Hair Restoration Answers
Dr. Bernstein answers frequently asked questions about hair transplantation, hair loss, and medical treatment for hair loss.
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
Rating:
5.00 stars from 2 vote(s)Topic: Age for Hair Transplant
Tags: Early Hair Loss, Early Hair Transplant, Follicular Transplantation: Patient Evaluation & Surgical Planning, Hair Loss in the Temples, Hair Loss Medication, Hair Transplant Young Patient, Mature Adult Hairline
Posted by Updated 2017-12-11
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
Rating:
Topic: Donor Area
Tags: Donor Area, Donor Hair, Follicular Unit Extraction, FUE & the Donor Area, FUE Scarring, Harvesting Outside Permanent Zone, Minimal Donor Hair, Permanent Hair Zone
Posted by Updated 2017-12-11
In Hair Transplant, What is Effect of Dense Packing on Grafts?
Q: Does dense packing hurt grafts? — P.L., Rye, NY
A: There is no absolute answer to this question. In a hair transplant, dense packing of grafts has a risk of decreasing yield if there is a significant amount of photo damage to the scalp (which alters the blood supply) and if there is a tendency for the grafts to pop (this is difficult to predict pre-operatively). Very closely spaced grafts exacerbate the popping and expose the grafts to desiccation (drying), hypoxia (lack of oxygen) and mechanical trauma from the necessary re-insertion.
That said, the skill of the hair transplant surgeon and placing team, the size of the recipient sites, and the way the grafts are dissected and trimmed all play important roles in determining graft survival in dense packing.
Read a thorough analysis of the “pros” and “cons” of large hair transplant sessions
Read answers to more questions on dense packing of grafts
Rating:
Topic: Hair Transplant
Tags: Blood Supply to Scalp, Dense Packing of Grafts, Desiccation, Graft Dissection, Graft Popping, Hair Transplant Surgeon, Hypoxia, Mechanical Trauma, Recipient Sites
Posted by Updated 2018-01-10
When Can I Judge the Effectiveness of Treatment with Propecia?
Q: I was wondering why you chose two years as the amount of time one should wait to judge the effectiveness of Propecia. Have you had patients who only saw results after that long? Why does Merck say 3-6 months and Dr. Rassman at New Hair say 6-8 months? I know these numbers aren’t arbitrary, but I’m just wondering what the logic is behind this and how does this relate to planning a hair transplant? — I.P., Hempstead, Long Island, NY
A: The Merck data showed that over 90% of patients had peak response at 1 year and this has been my experience as well.
Most patients show the most dramatic response between 6 to 12 months with some getting additional benefit up to two years. Prior to 6 months, the results are quite variable and there may even be a net loss due to shedding during this period, as the Propecia (finasteride) stimulates a new anagen cycle.
If one is planning to go on Propecia before a hair transplant to minimize any shedding from the surgery and to prevent future hair loss, one should start the medication at least one month prior to the procedure.
If one wants to use Propecia for the purpose of possibly avoiding hair restoration surgery, then one needs to wait at least a year to see if there will be enough regrowth.
Finally, if one is younger (i.e. in the 23-25 age range) one should be on Propecia for at least two years to give it every possible chance of working and see its maximum benefit before considering a hair transplant.
Read more about taking Propecia before a hair transplant
Read more about Propecia (finasteride)
Rating:
5.00 stars from 2 vote(s)Topic: Hair Loss Medication
Tags: Anagen Cycle, Dr. William Rassman, Early Hair Loss, Hair Loss Medication, Merck, New Hair Institute (NHI), Pharmeceutical Companies, Propecia (Finasteride), Propecia Duration, Propecia Peak Response, Shedding
Posted by Updated 2017-12-12
Can You Perform Hair Transplant into Scar Tissue?
Q: Can you perform a hair transplant into scar tissue? — A.H., Rockland County, New York
A: Yes, hair grows in scar tissue, but not quite as well as in normal tissue. The scar is not as elastic as normal tissue so the grafts are at slightly higher risk of being dislodged; therefore, more care must be taken to protect the grafted area after the hair transplant.
In addition, the blood supply in scar tissue is less than in normal tissue, so that area should not be transplanted as densely and the hair replacement should be performed over multiple sessions.
Finally, grafts do not grow well in thickened scars. If a scar can be thinned using injections of cortisone, it may improve the chance that the transplanted hair will grow.
Read about using hair transplant techniques to fix scar tissue
Read answers to other questions on hair transplants into scar tissue
Rating:
3.00 stars from 2 vote(s)Topic: Hair Transplant into Scar
Tags: Blood Supply in Scar Tissue, Cortisone, Graft Dislodgement, Multiple Hair Transplant Sessions, Scar Tissue
Posted by Updated 2016-05-06
How Long Should I Wait Before Having a Second Hair Transplant?
Q: If a second hair transplant is performed before the first had a chance to grow could the second procedure destroy the follicles from the first? — B.M., Upper East Side, NYC
A: Hair from the second hair transplant session would not damage the follicles transplanted in the first session, even if follicular unit grafts were transplanted in exactly the same spot as in the first session.
The reason to wait until the hair grows in, however, is so that you can better plan the subsequent hair restoration procedure. If two follicular units are placed on top of each other or very close together, you will essentially be creating a mini-graft and the results will not look natural.
We advise waiting at least 8 months between sessions with 10-12 months being ideal so that the grafts of the second session can be evenly distributed among the grafts of the first.
The extra few months not only allow the surgeon to identify all of the previously transplanted grafts, but enables him to get a sense of the “look” of the first session (i.e. the wave, the density, and how the patient will ultimately want to comb his newly transplanted hair). This is very useful in guiding the placement of grafts in the second session to maximize its cosmetic benefit.
Read more about a second transplant
See before after hair transplant photos of patients who had a second procedure
Rating:
5.00 stars from 1 vote(s)Topic: Hair Transplant
Tags: Appearance After Hair Transplant, Follicular Unit, Graft Placement, Hair Follicle, Multiple Hair Transplant Procedures, Second Hair Transplant
Posted by Updated 2017-12-11
In Early Hair Loss, Can Scalp Tingling and Hair Thinning be Related?
Q: I am twenty and think that I am starting to thin. I am also experiencing a slight tingling in my scalp. Are these related? — T.N., Philadelphia, PA
A: Most likely. Early androgenetic alopecia can be associated with a slight tingling or slight tenderness of the scalp.
You should see a dermatologist for evaluation and, if you have early male pattern baldness, consider starting finasteride (Propecia).
Rating:
Topic: Hair Loss
Tags: Androgenetic Alopecia, Early Hair Loss, Hair Thinning, Male Pattern Baldness, Propecia (Finasteride), Scalp Tenderness, Scalp Tingling
Posted by Updated 2017-12-12
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Updated: 2019-11-15 | Published: 2009-07-02
