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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

Can Hair Loss Be Caused By Braids and Extensions?

Q: Over the years, I have worn my hair in braids and extensions. My hair is not growing at my hairline and temples. Can the braids be the cause and can this be treated with a hair transplant? — Williamsburg, Brooklyn, NYC

A: The name for hair loss is this area is called alopecia marginalis. It is almost invariably caused by continued traction from braids or hair extensions. When this is the case, the condition is also called traction alopecia. If the problem is long-standing, the hair will rarely come back, even if the braiding is stopped, and a hair transplant would be indicated.

If there is enough hair loss on the sides of the scalp that the donor supply is significantly reduced, surgical hair transplantation may not be possible.


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Hair Restoration Answers

What are Follicular Unit Transplantation and Follicular Unit Extraction, and How do They Differ?

Q: What is Follicular Unit Transplantation and how is it different from Follicular Unit Extraction? — H.L., White Plains, NY

A: Follicular Unit Hair Transplantation, called FUT for short, is a procedure where hair is transplanted in the naturally occurring groups of one to four hair follicles. These individual groups of hair, or units, are dissected from a single donor strip using a stereo-microscope. The area where the donor strip was removed is sutured closed, generally leaving a thin, fine, line scar.

In Follicular Unit Extraction, or FUE, the individual units are removed directly from the back or sides of the scalp through a small round instrument called a punch. There is no linear scar. There is, however, scarring from the removal of each follicle. Although the scars of FUE are tiny and round, the total amount of scarring is actually more than in FUT.

In addition, since in FUE the bald skin around each follicular unit is not removed, the total amount of hair that can be removed in FUE is substantially less than in FUT. This is because if one were to remove all the hair in an area, it would be bald. In FUT, the intervening bald tissue is removed along with the follicles in the strip.

Read our page on FUE vs. FUT


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Hair Restoration Answers

What Causes Poor Hair Transplant Growth?

Q: Do you ever see poor growth from a hair transplant? What causes this to happen? — R.L., Edison, NJ

A: The situations where I have encountered poor growth are:

1) When hair is transplanted to areas of skin that has been thickened due to the prior placement of larger grafts or plugs (this is called “hyperfibrotic thickening”). Removal of the larger grafts can somewhat ameliorate this problem.

2) When hair is transplanted into a thickened scar.

3) When a hair transplant is performed into an area of severe chronic sun damage. In this case, a very modest number of grafts should be used in the first session and if these grow well, additional grafts can be added in a subsequent session.

Read answers on the topic of Growth After Hair Transplant


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Hair Restoration Answers

After Hair Transplant, Can I Wear A Hairpiece?

Q: What are your recommendations for wearing a hairpiece following a hair transplant? — P.K., Long Island City, Queens, NYC

A: First, some clarification. It is OK to wear a “hairpiece” (one that is attached to the hair with clips or to the scalp with tape) so that it can be removed each night, but NOT a “hair system” (that is woven to existing hair or glued to the scalp and must be removed by the salon).

Patients should wait a week before they resume wearing their hairpiece, although some patients use it as soon as two days later (but keep it on for very short periods of time).

After the first week, I don’t have any restrictions with regard to duration during the day, as long as the person removes the hairpiece at night and shampoos the scalp thoroughly at least once a day.

The hairpiece should be kept clean and it helps if the person has a spare. The piece should be attached with clips. A stiffening rod can be inserted along the front edge to keep it from lifting up. One should avoid using glue. Tape can be used in conjunction with clips only if the area of attachment of the tape is away from the implanted grafts.

Here are some resources for after your hair transplant:

After FUT Hair Transplant
After FUE Hair Transplant


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Hair Restoration Answers

What Did Dr. Jahoda’s Hair Cloning Research Show?

Q: I have heard that Dr. Jahoda was able to clone hair. Is that true? — M.T., Cincinnati, OH

A: Possibly the most interesting work related to cloning hair was done by Colon Jahoda in England over a decade ago. Dr. Jahoda’s work is significant because he identified an inducer cell — i.e. fibroblasts in the outer portion of the hair follicle (the outer root sheath) — that can stimulate the skin to produce new hair. It is well known that fibroblasts, unlike many other tissue cells, are relatively easy to culture.

Theoretically, a patient’s fibroblasts could be removed from the sheaths of just a few follicles and then cultured to produce thousands of follicles. These fibroblasts could then be injected back into the scalp to induce thousands of new hair follicles to grow.

In the study, fibroblasts from a man were injected into the forearm of genetically unrelated women. The cross-gender aspect of his experiment has received much publicity and is potentially of great importance to burn victims, but has little relevance to hair transplantation for male pattern baldness. Patients would probably benefit most from using their own cultured fibroblasts for the best match.

So far this important single study has not been reproduced.

Read about the latest in Hair Cloning Research


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Hair Restoration Answers

Can I Have a Hair Transplant If I Have Fine Hair?

Q: I have fine hair. Is that a problem for a hair transplant? — N.R., Boston, MA

A: Fine hair will give a thinner look than thicker hair, but will look completely natural. Thin hair doesn’t prevent one from having surgical hair restoration, providing your donor density and scalp laxity are adequate. These would need to be measured.

Visit our Hair Transplant Photos section to see before and after photos of some of our patients who had hair transplants with fine hair.

Before after photos of patients with fine hair


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Hair Restoration Answers

Can I Have a Hair Transplant Using Both FUT and FUE?

Q: Is it possible to use the strip technique with the extraction technique together? If so, would that hide the scar enough for me to wear my hair really short? — J.J., Austin, TX

A: The combination of Follicular Unit Transplantation (FUT) and Follicular Unit Extraction (FUE) used the way you are suggesting does make sense and is actually how I originally envisioned the two procedures to work together.

The camouflage of the donor scar will probably never be necessary, but if it is desired, it should be postponed until after the last FUT procedure. FUE will make it possible for most people to wear their hair very short.

Read about FUT Hair Transplants
Read about FUE Hair Transplants


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Hair Restoration Answers

Can I Have an FUE Hair Transplant Using Beard Hair?

Q: Can you use beard hair for a hair transplant using Follicular Unit Extraction? — A.C., San Francisco, CA

A:It is possible to use beard hair for a hair transplant, but there are three main differences between harvesting from the donor area and harvesting from the beard that should be taken into account. These are: 1) scarring 2) ease of extraction and 3) hair quality. Let’s explore these differences in turn.

First, in FUE, although there is no linear scar, there are small white round scars from where the hair is harvested. Normally these marks are hidden in the donor area and are not visible, even if the hair is clipped very short. However, if the scalp is shaven, these marks will become visible. When the beard is used as the donor source for the hair transplant, the patient must continue to wear a beard after the restoration, even if it is tightly cropped, or the faint white marks will show. The tiny round scars from FUE will generally be visible on a clean shaven face. As each person heals differently, we would perform a test before doing the actual procedure to make sure the marks from the extraction are not noticeable at the length that the person wants to wear his beard.

Second, FUE performed on beard hair differs from extraction from the scalp because of the greater laxity — or looseness — of facial skin. This makes extraction with minimal transection more difficult in some cases. A test prior to the hair transplant is particularly important in beard FUE so that the ease of extraction may be determined in advance.

Third, beard hair is coarser than scalp hair. Although the hair seems to take on some of the characteristics of the original hair in the transplanted area, the transformation is not complete. This makes beard hair an imperfect substitute for scalp hair.

A solution to the problem is to transplant beard hair behind the hairline for volume and scalp donor hair at the hairline for naturalness.

Read about FUE Hair Transplants


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Hair Restoration Answers

Should I Consider Hair Transplant if I Have Early Hair Loss in Crown and Donor Area?

Q: I’m currently 24 years old. Ever since turning 20, my hair on top began to thin little by little. I have noticeable thinning on the top part of my scalp and on my crown, but have no recession at the temples. My hairline looks amazingly young and hair on the donor areas seems quite thick. Am I in the early stages of male patterned baldness? I cannot place myself in the Norwood scale since my thinning doesn’t seem to follow the classic pattern. I just started on Propecia. Should I be considering a hair transplant? — B.R., Landover, MD

A: From the description, it sounds like you have typical Diffuse Patterned Hair Loss or Diffuse Patterned Alopecia (DPA). In this condition, the top of the scalp thins evenly, the donor area remains stable, and the hairline is preserved for a considerable period of time. Please see: Classification of Hair Loss in Men for more information.

Propecia would be the best treatment at the outset. When the hair loss becomes more significant, patients with DPA are generally good candidates for surgical hair restoration. It is important, however, that your donor area is checked for miniaturization to be sure that it is stable before a hair transplant is considered.


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Hair Restoration Answers

When Can I Take Aspirin Before and After Hair Transplant Procedure?

Q: I am taking a baby aspirin to prevent heart disease and I heard that I should stop this medication before my hair transplant. How long should I stop for? — G.A., Fort Lauderdale, FL

A: You should discontinue the aspirin 10 days prior to your hair restoration procedure.

Other NSAIDs (non-steroidal anti-inflammatory drugs) need only be stopped 3 days before the hair transplant.

Both aspirin and other NSAIDs can be resumed three days after surgery.1

Here are some resources for before your hair transplant:

Before FUT Hair Transplant
Before FUE Hair Transplant

Here are some resources for after your hair transplant:

After FUT Hair Transplant
After FUE Hair Transplant

  1. Otley CC: Preoperative evaluation and management in dermatologic surgery. J Am Acad Dermatol 2006; 54:119-2 []

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Hair Restoration Answers

Should I Have a Hair Transplant After Meeting with a "Medical Consultant"?

Q: What are “Senior Medical Consultants”? — E.W., Miami, FL

A: These are non-medical personnel who wear white coats to give the impression that they have formal medical training. They are actually salespersons and they should immediately identify themselves as such. Although non-medical personnel can help to answer general questions, they should not be examining you and making specific recommendations about your hair transplant procedure. That is the job of your doctor.

When a physician evaluates you and makes recommendations, he or she is responsible for informing you of the risks as well as the potential benefits of your surgery, and is ultimately responsible for your care. They will also have the knowledge to provide you with a balanced view regarding your surgery as well as other treatment options. This is the practice of medicine.

A “consultant” who is being paid to convince people to have a transplant, but who is not actually performing the surgery, does not bear this responsibility and may have a natural tendency to over-sell the procedure. Beware!

Here are some resources about hair loss consultations at Bernstein Medical:


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Hair Restoration Answers

Can a Hair Transplant Repair the Bald Areas Caused by Alopecia Areata?

Q: Can a hair transplant into bald areas caused by alopecia areata ever be successful? — R.K., Providence, R.I.

A: Alopecia areata is an autoimmune disease in which the body attacks its own hair follicles. It generally appears as round patches of smooth bald areas scattered in the scalp or beard. Less commonly, it can involve the entire scalp (alopecia totalis) or all facial and body hair (alopecia universalis). Unless the condition is well localized and totally stable, hair transplantation is not likely to be effective because the transplanted hair would be subject to the same problem.

We prefer that one have no new lesions for a minimum of two years before considering surgical hair restoration, although this does not ensure that the procedure will be successful.

You may find more information on this relatively common condition at the National Alopecia Areata Foundation (NAAF). For more information, visit: www.naaf.org.


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Hair Restoration Answers

Will Increased Propecia Dosage Improve Hair Growth?

Q: I have been taking Propecia for three months. Would it help to up my dose? — F.J., Red Hook, Brooklyn, NYC

A: For most people (of average body weight of approximately 150 pounds) 1 mg is the ideal dose of finasteride (Propecia).

This is a statistical statement, however. There are some people who fall outside the bell curve. As we don’t know who these people are, we occasionally increase the dose on non-responders after 1-2 years, particularly for those who weigh significantly more than 150 pounds.

Remember, an increased dose also results in an increased risk of side effects and most people experience no additional benefit. There have been no scientific studies to support this regimen.

Read more answers to questions on Propecia Dosage


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Hair Restoration Answers

At What Age Should I Consider a Hair Transplant?

Q: If my hair is just starting to thin, when should I have my first hair transplant? — T.O., Bayonne, NJ

A: It is best to wait until at least 25 before considering hair transplant surgery, although there are exceptions. The most important thing is to wait until you have hair loss that is a cosmetic problem. A hair transplant is a treatment for hair loss — it should not be used as a prevention. When hair loss is just starting, medical therapy is generally a better choice than surgery as it can both regrow hair and prevent future loss.

This issue is detailed in the publication Follicular Transplantation: Patient Evaluation and Surgical Planning.

Read our page on Hair Transplants in Young Patients


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Hair Restoration Answers

Can an FUE Hair Transplant Use Donor Hair from Outside the Permanent Zone?

Q: If someone doesn’t have enough donor hair, do you ever perform an FUE hair transplant using donor hair from outside the permanent hair zone? — M.V., Nashville, TN

A: No. If hair was taken from outside the permanent zone as the surrounding hair continued to bald, the scars from FUE, although small, would become visible.

In addition, the transplanted hair would not be permanent, and over time would eventually fall out.

Read more about FUE hair transplant procedures


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


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