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Robotic Hair Transplants & Hair Restoration
Flagship: 110 East 55th Street, New York, NY
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Dr. Bernstein answers frequently asked questions about hair transplantation, hair loss, and medical treatment for hair loss.

Hair Restoration Answers

Before Hair Transplant, How Long Should I Use Propecia?

Q: I am 28 years old and was told that I have early Norwood Class 3 hair loss. I want to have a hair transplant but my doctor told me to use Propecia for 6 months and then come back to discuss surgery. I don’t want to wait that long, what should I do? — L.B., Oyster Bay Cove, NY

A: Actually, you should wait a full year. If you are an Early Norwood Class 3, the Propecia can work so well (in actually growing hair back) that you may not even need a hair transplant. The important point is that Propecia only starts working at 3-6 months and during this time there may actually be some shedding as the new growing hair literally pushes out the old.

A hair transplant performed at 6 months may not only be unnecessary, but growth from the medication may be attributed to the hair restoration surgery. I suggest to wait and see what the medication can do before going for hair restoration surgery.


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Hair Restoration Answers

Should I Get a Hair Cut Before My Hair Transplant?

Q: Should I cut my hair prior to the hair transplant? — R.R., Poughkeepsie, N.Y.

A: It is easier for the hair transplant surgeon and his team to work when the existing hair in the area to be transplanted is cut short, but a skilled surgeon can work well in either situation. Most experienced surgeons are used to working without cutting the hair in the recipient area, since so few patients want their hair to be cut – particularly in New York.

The main advantage of having a closely clipped scalp is that one has better visibility and therefore the procedure moves along faster. This has little bearing in moderately sized sessions, but becomes very important in sessions over 2,400 grafts, when working through existing hair can make the duration of the procedure excessively long. Of course, the disadvantage of clipping the hair is that it is more difficult to “hide” the procedure.

I prefer for the patient to arrive the morning of the scheduled hair restoration with his/her hair having some length so that I can better see the demarcation of the area of thinning. Once the area is marked, the hair can be clipped to the appropriate length in the operating room. Although the hair transplant will be more visible post-op if the hair is clipped short, it is much easier for the scalp to be kept free of crusts.

It is important to differentiate between a closely clipped scalp, which is an advantage, and a shaved head, which makes performing the hair transplant more difficult. When there is some existing hair, the distribution and angle of the original hair is easy to discern and this allows the new grafts to be placed in a direction that follows the existing hair and in a distribution that complements that hair.


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Hair Restoration Answers

What is Graft Compression in a Hair Transplant?

Q: What exactly is compression in a hair transplant? — D.O., Short Hills, N.J.

A: Compression refers to the visible tufting of grafts due to the contraction of the grafts from the normal elasticity of skin around it, after it has been inserted into the recipient site. Compression is most commonly seen when minigrafts are used in the hair restoration (minigrafts contain more than four hairs each). Follicular units don’t show visible compression, since they are already naturally compact. However, if more than one follicular unit is placed into the same site, it can exhibit this phenomenon.

Compressed grafts will become less visible as more hair is transplanted to the area, but if they are close to the hairline or in areas where a lot of density may not be planned (such as in the crown) they may have to be removed. In this case, they can be placed under a microscope, divided up into smaller grafts and re-implanted.


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Hair Restoration Answers

Should I Have Hair Transplant and Use Hairpiece?

Q: What is your opinion on having a hair transplant to restore the hairline and then wearing a hair system behind it to regain the appearance of a full head of hair? K.Y. – Hackensack, New Jersey

A: It is my personal feeling that one should not use a hair transplant to supplement a hair system, especially at a young age. We have occasionally performed this procedure in older men and women.

In my view, a main purpose of a hair transplant is for it to be low maintenance. The combination of a hair transplant and a hairpiece is extremely fussy.

In addition, hair systems cause traction alopecia (hair loss from constant tugging) and the hair loss will become permanent over time, limiting the ability to have a hair transplant in the future. If one needs to have the high density of a system — i.e. for a career — then just use the system. It will give you more long-term options.


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Hair Restoration Answers

Will Multiple FUT Hair Transplants Leave Multiple Donor Scars?

Q: I understand that even if you have multiple hair transplants you will only be left with one scar in the donor area. — T.J., Yonkers, N.Y.

A: If the closure is performed without tension, each procedure should result in the same fine scar.

The best-placed incision is in the mid-portion of the permanent donor area. Since there is only one mid-point, there is one best position for the scar. All incisions should lie on this plane leaving one scar.


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Hair Restoration Answers

Before an FUE Hair Transplant What is the Recommended Hair Length?

Q: Is it possible to do a hair transplant using follicular unit extraction without shaving the donor area? — V.S., Syracuse, N.Y.

A: In follicular unit extraction, the area that is extracted is clipped to about 1-mm in length. However, if the session is not too large, then the clipped area can be long and thin so that the patient’s existing hair will cover it. The person’s hair should be left long for the procedure.


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Hair Restoration Answers

How Many Hair Transplant Grafts Will Give Best Results and Do Megasessions Yield Best Cosmetic Benefit?

Q: There is such a big deal made on the chats about people getting Megasessions of over 4000 grafts per session. When I look at the pictures on your website, the results look great, but I am surprised that not many grafts were used compared to what is being talked about. — N.R., Poughkeepsie, N.Y.

A: My goal is not to transplant as many grafts as possible, but to get the best results possible without exhausting a person’s donor supply. It is important to keep reserves for future hair loss. Unnecessarily large sessions also risk poor growth and have a greater incidence of donor scarring.

View Before and After Hair Transplant Photos


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Hair Restoration Answers

Will Hair Transplant be Detectable Immediately After Surgery and What is Typical Appearance Post-op?

Q: Is it possible to have a hair transplant that is totally undetectable immediately following surgery? — G.F., Stamford, C.T.

A: Not unless a person has a fair amount of existing hair that can cover the transplanted area.

Although surgical hair restoration techniques have improved dramatically over the past ten years, and wounds are so small that patients may shower the morning following the procedure, a hair transplant will be detectable for the first week. During this period, there may be some swelling that settles down on the forehead and some crusting and some residual redness.

Please visit the section on the Bernstein Medical – Center for Hair Restoration website entitled After Your Hair Restoration for more details. Also see the Instructions After Your Hair Restoration Surgery page regarding the normal post-op course following a hair transplant.


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Hair Restoration Answers

Can I Buy Propecia at a Discount?

Q: I am considering taking Propecia, but it I went to my local pharmacy in New York City and it is so expensive. Is there a way I can get it cheaper? — A.S.A., Midtown, Manhattan, NYC

A: The website www.drugstore.com sells Propecia online at a reasonable price. A doctor’s prescription is required.

Read about Propecia (finasteride)


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Hair Restoration Answers

Can Hair Transplant Procedure Remove Hair From One Person and Transplant to Another?

Q: Can hair be transplanted from one person to another? M.Y. – Hoboken, New Jersey

A: A hair transplant between individuals can only be performed on identical twins, since they are genetically the same.

In all other cases, including non-identical siblings, the transplanted hair will be rejected.

We are often asked how it is that one can perform kidney transplants from one person to another, but not hair transplants. The reason is that the skin is more antigenic than a kidney i.e. it is more likely to be rejected. The reason is complex, but this makes sense considering that the skin is the first line of defense against foreign organisms.


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Hair Restoration Answers

How Did Follicular Unit Transplantation and Follicular Unit Extraction Get Their Names?

Q: How did Follicular Unit Transplantation and Follicular Unit Extraction get their names? N.D. – Bergen, New Jersey

A: The first paper on Follicular Unit Hair Transplantation was published by Dr. Bernstein and Rassman in 1995 in the International Journal of Aesthetic and Restorative Surgery. The title of the paper used the abbreviated name Follicular Transplantation. The longer name “Follicular Unit Transplantation” was formalized by Bernstein et. al. in the paper “Standardizing the classification and description of follicular unit transplantation and mini-micrografting techniques.” This paper appeared in Dermatologic Surgery in 1998.

Follicular Unit Extraction derived its name from Rassman and Bernstein’s publication “Follicular Unit Extraction: Minimally invasive surgery for hair transplantation” that appeared in Dermatologic Surgery in 2002.

Read about Milestones in FUT and FUE hair transplantation


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Hair Restoration Answers

After Hair Transplant, Will Scalp Laxity Return to Normal and, if so, How Long After Transplant?

Q: After a strip procedure, will the scalps laxity return to normal and how long after the hair transplant does it take? C.B. – Roanoke, Virginia

A: The scalp regains most of its laxity in the first eight months following the hair transplant, but it will continue to loosen slightly after that.

It is interesting that if the scalp is tight prior to surgery, the scalp is less likely to have its full laxity return than in patients who had loose scalps to begin with. With average or loose scalps, there is usually no difference. However, over time, the patient rarely, if ever, notices any permanent tightness unless aggressive procedures have been performed or procedures such as scalp reductions and lifts.


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Hair Restoration Answers

What Factors Determine Hair Transplant Graft Count?

Q: Is it possible to tell me roughly how many grafts would be left from donor area if one had a hair transplant of 2,500 grafts and had a density of around 2.0? G.H. – New York, NY

A: How much hair can be harvested in total depends upon a number of factors besides donor density. These include: scalp laxity, hair characteristics (such as hair shaft diameter, color and wave), and the actual dimensions of the permanent zone.

Every person is different, so all of these factors would need to be taken into account to determine the total number of grafts that would be available for the hair restoration.


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Hair Restoration Answers

How Long Until I See Growth from Hair Transplant into a Donor Scar?

Q: I have had some grafts implanted into a donor scar. How long does it take to see the final result? B.K. – Newport, Rhode Island

A: In normal scalps, growth is generally complete by 10-12 months. Grafts placed in scar tissue may often take longer to grow.


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Hair Restoration Answers

What Causes ‘Graft Popping’ During Surgical Hair Restoration?

Q: What causes graft popping during a hair transplant? G.K. – Carle Place, N.Y.

A: Popping, or the tendency for grafts to elevate after they have been placed into the recipient area, is caused by a number of factors including:

  • Packing the grafts too closely, particularly when they are placed on a very acute (sharp) angle with the skin
  • Rough placing techniques
  • Bleeding
  • Poor fit between the graft and recipient site
  • Natural characteristics of the patient’s skin, including the elasticity and stickiness of wound edges

The problem with popping is that it exposes grafts to drying (while they are elevated on the skin surface) and trauma (when they have to be re-inserted).

The judgment and experience of the surgeon performing hair transplants is extremely important in minimizing popping. It is important that the surgeon customize the site size to the different size follicular unit grafts and to test the recipient sites as they are made, to make sure that the “fit” is perfect.

Although it is important to place grafts close together to get the best cosmetic result possible, over-packing of the grafts risks popping and other factors (such as overwhelming the blood supply) that may lead to poor growth.

In the end, maximum growth of the transplanted hair should be the primary goal.


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


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