Hair Restoration Answers
Dr. Bernstein answers frequently asked questions about hair transplantation, hair loss, and medical treatment for hair loss.
Can you use a hair transplant to treat radiation-induced permanent hair loss in pediatric patients?
Q: Can you use a hair transplant to treat radiation-induced permanent hair loss in pediatric patients?
A: Yes, but there are a number of things to consider:
- As in adults, if the hair loss from radiation is extensive, or involves the permanent zone of the scalp, there would not be enough donor hair to make the procedure worthwhile.
- Depending on the nature of the scarring, it may not take grafts well and always will require multiple procedures to achieve adequate density.
- Hair transplant procedures (both FUT and FUE) leave scarring, so future treatments for tumor recurrences that cause hair loss (radiation or chemo) may expose these scars and be an additional cosmetic problem.
- There is a concern that the younger patient may eventually develop androgenetic alopecia and this would be a problem if extensive and occurring early. Family history, of course, is important, but there is no way to tell with certainty the prognosis of AGA in a young person.
- For those that might develop AGA, finasteride is not indicated in males under 18 and there is no way to tell in advance if the person can tolerate this medication.
- The hair transplant procedure is long, so local rather than general anesthesia is used. That said, 12 y/o is generally the minimum age that a patient can tolerate the procedure and a 12 y/o needs to be mature and motivated. Certainly, waiting until the patient is older makes it easier surgically.
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Topic: Age for Hair Transplant, Hair Loss, Hair Transplant, Medical Conditions
Posted by Updated 2020-02-25
Is Hair from the Donor Area or Zone Permanent or Will It Thin with Age?
Q: Does donor area hair thin with age? – T.W.
A: Hair taken from the donor zone is considered to be permanent and should resist changes related to androgenetic alopecia also known as genetic patterned baldness. In other words, it will not be lost. Through the natural aging process, hair diameters may decrease over time making the donor area appear thinner.
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Topic: Age for Hair Transplant, Growth After Transplant
Tags: After FUT Hair Transplant, Age for Hair Transplant, Age-Induced Hair Loss, Hair Thinning
Posted by Updated 2019-12-05
I am an African-American Woman with a Failed Transplant. Should I Have Another Hair Transplant to Correct the First One?
Q: I am an African-American woman who had a unsuccessful hair transplant. Should I have another one? – S ~ Boston, MA
A: A common cause of a failed hair transplant in African Americans is the surgeon missing a diagnosis of primary scarring alopecia. In this case the scalp is literally attacking the transplanted hair and a repeat hair transplant would also not expected to be successful. This condition is recognized by scaling and redness around the follicles and diagnosed by biopsy. The condition is treated medically rather than by surgery. However, if the cause of the failed transplant was poor surgical technique, then a repeat procedure would be warranted as long at the remaining donor supply was adequate. In all cases, a repeat procedure should not be contemplated unless the cause of the failure can be identified and corrected.
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Topic: Hair Loss in Women, Post-op
Tags: African-American, Black Hair, Hair Loss in Women, Scarring Alopecia
Posted by Updated 2019-12-04
Will Scalp Laxity Exercises Better Prepare Me for FUT Surgery?
Q: I am preparing for FUT surgery and read about scalp laxity exercises. Will they better prepare me for my hair transplant? – O.U.
A: For the majority of patients, there is enough scalp laxity so that exercises are unnecessary. If a patient’s scalp becomes too tight for FUT, we would switch to FUE. On occasion, after multiple FUT procedures, if the scalp is snug and FUT is still desirable, then scalp laxity exercises can be useful.
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Topic: Hair Transplant, Scalp Exercises
Tags: Before FUT Hair Transplant, FUE, FUT, Hair Transplant, Scalp Laxity Exercises
Posted by Updated 2019-12-05
Is it Safe to Implant 6,000 Grafts in 2 Days Using FUE?
Q: Is it safe to implant 6,000 grafts in 2 days with an FUE procedure? — L.P. ~ Port Washington, N.Y.
A: A 6,000-graft procedure would be a very large hair transplant. Transplanting this many grafts at once would necessitate grafts being placed very close together. In this situation, the blood supply may not be adequate to support the growth of the newly transplanted grafts.
Another reason for concern is that when harvesting, FUE yields about 20 grafts/cm2. A 6,000-graft procedure would require 300 cm2. Since the donor area is about 30 cm long, this would require a donor height of 10 cm, clearly extending beyond the permanent zone of the scalp of most patients.
- Read more about large sessions
- See before and after photos of Bernstein Medical hair transplant patients
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Topic: Follicular Unit Extraction, Graft Numbers
Tags: FUE, FUE Hair Transplant, Graft, Graft Numbers, How Large Should Hair Transplant Sessions Be, Large Graft Hair Transplants, Megasessions, Number of Grafts Per Hair Transplant, Robotic FUE
Posted by Updated 2019-03-05
Can Women That Are Breastfeeding Have A Hair Transplant?
Q: Can a woman who is breastfeeding have a hair transplant? — M.R. ~ Long Beach, N.Y.
A: Since surgical hair restoration is an elective procedure, I would wait until 1 year after delivery and once breastfeeding has completed before considering a hair transplant. Often after pregnancy, there is a post-partum shedding that occurs as the hormones fluctuate and then return back to their normal levels. This active period of shedding can cause a few issues. The first issue is that active shedding can make it difficult for the surgeon to determine where best to place the grafts for the optimal long-term cosmetic result. Additionally, medications may be used during and after the procedure that can potentially appear in breast milk.
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Topic: Hair Loss in Women, Hair Transplant
Tags: Hair Loss After Pregnancy, Hair Transplant After Pregnancy, Hair Transplant in Women
Posted by Updated 2019-03-05
What is your Opinion of the Companies that Advertise Hair Loss Solutions like Hims and Keeps?
Q: What is your opinion of the companies that advertise hair loss solutions like Hims and Keeps?
In searching the web and riding the subway I’ve seen many ads for a company called Hims that offers hair loss medicine and other medical solutions for men’s problems. What are the medications used for hair loss and how do they compare to Propecia and Rogaine? — V.T., Long Island, NY
A: Hims and Keeps are digital wellness companies that are geared toward men. They prescribe the same hair loss products that you can receive from a doctor or from online stores like Amazon, such as minoxidil, finasteride, biotin, salicylic acid shampoos and other topical and oral medications. The patents on the most commonly used prescription medications have expired within the last few years, opening the door for companies to distribute their own generic versions. The online system that Hims uses allows people to get prescriptions without seeing a doctor. Although this might be convenient, receiving an in-person evaluation from an experienced physician is important to ensure that you receive the proper treatment. Medical treatments for hair loss are most effective when started early. Therefore, making sure the diagnosis is correct and that the medications are optimized, will give you the best chance of re-growing your hair and preventing future thinning.
- Schedule a Consultation at Bernstein Medical
- Read more Medical Treatment Options at Bernstein Medical
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Topic: Hair Loss Medication
Tags: Hair Loss Medications, Hair Loss Solutions, Hims, Keeps
Posted by Updated 2018-12-12
Can Rogaine Cause Miniaturization?
Q: Can Rogaine Cause Miniaturization?
When I am on Rogaine it seems – to my untrained eye – that I am having hair miniaturization and when I stopped briefly, I had shedding. Does this seem accurate based on what you have seen? Can Rogaine cause miniaturization? Is there a point you would recommend I stop Rogaine or is it something that likely can’t cause a negative impact on hair? — B.T., Brooklyn, NY
A: Minoxidil reverses miniaturization. It does not cause it. Shedding can occur after starting use of Rogaine but this means the medication is working should resolve with continued use. New miniaturized hairs are either from the progression of your genetic male pattern hair loss or newly forming hair that was stimulated by the minoxidil which can mimic miniaturized hair.
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Topic: Hair Loss Medication
Tags: Benefits of Rogaine for Hair Loss, How Minoxidil Works, Minoxidil Side Effects, Rogaine (Minoxidil), Rogaine Absorption into Scalp, Rogaine Side Effects, Shedding on Rogaine
Posted by Updated 2018-10-23
In What Cases Do You Think Scalp Micro-Pigmentation (SMP) Is Most Useful?
Q: In what cases do you think Scalp Micro-Pigmentation (SMP) is most useful?
— M.O., Greenwich, CT
A: Scalp Micro-Pigmentation (SMP) is used in patients who want to make their thinning hair look fuller and want to avoid the nuisance of daily application of cosmetic concealers, powders or fibers. It is for patients who want a permanent solution, but who do not want, or who are not candidates for hair transplant surgery. It can achieve a variety of looks such as a buzz cut by tattooing hundreds of microdots that appear like follicles or it can reduce the contrast between generalized dark hair that is thinning over a pale scalp. It can even give the appearance of hair over a scar that has now become noticeable.
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Topic: Scalp Micro-Pigmentation (SMP)
Tags: Cosmetic Camouflage, Dr. Christine M. Shaver, Dr. Shaver, Hair Loss Treatment, Hair Loss Treatments, Scalp Micro-Pigmentation, SMP
Posted by Updated 2020-09-11
How is Scalp Micro-Pigmentation (SMP) Performed?
Q: How is Scalp Micro-Pigmentation (SMP) Performed?
How is SMP done? — B.P., Long Island, NY
A: Scalp Micro-Pigmentation (SMP) is applied with tiny microneedles that mimics the appearance of hair in an area of the scalp that looks thin. It requires the use of local anesthesia and is performed in a doctor’s office. SMP is typically performed over a series of three or more sessions spaced at least 2-4 weeks apart. The length of each session varies depending on the area to be tattooed and can last from a few hours to a full day.
To perform successful SMP, the hair length and color must be analyzed in consultation along with a discussion of cosmetic goals and the potential techniques that could be implemented for the patient’s hair type. The procedure is performed under local anesthesia and is generally well tolerated with very few post-op limitations.
- Read more about Scalp Micro-Pigmentation
- Read about our practicing SMP physician, Dr. Christine M. Shaver
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Topic: Scalp Micro-Pigmentation (SMP)
Tags: Cosmetic Camouflage, Dr. Christine M. Shaver, Dr. Shaver, Hair Loss Treatment, Scalp Micro-Pigmentation, Scalp Micro-Pigmentation, SMP
Posted by Updated 2018-07-24
What is Scalp Micro-Pigmentation (SMP)?
Q: What is Scalp Micro-Pigmentation (SMP)?
What is SMP? — M.O., Greenwich, CT
A: Scalp Micro-Pigmentation (SMP) is a medical-grade scalp tattoo. It is a form of permanent cosmetic camouflage that can mimic the appearance of hair in locations such as scars or balding areas. SMP gives the appearance of fullness of hair without actual hairs being present. Although permanent dyes are generally used, semi-permanent materials can be substituted that will purposely fade over time.
Dr. Shaver is our dedicated in-house physician for Scalp Micro-Pigmentation procedures.
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Topic: Scalp Micro-Pigmentation (SMP)
Tags: Cosmetic Camouflage, Dr. Christine M. Shaver, Dr. Shaver, Hair Loss Treatment, Hair Loss Treatments, Scalp Micro-Pigmentation, Scalp Micro-Pigmentation, SMP
Posted by Updated 2018-07-25
Why Is My Hair Dry And Kinky After My Hair Transplant?
Q: I had a hair restoration procedure and the hair grew, but after one year the hair was kinky and dry. It has remained like this ever since.
From what I have read Dr Bernstein says this is uncommon but can happen. I understand there is no definitive explanation for this but I would like Dr Bernstein’s opinion on why this happens. My theory is that DHT is more prominent on the top of the head and is changing the structure of the transplanted hair. The hair is so dry and unmanageable it looks like I am wearing a wig. I await his response. — P.O., Greenwich, CT
A: Some dryness and texture changes can occur after a hair transplant and this usually self-corrects over 1-2 years during which time the transplanted hair gradually regains its original luster and texture. These changes are most likely due to the unavoidable trauma that takes place as follicles are removed from the scalp and placed into recipient sites. Excessive dryness can occur if the sebaceous glands had been stripped away from the graft. In FUT, this can be due to over dissection (i.e., grafts that are trimmed too much). In FUE, this can be due to loss or damage to the sebaceous glands in the extraction process. Persistent kinkiness may represent either damage to grafts from the procedure (improper handling, crush injury) or effects of scarring in the recipient area (usually from older procedures which used larger recipient sites) that distort the growth of follicles.
- Read about post-op care following an FUT hair transplant
- Read about post-op care following a Robotic FUE hair transplant
- Read more Q&A about post-op care
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Topic: Post-op
Tags: After FUE Hair Transplant, After FUT Hair Transplant, After Your Hair Restoration, Changes in Hair Texture, Hair Texture, Instructions After Your Hair Restoration Surgery, Post-op, Post-op Care, Post-op Instructions, Sebaceous Glands
Posted by Updated 2018-03-07
Can Anyone Tell Me Why Dr. Bernstein Is Still Bald?
Q: Can anyone tell me why Dr. Bernstein is still bald? — N.H., Brooklyn, NY
When Dr. Bernstein was younger and started to lose his hair, it really didn’t bother him. After medical school, he began his career as a dermatologist and became aware of surgical hair restoration. It was then when he realized that he would not be a good candidate for a hair transplant procedure, even if he wanted one, because his donor area is very thin. In the years since, he has gotten used to being bald. But his not being a candidate made him keenly aware of who is and who is not a good candidate for surgery, and this insight has helped earn him a reputation as an honest and ethical practitioner of hair transplantation.
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3.17 stars from 6 vote(s)Topic: Dr. Bernstein's Hair Loss
Tags: Donor Area, Donor Hair Density, Dr. Robert M. Bernstein, Minimal Donor Hair
Posted by Updated 2018-02-17
What is the Difference Between “Hair Transplant Reversal” and “Hair Transplant Repair”?
Q: I have read a lot on the forums about hair transplant reversal and hair transplant repairs. Are they the same thing, if not, what is the difference? Can you reverse a hair transplant? — K.J. ~ Park Slope, N.Y.
A: A “hair transplant repair” refers to techniques that improve the appearance of a poorly executed procedure or one performed with outdated methods. A “hair transplant reversal” refers to techniques that enable the individual to appear as if no hair restoration surgery had been performed. Although the techniques in attempting to perform a repair or a reversal may be similar, the ultimate goals of each are quite different. It is important to understand that although significant improvement can often be achieved, perfect repairs and/or full reversals are generally not possible.
The main reasons for seeking a repair include; large grafts transplanted to the frontal hairline giving an unnatural, “pluggy” appearance, a frontal hairline placed too far forward, hair placed in the wrong direction, and donor and recipient site scarring. Outdated procedures such as scalp reductions and flaps also need to be repaired.
If the transplanted grafts are large (“hair plugs”), it is possible to surgically excise these grafts, microscopically dissect them into smaller follicular unit grafts, and re-transplant them into the scalp in a more natural-looking, aesthetic way. After these large grafts are removed, the sites are sutured closed and heal with very fine, often imperceptible, white scars. Hair plug removal is often followed by one or more sessions of FUT or FUE in order to harvest additional hair for use in camouflaging any remaining plugs or improving the appearance of the region where the plugs had previously been. These combined repairs can lead to excellent outcomes.
If the grafts at the hairline are not large but are placed too low or too broadly, it is possible to use laser hair removal and/or tweezing to remove these hairs. Repeated treatments may be necessary until the hair ceases to grow back at these locations. Additionally, hair which was placed in a direction different from the way hair naturally grows will usually need to be removed.
Another challenge in hair transplant repair is fixing widened donor scars that had resulted from poorly performed FUT/strip procedures. These scars are permanent and may be visible if the hair is not worn long enough. Scars from FUT procedures can be repaired by harvesting hair from the surrounding donor area (using FUE) and transplanting these follicular unit grafts into the scarred tissue.
Scalp micro-pigmentation (SMP), a permanent micro-tattoo, may be useful to further camouflage these linear scars. SMP can also be used to improve the look of the stippled scars of FUE in patients. This can occur with overharvesting, when patients wear their hair too short, or when the balding is more extensive than anticipated and extends into the harvested area.
A hair transplant reversal, in theory, has the goal of having the person look as though a hair transplant had never been performed. While reversing a hair transplant completely is not possible, the techniques previously discussed can be utilized to achieve a number of important things. The donor site scarring can be minimized and/or camouflaged and the smaller follicular unit grafts in the recipient zone can often be removed without leaving behind any visible scarring of the underlying skin. What is not possible is to restore the person’s density to a pre-procedure level as improperly performed transplants always result in wasted hair.
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Topic: Hair Transplant Repair
Tags: Camouflage, Combined Repair, Graft Excision, Hair Plug Repair, Hair Plugs, Hair Transplant Repair, Hair Transplant Reversal, Hair Transplant Scar, Scalp Micro-Pigmentation, Scar Repair, SMP
Posted by Updated 2020-02-28
What is your Opinion of Nutrafol?
Q: What’s your honest take on Nutrafol? It is a product my dermatologist has recommended for my hair loss. — N.S. ~ New York, N.Y.
A: The traditional thinking is that that male pattern alopecia (androgenetic alopecia) is due to follicular sensitivity to DHT causing miniaturization and eventual loss of hair. The premise of Nutrafol is that hair loss is multi-factorial with an important inflammatory component and that it is important to address the inflammation as well as the DHT sensitivity.
This is a relatively new and important concept (I would like to stress this point!). However, the big leap is their conclusion: Since hair loss is multi-factorial, then broad, rather than targeted treatments would be most beneficial, and since naturally occurring “phytochemicals” are broader in action than targeted, FDA approved drugs (like finasteride and minoxidil), they should offer benefit in the treatment of hair loss and Nutrafol is the elixir that can accomplish this.
Although this makes sense in concept, there is no scientific evidence that Nutrafol can actually reverse or/mitigate androgenetic alopecia or any other type of hair loss. We need independent, blinded, controlled studies to show that Nutrafol actually works. Until then, it is very difficult to recommend this product and, more importantly, to recommend it over other treatments known to be effective.
- Read about treatments for men’s hair loss
- Read about treatments for women’s hair loss
- Discover the causes of hair loss
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Topic: Vitamins, Herbs, Supplements
Tags: DHT, Genetic Hair Loss, Hair Growth, Hair Loss, Hair Loss Medication, Hair Loss Products, Nutrafol, Vitamin Supplementation
Posted by Updated 2018-07-03
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Updated: 2019-11-15 | Published: 2009-07-02
