Dr. Bernstein was interviewed by Spencer Kobren on The Bald Truth, the critically acclaimed broadcast on hair loss and hair restoration. They discussed the latest in robotic hair transplant surgery, the ARTAS Robotic System, FUE and FUT hair transplant procedures, and the future of hair restoration.
Dr. Bernstein was interviewed by Spencer Kobren on The Bald Truth, the critically acclaimed broadcast on hair loss and hair restoration. They discussed the latest in robotic hair transplant surgery, the ARTAS Robotic System, FUE and FUT hair transplant procedures, and the future of hair restoration.
The follicular unit extraction (FUE) procedure consists of four steps: the separation of follicular units from the surrounding tissue, the removal of follicular units from the scalp, the creation of recipient sites, and the placement of follicular units into these sites. The first step is performed by the ARTAS robotic hair transplant system – the part of the FUE procedure requiring the greatest precision and that is most subject to human error.
While grafts can fall out within the first few days after a hair transplant, this is extremely rare. More often, patients will mistake the hair that normally falls out after a transplant for the graft itself. This is because the hair has a little bulb at the bottom of it, but that’s not the follicle; it’s just the root sheath, so it is nothing to be concerned about.
At Bernstein Medical, generally, we don’t perform surgical hair restoration on patients younger than 25. This is because it is difficult to determine if the donor area contains enough stable hair to perform a hair transplant. We advise patients in their late teens and early twenties to first use medication and to postpone surgery until they are at least 25 years old.
Recent news reports, coupled with warnings from Merck and the FDA, about Propecia’s possible persistent sexual side effects have caused growing concern about this popular hair loss treatment. An increasing number of men now fear that Propecia (finasteride 1mg) will cause permanent sexual dysfunction.
A 2014 meta-analysis, however, found that the number of self-reported cases of persistent sexual dysfunction by patients given finasteride was statistically no different from the number reported by patients given a placebo.
This latest research supports the conclusion of existing literature that there is no correlation between finasteride use and persistent or permanent sexual dysfunction. That said, this is an important issue that still needs to be studied.
Diffuse patterned hair loss (DPA) is characterized by hair loss (thinning) across the top of the scalp while the hair on the sides and back of the scalp remain intact. Because donor hair is taken from the sides and back of the scalp, those with a DPA hair loss pattern are often good candidates for surgical hair transplantation. Diffuse unpatterned hair loss (DUPA), on the other hand, is characterized by hair loss not only from the top of the head but also from the sides and back of the scalp. Because persons with DUPA hair loss have thinning on the sides and back, they are usually not good candidates for a hair transplant. DUPA is relatively uncommon in men but it is the most common type of hair loss in women. Both DPA and DUPA in men respond well to medical treatment using minoxidil and finasteride. Unfortunately, finasteride is not indicated for the treatment of hair loss in women.
Since 1993, minoxidil has been the most successful topical treatment for hair loss in both men and women, yet its exact mechanism of action remains unknown.
A 2004 review of minoxidil’s possible mechanisms of action (A.G. Messenger & J. Rundegren, 2004) suggests that the best evidence supports the idea that minoxidil causes hair follicles in the later phases of their resting phase (telogen) to shift prematurely into an active growth phase (anagen) sooner than they otherwise would; this causes rapid increase in hair growth. They also found good evidence that minoxidil works to thicken the hair by increasing hair diameter.
While minoxidil’s effects on other critical factors known to affect hair growth — such as cell proliferation, collagen synthesis, vascular endothelial growth factor and prostaglandin synthesis — remain uncertain, more recent research has found evidence that it may also suppress the androgen-androgen receptor responsible for androgenetic alopecia (Cheng-Lung Hsu, Jai-Shin Liu,An-Chi Lin, Chih-Hsun Yang, Wen-Hung Chung, & Wen-Guey Wu, 2014).
Understanding minoxidil’s exact mechanism of action remains today an important line of research both for the development of better hair loss treatments and for a better understanding of the biology of hair growth.
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, uncommonly, lead to male infertility by changing the consistency of the male ejaculate as well as decreasing the sperm count.
Ejaculate is a combination of sperm produced by the testes and a viscous fluid made by the prostate. Since finasteride shrinks the prostate it make the ejaculate less viscous (more watery).
Most patients taking Propecia and trying to conceive have no issues.
If one is trying to conceive for 4-6 months and having difficulty, 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 women does not come in direct contact with the medication.
Plug procedures, popular in the 1960s and 1970s, often resulted in an unsightly “pluggy” or “dolls head” look. In the past we tried to work around the plugs with fine grafts in order to camouflage them, but this proved ineffective. At Bernstein Medical, we now find it best to totally remove the old plugs, put them under a microscope, dissect them into smaller follicular units and then re-implant them. This process is called Combined Hair Transplant Repair. In this way, many of the cosmetic defects created by hair plug procedures can be partially or completely reversed.
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