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Robotic Hair Transplants & Hair Restoration
Flagship: 110 East 55th Street, New York, NY
212-826-2400 - [email protected]
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Dr. Bernstein answers frequently asked questions about hair transplantation, hair loss, and medical treatment for hair loss.

Hair Restoration Answers

Can Hair Loss Camouflage Products Damage My Hair?

Q: I have a question about one of the products referenced under the Camouflage section of your website. As you suggested, I have begun to use DermMatch as an alternative to a hair transplant as I have diffuse thinning and been told that hair restoration is not an option right now. I have been very impressed with the results of DermMatch. However, I am concerned that the product might be damaging my existing hair or impeding future growth. Should I have any concerns about this product?

A: None of the well-known cosmetic camouflage products will damage hair or inhibit its growth.

The products come in a variety of forms, including sprays, creams, powders.

A list of these products, their descriptions, and the telephone number where you can obtain them can be found on the Cosmetic Camouflage Products page of the Bernstein Medical website.


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Hair Restoration Answers

What is the Benefit of Staples in Closing Hair Transplant Donor Incision?

Q: I have heard that staples are uncomfortable after the hair transplant, why do doctors use them? — B.E., Great Falls, V.A.

A: Staples are used for two main reasons.

The first is that being made of stainless steel; they don’t react with the skin and, therefore, cause little inflammation.

The second is that, unlike sutures which are used with a continuous spiral stitch, each staple is separate and this causes minimal interruption to the blood supply. The combination of little inflammation and minimal interference with the blood flow facilitates healing and minimizes damage to hair follicles.

Although sutures are generally more comfortable after the hair transplant, the doctors who choose to use staples do so because they are the least injurious to the hair in the donor area.


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Hair Restoration Answers

Am I Too Old for Hair Transplant Surgery?

Q: Is there ever an age where you are too old for a hair transplant? — L.K., Norwalk, C.T.

A: One can be too young for surgical hair restoration, but not too old (as long as one is in good health medically).

Older people generally make excellent candidates for hair transplantation since their expectations are generally more realistic and the future extent of their hair loss more predictable than in those who are younger.

We have successfully treated a number of people in their 80s. In spite of the fact that their spouses and friends asked them, “What do you need a hair transplant for at your age,” the patients were uniformly happy that they did the surgery.


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Hair Restoration Answers

Can I Have a Hair Transplant if My Scalp is Tight from Prior Surgery?

Q: What can be done if I want to have a hair transplant and my scalp is very tight from prior surgeries? — R.R., Long Island, N.Y.

A: Follicular Unit Extraction is ideal in very tight scalps, provided that there is enough hair to extract without leaving the donor area too thin and provided that the follicles are not too distorted from the scarring.

With strip harvesting, undermining techniques may be helpful to close the wound edges once the strip is removed.

In undermining, the surgeon uses either a sharp instrument (scalpel) or blunt instrument (the dull edge of scissors) to separate the upper layers of the scalp (dermis and epidermis) from the lower part of the scalp (fascia). The hair transplant surgeon accomplishes this by spreading apart the fat layer of the skin or by cutting through scar tissue.

Undermining allows the upper layers of skin to literally slide over the lower layers and can significantly increase the ability to close a tight wound. However, if not done carefully, it may increase the risk of bleeding and injury to nerves and occasionally may damage hair follicles.

Undermining is usually used with a layered closure where the deeper tissues are brought together first with a layer of absorbable sutures before the surface of the skin is sutured closed with sutures that are removed.


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Hair Restoration Answers

How Do You Determine Size of Hair Transplant Donor Strip?

Q: I am interested in an FUT hair transplant. How do you figure out how large a strip to use for the hair restoration when transplanting all follicular units? — P.K., New York City, N.Y.

A: The length of the donor strip incision is determined by the number of follicular unit grafts required for the hair restoration. There are slightly less than 100 follicular units/cm2, so if a 1cm wide strip is used, a hair restoration procedure requiring 1800 grafts would need a strip that measured slightly more than 18cm in length.

A 2800 graft procedure would measure slightly more that 24cm if the strip were 1.2cm wide.

The width of the strip is determined by scalp looseness or laxity. For more information, please see the page on the Donor Area.

Read more about FUT hair transplant procedures


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Hair Restoration Answers

After an FUE Hair Transplant Can I Shave My Head?

Q: I am trying to have my donor scar repaired after a 1000 graft hair transplant. I was told the FUE’s placed into the scar would conceal it enough to shave my head? I would like to shave my head completely bald with a razor. — N.R., Poughkeepsie, N.Y.

A: In general, after a scar correction with follicular unit extraction you can clip your hair very short, but not shave your head. If you shaved your hair completely bald, you would generally see a vague outline of the linear scar as well as the small scars from FUE.


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Hair Restoration Answers

What Causes Poor Hair Growth After Hair Transplant?

Q I had a hair transplant 15 months ago at a well known clinic in Manhattan. There were about 1000 grafts transplanted in the front hair line. At this point I am upset with my results. My guess is that only about 50 new hairs have grown. My question is what would cause this to happen? It seems to me that the hair transplant took longer than expected and my grafts died before they were placed! Please help! — B.E., Ithaca, N.Y.

A There are many factors that can contribute to poor growth during the hair restoration process including grafts that are left out of the holding solution too long or kept under the microscope for a prolonged period of time where they dry out.

Grafts can be injured in the dissection process or can be traumatized during the placing – if they are grasped too tightly or manipulated too much.

If properly hydrated, grafts can survive outside the body for many hours, so this in itself is generally not a problem.

There is no way to really tell what the exact problem(s) may be without watching the entire hair restoration procedure, since so many steps are involved that can affect the survival of the grafts. All of these steps must be carefully controlled to insure optimal growth.


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Hair Restoration Answers

Is Propecia Necessary for Hair Transplant?

Q: I am 35 years old and have been using Propecia for the last 3 years, waiting to save enough money for a hair transplant. I no longer feel comfortable using it due to side effects. Can hair transplantation still be effective even without continuing to take this drug afterwards? — Y.C., Matinecock, New York

A: Many people choose not to take Propecia or choose not to take it due to side effects and the surgical hair restoration is just as effective. The only difference is that medications can prevent further hair loss whereas surgery cannot.

Medications are not needed for the hair transplant to be successful or the transplanted hair to grow and be permanent.


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Hair Restoration Answers

Where is Optimal Donor Incision for FUT Hair Transplant?

Q: I have heard that the hair for a hair transplant is taken from the back and sides of the scalp. Where exactly is the best place to remove the hair from? — L.L., Rivington, C.T.

A: You are correct. The best place to put the donor incision is in the mid-part of the permanent zone located in the back of the scalp. As more hair is needed the incision is extended towards the sides.

The vertical position can be found by feeling for the bump in the mid-part of the back of the scalp, also called the occipital protuberance. The strip should lie over this point.

If hair is removed too low on the back of the scalp, there is a greater chance that the wound will heal with a stretched scar from the movement of the underlying muscles. If the incision is too high, the hair will be subject to the same genetic balding and may not be permanent.


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Hair Restoration Answers

Why is Strip Harvesting in Hair Transplant Procedure Still Popular?

Q: Why are strips used so much in a hair transplant when there is now Follicular Unit Extraction (FUE)? — E.N., Long Island, N.Y.

A: Strip harvesting is used in the majority of hair transplant procedures because it allows the surgeon the ability to perform hair transplant sessions using large numbers of grafts while minimizing injury to the patient’s hair follicles.

This is possible because once a strip is removed from the back of the scalp, the tissue can be placed under a stereomicroscope where dissection is accomplished using direct visualization of the follicular units. This allows the grafts to be dissected with minimal trauma.

This degree of accuracy is not possible with other hair restoration techniques, such as FUE, where the separation of follicular unit grafts from the surrounding tissue is accomplished “in vivo” (directly from the scalp).


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Hair Restoration Answers

Do Propecia and Rogaine Act Synergistically?

Q: I have read on numerous websites that Propecia and Minoxidil work synergistically, and that a hair loss sufferer will see better results using them together than either one alone. Do you believe this is the case, or do you think Propecia is enough treatment by itself for someone who just began to experience slight hair thinning and is too early for hair transplantation? — K.V., Hewlett Bay Park, New York

A: They may act synergistically since their mechanisms of action are different.

Rogaine (Minoxidil) stimulates the hair follicle directly, but Propecia (Finasteride 1 mg) permits hair growth by blocking the negative effects of DHT. Of the two, Propecia is far more effective. It is reasonable to use the two together as long as the medications are used regularly.

For patients contemplating surgical hair restoration, we generally have them continue Propecia only, since applying Minoxidil is too fussy and offers only incremental benefit.


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Hair Restoration Answers

Does the Donor Area Decrease in Size Over Time?

Q: I am 22 and want to go for hair transplantation. I want hair restoration surgery now because I have a concern about my donor area that it might diminish if I postponed my transplantation. Could this be the case? — T.J., Westchester County, N.Y.

A: The logic is not correct. Having a hair transplant at an early age does not protect the donor supply.

If your donor area diminishes over time, then the transplanted grafts will fall out as well. Hair does not become permanent just because it’s moved in a hair transplant. It is never any better than the hair in the area where it came from.

The longer you wait – i.e. the older you are when a hair transplant is performed – the more information we will have about the stability of your donor area and this will allow for optimal planning of the hair restoration.


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Hair Restoration Answers

Should I Increase Dose of Propecia if Hair Loss Continues During Treatment?

Q: I recently turned 22 and have been on Propecia for about 2.5 years. The amount of hair that de-miniaturized with daily 1 mg peaked about a year ago and I have seen steady thinning since. I feel that I am too young for a hair transplant. My question is whether or not an increase in dosage of Propecia is indicated here or if I should seek other options entirely? — N.W., Portland, Oregon

A: At 22 years old, I would increase the dose of Propecia before considering hair restoration surgery. However, it is important to realize that there is no scientific evidence that increasing the dose will have any additional effects. There are published data by Roberts et al in the JAAD in 1999 demonstrating that 5 mg is no better than 1 mg from controlled clinical trials.

I usually increase the dose when someone has been on the same dose of medication for about three years, although there is no good data on how exactly to increase the dose, or that it will actually make a difference.

For this purpose, I generally use finasteride in the form of Proscar 5mg every other day (or Proscar 1/2 pill every day).

If you break up the pills, be mindful of the potential risk to pregnant women from handling crushed tablets.


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Hair Restoration Answers

What is Tumescent Anesthesia and is it Used in a Hair Transplant Procedure?

Q: I have read about something called “tumescent anesthesia” but didn’t understand what it is. What exactly is it? — S.S., Hoboken, N.J.

A: Tumescent techniques were first popularized in liposuction surgery where large quantities of fluid containing adrenalin were injected into the person’s fat layer to decrease bleeding before the fat was literally sucked out of the body. Bleeding was minimized because the epinephrine (adrenaline) constricted blood vessels and the fluid compressed the blood flow in the smallest blood vessels called capillaries.

The technique allowed small liposuction procedures to be performed safely as an out-patient procedure. In surgical hair restoration, low concentrations of anesthetic fluid and adrenaline are injected into the fat layer in the back of the scalp.

In a hair transplant, besides decreasing the bleeding, the fluid makes the skin more rigid so that the incision can be more easily made without cutting hair follicles. It also helps the doctor avoid damage to the deeper blood vessels and nerves in the scalp.


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Hair Restoration Answers

Which Gives More Donor Hair: FUT or FUE Hair Transplant?

Q: I am Norwood Class 6 and have read about both Follicular Unit Extraction (FUE) and Follicular Unit Transplantation (FUT). Which will give me more hair? — D.D., Highland Park, T.X.

A: In general, FUT will give you more hair since, in FUT, the best hair from the mid-portion of the permanent zone of the scalp (also called the “sweet spot”) can be utilized in the hair transplant.

With FUE, since only the hair follicles are extracted and not the surrounding bald skin, if too much hair is removed, the donor area will begin to look thin as hair is removed. This will limit the amount of hair that can be harvested.

Although in FUE additional areas of the scalp can be utilized to some degree, this will generally not compensate for the inability to access all of the hair in the mid-permanent zone and the total amount available for the hair restoration will be less.

Read about Follicular Unit Extraction (FUE)

Read about Follicular Unit Transplantation (FUT)


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


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