Dr. Bernstein was honored to deliver the keynote address at the ARTAS International Users Forum in San Francisco. “Follicular Unit Extraction: Then and Now,” reviewed the evolution of surgical hair restoration from FUT through FUE to the cutting edge technique of Robotic-FUE.
Dr. Bernstein is interviewed on surgical hair restoration procedures and how they have evolved over the years. Among topics discussed are follicular units, follicular unit transplantation (FUT), follicular unit extraction (FUE), and how robotic technology has improved the FUE procedure.
Q: I read your 20 pages of FAQs but could not find this question addressed. I’m currently taking Finasteride 5 mg (one-fourth tablet per day) but since some drug companies make an oblong tablet that is hard to cut into four pieces, I found a plastic bottle with four equal measurements and I dissolve the tablet in water, shake it up and drink one-fourth of the liquid each day. I read somewhere that you’re not really supposed to dissolve the pill in water. Is that correct or is it OK to keep doing it the way I’m doing? — W.I., Winnetka, Illinois
A: I would cut up the pills with a pill-cutter – they do not need to be in equal parts. Just finish a whole pill every four days. You can also take ½ pill every other day and achieve the same effect. I am not sure of the stability of the medication in water over several days. It is probably OK, but why take the chance?
The results of an 18-year study, just published in the New England Journal of Medicine, showed that finasteride does not increase the likelihood of death from prostate cancer in men who take the drug. Early results from the same study had suggested that finasteride might increase the risk of developing higher grade tumors; however, follow-up results from the long-term study show that men taking the drug do not have an increased risk.
Q: I am having a facelift next month and also want to have a hair transplant soon after. How long should I wait between procedures? — S.H., Boston, M.A.
A: Although it would be possible to do a hair transplant as soon as a week after a face or brow lift, ideally one should wait at least three months between procedures for the following reasons: 1) there will be less tension in the donor area and, therefore, it will be possible to harvest more grafts, 2) if there is any shedding from the facelift it will make the planning of the hair transplant more difficult, 3) it will leave the option of adding hair, in or around, any problematic surgical scars, and 4) will provide the ability to add hair to any area of thinning that might result from the facelift.
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“.

Dr. Bernstein is ranked as one of New York City’s best dermatologists in the 2013 edition of ‘Super Doctors’.

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.

