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

Hair Restoration Answers

Why Do You Shed Hair in First Months of Treatment with Rogaine?

Q: I started thinning and saw more hair in the tub. I began Rogaine and stopped shampooing every night and is seems that there is now more coming out every time I shower. What is going on? — E.U., Short Hills, NJ

A: Rogaine can cause shedding at the beginning of treatment (i.e. in the first 3 months) but this is expected as it causes some hair to begin a new cycle of shedding and re-growth. This means the medication is working.

Another reason for your apparent shedding is that the less you wash your hair, the more will be lost each time. Go back to shampooing every day and see what happens.


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Hair Restoration Answers

After Hair Transplant, How Long Until I Can Wash My Hair?

Q: When can I wash my hair after a hair restoration procedure?

A: If a follicular unit hair transplant is performed so that there is a “snug fit” between the graft and the incision into which it is placed, the grafts are reasonably secure the day after the procedure.

At this time, gently washing your scalp with lightly flowing water and a patting (rather than rubbing) motion is permitted. Vigorous rubbing, however, will dislodge the grafts.

Over the course of the week the grafts become more secure, and at 10 days post-op they are permanent. At this time, normal scrubbing of the scalp is permitted.


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Hair Restoration Answers

After Hair Transplant, is it OK to Pop or Scratch Pimples on Scalp?

Q: I have read that you can get pimples/ingrown hairs after 3-5 months post op. Is it ok if you pop or scratch these areas? — T.V., Los Angeles, C.A.

A: It is common to get small pimples that begin to erupt 2-3 months post-op. These are due to newly growing hairs trying to work their way through the skin. The pimples are transient and should be left to resolve on their own.

If they persist, you should see your doctor. Persistent inflamed pimples can be treated with antibiotics and may occasionally need to be drained.


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Hair Restoration Answers

How Do You Treat General Thinning in Women ?

Q: I’ve been losing my hair just around the front of my scalp for years, but now it’s bad enough that I need to wear a wig to hide the top and back. Do you transplant women?

A: If you have thinning in such a broad area, most likely your donor area is also thin and you would not be a good candidate for surgery.

An examination can determine this and also determine if there is some other cause of your hair loss other than genetics.


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Hair Restoration Answers

Can a Hair Transplant at the Temples Cover a Facelift Scar?

Q: I had a facelift about a year ago and the skin on the sides by my temples is really bare. It makes the scar a little obvious too. Can you transplant hair just at the temples to cover the scar? — L.H., Scarsdale, N.Y.

A: Hair loss in the temple area following a facelift is relatively common and can be treated with a hair transplant. If there is scar tissue, the hair restoration will generally require more than one session.


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Hair Restoration Answers

Before a Hair Loss Evaluation, Should I Fast or Change My Diet?

Q: I am a 47 year old woman with thinning on the top of my scalp for three years. I think I want to go for a comprehensive evaluation for hair loss and know that the doctor may want to take blood tests to help find out the cause of my hair loss. I am not sure if I need to fast before I come in? — R.B., West University Place, TX

A: Fasting is not necessary for a comprehensive evaluation.

The comprehensive diagnosis may include hair pull tests, hair pluck, hair density measurements, anagen telogen ratios, scalp biopsies and laboratory (blood) tests but no pre-test fasting or other preparation is necessary.


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Hair Restoration Answers

After a Hair Transplant Should I Continue Treatment with Propecia?

Q: If I get transplants, do I still have to continue taking Propecia? — P.V., Chelsea, N.Y.

A: Yes, you should.

You do not need finasteride (Propecia) for the hair transplant to work, or the transplanted hair to continue to grow, but finasteride can decrease further hair loss.


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Hair Restoration Answers

Is Hair Transplant Using Body Hair an Option?

Q: I have heard of body hair transplants as an option being considered by some patients. Do you think that could be an option for me as my donor area isn’t able to provide the hair that I need? — N.S., Winnetka, I.L.

A: With body hair transplants, the hair quality is poor and there can be a significant amount of scarring where the hair is harvested, so we are not recommending it at this time.


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Hair Restoration Answers

Which is Preferred: Rogaine Foam or Liquid Formula?

Q: Do you think there is a difference in the efficacy between the 5% Rogaine foam or liquid formula? — N.N., Dallas, TX

A: In theory, the foam should be as effective as the original solution (liquid). However, an important part of the efficacy is getting the medication directly onto the scalp – rather than just on the hair.

For patients who are applying the medication to areas with a significant amount of hair, using the solution with a dropper applicator enables the medication to best reach the scalp. Because of this, I prefer that patients use the solution with a dropper applicator if they are using the medications in areas with a significant amount of hair. If patients find the solution irritating to the scalp (or too messy) and the foam less so, then using the foam is better than nothing.


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Hair Restoration Answers

Hair Loss and Replacement for Dummies

Q: Why did you write another book on hair loss? — K.L., Greenville NY

A: Hair Loss and Replacement for Dummies is the first book that we have written that is specifically geared for the lay public. Besides hair restoration, it covers a wide range of topics including: the diagnosis and treatment of medical conditions that can cause hair loss, tips on hair care, information on hair systems, and a number of other topics not stressed in our other books.

Our prior books, The Patient’s Guide to Hair Restoration and The Guide to Hair Restoration focused on medical treatments and surgical hair restoration. Although very easy to understand, they are most helpful for someone that already has a basic understanding of hair loss or that had a consultation.


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Hair Restoration Answers

Is it More Important to Do Scalp Exercises Before First Hair Transplant or Second Hair Transplant?

Q: Is it more important to do scalp exercises before the first procedure or the second? — P.P., Richmond, V.A.

A: When the scalp is tight, it can be useful for either the first or the second hair transplant.

Keep in mind, however, that the scalp will naturally stretch between hair transplant procedures, so that if exercises were not needed for the first procedure, they will generally not be needed for the second.

In our practice, we generally wait one year between hair restoration sessions so that we can see the full cosmetic impact of the first procedure and give the scalp laxity a chance to return to normal on its own.

In addition, there is a risk that active massage after the first procedure may widen the donor scar. Therefore, before considering massage before a second hair transplant, make sure that enough time has elapsed between procedures so that stretching of the scar will not be a be a problem.

In general, since the scalp will normally continue to relax for up to a year after a procedure, it makes sense that when there is a tight scalp, one should wait at least a year before considering the next hair transplant session. If massage is contemplated, it should be started one year after the prior procedure. This will give the scalp a chance to loosen naturally and will ensure that the massage will not stretch the donor scar.

In my opinion, it is a mistake to plan hair restoration sessions too close together in patients where scalp laxity is a constraint.


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Hair Restoration Answers

Can I Have a Hair Transplant to Cover a Single Bald Patch?

Q: I just started to lose my hair but it’s just in one spot, like a circle on the left side of my head. Do you ever do a hair transplant just into a bald spot and not the whole head? — D.F., Esher, U.K.

A: It is possible to have a hair restoration procedure into a single bald spot. However, it would be most beneficial to first determine the cause of the condition.

Bald spots caused by alopecia areata (an autoimmune disease) are best treated with injections of steroids into the scalp, rather than with a hair transplant. In fact, the transplanted hair can be rejected in patients with this condition.

Traumatic scars (i.e. from an accident) can be treated with follicular unit hair transplantation as the hair grows quite well in scar tissue, as long as the scar is not thickened (hypertrophic).


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Hair Restoration Answers

After a Hair Transplant What are the Effects of DHT on Donor Hair?

Q: Hi! I wanted to ask if after hair restoration surgery the transplanted hair will eventually fall out? Because the surgery is to restore hair mainly for people with genetic hair loss which results from DHT, won’t the DHT make the new follicles implanted fall out as well? — B.C., Stamford, C.T.

A: Hair loss is due to the action of DHT (a byproduct of testosterone) on hair follicles that cause them to shrink and eventually disappear (the process is called miniaturization). The follicles on the back and sides of the scalp are not sensitive to DHT and therefore don’t bald (miniaturize).

When you transplant hair from the back and sides to the bald area on the front or top of the scalp the hair follicles maintain their original characteristics (their resistance to DHT) and therefore they will continue to grow.

Read about Miniaturization


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Hair Restoration Answers

Is Hair Loss Determined by Age or Family History?

Q: Why do some people have a full head of hair into their seventies or eighties and others start to go bald in their late teens or early twenties? — E.Z., Darien, CT

A: The difference is genetic with the inheritance coming from either side of the family.

Although a person will have the genes his/her whole life, a gene’s expression (also called phenotype) can be quite variable. The factors that cause this variability are still unknown.

Read more about the Genetics of Hair Loss


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Hair Restoration Answers

How Long Before Hair Transplant Should I Start Scalp Exercises?

Q: How long should I do scalp exercises before the procedure? — O.D., Newport, R.I.

A: To get the most benefit from scalp exercises, one should stretch vigorously on a regular basis for at least eight weeks prior to your hair restoration procedure. However, this will vary based upon the individual and upon how much the laxity needs to be increased.

Please remember that for the majority of patients scalp exercises are not necessary.


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


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