May 10th, 2005
Q: What are “Senior Medical Consultants”? — E.W., Miami, FL
A: These are non-medical personnel who wear white coats to give the impression that they have formal medical training. They are actually salespersons and they should immediately identify themselves as such. Although non-medical personnel can help to answer general questions, they should not be examining you and making specific recommendations about your hair transplant procedure. That is the job of your doctor.
When a physician evaluates you and makes recommendations, he or she is responsible for informing you of the risks as well as the potential benefits of your surgery, and is ultimately responsible for your care. They will also have the knowledge to provide you with a balanced view regarding your surgery as well as other treatment options. This is the practice of medicine!
A “consultant” who is being paid to convince people to have a transplant, but who is not actually performing the surgery, does not bear this responsibility and may have a natural tendency to over-sell the procedure. Beware!
Here are some resources about hair loss consultations at Bernstein Medical:
May 7th, 2005
SUMMARY of Dr. Harris’ Abstract from his presentation at the International Society of Hair Restoration Surgery, 2005 – Sidney, Australia
The SAFE System for FUE provided a novel methodology and new hair transplant instrumentation to increase graft production rates, decrease follicle transection rate, and expand patient candidacy for surgical hair restoration. However, the mechanism of the interaction of the blunt dissecting punch and the dermis produced follicular unit graft burial (approximately 7.2% of attempted extractions) that slowed the extraction process during the hair transplantation and resulted in inflammatory cysts requiring surgical excision in .02% of attempted graft extractions.
The purpose of this study was to assess the efficacy of a new dissecting tip that could potentially decrease the graft burial rate and increase the graft production rate in the hair restoration. In the study, three patients received a total of 422 grafts. The protocol utilized limited sharp dissection of the epidermis (using a 1-mm punch to a depth of approximately 1.3 mm) followed by the insertion of the specially modified dull dissecting tip to its full depth of 5 mm. The follicular units were then grasped with fine forceps and removed.
May 6th, 2005
Q: Can a hair transplant into bald areas caused by alopecia areata ever be successful? — R.K., Providence, R.I.
A: Alopecia areata is an autoimmune disease in which the body attacks its own hair follicles. It generally appears as round patches of smooth bald areas scattered in the scalp or beard. Less commonly, it can involve the entire scalp (alopecia totalis) or all facial and body hair (alopecia universalis). Unless the condition is well localized and totally stable, hair transplantation is not likely to be effective because the transplanted hair would be subject to the same problem.
We prefer that one have no new lesions for a minimum of two years before considering surgical hair restoration, although this does not ensure that the procedure will be successful.
You may find more information on this relatively common condition at the National Alopecia Areata Foundation (NAAF). For more information, visit: www.naaf.org.
April 28th, 2005
Q: I have been taking Propecia for three months. Would it help to up my dose? — F.J., Red Hook, Brooklyn, NYC
A: For most people (of average body weight of approximately 150 pounds) 1 mg is the ideal dose.
This is a statistical statement, however. There are some people who fall outside the bell curve. As we don’t know who these people are, we occasionally increase the dose on non-responders after 1-2 years, particularly for those who weigh significantly more than 150 pounds.
Remember, an increased dose also results in an increased risk of side effects and most people experience no additional benefit. There have been no scientific studies to support this regimen.
April 21st, 2005
Q: If my hair is just starting to thin, when should l have my first hair transplant? — T.O., Bayonne, NJ
A: It is best to wait until at least 25 before considering hair restoration surgery, although there are exceptions. The most important thing is to wait until you have hair loss that is a cosmetic problem. A hair transplant is a treatment for hair loss – it should not be used as a prevention. When hair loss is just starting, medical therapy is generally a better choice than surgery as it can both regrow hair and prevent future loss.
April 17th, 2005
SUMMARY of Dr. Haber’s Abstract from his presentation at the International Society of Hair Restoration Surgery, 2005 – Sidney, Australia
Harvesting high quality donor strips with minimal transaction remains an elusive goal for many hair transplant surgeons, particularly beginners. Hair restoration techniques that involve the use of scalpel blades demand the greatest skill and may cause significant transection. The Sandoval Score and Spread technique showed that non-traumatic dissection during hair transplantation is possible using a blunt instrument, but this technique is limited by poor ergonomics and the potential to cause tissue damage.
A new instrument for blunt dissection had been developed that is easy to use and is able to separate tissue along the natural planes of cleavage that causes minimal damage to hair follicles. This device has four sharp, staggered prongs aligned centrally and long handles developed for hair transplant procedures. This design utilizes the strong forearm muscles, as opposed to the weaker hand muscles, and distributes the spreading force over a larger area, minimizing trauma. A minimum depth scoring incision is made with a double-bladed scalpel to a depth of 1.5 mm. The device is inserted and expanded at intervals along the incision.
April 1st, 2005
“Hair Transplantation” is a part of a series of medical textbooks — Procedures in Cosmetic Dermatology, published by Elsevier Saunders — which offers step-by-step, practical guides to performing cutaneous surgical procedures.
In “Hair Transplantation,” Dr. Bernstein co-authored the chapters on Follicular Unit Transplantation and Follicular Unit Extraction, covering the philosophy, basic science, and techniques in a practical clinical format.
The book’s editors selected Robert M. Bernstein as a major contributor, as Dr. Bernstein was uniquely qualified to provide medical professionals with insight and training on the state-of-the-art in hair transplant surgery.
March 10th, 2005
Synopsis: This paper reviews the core concepts of Follicular Unit Transplantation, including basing the surgical planning on the follicular unit constant, using only individual, naturally occurring units in the transplant and accomplishing the restoration in a few number of large sessions. The section then describes the techniques of follicular unit hair transplantation as the procedure enters its second decade.
March 10th, 2005
PUBLISHERS NOTE: Single copies of this article can be downloaded and printed only for the reader’s personal research and study.
Synopsis: “Surgery of the Skin: Procedural Dermatology,” covers the entire range of dermatologic surgical procedures. It was conceived to be used as the core surgical textbook for dermatologic training programs. Dr. Bernstein’s chapter on follicular unit hair transplantation covers a wide range of subjects including the history of follicular unit hair transplantation, evaluating the patient, planning the surgery, setting-up the operating room, and maximizing the cosmetic outcome of the hair restoration. Specific topics include the techniques of Follicular Unit Transplantation including density assessment, single-strip harvesting, follicular unit extraction, anesthetic use, aesthetic design and many other important topics.
March 9th, 2005
Q: If someone doesn’t have enough donor hair, do you ever perform a hair transplant using FUE, using donor hair from outside the permanent hair zone? — M.V., Nashville, TN
A: No. If hair was taken from outside the permanent zone as the surrounding hair continued to bald, the scars from FUE, although small, would become visible.
In addition, the transplanted hair would not be permanent, and over time would eventually fall out.
