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October 1st, 2005

Follicular Unit Forum - Bernstein Medical - Center for Hair RestorationFollicular Unit Forum is unique in that it affords visitors an opportunity to anonymously ask questions about the “ins and outs” of hair transplant surgery, of those who actually have had the state-of-the-art Follicular Unit Hair Transplant procedures.

Questions are posted to people who have actually undergone hair restoration procedures. Individuals who are considering a surgical solution to their hereditary baldness are able to search through “threads” or conversations that will answer their most pressing concerns such as; what to expect before, during and after a hair transplant, and what kind of procedure one should have.

September 23rd, 2005

Q: I have heard that you should take Propecia for 6 to 12 months following a hair transplant. Is this correct? — P.E., Dallas, TX

A: I would only use Propecia if you plan to continue the medication long-term. That said, Propecia — the brand name of the hair loss drug finasteride — is very helpful in preventing further hair loss. I do recommend that patients who have hair loss stay on the medicine for an extended period, regardless of whether or not they decide to have a hair transplant procedure.

September 22nd, 2005

Q: Why does a hair transplant work? – L.L., Salem, Massachusetts

A: Hair transplantation works because hair taken from the permanent zone in the back and sides of the scalp maintains its original characteristics when transplanted to a new place in the balding area in the top of the head. This property of hair is called “donor dominance” and is the reason why hair transplants are possible.

The hair follicles in areas that go bald are genetically susceptible to DHT, a breakdown product of testosterone. In response to DHT, these hair follicles miniaturize (decrease in size) until they eventually disappear. When follicles from the permanent zone, that are resistant to the effects of DHT, are moved to a balding area, they maintain this property and continue to grow.

September 15th, 2005

Q: I have a scar on the top of my head the size of a quarter from an old injury. I would like hair to grow back on the bald spot. Can a hair transplant re-grow hair on the spot and not have any scar on my head at all? – E.D., Oceanside, N.Y.

A: Traumatic scars are readily treated with follicular unit hair transplantation. The hair generally grows quite well in scar tissue as long as the scar is not thickened (hypertrophic). Several sessions are usually required. Although the hair restoration can make the bald area undetectable, the underlying scar tissue will still be there.

September 8th, 2005

Q: What is “shock fall out”? – D.B., Chappaqua, N.Y.

A: Shedding after a hair transplant is also referred to by the very ominous sounding term “shock fall out.” The correct medical term is “effluvium” which literally means shedding. It is usually the miniaturized hair (i.e. the hair that is at the end of its lifespan due to genetic balding) that is most likely to be shed. Less likely, some healthy hair will be shed, but this should re-grow.

Interestingly, if transplants are spaced less than one year apart, one often notices some shedding of the hair from the first transplant, but this hair grows back completely. For most patients, effluvium is not a major issue and should not be a cause for concern.

Typically, when shedding occurs, a patient looks a little thinner during the several month period following the transplant, before the transplanted hair has started to grow. The thinning is often more noticeable to the patient than to others. Shedding is generally noted as a thinning, rather than of “masses of hair falling out,” as the term “shock fall out” erroneously suggests.

In general, the more miniaturization one has and the more rapid the hair loss, the more likely shedding will be from the hair restoration surgery. Young, actively balding patients would be at the greatest risk. Older patients with stable hair loss would have the least risk. In either situation, since miniaturized hair is eventually going to be lost, the effluvium has no long-term effect on the outcome of the procedure.

September 2nd, 2005

Q: When harvesting donor hair, how does the surgeon know when to stop? – D.D., Pleasantville, N.Y.

A: The patient must first decide the shortest length he/she is comfortable wearing his/her hair.

Donor hair can be removed — whether through Follicular Unit Transplantation (FUT) or Follicular Unit Extraction (FUE) — as long as, at this length, the back and sides do not look too thin (i.e. do not have a transparent look) and the donor scars are not visible. The surgeon needs to use his judgment when harvesting, so that this endpoint is not crossed.

Additionally, the surgeon must anticipate that the caliber of hair in the donor area will decrease slightly over time as a normal course of events. The actual number of grafts that can be harvested varies greatly from person to person. It depends on the patient’s donor density, scalp laxity, hair characteristics and size of the donor area.

September 1st, 2005

The progressive decrease in hair shaft diameter that causes thinning (also called miniaturization) characteristic of male pattern baldness, can be decreased by the use of the DHT blocker Propecia (chemical name finasteride). Most men undergoing hair restoration surgery have some existing hair in the area that is to be transplanted that will thin over time and, in fact, may thin a bit more quickly as a result of the surgery. For men undergoing surgical hair restoration, the thinning of the surrounding hair can diminish the overall impact of the hair transplant. Even though Propecia has no effect on the transplanted hair, it can help to maintain the patient’s surrounding hair and is, therefore, useful as an adjunct to hair transplant surgery, to enable the patient to obtain a better overall result.

The present study looks to see if Propecia given from one month before surgical hair restoration until eleven months after, can increase hair growth in the area surrounding the hair transplant. In the study, consisting of almost eighty men divided into two groups in a double-blind fashion were either given Propecia or a placebo. Growth was recorded by hair counts and by photos.

The study showed that Propecia was substantially better than the control group in increasing hair counts and in increasing visible fullness when patients started Propecia a month before their hair transplant and were on the medication for one year.

August 25th, 2005

Q: I have a bald patch on my scalp diagnosed as DLE, can this be corrected with a hair transplant? – V.Q., Scarsdale, N.Y.

A: DLE or discoid lupus erythematosus is a type of autoimmune disease where the body produces an inflammatory reaction to components of the skin, causing it to scar and lose hair.

The skin in the area of hair loss generally has a smooth appearance with tiny empty hair follicles, redness, and altered pigmentation. These skin changes help to differentiate it from the more common condition alopecia areata where the underlying skin appears normal.

The diagnosis of DLE can be confirmed by biopsy. Because DLE may exhibit a property called Koebnerization, where direct trauma can make the lesions enlarge, surgical hair restoration risks making the condition worse and is, therefore, not indicated.

August 24th, 2005

Q: This is my second hair transplant and is seems like it is growing more slowly than my first. Is this normal? – J.D., Port Washington, N.Y.

A: It is common for a second hair transplant to take a bit longer to grow than the first, so this should be expected. It is also possible that there is some shedding from the procedure, or a continuation of your genetic hair loss.

Propecia may be helpful in this regard. It is important to wait at least a year for the transplant to grow in fully and to give a chance for any hair that was shed to regrow.

August 19th, 2005

Q: What is graft compression? — E.Z. Wayne, N.J.

A: Graft compression refers to a tufted look resulting from the contraction of grafts caused by the normally elastic skin that contracts around the graft as the hair transplant heals. This was a common occurrence with mini-micrografting where 5 or more hairs from two or more follicular units were placed into one recipient site.

With follicular unit hair transplantation, follicular units won’t show visible compression since they are already naturally compact.



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