Hair Restoration Answers
Dr. Bernstein answers frequently asked questions about hair transplantation, hair loss, and medical treatment for hair loss.
Can A Hair Transplant Restore Hair Loss After Radiation Treatment?
Q: I received radiation therapy to my scalp two years ago to treat a brain tumor. I lost my hair during treatment and it has not grown back. The doctors said that this treatment might result in permanent hair loss. Is a hair transplant a viable option after radiation treatment? — K.G., Darien, C.T.
A: Unlike chemotherapy which generally causes a reversible shedding of hair (called anagen effluvium), radiation therapy can cause both reversible shedding and the permanent loss of hair follicles (scarring alopecia). Hair can be successfully transplanted into these scarred areas – but there must be enough donor hair to do so. If the radiotherapy was localized, a hair transplant procedure is often quite effective – although several procedures may be required to achieve adequate coverage of the irradiated areas.
Rating:
Topic: Hair Transplant
Tags: Anagen Effluvium, Donor Area, Follicular Unit Extraction, Follicular Unit Transplant, Hair Transplant, Radiation Hair Loss, Scarring Alopecia
Posted by Updated 2017-12-01
What is the Main Advantage of Robotic FUE Over Manual FUE?
Q: I’ve heard that robotic-assisted FUE is better than manual FUE, but what exactly is the main advantage of Robotic FUE? — N.K., Bergen County, NJ
A: Robotic FUE is a significant improvement over other FUE techniques for a number of reasons. The accuracy and ability of a robot to perform countless repetitive motions are key reasons why robotic techniques are an improvement over manual techniques.
In a manual procedure, the skill and speed of a physician are under constant stress, as he or she must follow the angle and depth of the hair precisely hundreds to thousands of times. This task is almost impossible for even the best surgeons to perform without risking harm to the integrity of the follicles. Entering the skin at the wrong angle risks transecting or cutting the follicles and may render them useless for transplantation. Making too shallow an incision can also damage follicles, as the important base of the follicle can become sheared off when it is subsequently extracted.
The robot is engineered to avoid these problems, and so the number of viable grafts that the robot extracts is increased. As a result, the likelihood of the success of the transplant is greater using the robotic system.
Read more about Robotic Hair Transplant
Rating:
4.00 stars from 4 vote(s)Topic: Robotic FUE
Tags: ARTAS Robot Accuracy, ARTAS Robot Consistency, ARTAS Robot for FUE, Follicular Unit Extraction, Robotic FUE Benefits, Robotic FUE vs Manual FUE, Steps in FUE Procedure
Posted by Updated 2017-12-11
Can A Robotic Hair Transplant System Create a Natural Looking Transplant?
Q: I’ve heard it takes the artistry of the surgeon to create a natural looking hair transplant. How do you do this with a robot? — S.S., Shanghai, China
A: I currently create the recipient sites by hand using different size needles. They determine the angle, direction and distribution of the grafts, and these three variables determine the aesthetic aspects of the hair transplant.
However, I am working with Restoration Robotics to have the ARTAS System create recipient sites and we are currently beta-testing this technology. The robot can now make very precise recipient sites. The ability of the robot to mimic the art of the surgeon is in the works, and we expect it to be ready in the fall of 2014.
In this new robotic-assisted process, the surgeon designs the hairline and delineates the area to be transplanted directly on the patient’s scalp. The surgeon then photographs the patient’s scalp and feeds the photograph into the robot’s computer to create a digital 3-D image. The doctor, in order to have the robot mimic what he would do by hand, can then manipulate various parameters, such as hair angle, direction and density.
Read more about Recipient Site Creation in a Robotic Hair Transplant
Rating:
5.00 stars from 1 vote(s)Topic: Robotic FUE
Tags: ARTAS Robot for FUE, ARTAS Robot Recipient Site Creation, FUE, Image-guided Robotic System, Recipient Site Creation
Posted by Updated 2017-12-11
Why does the ARTAS® Robotic System only do FUE, Not FUT?
Q: Why does the ARTAS® Robotic System only do FUE, not FUT? — V.Z., Chicago, Illinois
A: Currently the robot is only used for harvesting grafts from the donor area. In FUE, the doctor punches out hundreds to thousands of individual follicular units from the back and sides of the scalp by hand using a small round instrument called a punch. The punch has to be held at exactly the right angle, with just the right pressure applied, stopped at a precise depth and, during this time, rotated (or spun mechanically) without changing the alignment.
As one can imagine, this exhaustingly tedious process can best be done using the precision of a robotic device.
In FUT, the harvesting is done by a surgeon using a scalpel to make a long incision in the back of the scalp. It only takes a few minutes. The harvested strip is removed and then placed under dissecting microscopes where the individual follicular units are isolated. This dissection, thus far, can only be done by hand. There is no robotic technology available to do this.
Harvesting the donor hair, of course, is only one part of a hair transplant. The other steps, recipient site creation (making the holes that the grafts are placed into) and actually placing the grafts into those sites are similar in both FUE and FUT.
It is anticipated that robotic site creation will be available in the fall of 2014 and robotic graft placement, the third and final step, about two years after that. At that time, the robot will be able to perform the entire FUE procedure and the last two parts of the FUT procedure.
Of course, the robot doesn’t do the surgery alone. The physician must input all the information regarding the design and planning of the procedure and closely monitor each step of the robotic process. Unlike automating industrial production, the human scalp has great variability, so there is no one formula that will be appropriate for every patient. Physician skill and involvement is just as important in robotic hair transplantation as it is with every other type of surgical hair restoration procedure.
Rating:
5.00 stars from 1 vote(s)Topic: Robotic FUE
Tags: ARTAS Robot for FUE, ARTAS Robot Recipient Site Creation, Hair Transplant By Robot, Robotic Hair Transplantation
Posted by Updated 2017-12-11
If I Was Told That I Am Not A Good Candidate For An FUT Procedure Can I Have FUE?
Q: At one time, I was told my donor area was not sufficient for an FUT hair transplant procedure. Does this also mean I’m not qualified for a FUE procedure either? — K.K., Houston, T.X.
A: Great question. You are not giving me quite enough information to answer your question specifically, so I will answer in more general terms. If your donor hair supply was not good enough to do FUT (i.e. you have too little donor hair and too much bald area to cover) then most likely you will not be a candidate for FUE either, since both procedures require, and use up, donor hair. That said, if don’t need that much donor hair, but the nature of your donor area is such that a linear FUT scar might be visible then FUE might be useful.
An example would be the case in which a person has limited hair loss in the front of his scalp, has relatively low donor density, and wants to keep his hair on the short sides. In this case, FUT would not be appropriate as you might see the line scar, but we might be able to harvest enough hair through FUE to make the procedure cosmetically worthwhile. Remember, with low density neither procedure will yield that much hair to be used in the recipient area.
Another example is an Asian whose hair emerges perpendicular from the scalp so that a line incision is difficult to hide, i.e. the hair will not lie naturally over it. A third example is where the patient’s scalp is very tight. In this case, the donor density might be adequate, but it would just be hard to access it using a strip FUT procedure. In this case, FUE would also be appropriate.
From these situations, one can see that the decision to perform FUE vs FUT, or even a hair transplant at all, can be quite nuanced and requires a careful evaluation by a hair restoration surgeon with expertise in both procedures.
Rating:
3.67 stars from 3 vote(s)Topic: FUE vs FUT
Tags: Asian Hair, Donor Area, Donor Area Stability, Donor Area Thinning, Donor Hair Supply, FUE, FUT, FUT vs. FUE
Posted by Updated 2017-12-01
Why Am I Still Losing Hair (Shedding) After 6 Months on Minoxidil And Finasteride?
Q: I have been using an increased dosage of Propecia now for around 8 months and Rogaine for about 6 months. I know that shedding can be expected for the first 3-6 months, but I believe I am now beyond that timeframe. Have you seen cases in which these products merely exacerbate hair loss without the expected regrowth? — N.E., Travilah, Maryland
A: It is a bit long to still see shedding, but from my experience, either the medications are working (and you are still in the shedding phase) or you are not responding to them. I have not seen minoxidil or finasteride worsen hair loss. My advice would be to continue the same course for at least a year before re-evaluating their use.
Rating:
3.45 stars from 11 vote(s)Topic: Hair Loss, Hair Loss Medication
Tags: Causes of Hair Loss, minox, Propecia (Finasteride), Propecia Doesn't Work, Propecia Duration, Rogaine (Minoxidil), Shedding on Propecia, Shedding on Rogaine
Posted by Updated 2017-12-11
What Part Of a Hair Transplant Can Be Done By a Robot?
Q: Is it true that hair transplants can now be done totally by a robot? — M.S., Los Angeles, California
A: The ARTAS Robotic System, developed by Restoration Robotics, is the most advanced technology for extracting grafts (the first and most difficult step in a Follicular Unit Extraction procedure), but it cannot yet do the entire hair transplant procedure, nor can it work without the supervision of the hair restoration surgeon.
Currently, the ARTAS System assists the surgeon in performing the first part of an FUE hair transplant (i.e., the extraction phase) with greater precision and consistency than can be done by hand. Engineers and researchers are currently developing the ARTAS to do the remainder of the procedure as well, i.e., making recipient sites in parts of the scalp that have lost hair and then implanting the harvested grafts into these sites.
The next step, recipient site creation, will be available in the latter half of 2014. Dr. Bernstein is already testing a beta version of this new technology. We anticipate that within two years, under the supervision of the surgeon, the ARTAS robot will be performing most of the FUE hair transplant procedure.
Rating:
5.00 stars from 1 vote(s)Topic: Robotic FUE
Tags: ARTAS Robot for FUE, Follicular Unit Extraction, FUE, Hair Transplant By Robot, Surgical Hair Restoration
Posted by Updated 2017-12-11
Is a Hair Transplant Possible Using Someone Else’s Hair?
Q: Can you do a hair transplant using someone else’s hair? — K.K., Garden City, N.Y.
A: Unfortunately, this is not possible because your body would reject the hair transplant without the use of immunosuppressive drugs. The problem with immune suppressants is that they will lower your natural immune response, increasing your susceptibility to infections and even cancer, and you’ll have to take them for the rest of your life.
A transplant using someone else’s hair is also not desirable for aesthetic reasons. There’s the style of the hair, its texture, thickness, color, etc. Trying to find the perfect donor whose hair would complement and flatter your particular features and blend in with your remaining hair would be a significant, if not impossible, challenge. It would be possible, however, to transplant the hair from one identical twin to another, but most likely if one went bald, so would the other.
Rating:
Topic: Hair Transplant
Tags: Follicular Unit, Follicular Unit Extraction, Follicular Unit Transplant, Hairline
Posted by Updated 2017-12-01
Do You Transplant Hair Evenly if I Part My Hair on the Left?
Q: For patients who intend to keep their hair parted on the left side, do you follow any rule of making the left side more dense then the right or is it distributed evenly? — M.S., Simi Valley, C.A.
A: On a first hair transplant procedure, I generally place the sites/grafts symmetrically, even if a patient combs his hair to one side. The reason is that the person may change his styling after the procedure and I like to have the first hair transplant symmetrical for maximum flexibility. An exception would be a person with limited donor reserves. In this case, weighting on the part side is appropriate in the first procedure. Once the first hair transplant grows in and the person decides how he wants to wear his hair long-term a second transplant can be weighted to accommodate this. Weighting can be done in one, or both, of two ways: 1) by placing the sites closer together on the part side or 2) by placing slightly larger follicular units on the part side.
If a person decides to comb his hair back, then forward weighting is used. For greater details on this, please see some of my publications where I address the aesthetics of hair transplantation:
- Bernstein RM, Rassman WR: The Aesthetics of Follicular Transplantation. Dermatol Surg 1997; 23: 785-99.
- Bernstein RM, Rassman WR: Follicular Transplantation: Patient Evaluation and Surgical Planning. Dermatol Surg 1997; 23: 771-84.
Rating:
Topic: Hair Transplant
Tags: Aesthetics of Follicular Transplantation, First Hair Transplant, Follicular Transplantation: Patient Evaluation & Surgical Planning, Hair Style, Hair Style After Transplant, Hair Transplant Aesthetics, Hair Transplant Design, Hair Transplant With Hair Parted, Second Hair Transplant
Posted by Updated 2017-12-01
When will Dr. Christiano’s Research on Follicular Neogenesis (Hair Cloning) be Available?
Q: I read, with considerable interest, your excellent article on the latest in Dr. Angela Christiano’s work on follicular neogenesis. It seems to me that the next questions we should be asking are: when will testing begin on human subjects and when might her research develop into a hair cloning treatment that is available to the general public?
A: It is very difficult to determine when this phase of the research might begin and it is even harder to predict when treatment might become available. First, the technology is not quite there. Dr. Christiano showed in her recent paper that changing the environment of skin (fibroblast) cells so that they could form into 3-D cultures enabled them to induce human hair-follicle growth. Although this was a major step towards cloning hair, additional work needs to be done before we will be able to mass produce fully-functioning human hair follicles to the extent needed for hair transplantation.
In addition, research on human subjects requires that experiments meet rigorous federal regulatory standards and these take time to be approved and carried out. Supposing that further study of follicle neogenesis results in a breakthrough treatment for hair loss, this treatment would still require meeting substantial efficacy and safety requirements of the FDA before it would be made available to the public. We will be communicating important developments as they occur through our Hair Cloning Research section and through periodic updates in the Bernstein Medical Newsletter.
- Read about Dr. Christiano’s Columbia University Study
- More in Hair Cloning Research
- Follow major updates by joining the Bernstein Medical Newsletter
Rating:
Topic: Hair Cloning
Tags: Columbia University, Dr. Angela Christiano, Dr. Robert M. Bernstein, Fibroblasts, Follicular Neogenesis, Hair Cloning, Hair Cloning Research, Hair Loss Treatment
Posted by Updated 2017-10-17
Can I Dissolve Finasteride In Water?
Q: I read your 20 pages of FAQs but could not find this question addressed. I’m currently taking Finasteride 5 mg (one-fourth tablet per day), but since some drug companies make an oblong tablet that is hard to cut into four pieces, I found a plastic bottle with four equal measurements and I dissolve the tablet in water, shake it up and drink one-fourth of the liquid each day. I read somewhere that you’re not really supposed to dissolve the pill in water. Is that correct or is it OK to keep doing it the way I’m doing? — W.I., Winnetka, Illinois
A: I would cut up the pills with a pill-cutter – they do not need to be in equal parts. Just finish a whole pill every four days. You can also take ½ pill every other day and achieve the same effect. I am not sure of the stability of the medication in water over several days. It is probably OK, but why take the chance?
Rating:
2.80 stars from 5 vote(s)Topic: Hair Loss Medication
Tags: Cutting Propecia Tablets, Finasteride Dissolved In Water, Propecia (Finasteride), Propecia Dosage, Propecia Label Information
Posted by Updated 2017-12-11
How Long After Facelift Can I Have Hair Transplant?
Q: I am having a facelift next month and also want to have a hair transplant soon after. How long should I wait between procedures? — S.H., Boston, M.A.
A: Although it would be possible to do a hair transplant as soon as a week after a face or brow lift, ideally one should wait at least three months between procedures for the following reasons: 1) there will be less tension in the donor area and, therefore, it will be possible to harvest more grafts, 2) if there is any shedding from the facelift it will make the planning of the hair transplant more difficult, 3) it will leave the option of adding hair, in or around, any problematic surgical scars, and 4) will provide the ability to add hair to any area of thinning that might result from the facelift.
Rating:
Topic: Hair Transplant
Tags: Brow Lift, Donor Area, Facelift, Hair Transplant, Hair Transplant to Camouflage Scar, Scalp Laxity, Shedding
Posted by Updated 2017-12-01
Does Surgeon Determine Angle of Hair In Hair Transplant?
Q: I notice that some patients end up with hair that seems to stand straight up while others have hair that flows to one side or the other. Does the angle at which you place the follicles in the scalp ultimately determine how the hair will lie? Is there some artistic talent needed when placing these follicles so that patients end up with hair that lies flat or sticks straight up? What determines this? Do we have control over it? — H.B., Fort Lauderdale, F.L.
A: Great question. You are correct, the angle of the recipient sites largely determines the hair direction. Hair should be planted the way it grows (i.e., in a forward and horizontal direction at the frontal hairline.) It is extremely important that it is transplanted that way to look natural. The body will alter the angle a bit as it heals, usually elevating it slightly and re-creating any prior wave (yes, waves are determined by the scalp, rather than by the hair follicles per se). In a properly performed hair transplant, a straight-up appearance should be due to grooming, it should not have been a result of the actual procedure. Hair should never be transplanted perpendicular to the scalp. I discussed these important concepts way back in my 1997 paper “The Aesthetics of Follicular Transplantation“.
Rating:
5.00 stars from 1 vote(s)Topic: Hair Transplant
Tags: Aesthetics of Follicular Transplantation, Angle of Hair, Appearance After Hair Transplant, Hair Character, Hair Style, Hair Transplant Aesthetics, Hairline, Recipient Sites
Posted by Updated 2017-12-01
After Hair Transplant Is There Shock Hair Loss In Donor Area?
Q: I have seen through forums that a hair transplant gives severe shock loss in the donor zone (especially behind ears) after the surgery. Doctors say it is temporary and can last about six months or more. Frankly, do you believe in this? Will the donor shocked hair recover? — M.D., Darien, C.T.
A: It depends if you are speaking about follicular unit hair transplantation using strip harvesting (FUT) or Follicular Unit Extraction (FUE). With FUT, it is extremely uncommon to have any shock hair loss in the donor area. This could occur if the hair transplant procedure was done improperly, i.e. the donor area was closed too tightly. In this case, some hair loss may be permanent. This is one of the reasons that very large hair transplant sessions are unwise. Shock hair loss in FUE is more common, but is generally not significant and should eventually recover completely.
That said, some shock hair loss in the recipient area is quite common with either hair restoration procedure (FUT or FUE). This is particularly the case if there is a lot of existing miniaturized hair (hair that is starting to thin) in the transplanted area.
Rating:
4.33 stars from 3 vote(s)Topic: Hair Transplant
Tags: After FUE Hair Transplant, After FUT Hair Transplant, Donor Area, Donor Area Closure, FUE, FUT, Miniaturization, Shedding After Hair Transplant, Shock Fall Out, Shock Loss, Shock Loss in Donor Area, Shock Loss in Recipient Area
Posted by Updated 2017-12-01
What is the Incidence of Hair Loss in Adults?
Q: How common is hair loss in adult men and women? — N.F., Bronxville, NY
A: The incidence of androgenetic alopecia (common baldness) is quite high for both men and women. By age 50, 50% of men and 30% of women are affected. By age 70, that increases to 80% of men and 60% of women. Fortunately, in spite of significant thinning, women often preserve their hairline and have a diffuse pattern, so their hair loss can be camouflaged for many years.
Rating:
Topic: Hair Loss
Tags: Androgenetic Alopecia, Camouflage, Diffuse Hair Loss in Women, Hair Loss Age, Hair loss in Men, Hair Loss in Women, Hairlines in Women
Posted by Updated 2017-12-12
Browse Hair Restoration Answers by topic:
Updated: 2019-11-15 | Published: 2009-07-02
