Q: Does a man’s height and weight affect the dose of finasteride or Propecia he should take? i.e. will a 6’4″ man need a higher dose than a 5’7″ man. ~ T.B. — Rye Brook, NY
A: The dose of finasteride is the same (i.e. 1mg) regardless of a person’s height or weight. The reason is that one needs only 0.5mg a day for it to be effective, so there is much leeway built into the dose (but the rate of non-responders is slightly higher at the 0.5mg/day dose). That said, after 5 years or so, finasteride seems to be less effective and doctors often increase the dose a bit. The next step-up is generally to take 1/3 of a 5mg pill each day. Keep in mind that the dosing we are speaking about is for hair loss (androgenetic alopecia). When finasteride is used for prostate enlargement, the dose is 5mg a day.
Dr. Bernstein appears on The Bald Truth where he discusses the advantages of creating recipient sites prior to follicular unit harvesting in an FUE hair transplant procedure. By allowing recipient sites to begin healing, “pre-making” the sites helps avoid graft popping and potentially reduces mechanical injury during graft insertion.
Synopsis: The current robotic system harvests follicular unit grafts in a random manner. A new capability of the ARTAS robot is to select follicular units based on the number of hairs they contain, in order to increase the hair/wound yield. This bilateral controlled study of 24 patients was designed to evaluate this functionality. Results showed that, compared to random follicular unit harvesting, robotic follicular unit graft selection produced more hairs per harvest attempt (2.60 vs. 2.22) and more hairs per graft (2.72 vs. 2.44). The clinical benefit was statistically significant at p<.01.
Q: I have a diagonal scar in the middle of my donor area that I got during a childhood accident and I am concerned that it will limit my options for hair restoration. Will this type of scar prevent me from having either FUT or FUE? Do you recommend one or the other? — R.F., Upper West Side, NY
A: Traumatic scars in the donor area do not preclude us from performing a hair transplant. With an FUT/strip procedure, we can remove all or part of the scar when we excise the donor strip. In Robotic FUE, the ARTAS Robot can be programmed to avoid a scar during harvesting. In either procedure, we can improve the appearance of the scar by implanting follicular unit grafts directly into the scar tissue. The hairs will grow permanently in the scar, just like ones we implant in the recipient area, and the scar will become harder to detect.
It is important to note that transplanted hair will not grow in a thickened scar. If your scar is thickened, the doctor can thin it out (soften it) with injections of cortisone. They are usually repeated at 4-6 week intervals in advance of the procedure. The number of injection sessions required depends upon the thickness of the scar and your individual response to the medication.
The presence of a traumatic scar should generally not determine which type of transplant you have. That should be decided in consultation with your physician based on factors such as how much volume you need, how you intend to style your hair, how short you would like to keep it, how soon you need to return to strenuous physical activity, and other general considerations for a hair transplant.
We recently posted photos from a patient who had a robotic hair transplant with a scar in his donor area. The photos include images of his donor area (with scar) before his procedure, immediately after robotic graft harvesting and 11 days post-op. View this patient’s before after photos.
Hair transplant pioneer Dr. Robert M. Bernstein and his colleague Dr. William R. Rassman have received a patent on a new method that improves the outcome of Follicular Unit Extraction (FUE) – the type of procedure used in half of all hair transplants performed world-wide. The key invention is the addition of a delay between the creation of recipient sites and the insertion of follicular units into those sites. The delay allows the healing process to commence before grafts are inserted, resulting in increased success of the transplant and an improved outcome.
Q: I am an MMA fighter and I want to get a hair transplant. How long do I have to be out of commission and which type of procedure should I have, FUE or FUT? — J.A., Columbus, OH
A: With any type of hair transplant it takes 10 days for the transplanted grafts to be permanently fixed in place. The difference between FUE and FUT is in the limitations of activity due to the donor area. With FUE one would need to abstain from MMA for the same 10 days it takes the recipient area to heal (the grappling component of Mixed Martial Arts is the most stressful on the scalp). With FUT, however, one would need at least three months for the linear donor scar to heal before one could resume contact sports like MMA.
Dr. Bernstein demonstrates how he harvests follicular units below the occipital protuberance in the donor area on the back of the scalp using Robotic FUE techniques and describes how he positions the patient enabling the ARTAS® Robotic Hair Transplant System to harvest from the lower portion of the donor area.
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.
Q: How can I better understand how I will look after my hair transplant before I actually do the procedure? — E.M. ~ Wantagh, N.Y.
A: A key part of a hair loss evaluation is for the doctor to manage the patient’s expectations for possible benefits from both medication and surgery. The way we decide how to plan a hair transplant is through a careful history and examination, demarcating the extent of the hair transplant on the patient’s actual head and photographing it. When showing other photo results to patients, it is important to not only show before and after photos of the recipient area but also of the donor area; how the back of the head looks immediately after the procedure, at post-op intervals, and at different hair lengths. Most importantly, one should point out that every patient is different so that a picture of another person does not necessarily represent what you might achieve.
Q: What is the problem with transplanting the crown too early? — P.L., Newark, NJ
A: If a person’s hair loss continues –- which is almost always the case -– the crown will expand and leave the transplanted area isolated, i.e. looking like a pony-tail. The surgeon can perform additional hair transplant procedures to re-connect the transplanted area to the fringe, but this is a large area that can require a lot of hair, and it is often impossible to determine when a person is young if the donor supply will be adequate. View the full post to see a photo of a patient who had an early hair transplant to his crown.
Hair transplant pioneer Dr. Robert M. Bernstein and his colleague Dr. William R. Rassman have received a patent on a new method that improves the outcome of Follicular Unit Extraction (FUE) – the type of procedure used in half of all hair transplants performed world-wide. The key invention is the addition of a delay between the creation of recipient sites and the insertion of follicular units into those sites. The delay allows the healing process to commence before grafts are inserted, resulting in increased success of the transplant and an improved outcome.
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.
