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

Hair Restoration Answers

After Hair Transplant, When Can Patients Expose Scalp To Sunlight?

Q: When can patients go in the sun after a hair transplant? — S.M., Glencoe, I.L.

A: Following a hair transplant, patients should protect their scalps from the sun for about a month.

This does not mean one needs to stay indoors. It just means that after a hair restoration surgery you should wear a hat or a good sunscreen when outdoors.

Sunburns on the scalp should be avoided, not just for persons having a hair transplant, but for everyone.


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Hair Restoration Answers

Is Propecia Effective In Young Patients?

Q: I know that Propecia works in only about half of patients. Are younger people more likely to be helped by this medication? — V.C. Greenpoint, Brooklyn

A: The main studies by Merck looked at men between the ages of 18 and 41. The five year data (which, in my view, is most important) showed that 48% of men had an increase in hair growth and 42% had no change over baseline. Thus a full 90% held on to their hair or had more over a 5-year period. This compares very favorably to the placebo group where 75% lost hair over the 5-year period.

I think the most interesting question relates to the 10% who continued to lose hair in the treated group. Did these men lose hair at a slower rate than the non-treated group? Based on the action of finasteride on blocking DHT and DHT’s central role in causing male pattern hair loss, it is reasonable to assume that even these “non-responders” did have some benefit from the drug, albeit small. If half of those on the medication who continued to lose hair did so at a rate slower than the placebo group, then 95% of patients actually benefited from the medication to some degree – an extraordinarily high success rate, in my opinion.


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Hair Restoration Answers

After Hair Transplant, Do Patients Wear Bandage And If So, For How Long?

Q: Do patients need to wear a bandage after the surgery and for how long? — L.H., West University Place, T.X.

A: In a properly performed follicular unit hair transplant, the patient can remove any bandages the day after the procedure and gently shower/shampoo the transplanted area. The bandages do not need to be reapplied. The reason the dressing can be removed so soon is that follicular unit grafts fit into tiny needle-size incisions that heal in just one day.


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Hair Restoration Answers

Can You Transplant Cloned Hair Into a Scar?

Q: If you have already had a hair transplant, once cloning becomes available, will you be able to transplant the cloned hair into the first transplant’s scar on the back of the head? I like to wear my hair short, especially in the summer, and also would feel more comfortable knowing there is no scar in my head. — H.I., Rockville Centre, N.Y.

A: Yes, as long as the scar is not thickened, cloned hair should grow just as normally transplanted hair would and would be a great way to address any residual scarring from the procedure.

Although hair can be transplanted into widened scars, hair does not grow well in thick scars – this would apply to hair restoration procedures performed via traditional means as well as those using cloned hair.


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Hair Restoration Answers

After Hair Transplant, What Is Recommended Hair Length To Hide Scar?

Q: I never kept my hair really long, what length can I wear my hair after a hair transplant to hide that I had a procedure? — D.F., Chappaqua, N.Y.

A: Hair transplants, whether using the strip method to harvest the donor hair or by extracting individual follicular units one-by-one directly from the scalp, will leave some scarring. If the hair is long enough so that the underlying scalp is not visible, these scars will not be seen.

The quality and density of a person’s donor hair will affect this coverage and determine how short a person may keep his hair. In some cases the back and sides can be cut to a few millimeters, in others it would need to be kept longer. Since there is no scarring in the recipient area (the front and top of the scalp where the grafts are placed) the hair in these areas may be kept at any length.


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Hair Restoration Answers

Why Is Hair Loss In Women Harder To Treat With A Hair Transplant Than Hair Loss In Men?

Q: Why is hair loss in women harder to treat with hair transplants than hair loss in men?

A: The majority of women present with diffuse hair loss (i.e. thinning all over) rather than the patterned hair loss seen in men (where the hair loss is localized to the front and top of the scalp).

Diffuse thinning presents two problems for a potential hair transplant candidate.

The first is that there is no permanent area where the hair can be taken from. If hair is taken from an area that is thinning, the transplanted hair will continue to thin after the procedure, since moving it doesn’t make it more permanent.

The second problem is that since the areas to be transplanted are thin, rather than completely bald, the existing hair in the area of the hair transplant is at some risk to shedding as a result of the procedure.

When women have a more defined pattern (i.e. more localized thinning on the front part of the scalp with a stable back and sides), they can make excellent candidates for surgery. This pattern occurs in about 20% of women. A small percentage of men have diffuse thinning and are, therefore, poor candidates for a hair restoration surgery as well.


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Hair Restoration Answers

When Will Newly Transplanted Hair Start To Grow?

Q: It has been over a month after my hair transplant procedure and I am starting to get nervous. When can I expect to see some growth? — J.N., Winnetka, I.L.

A: Transplanted hair begins to grow, on average, about 10 weeks after the procedure, although this number can vary. Hair tends to grow in waves and occasionally some new hair may start to grow as long as a year after your procedure. In general, growth is a bit slower with each hair transplant procedure, although the reason for this is not fully understood.


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Hair Restoration Answers

Is Hair Cloning Technique Using ACell a Breakthrough?

Q: I just read a press release saying that researchers have developed a successful technique to clone hair by using a wound healing powder. To paraphrase, the press release says:

MatriStem MicroMatrix, a product of regenerative medicine, ACell, Inc., is a wound healing powder that promotes healing and tissue growth and has now proven to help regenerate hair in the donor and recipient regions of hair transplant patients. While intended to heal ulcers and burns, Gary Hitzig, M.D. and Jerry Cooley, M.D., have found that its properties offer a broader scope of treatment, including hair cloning. “We’ve made amazing breakthroughs using MatriStem as a hair cloning tool,” said Dr. Hitzig. “We’ve been able to multiply the number of hair follicles growing in the recipient area, and as an added benefit are seeing faster hair growth. This new hair cloning technique also makes hair transplantation surgery less invasive.”

Is this new technique really a breakthrough in hair cloning? And if so, when can we start cloning hair?

A: It appears from preliminary studies that plucked hairs stimulated by ACell are in some cases able to regenerate new hair. Because the hair is placed into the recipient area and is partially derived from cells in the dermis, it is not yet clear whether the hair will be effected by androgens over time or if it will continue to bald.

The research so far is promising and a number of doctors are doing research in this area, including Dr. Schweiger and myself at Bernstein Medical – Center for Hair Restoration.

For more on the topic, visit our Hair Cloning section, our page on ACell extracellular matrix devices, and answers to questions on Hair Cloning.


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Hair Restoration Answers

Why Does A Hair Transplant Work?

Q: Why does a hair transplant grow – why doesn’t the transplanted hair fall out? — J.F., Redding, C.T.

A: Hair transplants work because hair removed from the permanent zone in the back and sides of the scalp continues to grow when transplanted to the balding area in the front or top of one’s head. The reason is that the genetic predisposition for hair to fall out resides in the hair follicle itself, rather than in the scalp — this idea is called Donor Dominance. This predisposition is an inherited sensitivity to the effects of DHT, which causes affected hair to decrease in diameter and in length and eventually disappear — a process called “miniaturization.” When DHT resistant hair from the back of the scalp is transplanted to the top, it will continue to be resistant to DHT in its new location and grow normally.

Read more about Miniaturization
Read about the Causes of Hair Loss in Men


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Hair Restoration Answers

Which is Better Hair Loss Treatment: Minoxidil With Retin-A or Without Retin-A?

Q: Is using Minoxidil combined with Retin-A better than regular Minoxidil for Hair Loss? — L.W., Gowanus, New York

A: Minoxidil has been prescribed (off-label) in combination with other medications, such as topical retinoic acid (Retin-A), to enhance its penetration into the skin and thus increase its effectiveness. This combination of medications can increase the absorption of minoxidil into the bloodstream and may increase the risk of potential side effects, including changes in blood pressure and scalp irritation. It is important to use combination therapy under the supervision of a physician.

If person wants to add Retin-A to the minoxidil regime, the Retin-A should be applied only once a day, since the Retin-A will bind to the skin and will last for at least 24 hours.

Applying Retin-A more frequently will not increase its effectiveness (in facilitating the absorption of minoxidil); it will only increase the incidence of side effects. Retin-A can be applied to the scalp at the same time as Minoxidil, or by itself.

Explore the pro’s and con’s of Minoxidil — also known by its over-the-counter product Rogaine — at the Rogaine/Minoxidil page or by viewing posts tagged with Rogaine (minoxidil).


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Hair Restoration Answers

In Follicular Unit Hair Transplant, Can You Double-up Follicular Units and Still Call it FUT?

Q: Dr. Bernstein, I think that you have established a great monument in the history of hair transplantation. Especially, your historical works about Follicular Unit Transplantation, which you published about 15 years ago, have contributed greatly to the spread of modern hair transplant technique in the whole world.

In the past days, there might have been many physicians who did not care much about the importance of the follicular unit and they have only cut the grafts to size. Now, every hair transplant physician believes the importance of follicular unit, and there is no one who cut the grafts to size ignoring each follicular unit.

However, there are some physicians who shout that a hair transplant procedure can be called FUT only when people use all single FU exclusively, and the procedure cannot be called FUT, if mixture of single FU and double FU are used in a session.

I would like to ask you, if you could accept the usage of combination of single FU and double FU under the name of FUT, as long as the grafts were cut according to each FU and intact FU are used throughout the procedure. Could you accept easing of the very strict definition of FUT, which you published about 15 years ago? Could you agree to use mixture of single FU and double FU under the name of FUT? — N.W., Huntington, N.Y.

A: Thank you for the kind words. In thinking about hair transplantation in general, it is important to consider that a hair restoration procedure spreads hair around and, as a result, the transplanted hair will be less dense than the person’s original hair. Therefore, one would never want grafts larger than the largest original follicular units or the results will not look natural. The artificially large grafts will stand out in relatively thin surroundings. If one were to try to fix this by transplanting the doubled FUs very close together (over one or more sessions) one risks running out of grafts for other areas of the scalp. In other words, you can’t fool mother nature.

For example, if a person has thin hair and has only 1-, 2- and 3-hair units occurring naturally in his scalp, then creating 4-hair grafts (by combining two 2’s or 1’s and 3’s) can result in an unnatural, tufted look. Doubling larger follicular units also necessitates larger wounds to receive the grafts which defeats one of the main advantages of FUT, namely to minimize recipient wounding.

That said, it is not unreasonable to place two 1-hair FUs in a single site (if there are extra 1s from the FU dissection) in order to increase density in an area and to eliminate an extra wound.) We do this for crown hair transplants when we are not doing a hairline and there is no need for 1-hair grafts. However, this is the exception.

Technically speaking, anything other than transplanting individual, naturally occurring follicular units is not FUT. However, a physician should make modifications to the procedure for the specific needs at hand. This is the art of medicine. By understanding and applying the underlying principles of Follicular Unit Transplantation, rather than being limited by its nomenclature, the physician will serve his patient best.

In addition to exploring Hair Restoration Answers to learn more about this topic, visit the Follicular Unit Transplant (FUT) section of our website and read detailed information about the hair transplant evaluation, the hair restoration procedure, follicular unit grafts, the donor area, and more.


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Hair Restoration Answers

Can You Have a Hair Transplant to the Crown Before the Front or Top of Scalp?

Q: Can the crown be transplanted first instead of frontal area? Why is the crown the last choice? Any reasons behind it? — H.H., Ladue, M.I.

A: The crown can be transplanted first in patients who have very good donor reserves (i.e., high density and good scalp laxity). Otherwise, after a hair restoration procedure to the crown you may not be left with enough hair to complete the front and top if those areas were to bald.

Cosmetically, the front and top are much more important to restore than the back. A careful examination by a trained hair restoration surgeon can tell how much donor hair there is available for a hair transplant.

For more information on this topic, see my publication on surgical planning of hair transplants, “Follicular Transplantation: Patient Evaluation and Surgical Planning.”


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Hair Restoration Answers

Is Lgr5 Gene Discovery a Hair Cloning Breakthrough?

Q: I heard about the Lgr5 gene being a breakthrough in hair cloning. What’s the latest on that?

A: Many scientists feel that adult stem cells house the answer to cloning (regeneration) of hair follicles. One of the problems of hair cloning, however, is that the cells, once duplicated, “forget” that they are hair follicle cells.

It has recently been discovered that the Lgr5 gene, located in stem cells, appears to contain the “global marker” present in all adult hair follicles. If Lgr5 gene is the “calling card” of the cell, it may carry the cell lineage and shoulder the responsibility of signaling to surrounding stem cells what they are actually supposed to do as they multiply.

Recent experiments have shown that these Lgr5 cells maintain the cells ability to differentiate as hair follicles after many generations of being multiplied in the test tube and, therefore, have the potential of serving as the building blocks of entire new hair follicles. The successful exploitation of this gene would eliminate a major barrier to cloning hair.

Reference
Haegebarth A, Clevers H: Wnt signaling, lgr5, and stem cells in the intestine and skin. Am J Pathol. 2009 Mar; 174(3):715-21.

For more on how hair cloning works, visit our page on hair cloning and multiplication.


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Hair Restoration Answers

Does Low Level Laser Therapy (LLLT) Affect Hair Loss in Men and Women Differently?

Q: Have there been any studies showing the difference between men and women in their response to laser treatments for hair loss?

A: In the International Journal of Cosmetic Surgery and Aesthetic Dermatology (Vol. 5, Number 2; 2003), a study on low level laser therapy (LLLT) was conducted which indicated that there was a 55% increase of growth (hair count) in the temporal area as well as 64% in the vertex of the female subjects who were treated with LLLT for hair loss. The study also indicated a 74% increase in the hair counts of the male subjects in the temporal area and 120% in the vertex region. These results would initially indicate that LLLT works better in men than in women, but there were four times as many men in this study so the results might be different in a larger test group.

However, even in this notably smaller female group, the tensile strength of the hair increased dramatically over the tensile strength observed in the male subjects after treatment. This would indicate that, at least in this study, there was not only an increased hair count in women, but the tensile strength of that hair was greatly improved as well. This would be initially indicative that LLLT may be found to be more beneficial to women than to men.

It is important to note that this study was published in 2003. Further studies need to be conducted to confirm the initial results and to further elucidate the possible mechanisms of low level laser light therapy in both men and women with alopecia. As important, long term data needs to be accumulated to show the continued efficacy of this treatment. It had been our clinical experience that LLLT is not as effective as one would assume from the results of the initial studies.

Visit the page on Laser Therapy for more information, or read more answers to questions about laser therapy.


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Hair Restoration Answers

Is Genetic Test for Hair Loss Worthwhile?

Q: Is it worth getting the genetic test for balding?

A: You’re referring to Hair DX (hairdx.com), which costs about $150 and came to market in January of 2008 as the first test for androgenetic alopecia, aka male pattern baldness.

The test screens for variations in the androgen receptor gene on the X chromosome, the gene that is associated with male pattern hair loss. The purpose of the test is to identify persons at increased risk of developing hair loss before it is clinically apparent – so that medical intervention can be started early, when it is most effective.

It is important to realize that, at this point, there is just an association with this gene and hair loss; the cause and effect has not been proven and the association is not anywhere near 100%. A danger is that patients may overreact to the relatively incomplete information that the test provides. It is best to have the test performed under a doctor’s supervision, so that it can be put in the context of other information that the physician gleans through a careful history, physical and a densitometry hair evaluation. As of this posting, genetic testing for hair loss is not permitted in New York State.


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


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