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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 I Need a Prescription to Buy the HairMax Laser Comb?

Q: Do I need a doctor’s prescription to get the Laser Comb?

A: The HairMax Laser Comb is an over-the-counter hair loss treatment so it does not require a doctor’s prescription. You can order a Laser comb without consulting a physician and you do not need to be monitored by a doctor when using it.


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Hair Restoration Answers

Where Can I Buy HairMax Laser Comb?

Q: Where can I buy the HairMax Laser Comb?

A: The Laser Comb is currently available for purchase on-line at a variety of hair loss and hair related websites including Drugstore.com, Amazon.com and Hairmax.com.


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Hair Restoration Answers

How Much Does a Laser Comb Cost?

Q: How much does the LaserComb cost?

A: There are two types of HairMax Laser Combs currently available:

  • The Premium Comb has 9 laser beams and the cost is approximately $545.00 plus shipping.
  • The SE Compact version of the Laser Comb has 5 laser beams and costs $395.00.

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Hair Restoration Answers

How Effective is Laser Comb in Regrowing Hair?

Q: How effective is the HairMax Laser Comb?

A: It is difficult to tell since there are no long-term studies using the LaserComb.

From the data we have available, it seems to be about as effective as Rogaine (Minoxidil). As most who have used Minoxidil know, it only works in areas where there is a fair amount of miniaturized hair and over time loses its effectiveness.

The HairMax LaserComb is not as effective as Propecia (Finasteride) and, of course, is not a substitute for surgical hair restoration.


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Hair Restoration Answers

Do You Use Sutures or Staples in an FUT Hair Transplant?

Q: Can you please comment on the use of sutures verses staples in hair restoration procedures? — S.S., Prospect Park, NY

A: Sutures are great on non-hair bearing skin and allow perfect approximation of the wound edges, but on the scalp they can cause damage to hair follicles below the skin’s surface. The reason is that a running (continuous) suture traps hair follicles and when the skin swells (as it normally does after hair transplants) the trapped follicles can strangulate and die.

Since staples are placed individually – about ½ cm apart – they don’t strangle the tissue. This allows the blood supply to flow freely to the wound edge permitting the blood’s oxygen to reach the follicles in the stapled area and minimizing the risk of any hair loss. The unimpeded blood flow also facilitates wound healing and can sometimes result in a finer scar, particularly in a tight scalp.

For these reasons, we now use staples in most of our hair transplants.


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Hair Restoration Answers

How Does Hair Cloning Grow Hair Follicles from Cultured Cells?

Q: Considering cell cultivation is made possible how could their injection create a normal formation of hair on the scalp and can they induce hair growth also in scarred areas where previously hair stopped growing?

A: That is the question. It is not known if these induced follicles will resemble normal hairs, and be cosmetically acceptable on their own, or if they will grow unruly and must be used as a filler behind more aesthetically pleasing transplanted hair.

Hair growth is an interaction between the dermal components (fibroblasts in the dermal sheath and dermal papillae) and the epidermal structures.

It is possible that the injected dermal fibroblasts will interact with resident epithelial cells to produce a properly oriented hair. A tunnel of epithelial cells can also be created to facilitate this process and some researchers are using cultures of both dermal and epithelial cells.

As you suggest, part of the challenge is not just to multiply the hair but to find a way for the hair to grow in its proper orientation. With scar tissue, the task will obviously be much more difficult.

Another issue is that the induced follicles are just that, they are single hair follicles rather than complete follicular units. Because of this they wouldn’t have the cosmetic elegance of one’s own natural hair, unlike that which is possible in follicular unit hair transplantation.

That said, much work still needs to be done and it is not clear at this time what might be the solution.

Read more on the Hair Cloning page on the Bernstein Medical – Center for Hair Restoration website.


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Hair Restoration Answers

How Do You Treat Hair Loss from Pseudopelade or Scarring Hair Loss on the Scalp?

Q: I am suffering from Pseudopelade for four years now. I have lost a lot of hair & there are big bald patches on the top of my scalp that are difficult to hide. Is there any hair transplant surgery or follicle transplant surgery possible in my case, or anything else I can do? — T.L., Boston, MA

A: In general, hair transplantation does not work for Pseudopelade (a localized area of scarring hair loss on the top of the scalp) since the condition is recipient dominant rather than donor dominant.

With a donor dominant condition, such as androgenetic hair loss, the tendency to have the condition, or be resistant to it, is located in the hair follicle and moves with the hair follicle when the follicle is transplanted to a new area. Therefore, in androgenetic alopecia, healthy permanent hair taken from the donor area in the back of the scalp will continue to grow in the a new location in the balding part of the scalp.

In a recipient dominant condition, such as Pseudopelade, the problem is in the skin, so if you perform a hair transplant into an affected area of skin, the transplanted hair will become affected by the same process and be lost.

The disease process can often be slowed down with anti-inflammatory agents, such as corticosteriods, applied or injected locally and the bald area can be camouflaged with cosmetics specially made for use on the scalp. See the Cosmetic Camouflage Products page on the Bernstein Medical – Center for Hair Restoration website.


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Hair Restoration Answers

Can Hair Transplant Restore Hairline in 21 Year Old With Early Hair Loss?

Q: I am a 21 year old male experiencing the first signs of hair loss as of late. I looked at your before and after pictures of hair transplant patients and honestly right now I have a lot more hair than the patients, even in the after photos. By no means do I intend to criticize your work at all, but I noticed that they still had a receding hairline. I myself am an artist and pay close attention to detail. What I want out of a hair transplantation procedure is to basically have the full head of hair that I had even before puberty. Is it possible for this to be done? — P.N., New York, NY

A: Your concerns and goals, although understandable, are impossible to achieve through hair transplantation and is exactly the reason why we don’t perform hair transplants in young persons.

Surgical hair restoration can never give you your original density back since we are just redistributing a smaller amount of hair.

In addition, your original hairline should not be restored since a transplanted hairline is permanent and will not evolve naturally as you age. A mature hairline must be built into the design of the first hair restoration procedure, regardless of a patient’s age.

Read about the Candidacy for a Hair Transplant


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Hair Restoration Answers

Do You Recommend Finpecia or Generic Finasteride?

Q: I am 26 years old and in the beginning of losing my hair and not ready for hair transplant surgery. It seems to have stopped now but 4 months ago I shed a lot of hair and can visually see that my hair on the scalp is thinning out. I have looked into and read up on taking Propecia or more exactly Finpecia (I’m a student so cost is a factor), but can I trust this generic drug? Have looked at the company (Cipla) website but I’m still a bit scared of taking something I don’t really know what it is. What is your opinion on choosing Finpecia over Propecia? — E.E., Midtown East, N.Y.

A: Finpecia is manufactured in India by a slightly different method than the way Propecia is produced in the U.S. Since finasteride 5mg is now available in a generic from in the U.S., I suggest that you use finasteride 5mg and quarter the 5mg tablet with a pill cutter and take 1/4 tablet a day. The parts do not need to be the same size. In the U.S., generic finasteride and Propecia (1mg) and Proscar (5mg) are all made the same way. Cipla is a large company, but is not under U.S. FDA supervision.


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Hair Restoration Answers

How Big is the Donor Strip in an FUT Hair Transplant?

Q: Can you give me an idea of the average width of a donor strip, i.e. the actual width taken from the back of your scalp for a hair transplant? — A.E., Fort Lee, N.J.

A: The average donor strip is 1cm wide, although this will vary depending on the patient’s scalp laxity, density, and the number of grafts desired for the hair restoration.

The length also depends on the number of grafts needed. We average 90-100 follicular unit grafts per cm2 of donor tissue (that is the density of follicular units in an average person).

A 2,000 graft procedure, for example, would require a donor strip 22 cm long and 1cm wide. A 2,500 graft session would be 1.2 cm wide and 23 cm long.


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Hair Restoration Answers

Can Hair Loss Treatment with Propecia Affect Prostate Specific Antigen (PSA) Level?

Q: I have been on Propecia for approximately 5 years. What does Propecia do to your PSA level, lower it or make it higher? Also, what would you consider a normal level while on Propecia? — H.K., Long Island City, N.Y.

A: Finasteride 1mg a day lowers your PSA around 50%. Therefore, when patients are taking finasteride, the PSA reading should be doubled.

Finasteride does not appear to decrease the sensitivity of the PSA test to detect prostate cancer – its main purpose.

PSA levels vary by age and by lab so I would check with your internist/urologist to evaluate your specific level.

In very general terms, for adults, it is ideal to have a PSA < 1.0 off Propecia and < 0.5 on it, but higher levels can also be fine.


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Hair Restoration Answers

Can Hair Loss Increase on Propecia for Four Months?

Q: I believe I am an “early” IIIA or IVA. I am not losing any hair on the back of the scalp. There is no substantial hereditary hair loss on either side of the family, but I began taking Propecia four months ago and recently noticed a dramatic thinning of hair on the top (front) of the scalp, extending back to the rear of the head. — B.M., Lower East Side, N.Y.

A: Often people experience some shedding the first six months on finasteride as the new hair essentially pushes out some of the old. I would wait a full year before making any judgments about a hair transplant since you may see significant regrowth from finasteride in the second six months and may not need surgery at this point, particularly if the hair loss is early.


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Hair Restoration Answers

Should I Use Multiple Hair Loss Medications, Such as Both Avodart and Propecia?

Q: I’m 52 years old and have been taking Propecia (finasteride) for two years. It seems to maintain the status quo with no apparent regrowth. I am considering adding a dose of Avodart (dutasteride) once a week in conjunction with the daily Propecia. My question is twofold: (1) Since dutasteride blocks production of both enzymes (type I and II) that produce DHT from testosterone, is it redundant to take the finasteride that only blocks the type I enzyme? — Y.B., Orlando, Florida

A: It is redundant to take both.

However, you may not be taking the optimal dose of dutasteride which seems to be at least 0.5mg a day for hair loss.


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Hair Restoration Answers

Can Hair Transplant Use Cloned Hair from Someone Else’s Donor Tissue?

Q: I was reading the hair cloning area on your site and came across this passage:

“Donor cells can be transferred from one person to another without being rejected. Since repeat hair implantations did not provoke the typical rejection responses, even though the donor was of the opposite sex and had a significantly different genetic profile, this indicates that the dermal sheath cells have a special immune status and that the lower hair follicle is one of the body’s ‘immune privileged’ sites.”

Does this mean that I could get a hair transplant from someone else’s head of hair one day? Any type of hair?

A: Yes, in theory we will be able to use someone else’s donor tissue to clone hair – but the technology to actually do this is still years away.


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Hair Restoration Answers

Multiple Hair Loss Medications: Do You Recommend Stopping One if No Improvement?

Q: If I use the dutasteride for one year and do not see a noticeable improvement can I quit the Avodart, continue the daily dose of Propecia and expect to retain the same “holding pattern” I have now?

A: If Avodart is helping to maintain the status quo then you can expect to lose some hair, i.e. return to where you would have been if you had used finasteride alone.

Read more about Hair Loss Medication


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


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