anagen, is associated with angiogenesis.” Journal of Investigative Dermatology 2000, 114:5; 909–916. []
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Hair Restoration Answers

Which Platelet Rich Plasma (PRP) System Do You Use?

June 11th, 2015

Q: I have seen some talk about different forms of platelet rich plasma (PRP). Which is the best system for preparing PRP for hair loss? Which are you using? — E.C., Seattle, WA

A: We use the Emcyte Pure PRP system. It is a double centrifuge system that I think is the best.

Platelet Rich Plasma (PRP) FAQ
See the PRP Treatment Slideshow

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Hair Restoration Answers

Can I Have Platelet Rich Plasma Therapy Instead of Hair Transplant Surgery?

June 11th, 2015

Q: It was recommended by the doctor that I have a hair transplant. Can I do platelet rich plasma (PRP) instead? — W.D., Denver, CO

A: PRP will generally be inadequate for patients who are candidates for a hair transplant. PRP works to reverse miniaturization (thinning hair) as do other medical treatments (Propecia, Rogaine, LLLT). Unfortunately, medical treatments do not grow hair back once it has been lost.

Platelet Rich Plasma (PRP) FAQ

See the PRP Treatment Steps

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Hair Restoration Answers

Does Platelet Rich Plasma (PRP) Therapy For Hair Loss Involve Surgery?

June 10th, 2015

Q: How is platelet rich plasma therapy for hair loss performed? Does it involve surgery? — T.A., Tribeca, NYC

A: Platelet rich plasma (PRP) therapy for hair loss is performed during a simple office visit, takes about 30-45 minutes, and does NOT involve surgery.

The first step in PRP treatment for hair loss involves drawing a patient’s blood into a syringe.

Next we use a double-centrifuge platelet concentration system (the Emcyte Pure PRP system) to separate and then concentrate platelet-rich plasma from the blood.

The last step involves transferring the platelet-rich plasma into a syringe and then injecting the plasma directly into the patient’s scalp.

After the treatment, some patients may experience very temporary soreness and/or swelling, but many patients will experience nothing.

After the initial treatment, patients will typically receive two more treatments at 6 week intervals. After that, they will receive additional treatments every 3 months over the course of the first year. After the first year, patients will receive treatments approximately every 6 months.

Platelet Rich Plasma (PRP) FAQ

See the PRP Treatment Steps

Read about the latest research into PRP therapy for hair loss

Read more in our section on Platelet Rich Plasma

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Hair Restoration Answers

Are There Any Side Effects or Safety Concerns in Using PRP to Treat Hair Loss?

April 20th, 2015

Q: I’ve heard about using platelet rich plasma (PRP) therapy to treat hair loss. Are there any potential serious side effects that I should be aware of? — L.S., Roslyn, Long Island, NY

A: PRP is a therapy that has been used since 1987 to help promote the healing of hard tissue (bone, joints) and soft tissue (skin). To date, there have been no reported major side effects.[1]

Only a handful of published studies have tested PRP’s effectiveness and safety in treating hair loss; however, none of those studies have reported serious side effects.[2],[3],[4],[5],[6],[7]

This lack of any reported major side effects coupled with the fact that PRP is obtained from a patient’s own blood makes doctors relatively confident that PRP treatments are safe for hair loss.[8]

All this said, researchers are continuing to evaluate both the efficacy and the safety of PRP therapy for the treatment of male and female pattern baldness.

References:
  1. Hall MP, et al “Platelet-rich Plasma: Current Concepts and Application in Sports Medicine” J Am Acad Orthop Surg, Vol 17, No 10, October 2009, 602-608. []
  2. Kang JS1, Zheng Z, Choi MJ, Lee SH, Kim DY, Cho SB. The effect of CD34+ cell-containing autologous platelet-rich plasma injection on pattern hair loss: a preliminary study. J Eur Acad Dermatol Venereol. 2012 Jan;28(1):72-9 []
  3. V. Cervelli, S. Garcovich, A. Bielli, G. Cervelli, B. C. Curcio, M. G. Scioli, A. Orlandi, P. Gentile. “The effect of autologous activated platelet rich plasma (AA-PRP) injection on pattern hair loss: clinical and histomorphometric evaluation,” BioMed Research International Volume 2014 []
  4. Khatu S.S, More Y.E, Gokhale N.R, Chavhan D.C, Bendsure N. Platelet-rich plasma in androgenic alopecia: myth or an effective tool. J Cutan Aesthet Surg. 2014 Apr;7(2):107-10. []
  5. Schiavone G, Raskovic D, Greco J, Abeni D. Platelet-rich plasma for androgenetic alopecia: a pilot study. Dermatol Surg. 2014 Sep; 40(9):1010-9. []
  6. Takikawa M, Nakamura S, Nakamura S, Ishirara M, Kishimoto S, Sasaki K, Yanagibayashi S, Azuma R, Yamamoto N, Kiyosawa T. Enhanced effect of platelet-rich plasma containing a new carrier on hair growth.Dermatol Surg. 2011 Dec;37(12):1721-9 []
  7. Trink A, Sorbellini E, Bezzola P, Rodella L, Rezzani R, Ramot Y, Rinaldi F. A randomized, double-blind, placebo- and active-controlled, half-head study to evaluate the effects of platelet-rich plasma on alopecia areata. Br J Dermatol. 2013 Sep;169(3):690-4. []
  8. Platelet-rich plasma: Clarifying the issues. The American Academy of Orthopaedic Surgeons website, www.aaos.org, September 2010. []
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Hair Restoration Answers

Does Finasteride Need to be Taken Every Day?

April 13th, 2015

Q: Does finasteride need to be taken every day? — M.B., Atlanta, GA

A: Finasteride (Propecia) is a competitive inhibitor of Type II, 5 alpha-reductase (5AR is the enzyme that converts Testosterone to DHT which then causes hair to miniaturize and eventually be lost). Finasteride is 100x times more selective in inhibiting the Type II enzyme (present in hair follicles) than the Type I enzyme (present in other body tissues). The turnover (T1/2) of the finasteride/5AR Type II complex is 30 days and the finasteride/5AR Type I complex is 15 days. This explains why finasteride does not need to be taken every day and why, after stopping finasteride, the effects may take a month or longer to begin to disappear.

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Hair Restoration Answers

How Does Platelet Rich Plasma (PRP) Treat Androgenic Alopecia?

April 13th, 2015

Q: How does PRP therapy for hair loss work? — B.T., Upper West Side, NYC

A: In theory, platelet rich plasma (PRP) stimulates the growth of hair follicles by reversing the hair miniaturization (thinning hair) process seen in androgenic alopecia (common baldness).

While it is not exactly known how PRP reverses miniaturization, researchers do have a few ideas. First, PRP may counteract miniaturization by prolonging the growth (anagen) phase of hair follicle.[1] Second, PRP has been observed to increase the number of stem cells in hair follicles. This is known to help protect a hair follicle from apoptosis, a natural process of programmed cell death. Researchers think that this anti-apoptotic effect could stimulate new hair growth.[2] Finally, PRP treatment has been observed to promote growth of new blood vessels around treated hair follicles. Researchers have suggested that this could also stimulate new hair growth.[3]

In sum, a number of factors may come into play to effect new hair growth during treatment with platelet rich plasma. Research is ongoing to further clarify the specific mechanisms involved.

References:
  1. Z. J. Li, H.-I. Choi, D.-K. Choi et al., “Autologous platelet-rich plasma: a potential therapeutic tool for promoting hair growth.” Dermatologic Surgery, vol. 38, no. 7, part 11, pp. 1040–1046, 2012. []
  2. Takikawa M, Nakamura S, Nakamura S, et al. “Enhanced effect of platelet-rich plasma containing a new carrier on hair growth.” Dermatol Surg. 2011 Dec;37(12):1721-9. []
  3. L. Mecklenburg, D. J. Tobin, S.Muller-Rover, et al. “Active hair growth (anagen) is associated with angiogenesis.” Journal of Investigative Dermatology, vol. 114, no. 5, pp. 909–916, 2000. []
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Hair Restoration Answers

Why is Robotic Recipient Site Creation an Advantage?

April 9th, 2015

Q: Why is using the robot to create recipient sites useful in a hair transplant? — S.K., Jersey City, NJ

A: The ARTAS® Robotic Hair Transplant system eliminates the inconsistencies inherent in creating large numbers of recipient sites by hand. The robot can create sites at a rate of up to 2,000 per hour. Although there is more set-up time compared to sites made manually, once the physician specifies the parameters such as punch depth, punch angle, and site direction, recipient site creation is precise and rapid.

One of the benefits of robotic site creation is that the distribution of grafts over a fixed area of the scalp can be exact. For example, if one wants to transplant 1,000 grafts evenly over 50cm2 of area, this can be done with great precision and with uniform site spacing. In addition, the physician can vary the densities in select regions of the scalp and the robot will adjust the densities in other areas so that the total number of sites remains the same.

Another benefit of the new technology is that the robot can be programmed to avoid existing hair and select which specific hair diameters to avoid. The robot is programmed to keep a specified distance from the existing hair to ensure that the resident follicles will not be damaged and that the distribution of new hair is even and natural. This computerized mechanism appears to be more accurate than what can be done by hand and, importantly, does not sacrifice speed in the process.

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