Hair Transplant, Hair Restoration & Repair
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Bernstein Medical - Center for Hair Restoration

Dr. Bernstein answers frequently asked questions about hair transplantation, hair loss, and medical treatment for hair loss.

Hair Restoration Answers

What is a Double Centrifuge System for PRP and What are the Benefits?

Q: What is a double centrifuge system for PRP and what are the benefits?

A: The double centrifuge system is a process used in preparing Platelet-Rich Plasma (PRP) where the whole blood is spun two times to optimize the concentration of the platelets. In the first spin, the red blood cells are separated from the plasma, which contains the platelets. In the second spin, the cellular components in the plasma are further concentrated. The platelets and growth factors that are recovered from the plasma are then injected into the scalp. Additional growth factors are released from the platelets after the injections and it is these proteins that provide the benefit of helping to maintain the hair and to stimulate growth. By using a double centrifuge technique, the ideal concentration of platelets and growth factors are achieved.

  • Read more about Platelet-Rich Plasma (PRP) for Hair Loss
  • View a slideshow of how PRP is prepared

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Are Topical DHT Blockers as Effective as Oral Finasteride?

Q: What is more important against baldness, decreasing DHT in serum with oral finasteride or decreasing DHT in the scalp with topical finasteride?

A: Decreasing serum DHT with oral finasteride is more effective in combating hair loss, as the decreased blood levels also lowers the DHT in follicles and seem to do it better than finasteride applied topically.

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Hair Restoration Answers

Would A Hair Transplant In Turkey Be Performed Just By Technicians?

Q: I was thinking of having an FUE hair transplant procedure done in Turkey, but I am concerned that it will be done with just technicians. Any thoughts?

A: I do not have first-hand information on the clinics in Turkey, but there is a recent “Letter to the Editor” in Hair Transplant Forum International, the official publication of the “International Society of Hair Restoration Surgery” that you might find informative. From the article:

“In Turkey, there are 300 FUE clinics in Istanbul alone but, unfortunately, at only 20 of them are operations are done by doctors. We do not exactly know how many of those 300 clinics have legal permissions, but we know very well that an average of 500-1,000 FUE operations are done per day.”

If you would like to read the entire article, the reference is: A Report from Turkey – the situation in a top FUE destination. Hair Transplant Forum International July/August 2017 p 162.

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Hair Restoration Answers

Do Women Have Less Shock Loss Than Men?

Q: I have heard that shock loss can occur after a hair transplant. Do women experience less shock loss than men?

A: Actually, the risk of shock hair loss is usually greater in women than in men since women generally have a more diffuse pattern of thinning. This is because females often have more miniaturized hair, the hair that is most subject to post-op shedding.

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Hair Restoration Answers

Is Manual FUE Better Than Robotic FUE Because The Physician Can “Feel” The Follicle During Extraction?

Q: Is it true that manual FUE hair transplant procedures are better than robotic hair transplants because the physician can adjust and feel the follicle when extracting? — M.H. ~ Great Neck, N.Y.

A: The ARTAS robot is a physician controlled, computerized device that uses a three-dimensional optical system to isolate follicular units from the back of the scalp in a hair transplant. The robotic system assists the physician in the extraction of grafts with precision and speed. Although there is some advantage to having “human feel” for the tissue, this is far outweighed by the fact that repetitive procedures performed manually thousands of times lead to operator fatigue and result in increased transection and damage to grafts. With the ARTAS robotic system, the quality of the first and the last graft harvested will be the same.

Read about advantages of the ARTAS Robot over manual FUE procedures

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Hair Restoration Answers

What is Trichophytic Closure After An FUT Hair Transplant?

Q: I have read that some doctors perform something called a trichophytic closure. What is this?

A: Trichophytic closure is a way to minimize the appearance of the donor scar in a hair transplant using a strip incision. The technique provides improved camouflage of a linear donor scar in Follicular Unit Transplantation (FUT). Normally, in FUT, the surrounding hair easily covers the scar. For some patients with very short hairstyles, the resulting donor scar may be visible. With the trichophytic closure technique, Dr. Bernstein trims one of the wound edges (upper or lower), allowing the edges to overlap each other and the hair to grow directly through the donor scar. This can improve the appearance of the donor area in patients who wear their hair very short.

The trichophytic donor closure can be used on patients who have had previous hair transplant procedures and are looking for improvement in the camouflage of their donor scar. It is particularly useful in hair transplant repair or corrective work. Trichophytic closures work best with sutured incisions. Stapled closures have their own advantages. The doctor will recommend which type is best in your case.

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Hair Restoration Answers

Why Visit a Practice That Specializes in Both FUT and FUE?

Q: Why go to a hair restoration practice that specializes in both FUT and FUE? — L.P., Bayside, NY

A: This is a great question, but the answer may be counterintuitive in today’s age of specialization. The answer is that you should always go to the practice that offers both. To deliver the best care, hair restoration physicians should have expertise in both Follicular Unit Transplantation (FUT) and Follicular Unit Extraction (FUE) techniques and should offer both in their practices. There are at least five good reasons why:

1. FUT and FUE are both excellent techniques but have different indications for use

The main advantage of FUT is that it typically (but not always) gives the highest yield of hair. Therefore, when the patient’s primary goal is to achieve maximum fullness, FUT should be performed. There are many well-described reasons for this, including the precision of stereo-microscopic dissection and the ability to harvest efficiently from a more select area of the donor zone, but these are beyond the scope of this brief commentary.

The main advantage of FUE is no linear scar. Therefore, when the patient’s primary goal is to be able to wear his hair very short, FUE should be performed. FUE is also indicated when there is an increased risk of a widened scar or when scalp laxity does not permit a strip excision. The patient may sometimes choose FUE simply to avoid the stigma of a linear donor scar.

2. The same patient may benefit from both procedures

There are situations in which both procedures are useful in the same patient. For example, FUT may first be used to maximize yield, but then, after several sessions, the scalp may become too tight to continue to perform FUT, or the donor scar may become wider than anticipated. In the former case, the physician can switch to FUE to obtain additional grafts; in the latter case, FUE may be used to camouflage the scar of the FUT procedure.

3. There is a cross-over set of skills from FUT to FUE

To do an FUE procedure well, the follicular unit grafts that are extracted should be examined carefully under a stereo-microscope and, when needed, trimmed and sometimes subdivided into individual hair follicles (such as for hairlines, eyebrows, temples, etc.). Stereo-microscopic dissection is basic to FUT and is thus a skill that is second-nature to the staff of practices that regularly perform FUT procedures, so this critical step will not be hit or miss.

4. Practices that offer both procedures are usually more experienced

It is easier to learn and train one’s staff in just one hair transplant technique. In particular, FUE procedures require a smaller staff than FUT and, thus, many doctors entering the field of hair restoration surgery will perform FUE but not master the skill or make the commitment to hire and train the staff to perform FUT.

5. Better decision making

One could argue that if a doctor performed only one procedure but the patient needed the other, then he/she would refer the patient to a colleague. Although this sounds nice in theory, it is very rare for a doctor to refer a surgical case to a colleague if it is a condition that he actually treats. More likely, the doctor will convince the patient (and probably himself) that the procedure he offers is the appropriate one, although, as one can see from the discussion above, this may often not be the case.

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Hair Restoration Answers

Can Hair Transplant “Plugs” be Repaired by Lasers or Electrolysis?

Q: After an old hair transplant using plugs, can you use lasers or electrolysis to remove the transplanted hair?

A: You can remove the hair in plugs with electrolysis, but it is difficult since the scarring distorts the architecture of the hair shaft and makes it hard to insert the electrolysis needle. Laser hair removal is a far more efficient way of removing the hair but takes multiple treatments. However, the problem with either of these techniques is that the hair is destroyed and the underlying scarred scalp is not improved. In fact, it is made more visible when the hair has been removed.

Our preferred method of repair is to completely remove the plugs, dissect out the individual follicular units from those plugs and then re-implant them in the proper location and direction. In this way, the hair can be reused and the appearance of underlying scarred scalp can be improved, as well as camouflaged with new hair.

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Hair Restoration Answers

Does Frequent Combing Cause Hair Loss?

Q: Is it ill-advised to comb one’s hair more than twice a day, especially hair that has been transplanted? Will frequent combing induce hair loss?

A: Combing or brushing one’s hair does not cause hair loss – no matter how many times a day you do it. However, constant traction with braids or hair extensions can cause hair loss and this loss can be permanent.

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Hair Restoration Answers

If I Am Starting to Thin, Should I Have A Hair Transplant Or Try Medication First?

Q: My hair is starting to thin in the front, but it is not yet bald. I have been going back and forth about whether to get a hair transplant or use Propecia. I’m not sure what my first step should be. What do you think?

A: In general, patients who are thinning, but not actually bald, should begin with combined medical therapy (finasteride and minoxidil) for at least a year prior to considering surgery. In many cases, with this regiment, surgery can be postponed or even avoided completely. Unfortunately, some patients cannot tolerate finasteride or choose not to take it due to concern about potential side effects. Minoxidil, although useful, does not significantly alter the long-term course of hair loss when used alone.

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In Hair Transplant Repair, Do You Always Harvest Additional Hair Via FUT or FUE? Which is Better for Repair Procedures, FUT or FUE?

Q: In hair transplant repairs do you always harvest additional hairs to give the hair restoration a better result? Which is better for repair procedures, FUT or FUE?

A: We do not always harvest additional hair in repair procedures, but we do if possible because it can improve the aesthetic outcome by adding additional density and camouflage. This is called Combined Repair. As for whether we use FUT or FUE in repair procedures, the answer depends on the clinical situation. For example, a loose scalp favors FUT. If the person wants to wear their hair short, that favors FUE. If donor scars from the plugs need to be removed, that favors FUT. If scarring in the donor area needs to be camouflaged rather than removed, that favors FUE.

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In Hair Transplant Repair, Can You Remove Plugs By Follicular Unit Extraction?

Q: I was wondering if it was possible to use Follicular Unit Extraction (FUE) on the old plugs instead of graft excision.

A: Graft excision generally works better than FUE in removing old plugs and mini-grafts. The reason is that, in these grafts, the hair is not aligned due to the scar tissue that tugs on, and bends the hair. Because the hair direction is altered from the scar tissue, there is much more damage when the grafts are removed with the tiny FUE punches. In addition, FUE only removes a very small part of the plug. If the hair in the plug is pointing in the wrong direction or the plug is in the wrong location, the entire graft needs to be removed.

Another benefit of graft excision is that we can remove the underlying scar tissue and improve the appearance of the underlying skin. In FUE, only a tiny bit of the scar tissue is removed and, since FUE holes are left open, FUE actually causes its own scarring. With graft excision, the sites are sutured closed so some scar tissue is removed and the quality of the underlying skin looks more natural.

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In Hair Transplant Repair, What is Hair Follicle Survival Rate for Re-implanted Grafts?

Q: When you remove hair plugs and re-use the hair from the grafts, what is the survival rate for those follicular units?

A: The survival rate is close to that when grafts harvested via FUT or FUE. However, if the grafts are placed into a significantly scarred scalp, this can have a negative impact on growth.

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Updated: 2017-08-14 | Published: 2009-07-02




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