Hair Restoration Answers
Dr. Bernstein answers frequently asked questions about hair transplantation, hair loss, and medical treatment for hair loss.
What Do I Do If I Start Experiencing Side Effects from Propecia?
Q: What do I do if I start experiencing side effects on finasteride? — L.L. ~ Riverdale, N.Y.
A: Don’t panic, just stop the medication and let your doctor know. He or she will give you guidance based on your symptoms.
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Topic: Hair Loss Medication
Tags: Finasteride Side Effects, Hair Loss Medication, Hair Loss Medication Side Effects, Medication Side Effects, Post-Finasteride Syndrome, Propecia (Finasteride), Propecia Side Effects, Sexual Side Effects, Side Effects Duration
Posted by Updated 2018-07-03
If I Am Starting to Thin, Should I Have A Hair Transplant Or Try Medication First?
Q: My hair is starting to thin in the front, but it is not yet bald. I have been going back and forth about whether to get a hair transplant or use Propecia. I’m not sure what my first step should be. What do you think? — N.K. ~ Pleasantville, N.Y.
A: In general, patients who are thinning, but not actually bald, should begin with combined medical therapy (finasteride and minoxidil) for at least a year prior to considering surgery. In many cases, with this regiment, surgery can be postponed or even avoided completely. Unfortunately, some patients cannot tolerate finasteride or choose not to take it due to concern about potential side effects. Minoxidil, although useful, does not significantly alter the long-term course of hair loss when used alone.
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Topic: Hair Loss
Tags: Hair Thinning, Hair Transplant, Hair Transplant Or Medication, Propecia (Finasteride), Rogaine (Minoxidil), Thinning Hair
Posted by Updated 2018-07-03
In Hair Transplant Repair, Can You Remove Plugs By Follicular Unit Extraction?
Q: I was wondering if it was possible to use Follicular Unit Extraction (FUE) on the old plugs instead of graft excision. — N.B. ~ Westport, C.T.
A: Graft excision generally works better than FUE in removing old plugs and mini-grafts. The reason is that, in these grafts, the hair is not aligned due to the scar tissue that tugs on, and bends the hair. Because the hair direction is altered from the scar tissue, there is much more damage when the grafts are removed with the tiny FUE punches. In addition, FUE only removes a very small part of the plug. If the hair in the plug is pointing in the wrong direction or the plug is in the wrong location, the entire graft needs to be removed.
Another benefit of graft excision is that we can remove the underlying scar tissue and improve the appearance of the underlying skin. In FUE, only a tiny bit of the scar tissue is removed and, since FUE holes are left open, FUE actually causes its own scarring. With graft excision, the sites are sutured closed so some scar tissue is removed and the quality of the underlying skin looks more natural.
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Topic: Hair Transplant Repair
Tags: Circular Scar from Plug Grafts, Follicular Unit Extraction, Follicular Unit Extraction Scarring, FUE Scarring, Graft Excision, Hair Plug Repair, Hair Plugs, Hair Transplant Repair, Minigrafts, Plug Removal, Scar Tissue, Scarring
Posted by Updated 2019-05-02
In Hair Transplant Repair, What is Hair Follicle Survival Rate for Re-implanted Grafts?
Q: When you remove hair plugs and re-use the hair from the grafts, what is the survival rate for those follicular units? — W.B. ~ Upper West Side, N.Y.
A: The survival rate is close to that when grafts harvested via FUT or FUE. However, if the grafts are placed into a significantly scarred scalp, this can have a negative impact on growth.
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Topic: Hair Transplant Repair
Tags: Graft Survival During Hair Transplant, Hair Plug Repair, Hair Transplant Into Scar, Hair Transplant Repair
Posted by Updated 2018-07-03
After a Hair Transplant Will Scars Be Visible in the Recipient Area?
Q: I’ve read some information on your website about donor area scarring from FUT and FUE. Since I wear my hair longer in the back, I am not really concerned about that. But what about the recipient area where my hair is thin? Are any scars visible in the recipient area after a hair transplant? How long after a hair transplant will you be able to see redness, marks, or scars on the top of my scalp? — A.N., Chicago, IL
A: The marks and redness from a hair transplant should fade in about 10 days, although there is significant patient to patient variability. The tiny recipient sites that we use prevent visible scarring, pitting, or other surface irregularities as a result of the procedure.
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2.33 stars from 3 vote(s)Topic: Scarring
Tags: Hair Transplant Scar, Recipient Site Healing, Recipient Sites, Recipient Sites Too Large, Scarring, Scarring in Recipient Area, Snug Fit For Grafts In Recipient Sites
Posted by Updated 2018-07-03
Are Lab Tests Required Before Starting Propecia?
Q: I had a good friend get a transplant at your practice and it seems that your practice is the industry leader in hair transplantation. I may one day be looking for one. That being said, my friend said I shouldn’t trust anyone else. I wanted to know if you may be able to tell me what tests/specific labs you have your patients do prior to starting Propecia. I am having my doctor put me on it but he does not recommend any labs but I don’t trust this. So I’m not looking for medical advice, just what your practice may advise a patient to get (in terms of labs/blood tests) prior to starting Propecia. I’m really hoping you can help as I have already contacted a number of other sources and can’t seem to get an answer. — M.B. ~ Upper East Side, N.Y.
A: Blood tests are not required before starting finasteride and we do not routinely perform them. If a patient requests test then Total and Free Testosterone, DHT, and Prolactin are reasonable to obtain, but there is no consensus on what the appropriate tests might be. If a patient requests tests because he has symptoms (i.e. such as lack of energy associated with low T), he should see his internist, urologist, or GP. That said, patients 50 and over (40 and over in patients with a high risk of developing prostate cancer) should have a PSA before starting finasteride.
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2.80 stars from 5 vote(s)Topic: Hair Loss Medication
Tags: Blood Test, DHT, Dihydrotestosterone, Finasteride & Prostate Disease, Low Testosterone, Prolactin, Propecia (Finasteride), Propecia and PSA Levels, Prostate Cancer, Prostate Specific Antigen (PSA), Testosterone
Posted by Updated 2018-07-03
If I Have Shock Loss After a Hair Transplant, How Long Until Hair Grows Back?
Q: I had an FUE hair transplant three weeks ago and some of my existing non-transplanted hair has fallen out. I was a Norwood 3V, but now I look more like a 4 or 5 without the hair that used to help cover up my thinning area. Am I destined to look balder for the next few months? When can I expect to look like before? — T.M., New Haven, CT
A: You are describing shedding that is pretty typical following a hair transplant. The hair which is shed generally grows back together with the transplanted hair beginning at about three months. You should expect hair that is shaved for the FUE procedure to grow back right away at the normal rate of 1/2mm per day.
The shedding (also called shock hair loss) doesn’t mean permanent damage to the hair follicles. What it refers to is a physiological, or normal, response to trauma to the scalp which is caused by the hair restoration procedure. In general, only miniaturized hair (the hair that is affected by androgens and that has begun to decrease in diameter) is shed after a transplant. This hair would be lost in the near term anyway. Existing healthy hair is unlikely to shed, but if it were to shed, you could expect it to grow back as the transplanted hair grows in.
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2.83 stars from 6 vote(s)Topic: Shedding
Tags: After FUE Hair Transplant, After Your Hair Restoration, Appearance After Hair Transplant, Growth After Hair Transplant, Hair Loss After Transplant, Shedding After Hair Transplant, Shock Fall Out, Shock Loss, Shock Loss in Recipient Area
Posted by Updated 2018-01-12
Why Is It Important to Wash My Scalp After a Hair Transplant?
Q: Is it harmful if I do not rinse or wash my recipient area for 5 to 7 days after the hair transplant? — T.E., Yonkers, NY
A: The purpose of showering the day after the procedure is to remove scabs and dried blood. This will allow for quicker healing, less inflammation (redness), and a reduced incidence of infection. It will also shorten the time post-op where the procedure might be detectable. In our practice, patients are instructed to start showering and gently washing the recipient area the day after the surgery. The first day after surgery the patient will shower three times, and for the remainder of the week, showering will be twice daily. When showering, patients can clean the transplanted area with a special medicated shampoo that is gentle on grafts. The follicular unit grafts are made to fit snugly into the recipient sites and will not be dislodged in the shower, as long as the patient washes gently.
- Read about post-op care following an FUT hair transplant
- Read about post-op care following a Robotic FUE hair transplant
- Read more Q&A about post-op care
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3.00 stars from 2 vote(s)Topic: Post-op
Tags: After FUE Hair Transplant, After FUT Hair Transplant, After Your Hair Restoration, Instructions After Your Hair Restoration Surgery, Medicated Shampoo, Post-op, Post-op Care, Post-op Instructions, Scabbing, Scalp Crusting After Hair Transplant, Shampoo After Hair Transplant, Shower After Hair Transplant
Posted by Updated 2018-01-09
Can I Have Robotic FUE If I Have Gray Hair or Curly Hair?
Q: I have read that the ARTAS System works best on straight black hair. Is this an option for gray hair? How about wavy or curly hair? – P.W., Fort Lee, NJ
A: The ARTAS robotic system can be used in patients with any hair color although in order for the robot to visualize white hair (or very light blond hair) the hair must be dyed. Curly hair is also not a problem as the donor hair in a robotic procedure is shaved to approximately 1 mm in length so a wave or curl is eliminated. In patients of African descent, where the hair below the surface of the skin may be curved, a slightly larger punch can be used. we have patients dye their hair the evening before or the day of the procedure. For convenience, only the hair in the donor area (back and sides) where the robot will be doing the harvesting needs to be dyed.
In patients who prefer not to shave or dye the entire back and sides of the scalp, we can perform the ARTAS robotic FUE using the long-hair technique. With this technique, you will grow your hair on the back and sides of the scalp a bit longer so it can cover the harvested area. On the day of the procedure, we will lift up the hair, clip a long thin band of donor hair and then extract follicular units from this limited region of the scalp. After the procedure, you can simply comb down your hair to cover the donor zone. The area that has been harvested (and possibly dyed depending on your hair color) will not be visible.
- Read about the ARTAS Robotic System
- Read about dying white hair in advance of Robotic FUE
- Read about the long-hair Robotic FUE technique
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2.75 stars from 4 vote(s)Topic: Robotic FUE
Tags: African-American Hair, ARTAS Hair Transplant, ARTAS Robot for FUE, Blond Hair, Curly Hair, Donor Hair Harvesting, Dying Hair for Robotic FUE, Gray Hair, Long-Hair Robotic FUE, Robotic FUE, Robotic FUE Hair Types, Robotic Hair Transplant, Robotics in FUE, White Hair
Posted by Updated 2017-10-17
Is PRP Safe for Older People with Hair Loss?
Q: I am a 65 year old female who has recently experienced thinning hair and I’ve heard of PRP treatments. Is PRP safe and does it work for older people? — R.E., Upper East Side, NY
A: PRP (Platelet Rich Plasma) is safe for persons of any age, although we don’t administer it to pregnant women and those under 18. It can be helpful as long as the person has enough miniaturized hair for it to work on. It will not work on a totally bald area of the scalp.
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2.57 stars from 14 vote(s)Topic: Platelet Rich Plasma (PRP)
Tags: Hair Loss Treatment, Platelet Rich Plasma (PRP), PRP Efficacy, PRP in Older Patients, PRP Safety, PRP to Treat Hair Loss, PRP Treatment, treatmen
Posted by Updated 2017-10-17
Does Minoxidil Improve Graft Survival After a Hair Transplant?
Q: Does minoxidil play any role in the survival of the grafts after a Neograft/FUE procedure? — J.W., Philadelphia, PA
A: When a doctor performs a hair transplant, the hair should be taken from the permanent zone so, by definition, that hair is not affected by medication (i.e. does not need to be maintained by either minoxidil or finasteride). If the doctors using Neograft are suggesting that minoxidil increases survival, then they are probably harvesting hair outside the permanent zone. To clarify, I use the ARTAS robotic system for our FUE procedures, not Neograft, as the former is a far more accurate device for harvesting.
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1.00 stars from 2 vote(s)Topic: Growth After Transplant
Tags: ARTAS Robot for FUE, Graft Survival During Hair Transplant, Growth After Hair Transplant, Propecia (Finasteride), Propecia After Hair Transplant, Rogaine (Minoxidil), Rogaine After Hair Transplant
Posted by Updated 2017-12-01
Is the Dose of Finasteride the Same for Everyone?
Q: Does a man’s height and weight affect the dose of finasteride or Propecia he should take? i.e. will a 6’4″ man need a higher dose than a 5’7″ man. — T.B., Rye Brook, NY
A: The dose of finasteride is the same (i.e. 1mg) regardless of a person’s height or weight. The reason is that one needs only 0.5mg a day for it to be effective, so there is much leeway built into the dose (but the rate of non-responders is slightly higher at the 0.5mg/day dose). That said, after 5 years or so, finasteride seems to be less effective and doctors often increase the dose a bit. The next step-up is generally to take 1/3 of a 5mg pill each day. Keep in mind that the dosing we are speaking about is for hair loss (androgenetic alopecia). When finasteride is used for prostate enlargement, the dose is 5mg a day.
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2.18 stars from 11 vote(s)Topic: Hair Loss Medication
Tags: How To Take Finasteride, Propecia (Finasteride), Propecia Dosage
Posted by Updated 2017-10-17
Can I Have a Hair Transplant if I Have a Scar in My Donor Area? If So, Which Do You Recommend, FUT or FUE?
Q: I have a diagonal scar in the middle of my donor area that I got during a childhood accident and I am concerned that it will limit my options for hair restoration. Will this type of scar prevent me from having either FUT or FUE? Do you recommend one or the other? — R.F., Upper West Side, NY
A: Traumatic scars in the donor area do not preclude us from performing a hair transplant. With an FUT/strip procedure, we can remove all or part of the scar when we excise the donor strip. In Robotic FUE, the ARTAS Robot can be programmed to avoid a scar during harvesting. In either procedure, we can improve the appearance of the scar by implanting follicular unit grafts directly into the scar tissue. The hairs will grow permanently in the scar, just like ones we implant in the recipient area, and the scar will become harder to detect.
It is important to note that transplanted hair will not grow in a thickened scar. If your scar is thickened, the doctor can thin it out (soften it) with injections of cortisone. They are usually repeated at 4-6 week intervals in advance of the procedure. The number of injection sessions required depends upon the thickness of the scar and your individual response to the medication.
The presence of a traumatic scar should generally not determine which type of transplant you have. That should be decided in consultation with your physician based on factors such as how much volume you need, how you intend to style your hair, how short you would like to keep it, how soon you need to return to strenuous physical activity, and other general considerations for a hair transplant.
We recently posted photos from a patient who had a robotic hair transplant with a scar in his donor area. The photos include images of his donor area (with scar) before his procedure, immediately after robotic graft harvesting and 11 days post-op. View this patient’s before after photos.
- View Patient RSI’s hair transplant photos
- Read about techniques used to fix scars
- Video: How Does the ARTAS Robotic Hair Transplant System Locate and Dissect Follicular Units?
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2.50 stars from 2 vote(s)Topic: Donor Area
Tags: ARTAS Robot for FUE, ARTAS Robot Programmed to Avoid Scar, FUE & the Donor Area, Hair Transplant Into Scar, Robotic FUE, Robotic FUE Benefits, Scar in Donor Area, Scar Repair, Scar Thickening, Traumatic Scar
Posted by Updated 2018-01-12
Is FUE or FUT Better for an MMA Fighter?
Q: I am an MMA fighter and I want to get a hair transplant. How long do I have to be out of commission and which type of procedure should I have, FUE or FUT? — J.A., Columbus, OH
A: With any type of hair transplant it takes 10 days for the transplanted grafts to be permanently fixed in place. The difference between FUE and FUT is in the limitations of activity due to the donor area. With FUE one would need to abstain from MMA for the same 10 days it takes the recipient area to heal (the grappling component of Mixed Martial Arts is the most stressful on the scalp). With FUT, however, one would need at least three months for the linear donor scar to heal before one could resume contact sports like MMA.
- View our FUE vs. FUT page with a detailed summary of the pros and cons of each procedure
- After FUE Hair Transplant Surgery
- After FUT Hair Transplant Surgery
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Topic: FUE vs FUT
Tags: After FUE Hair Transplant, After FUT Hair Transplant, Exercise After Hair Transplant, Follicular Unit Grafts, FUE vs. FUT, FUT vs. FUE, Graft Dislodgement, Graft Dislodgement After Hair Transplant, Grafts Permanent Ten Days After Hair Transplant, Post-op
Posted by Updated 2018-01-09
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Updated: 2019-11-15 | Published: 2009-07-02
