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Robotic Hair Transplants & Hair Restoration
Flagship: 110 East 55th Street, New York, NY
212-826-2400 - [email protected]
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Dr. Bernstein answers frequently asked questions about hair transplantation, hair loss, and medical treatment for hair loss.

Hair Restoration Answers

Do You Perform Hair Transplants With Body Or Leg Hair?

Q: Dr. Bernstein, can you please comment on leg and body hair transplants? — J.R., Ridgewood, NJ

A: I’ve tried the technique in the past but have been dissatisfied with the results. Scalp hair, unlike the rest of the body, has multiple hairs rising out of each follicle. With leg and body hair, you have only one hair per follicle, not follicular units of multiple hairs. Leg hair is also very fine. It might thicken up a little bit after it is transplanted, but not enough to be clinically useful. In men you want full thickness hair, so fine hair can make it look like it is miniaturizing, as it does when you’re losing it.

Body hair has been successful in softening hairlines, but most people have enough scalp hair to due this, since it often requires very little if properly placed. Another issue is that because leg hair emerges from the skin on a very acute angle, more wounding of the skin occurs as each hair is individually extracted and this leaves marks.

Body hair, from the chest or back, does hold better potential for success than leg hair, particularly if it is plentiful, but it still is extracted one hair at a time and can leave significant scarring when done in large numbers.


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Hair Restoration Answers

Preventing Shock Hair Loss After Hair Transplant

Q: Can shock loss be eliminated by using special surgical techniques? — R.P., Short Hills, NJ

A: Although there have been no scientific studies proving this, shock hair loss can most likely be minimized by keeping the recipient sites parallel to the hair follicles, by not creating a transplanted density too great in areas of existing hair, and by using minimal epinephrine (adrenaline) in the anesthetic. We implement all of these techniques. Finasteride may also decrease shock hair loss, or at least help any (miniaturized) hair that is lost to re-grow. That said, some shock hair loss from a hair transplant is unavoidable regardless of the technique as it is a normal physiologic response to stress.


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Hair Restoration Answers

Using Avodart If Propecia Does Not Work

Q: I am 27 years old and I have been on Propecia for 12 months now. Honestly, I have seen no response from it. In my dermatologist’s opinion I am a non-responder. I asked about Avodart and he said, since Propecia didn’t help then Avodart won’t help as well since both are DHT blockers, and if one didn’t work the other won’t either. In your opinion do you think Avodart is better? I have read that it blocks more DHT than Propecia. What is the dosing for Avodart? If someone does not respond to Propecia will they also not respond to Avodart? — A.C., West University Place, Texas

A: Avodart (dutasteride) is more effective than Propecia (finasteride) and some patients will respond to dutasteride who do not respond to finasteride. Dutasteride decreases serum DHT about 90% compared to 70% for finasteride. The usual starting dose of Avodart is 0.5mg a day.

That said, dutasteride is not FDA approved for use in hair loss and if a person has sexual side effects, the side effects are more likely to be persistent after stopping the medication compared to finasteride.

Read more about Avodart (dutasteride)

Read more about Propecia (finasteride)


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Hair Restoration Answers

Does ARTAS Robot For FUE Work With Blond Hair?

Q: Can the ARTAS Robot FUE hair transplant be performed on blonds? I heard it only works on dark-haired individuals? — T.W., Jersey City, NJ

A: Correct, robotic FUE doesn’t work well on light-blond or white hair -– but it is easy to dye the hair prior to surgery, and this will solve the problem. We generally advise patients to dye their hair two to three days prior to the procedure so that any residue of the dying still on the scalp can be washed off.

Read more about Robotic FUE Hair Transplantation


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Hair Restoration Answers

What is the Effect of Propecia on a Hair Transplant?

Q: Is taking Propecia absolutely essential to retain the transplanted hair after a hair transplant? — D.W., Toronto, Canada

A: Propecia (Finasteride 1mg) does not affect transplanted hair. The purpose of taking finasteride is to prevent further loss of the non-transplanted hair after the hair restoration procedure.


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Hair Restoration Answers

How Long Between Hair Transplant Procedures?

Q: If I wanted a second procedure what is the typical time that I should wait after the first hair transplant? — P.L, Queens, NY

A: It takes about a year to see the full results of a hair transplant, so it is generally best to wait at least this time before considering a second -– since you may not need one.


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Hair Restoration Answers

ARTAS Robot vs. Neograft Machine in Follicular Unit Extraction

Q: I wanted to find out about the difference between what Dr. Bernstein does with his robotic system versus NeoGraft. — G.M., Newark, NJ

A: The ARTAS robotic system, used at Bernstein Medical, has robotic control, video imaging and uses a blunt dissection technique. This allows for very precise extraction of follicular units from the donor area with minimal transection. The Neograft machine for FUE is a manually operated machine which uses sharp edge dissection. Because it relies on manual controls rather than robotics, it is less accurate and the cutting tip causes more graft injury. The precision of the robot allows the grafts to be harvested with less trauma and will thus result in better growth. In my opinion, these differences are very significant.

Read more about the differences between the ARTAS Robot and Neograft


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Hair Restoration Answers

Can I Stop Medical Treatment For Hair Loss Once Started?

Q: I am taking finasteride as you prescribed. You also suggested using minoxidil liberally over the entire front and top of my scalp once a day. During our meeting I think that you said that once I start using this I would not be able to stop it, and, if I did, it might lead to further hair loss. Hence, I decided to use the laser comb three times a week in addition to the finasteride. Having said that, if you still feel I should start using minoxidil daily, I will start doing so. — H.K., Brooklyn, NY

A: Stopping therapy doesn’t lead to further hair loss in that it doesn’t accelerate it; you just continue on the path that you would have been without the treatment. When you stop, there may be an initial shedding as you quickly lose any benefits that you had from the treatment.

The following applies to all three treatments: finasteride, minoxidil, and laser therapy:

  1. Only work when you use it
  2. Reversion to where you would have been when you stop (but not worse)

However, the important issue is efficacy:

Finasteride >> minoxidil > laser therapy

This is the reason I recommended finasteride and minoxidil.


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Hair Restoration Answers

When To Assess One’s Donor Supply?

Q: I am 24 years old and just starting to thin. I was told by another doctor that it was too early to have a hair transplant, but the hair on the back and sides of my scalp seems really thick. Shouldn’t I have a hair transplant now, just in case I am not a candidate in the future? — A.S., Cherry Hill, NJ

A: The most important criteria in determining who will be a candidate for a hair transplant is the presence of sufficient permanent donor hair. When hair loss is early, it is often hard for the doctor to determine this, since early on the donor area can appear very stable. It is not until the front and/or top of the scalp has significant thinning that the donor area may also show thinning. Therefore, it is only at this time that the stability of the donor area can adequately be assessed.

It has been argued, that one should have a hair transplant early, before the donor area can thin. This is not a reasonable argument, since doing a hair transplant early, does not make the donor hair more permanent. If the donor area is not stable, the transplanted hair will continue to thin after it has been moved to the new location. This will cause the hair transplant to gradually disappear and also risk the donor scar from becoming visible as the hair covering it continues to thin. This problem can affect patients undergoing both FUT and FUE procedures.

Age itself is another factor to consider. The donor area in young people almost always appears adequate. However, the older a person is, the more likely he/she will show donor changes. Therefore, the older a person is, the more confident we are of donor area measurements being accurate. In very general terms, it is very difficult to assess the permanency of one’s donor area in patients under 25 year of age.


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Hair Restoration Answers

What Is Cost of Robotic FUE Hair Transplant Compared To Traditional FUE?

Q: Is robotic FUE hair transplantation more expensive than traditional Follicular Unit Extraction? — K.M., Wayne, NJ

A: In our practice, we charge the same per graft for both procedures. However, there is a slightly higher minimum fee for robotic FUE procedures. See our Hair Transplant Costs & Consultation Fees page.


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Hair Restoration Answers

What Part of FUE Hair Transplant Does ARTAS Robotic System Perform?

Q: Does the robotic hair transplant system do the whole operation or does the doctor do any of it? — B.W., Brooklyn, NY

A: The ARTAS robot only performs a small part of the FUE procedure, although it is an important one. FUE comprises four basic steps:

  1. Isolation of follicular units from the surrounding skin
  2. Removal of follicular units from the scalp
  3. Making recipient sites
  4. Placing grafts into these sites

The robot only performs the first step, follicular unit isolation.

Even in this first step, however, physician control is extremely important, as the doctor must determine the precise depth to which both the sharp and blunt dissection are set. They must also make constant adjustments to the angle that aligns the instrument with the graft.

The ARTAS robotic system gets all of its cues from the surface of the skin, so that it can place the target follicular unit in the exact center of the cutting field of the robotic tip. It can also align the tip parallel with the emergent hairs. However, the angle of the hair as it emerges from the scalp is slightly different than the angle below the skin and the doctor needs to tell the robot what this angle is. Fortunately, the robotic imaging system provides the doctor with the information he needs to make this determination.

Read about Robotic Hair Transplantation.


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Hair Restoration Answers

Is Robotic FUE Faster Than Traditional FUE Hair Transplantation

Q: Is Robotic FUE faster than traditional FUE hair transplants? — F.W., Hoboken, NJ

A: Yes. Although, the speed of removal per graft is about the same, the actual procedure time is shortened when using the robotic device. The ARTAS robotic FUE system has a longer set-up time, but this is more than offset by the fact that the robot doesn’t “tire” during longer procedures.

For more information, visit the page on Robotic FUE Hair Transplantation or read answers to questions on Robotic FUE.


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Hair Restoration Answers

How Many Devices Exist for Robotic FUE Hair Transplantation?

Q: How many different kinds of robotic devices are there? — T.R., Boca Raton, FL

A: There is only one, the robot called the ARTAS System for FUE, made by Restoration Robotics. The Neograft machine, occasionally confused with a robotic device, is actually a hand-held instrument that is not robotically controlled and lacks image-based tracking. It is, therefore, not capable of eliminating the operator error and variability of hand operated devices and does not decrease the damage to follicles, called transection, inherent in manual techniques.

Read more about Robotic FUE hair transplantation.


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Hair Restoration Answers

Does Robotic FUE Leave Donor Area Scars?

Q: Does Robotic FUE leave any scars? — T.B, White Plains, NY

A: Robotic FUE leaves the same tiny, white scars in the donor area produced by manual Follicular Unit Extraction.


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Hair Restoration Answers

Does Propecia Stop Working After Five Years?

Q: I heard that Propecia stops working after five years. Is this true and why in five years? — B.P., Stamford, CT

A: That is not correct. Although the effects of Propecia (finasteride 1mg) will diminish over time, it does continue to work. Using finasteride long-term will still be better than stopping it at some arbitrary interval. In clinical practice, I often increase the dose of finasteride, after someone had been on the medication 3 to 5 years, to help maintain its effectiveness.


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Updated: 2019-11-15 | Published: 2009-07-02


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