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

Hair Restoration Answers

Does FUT Hair Transplant Use Sutures or Surgical Staples?

Q: Do you currently prefer sutures or staples to close the donor area? — O.C., Dallas, TX

A: Staples, because they conserve more hair.


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Hair Restoration Answers

Traveling From Abroad: When Can I Fly Home After a Hair Transplant and Will I Need to Return?

Q: I am traveling from England for the hair transplant. When can I fly home and will I have to return after the procedure? — T.W., London, UK

A: You can fly home the second day after the procedure. We usually remove staples 10 and 20 days post-op. Patients that travel can have this done in their home town. We provide instructions and a staple remover that is easy for any health care professional to use. There should be no other reason to return to the office other than an optional one-year follow up.


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Hair Restoration Answers

Why is Cell Differentiation the Major Obstacle for Hair Cloning?

Q: What is the major obstacle to hair cloning?

A: Although many problems remain, the main one is to keep cloned cells differentiated (the ability to perform a specialized function, like producing a hair). There are certain cells in the skin, called fibroblasts, which reside around the base of the hair follicle. These cells are readily multiplied in a Petri dish. When these cells are injected into the skin, they have the ability to induce a hair to form (they are differentiated). The problem is that when these cells are multiplied in culture, they tend to lose this ability (they become undifferentiated).

A number of methods are being examined to keep these cells differentiated. Among them is the insertion of new genes into the cell’s nucleus to alter the expression of the existing genes. Another method is to change the spatial relationship of multiplying cells. The idea behind the second technique is that all embryonic cells have the same basic genetic material, but grow to have different functions (i.e., grow to form muscle, bone or nerves). One reason is that that the cells have a different physical relationship to one another and thus send different signals to each other based on this relationship. For example, the cells on the outside of a growing ball of cells may act differently than the cells on the inside, etc. If researchers can influence the way cells orient themselves as they multiply in the lab, this may enable them to become differentiated to produce hair and stay that way as the multiplication process continues.

For more on this intriguing topic, see the Hair Cloning and Hair Cloning Methods pages at the Bernstein Medical – Center for Hair Restoration website.


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Hair Restoration Answers

Will Second Hair Transplant Session be Different than First Session?

Q: My first hair transplant was a breeze. Will a second procedure be any different than the first? — B.B., Murray Hill, N.Y.

A: Generally in a second procedure, a patient can expect less swelling post-up although the reason for this is not known.

There will also generally be less shedding in the second hair transplant session since the weak miniaturized hair that will be shed is often lost in the first session and the previously transplanted hair is generally more resistant to shedding.

In a second session we generally, but not always, transplant fewer numbers of grafts.

If the old scar in incorporated into the new incision, then there will be slightly less hairs per graft since the density in and around the scar will be slightly altered.

For those who are bald, the second hair restoration is sometimes less dramatic than the first since the second is used for fine tuning rather than taking the person from completely bald to having hair.


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Hair Restoration Answers

Do You Use Digital Imaging to Forecast Hair Transplant Results?

Q: Do you use computer type imaging to create the best way to ensure you (or any hair transplant surgeon) have the same goal or target “picture” of the particular patient’s restoration as that particular patient has as his “picture?” –F.D., Laude, Missouri

A: I prefer not to do imaging since it tends to oversell the hair restoration procedure.

In addition, the technology is unable to accurately represent what the hair transplant will really look like as there are many hair characteristics that it can’t take into account.

Seeing lots of actual photos of hair transplant patients is much more instructive – and more honest (if the photos are taken correctly). At the time of the consult I design the hairline and photograph it.


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Hair Restoration Answers

Can Stress Cause Diffuse Unpatterned Hair Loss (DUPA)?

Q: Can stress produce diffuse unpatterned hair loss (DUPA), or was it bound to happen anyway? — D.D., Park Slope, Brooklyn

A: Both DPA (diffuse patterned hair loss) and DUPA (diffuse unpatterned hair loss) are genetic conditions, unrelated to stress and would have happened anyway. These types of hair loss are characterized by a high percentage of mininiaturized hair in broad areas of the scalp. See the Classification of Hair Loss in Men and Classification of Hair Loss in Women pages on the Bernstein Medical – Center for Hair Restoration website for more information on this topic.

In contrast, stress generally presents as increased hair shedding, a reversible condition referred to as telogen effluvium. It is called this because the normal growing hair is shifted to a resting (telogen) phase before it temporarily falls out. Increased miniaturization is not associated with telogen effluvium.


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Hair Restoration Answers

Allergic Reaction to Rogaine Liquid but Not Foam?

Q: Our dermatologist originally suggested our son use the 5% Rogaine and he developed an allergic reaction to it. Allergy tests confirmed it was the propylene glycol causing the reaction. I understand that Rogaine foam has 5% minoxidil in it but no propylene glycol. Is that correct? — B.M., Lower East Side, N.Y.

A: In addition to minoxidil 5%, Rogaine Foam contains: butane, butylated hydroxytoluene, cetyl alcohol, citric acid, fragrance, glycerin, isobutane, lactic acid, polysorbate 60, propane, purified water, SD alcohol 40-B, stearyl alcohol — but no propylene glycol.


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Hair Restoration Answers

After Hair Transplant, What are White Specks on Scalp?

Q: After the day of the procedure, I could see what appeared as white specks on top of my scalp. Some are sticking out above the scalp more than others. I was wondering if the entire follicular unit should be at the level of the scalp. Is it normal for some part of it to be above the scalp? (I did not receive the procedure from you.) — T.C., London, U.K.

A: It is normal for the grafts to be a little elevated and you should expect them to flatten as they heal.

The effect may be exaggerated in the shower as the grafts become hydrated, but they should settle down soon after you dry off.

As long as the grafts were no larger than follicular units and the graft sites no larger than the size of a 19g needle, there should be no permanent marks.


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Hair Restoration Answers

Can Stress Cause Hair Loss or is that a Myth?

Q: I’ve been dealing with daily mental stress for the past few months. I’ve noticed that during that time, I’ve experienced a lot of frontal hair loss and thinning. I thought stress was a myth for causing hair loss. — R.P., Upper East Side, Manhattan

A: Stress may cause temporary shedding, but it generally does not affect the long-term course of genetic hair loss.

It seems that women’s hair is affected by stress more commonly than men’s hair, but the reason is not clear.


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Hair Restoration Answers

Should Young Person Start with Hair Transplant at Crown?

Q: I am 26 years old, have had two successful hair transplants, but am still losing hair in the crown area. The doctor I have worked with told me that he does not do crown work on anyone until they are at least 40 (due to lack of donor area). I have very thick hair and the transplanted area looks as if nothing was lost. Would you do work on someone my age in their crown area if they have enough donor hair? — A.W., Brooklyn, N.Y.

A: Although I am hesitant to start with the crown when transplanting a younger person, if you have good coverage on the front and top of your scalp from the first two sessions then extending the hair transplant into your crown may be reasonable. It depends upon your remaining donor supply and an assessment of how bald you will become. I would need to examine you.

If it is likely that you will progress only to a Norwood Class 6, then transplanting your crown can be considered. If you will progress to a Class 7 then you should not since, in the long term, hair that was placed in the crown might be better used for other purposes, such as connecting the transplanted top to receding sides.


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Hair Restoration Answers

Does Propecia Affect Beard Growth?

Q: I am a 21 yrs old male having serious hair loss over the last few years. I also have very little facial hair. Since Propecia is a DHT blocker can it inhibit beard growth? — E.M., Astoria, N.Y.

A: As you suggest, it would be reasonable to assume that since DHT stimulates beard growth, blocking DHT (with finasteride) would tend to inhibit its growth. In practice, this does not seem to be the case, i.e. we don’t find that Propecia has any effect on facial hair. The reason is not clear.

It is interesting to note that testosterone stimulates growth of axillary and pubic hair, but not scalp hair. Scalp hair growth is not androgen dependent, only scalp hair loss is.

DHT stimulates terminal hair growth of the beard, trunk and limbs, external ears and nostrils. Of course, it also is responsible for the bitemporal reshaping of hairline as one passes into adulthood and causes male patterned baldness (androgenetic alopecia).


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Hair Restoration Answers

Can I Tell if a Hair Transplant is Successful After Five Months?

Q: It had been 5 months since my hair transplant. I only see minimal growth of maybe a few hundred fine hairs. My transplant consisted of 2,217 grafts. Could you give me your opinion if this is normal or is it a failed hair transplant? — L.D., Miami, F.L.

A: It is too early to tell. Hair grows in very gradually with great variability from person to person.

Some patients only have a little fuzz at five months and then have great growth by one year.

You really need to wait the full 12 months to evaluate the success of the hair restoration.


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Hair Restoration Answers

Are Women Less Likely to be Candidates for a Hair Transplant?

Q: I heard that a smaller per cent of women are candidates for hair transplants compared to men. Is this true?

A: Yes, that is true. Women more commonly have diffuse hair loss where the thinning is all over the scalp. This means that the donor area (the back and sides of the scalp) are thinning as well.

If the donor area is not stable, then there is no point in doing a hair transplant, since the transplanted hair will continue to fall out. Remember, the transplanted hair is no better than the area where is comes from.

On the other hand, women with stable donor areas can be great candidates for surgical hair restoration. The stability of the donor area can be assessed using a procedure called densitometry and should be part of the hair loss evaluation when you see your physician.


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Hair Restoration Answers

How do You Treat Early Hair Loss in Women?

Q: I am a 33 year old women and am just starting to thin on the top of my scalp behind my frontal hairline. What should I do? Should I have a hair transplant?

A: There are a number of things that you should consider that can be effective in early hair loss. These include minoxidil (Rogaine), laser therapy, and using cosmetics specifically made to make the hair appear fuller. Lightening or streaking the hair, as well as parting the hair off to the side, will also make the hair appear fuller.

If a surgical hair restoration is performed too early and there is still a lot of existing hair in the area, the hair transplant may actually accelerate hair loss. Surgery should not be performed prematurely.

Also, it is important that the doctor check the stability of the donor area, using densitometry, to make sure that the procedure is even possible. For those women who are good candidates, and if it is done at the appropriate time, a follicular unit hair transplant is a great procedure that can produce really natural results.


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Hair Restoration Answers

Some Hair Transplant Photos Seem Too Good to be True, Are they Real?

Q: I have seen some incredible photos on some websites. In some cases, they seem too good to be true. Are they real? — P.V., Jersey City, N.J.

A: Evaluating results is more complicated than simply looking at photos – even if they are un-retouched and not studio shots.

For example, if 4,000 grafts were used to make a young person’s hair line look very dense, you might say that was a spectacular result. However, if he only has a total of 6,000 follicular units in his donor area (the average), then he is going to have many problems as he continues to bald, since there will be only 2,000 grafts left for the rest of his head.

Not only was too much hair used up in the front, but the high density of the frontal hair line will not look balanced as the person ages, as this density can not be sustained.

Similar problems occur when the frontal hairline is placed too low or is too broad. These look great in photos early on – and are great for marketing purposes – but become real problems as the person ages.


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


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