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

Hair Restoration Answers

Dr. Bernstein’s Hair Loss: Why No Hair Transplant?

Q: Dr. Bernstein, why have you not had a hair transplant? I’m sure this question gets asked a lot. Thanks. — I.L., Kentfield, CA

A: Yes, all the time.

My donor area is very thin (so I am not a good candidate) and I have gotten used to being bald. It has been years.


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Hair Restoration Answers

Can Dermabrasion Repair "Pluggy" Hair Transplant Scars?

Q: Can dermabrasion help eliminate the circular edges of raised plug grafts caused by old hair transplants? Is this similar to the suturing and excision look?

A: Although dermabrasion can flatten elevated edges, it will not eliminate the round, white, circular scars that result from old punch graft hair transplants. The scarring in these procedures goes all the way through the dermis to the fat. Dermabrasion can only go down to the upper part of the dermis without causing further scarring.

Graft excision with suturing removes the plug as well as the underlying scar and eliminates the tell-tale circular marks of the older hair restoration procedures.


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Hair Restoration Answers

Why Same Photos on Bernstein Medical Website and NewHair.com?

Q: I was looking at the hair transplant photos on the Bernstein Medical – Center for Hair Restoration website. I noticed that you and the NHI website have some of the same pictures. Did you both perform surgeries on these people? — B.B., Columbus Circle, N.Y.

A: All of the patients that appear on the Bernstein Medical website were operated on by me personally. My own staff assisted me in these procedures.

I worked with Dr. Rassman at NHI from 1995 to 2004. Photos of patients that I operated on during this period may therefore also appear on the NHI website.


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Hair Restoration Answers

Will Increasing the Dosage of Propecia Stop the Miniaturization Process?

Q: I have been using Propecia since it was released to the public in 1998 and have found it to work very well. Recently, its effectiveness has stopped and my hairs are miniaturizing again. I am going to increase the dosage to 1/2 a pill Proscar every day. How long will the increased dosage take to stop the miniaturizing process? — T.U., Chappaqua, N.Y.

A: It seems to take the same time to work as when you initially started Propecia.

When patients increase their dose, I rarely see re-growth, but rather the expectation is that further hair loss will be decreased. When it does work to actually re-grow hair, we sometimes see an initial period of shedding, similar to when finasteride was first started.


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Hair Restoration Answers

Will Hair Transplant Affect Ability for Hair Cloning or Vice Versa?

Q: If someone were to get a hair transplant now, and then in the future when hair cloning becomes a possibility, would the hair transplant grafts be affected by hairs from the hair cloning procedure?

A: Cloned hair should not be affected by hair that is transplanted the traditional way and visa versa. If you have a hair transplant now, the hair restoration surgeon can add more hair in the future when cloning becomes available.


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Hair Restoration Answers

Is Donor Area Thinning Common After an FUE Hair Transplant?

Q: I recently had a follicular unit extraction procedure of 320 grafts to fix an old strip scar. The donor area where the FUE’s were taken looks very diffuse – worse than the original scar ever was, it looks horrible. My doctor said this was just shock loss. Have you seen that happen where the donor area gets all diffuse from shock? If not, have you seen it where the FUE’s are taken in an illogical pattern resulting in new scarring that is noticeable? — E.O., Providence, R.I.

A: You can have shedding in the donor area from an FUE procedure, although it is not common. In FUE, the hair must be taken from the permanent zone and if there is too much wastage in the extraction process, too large an area may be needed to obtain the hair. This can leave a thin look even without shock loss (shedding).


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Hair Restoration Answers

After a Hair Transplant Does Hair Grow in Stages?

Q: I had my first hair transplant of 1100 grafts five months ago. The hair has been growing in well and I am very satisfied with the progress, but the new growth appears to occur in different cycles. Some of the hair never fell out and started growing within weeks. At around three months, a lot more started to grow, and now there seems to be even more growth of new hair coming in its finer stages. Is it normal for transplanted hair to begin growing at different times? Why does some hair come in looking thick and other hair start off finer and then gradually thicken up? — E.R., Bushwick, N.Y.

A: You are describing accurately how hair grows after a hair transplant. After the hair restoration procedure, the transplanted stubble is shed and the hair goes into a dormant phase. Several months later, growth begins as fine, vellus hair that thickens over time. The hair usually does not have its original thickness right away.

Typically, growth occurs in waves so that initially some areas will have more hair than others. Over the course of a year the cycles will even out and the hair will thicken to its final diameter.


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Hair Restoration Answers

Will I Lose Benefits of Laser Therapy if I Stop Treatment?

Q: If I stop the treatment will any benefit that I had be lost?

A: As with other medical therapies for hair loss, once the treatment is completely stopped, any benefit should subside.

It is anticipated, therefore, that periodic treatments will be needed after than the initial treatment course.


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Hair Restoration Answers

How Long Does Low Level Laser Therapy (LLLT) Treatment Last?

Q: How long will Low Level Laser Therapy (LLLT) treatments for hair loss last?

A: The studies submitted to the FDA looked at the effects of low level lasers over a 6-month period. There is no published data for use beyond this time period.

Therefore, the long-term effectiveness of these lasers in treating hair loss is not currently known.


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Hair Restoration Answers

What Makes Eyebrow Transplant Different From Other Hair Transplants?

Q: I have had thinning eyebrows since my early twenties (I am now 32) and they have gotten to the point that I can’t make them look good with mascara anymore. I am considering an eyebrow hair transplant, how is it different from other hair transplants? — C.C., Williamsburg, N.Y.

A: Eyebrow hair restoration procedures are similar to hair transplants to the scalp in that the hair, once transplanted, is permanent. They differ both in the techniques used to perform them and in the results.

In eyebrow transplants, only individual hairs should be used, whereas follicular units containing from 1 to 4 hairs are used in a hair transplant to the scalp. In eyebrow transplants, the hairs must be positioned to lie as flat as possible to the surface of the skin. In hair transplantation to the scalp, the angle between the hair and the scalp surface can be as much as 45 degrees or more.

As with hair transplants to the scalp, the hair transplanted to eyebrows will continue to grow and must therefore be cut. However, in contrast to hair transplants where the donor hair is generally a perfect match for scalp hair, in eyebrow transplants the hair is taken from a different part of the body and will have slightly different characteristics both in growth rate and in appearance.

Visit our eyebrow transplant page for more information on eyebrow transplant and restoration procedures.


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Hair Restoration Answers

Hair Loss Causes: What is Miniaturization and What is Effect of DHT on Hair Follicles?

Q: I have read that in the evaluation of a patient for hair restoration surgery some doctors use a densitometer to measure miniaturization – the decrease in size of hair diameters. I read that miniaturization is a sign of genetic hair loss, but when there is miniaturization of greater than 20% in the donor area, a person may not be a good candidate for hair transplants. Is this correct and does 20% miniaturization mean that 20% of the population of terminal hairs have become fine vellus-like hairs or that there is a 20% decrease in the actual diameter of each of the terminal hairs? — B.A., New Albany, Ohio

A: Miniaturization is the decrease in hair shaft length and diameter that results from the action of DHT on healthy, full thickness terminal hairs. The hairs eventually become so small that they resemble the fine, vellus hair normally present in small numbers on the scalp and body. Miniaturized hairs have little cosmetic value. Eventually miniaturized hairs will totally disappear. Twenty percent miniaturization refers to the observation, under densitometry, that 20% of the hairs in an area show some degree of decreased diameter.

In the evaluation of candidates for hair transplantation, we use the 20% as a rough guide to include all hairs that are not full thickness terminal hairs. Of course we are most interested in the presence of intermediate diameter hairs — i.e. those whose diameters are somewhere between terminal and vellus and are clearly the result of DHT. I don’t know if one can tell the difference on densitometry between vellus hairs, fully miniaturized hairs and senile alopecia. The partially miniaturized population is most revealing.

Miniaturization in the recipient scalp (i.e. the balding areas on the front top and crown that we perform hair transplants into) is present in everyone with androgenetic hair loss. Miniaturization in the donor area, however, is less common (in men). It means that the donor area is not stable and will not be permanent. Men with more than 20% of the hair in the donor area showing miniaturization are generally not good candidates for hair transplant surgery.

Read about Miniaturization
Read about Candidacy for Hair Transplant Surgery


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Hair Restoration Answers

Will Hair Transplant Grow Slower in Crown than Front of Scalp and Will Hair Grow More Slowly After Second Transplant?

Q: I had my second hair restoration procedure nearly 5 months back. New hair in the front part of the head is growing well, but the crown is growing slow. Is this common? Also does the new hair grow more slowly after second hair transplant procedure? — B.V., Richmond, U.K.

A: Yes, it is typical for hair in the crown to grow more slowly than the front and top of the scalp and the second procedure generally grows more slowly than the first.


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Hair Restoration Answers

In Hair Transplant Repair, Can You Re-use Hair Follicles from Old ‘Plug’ Grafts?

Q: I had several prior hair transplants that left me with a pluggy look, I was hoping to re-utilize the removed hair and re-implant it, perhaps in the front as a new, more recessed hairline. It is possible?

A: The hair from the excised grafts is always re-implanted.

The grafts that are removed are dissected into individual follicular units and then placed back in the recipient area in a more natural distribution and angle. See Patient LKE’s before and after photos in the Hair Transplant Repair Photo Gallery.


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In Hair Transplant Repair, Can You Repair Scars from Old ‘Plug’ Hair Transplant?

Q: I had an old hair transplant and I’m hoping to remove these plugs and of course am concerned how much additional scarring would result. I’m wondering if removal of the total hair plugs (which are perhaps 2 or 3 mm in diameter) by coring them out would result in a lot of additional scarring.

A: It will significantly reduce the scarring.

The reason is that the round disc of scar tissue at the bottom of the graft from prior plug hair transplants will be removed and the normal skin edges will be brought together resulting in a barely perceptible fine line scar.

See the Graft Excision in Hair Transplants page.


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Hair Restoration Answers

Can Avodart Hair Loss Medication Cause Shedding?

Q: I’m male, early thirties and in the early stages of hair loss, too early for hair transplants. I am experiencing extreme shedding. I took Avodart for 6 weeks, but because of the shedding I stopped. Now, it still continues as strong as ever. I’ve been losing about 200 hairs every day in the shower. 3 months ago I had so much more hair, what is going on? I heard that shedding can happen, but not like this. Could this have caused telogen effluvium, or something else? — M.M., Boston, Massachussetts

A: Since Avodart (dutasteride) is a more potent medication than Propecia (finasteride), the shedding (telogen effluvium) may be more dramatic. If you have made a decision to use Avodart, then you need to tolerate this short-term effect. It should subside within the first 6 months on the drug.


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


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