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Hair Restoration Answers

Dr. Bernstein and Dr. Shaver answer frequently asked questions about hair transplantation, hair loss, and medical treatment for hair loss.
Hair Restoration Answers

Do Propecia (Finasteride) and Rogaine (Minoxidil) Work on Front of the Scalp?

Q: I have done a lot of research over the past year including seeing a dermatologist and receiving consultation from a surgeon. Both recommended Propecia and Rogaine. After my consults I researched these products online and read that they do not work on the front of the scalp to improve my receding hairline, only to regrow hair in the crown area. Can you settle the issue once and for all? Do Propecia and Rogaine work on the front of the scalp? Can they improve my receding hairline? — J.S., Great Falls, Virginia

A: Both Propecia and Minoxidil definitely can work in the front of the scalp as long as there is some hair in the area. Although their mechanisms of action are different, both Propecia (finasteride) and Rogaine (minoxidil) act to thicken miniaturized hair regardless of where it is on the scalp. In fact, there are published data ((Leyden, James et al. “Finasteride in the treatment of men with frontal male pattern hair loss.” J Am Acad Dermatol. 1999 Jun;40(6 Pt 1):930-7.)) demonstrating this improvement with finasteride in a controlled clinical trial of men with frontal hair loss.

The source of the confusion is that the FDA limited the application of the drugs to the crown on the package inserts for both Propecia and Rogaine. The FDA did this because Upjohn (the company that introduced Rogaine) and Merck (Propecia) only tested the medications on the crown in the clinical trials. Logically, the fact that DHT causes frontal hair loss and Propecia works by blocking DHT gives a reasonable explanation for the efficacy of the drug on the front of the scalp. Also, a side effect of the use of minoxidil is facial hair, so how could it not also work on the front of the scalp? It is regrettable that some doctors and many patients think that these medications won’t work on the front of the scalp. Unfortunately, many hair restoration surgeons have done little to educate the public and dispel this myth.

To reiterate, yes, both of these medications can work on the front of the scalp to prevent hair loss and thicken a thinning hairline. However, it is important to note that neither of these medications can grow hair on a totally bald scalp or lower an existing hairline. Hair follicles must exist for the medications to work. It is also important to stress that the best results come from using both finasteride and minoxidil together.

Hair Restoration Answers

Does Propecia Cause Infertility?

Q: I’ve heard that FDA added a description of reports of male infertility to the side effect labels of both Propecia and Proscar (finasteride). Is this a likely side effect in your experience? — S.S., Rolling Hills, California

A: Propecia (finasteride 1mg) may lead to male infertility not only by changing the consistency of the male ejaculate but by decreasing the sperm count as well, but this is uncommon.

Ejaculate is a combination of sperm produced by the testes and a viscous fluid made by the prostate. Since finasteride shrinks the prostate, it can make the ejaculate less viscous (more watery).

Most patients trying to conceive will have no issues while taking Propecia.

If one is having difficulty trying to conceive for 4-6 months, then it is reasonable to stop taking Propecia.

It is important to know that taking Propecia while trying to conceive will not lead to congenital deformities or issues with the fetus as long as the woman does not come in direct contact with the medication.

Hair Restoration Answers

Can A Hair Transplant Completely Replace My Lost Hair?

Q: I have a significant amount of hair loss. Can a hair transplant make me look exactly the way I did before I lost my hair? — V.S., Fairfield, C.T.

A: In most cases, the answer is no. All surgical hair restoration procedures move hair – they cannot create new hair. Specifically, surgical hair transplantation takes existing hair from the donor area (located in the back and on the sides of the scalp) and moves (transplants) them to the part of the scalp that has lost hair. It is usually the case that there is not enough hair in one’s donor area to replace all lost hair. That said, in persons with extensive hair loss, the restoration can often produce a dramatic improvement in one’s appearance.

Hair Restoration Answers

Can A Hair Transplant Damage Existing Hair Follicles In A Thinning Area?

Q: My hair is thinning, but I’ve been told I have too much existing hair to warrant a hair transplant. I heard that transplanting new hair into my thinned areas will lead to a loss of existing hair follicles. I was told to delay a hair transplant procedure until my density has further decreased. Is this true? — M.S., Maple Glen, P.A.

A: A hair transplant does not cause loss of hair follicles in the recipient area. The procedure may cause a temporary “shock” loss of the hair. Shock hair loss is a physiologic response to the trauma to the scalp which is caused by a hair transplant. Hair that is healthy is going to come back after some period of time – generally 6 months. Hair that may be near the end of its lifespan may not return. When a hair transplant is performed at the proper time, in the proper candidate, shock hair loss should just be an incidental issue.

It is possible that you simply don’t need a hair transplant at this time. If you have early thinning, it may be best treated with medication, or not at all. As you age, we will have a better idea of your thinning pattern and, at that time, a hair transplant may be more appropriate.

Hair Restoration Answers

Can You Transplant More Grafts With Robotic FUE Or Manual FUE?

Q: Is robotic FUE different in the number of follicular unit grafts one can extract compared to manual FUE? — R.V., Stamford, CT

A: We can extract (and transplant) the same number of follicular unit grafts robotically as we can manually?

The goal of a hair transplant is not to simply transplant as many grafts as possible but to achieve the best possible cosmetic result given the number of hair follicles in your donor reserve. Remember, this is always a limited supply.

While there is no difference between robotic and manual FUE in terms of the number of follicular unit grafts that each can extract, robotic FUE does differ from manual FUE in several important ways.

First, there is generally less transection of the hair follicles with robotic FUE, since the method is more precise. This enables us to obtain follicular units with less trauma to the grafts.

Second, while the robot is not necessarily faster than the human surgeon, the robot is much more consistent since, unlike the human surgeon, it never fatigues and the accuracy is maintained throughout the entire procedure.

Read more about Robotic Hair Transplant

Hair Restoration Answers

How Long Do Stitches Stay in After a Hair Transplant?

Q: I’ve heard that healing after a hair transplant requires stitches. How long will they stay in? — S.R., Cresskill, N.J.

A: In a Follicular Unit Transplant (FUT), the surgeon removes a thin strip of scalp from the patient’s donor area that supplies the follicular unit grafts for the hair transplant. After the strip is removed we use either sutures (stitches) or staples to close the wound.

We now close most wounds in the donor area with staples, rather than sutures, because we have found that staples cause less injury to the remaining hair follicles compared to sutures; therefore, more hair will be available for future hair restoration sessions. For more about sutures vs. staples, see Why We Changed from Sutures to Staples in FUT Hair Transplants.

Hair Restoration Answers

Going Bald. Do You Perform a Test for LPP (Lichen Planopilaris)?

Q: Hi Dr. Bernstein, I am a 30 year old man with a balding crown. I’m 99.9% sure its male pattern baldness (I’m currently on Propecia and Rogaine). I recently read about how people going bald are getting tested for LPP (lichen planopilaris). Do you perform this test? — F.L., Scarsdale, NY

A: Lichen Planopilaris (believed to be a type of autoimmune disease) occurs more frequently in women than in men and more commonly in African-Americans than in Caucasians. The variation that could be confused with androgenic alopecia in men is central centrifugal cicatricial alopecia (or CCCA). While definitive testing would involve a scalp biopsy, this is rarely necessary as the doctor can easily tell by just examining you with the naked eye using magnification (densitometry).

Hair Restoration Answers

What’s the Outlook on a Hair Transplant Robot Performing the Entire Procedure?

Q: I understand that in robotic hair transplantation, a robot performs the extraction part of the FUE procedure. What’s the outlook on the robot doing more of the hair transplant procedure? — B.B., Greenwich, CT

A: Currently, the ARTAS® Robotic System is a technology for extracting grafts. This is the most difficult part of a follicular unit extraction procedure, but it is only one part.

There are two other major parts to the FUE procedure: one part is the creation of recipient sites (in our practice, we create the recipient sites first, so that once we harvest the grafts, we can immediately place them into the scalp), and the other part is graft placement.

Recipient site creation involves more than merely making holes in the recipient area. It involves making decisions on hairline design, graft distribution, hair direction, recipient site size and depth. When done manually, the surgeon first designs the new hairline so that the hair transplant will look as natural as possible, particularly as the person ages. Next, the surgeon will demarcate the extent of the area to be transplanted and decide on the graft distribution (i.e., how much hair will be placed in each part of the scalp) and will then prepare a “recipient site” in the part of the scalp that has lost hair. The surgeon will then manually create incisions in the recipient site into which the follicular units will be placed.

On February 8, 2014, Dr. Bernstein unveiled “recipient site” creation capabilities of the hair transplant robot. These new capabilities allow the doctor to import a hairline design and other markings that have been made on the patient’s scalp directly into the robot. The robot then maps the design onto a precise 3-D model of the patient’s head. The physician can then program the proper distribution, direction and depth of the future recipient sites and the robot then creates the sites according to the physician’s specifications.

Graft placement, the last step, is perhaps the most challenging to automate. Engineers are currently working to design and build the capacity to automate the placement of extracted follicular units into recipient site incisions. Done manually, it requires significant hand-eye coordination and a very slow learning curve. For the hair transplant robot, it will be a significant challenge with development taking several years or more.

Read more about Robotic Hair Transplant

Hair Restoration Answers

Compared to Manual FUE, Does Robotic Transplanted Hair Grow Faster?

Q: Does transplanted hair grow faster after robotic FUE? — P.P., Flatiron, NY

A: There is no difference in the rate of growth between manual FUE verses robotic FUE. However, with Robotic FUE, the actual growth should be better due to less transection, i.e., less damage to follicles during the harvest.

In general, one can expect transplanted hair to start to grow within two to five months with the transplanted hair taking on its final appearance after approximately one year.

Hair Restoration Answers

How Experienced Are Bernstein Medical Hair Restoration Technicians?

Q: I know Dr. Bernstein is one of the leading hair restoration surgeons in the country, but what about his medical assistants? How experienced are the hair restoration technicians that help him during surgery? — E.N., Redding, C.T.

A: My medical assistants and technicians are full time employees, and many of them have worked closely with me for many years. In fact, many of them have been with me since the inception of FUT, the procedure I pioneered way back in 1995. I do not hire, nor have I ever hired, per diem technicians.

All my hair restoration technicians are highly skilled and experienced in stereo-microscopic dissection and follicular unit graft placement. Even with Robotic FUE, being highly skilled and experienced in stereo-microscopic dissection is important since every graft that the robot harvests is examined, counted, and, when necessary, trimmed to ensure they are of the highest quality before being implanted into the scalp.

Because of the intense in-house training of our staff, we have received national accreditation from the “Accreditation Association for Ambulatory Health Care” (AAAHC/Accreditation Association) for maintaining rigorous standards in patient care.

Read more about how we train our surgical staff.

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Address

110 E. 55th Street, 11th Floor
Between Park Ave and Lexington
New York, NY 10022

Phone

(212) 826-2400

Clinic Hours

Monday – Friday
8:00 AM – 4:30 PM

Facebook Twitter Youtube Instagram

Services

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Contact Us

  • This field is for validation purposes and should be left unchanged.

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