The Notable Articles Project: Revisiting the Articles That Helped Shape the Specialty
Synopsis: The traditional order for the steps of a hair transplant sur gery has been to first perform donor harvesting then make sites and place grafts. Hair transplant surgery can often be a long procedure, and one goal of many teams is to find ways to decrease the length of the procedure to improve the patient experience, decrease the physical strain on the team, and specifically decrease the out-of-body time of the grafts to improve graft survival.Read: Full Article | View PDF
Innovations In Robotic Hair Restoration
Bernstein RM, Wolfeld MB
Synopsis: With the latest version of the ARTAS platform, 9x, Restoration Robotics has designed a faster and more accurate system for hair transplantation. The improved accuracy of harvesting and shortened procedure time increases graft viability, while smaller needles reduce scarring and allow patients to wear shorter hairstyles. Many of the changes in this upgrade have been made as a response to specific physician feedback.Read: Full Article | View PDF
Advances in Robotic FUE
Bernstein RM, Wolfeld MB
Synopsis: Since the publication of “What’s New in Robotic Hair Transplantation” (Hair Transplant Forum Int’l. 2017; 27(3):100-101), there have been important improvements to the robotic system in both its incision and recipient site creation capabilities. These advances fall into four overlapping categories:increased speed, increased accuracy, increased functionality, and improved artificial intelligence (AI). The overlap occurs since improvements in functionality, accuracy, and AI can also increase the overall speed of the procedure. A faster procedure decreases the time grafts are outside the body and allows the physician to perform larger cases without placing additional oxidative stress on the follicles.Read: Full Article | View PDF
Commentary on Redefining the “E” in FUE: Excision = Incision + Extraction
Bernstein RM, Rassman WR
Synopsis:There has been a change in the nomenclature of the FUE procedure. It will not be called Follicular Unit Excision, describing the two main components of an FUE procedure, incision (separatioin of the follicle from the tissue) and extraction (the removal of the follicular unit from the scalp once it is separated). Drs. Robert M. Bernstein and William R. Rassman’s commentary explains the importance of this change in terminology.Read: Full Article | View PDF
Innovation and Quality in Hair Restoration Surgery
Bernstein RM. Innovation and Quality in Hair Restoration Surgery. Hair Transplant Forum Intl. 2017; 27(5): 187.
Synopsis: Hair restoration has advanced dramatically in the past 25 years, most recently with the growing popularity of FUE. The challenge of FUE is that the grafts are more fragile compared to the follicular units generated in traditional FUT/strip procedures. Innovations such as the ARTAS Robot and other devices attempt to address this problem. With the increasing participation of ISHRS members – now 1,200 strong – progression in this field should continue at an accelerating pace.Read: Full Article | View PDF
What’s New in Robotic Hair Transplantation
Bernstein RM, Wolfeld MB, Krejci J. What’s New in Robotic Hair Transplantation. Hair Transplant Forum Intl. 2017; 27(3): 100:101.
Synopsis: Since the introduction of robotic FUE technology over five years ago, there have been numerous upgrades to the system. The current paper describes the most recent advances. These include a more user-friendly interface, the ability to select for larger follicular units, greater range-of-motion of the robotic arm, improved methods for stabilizing the scalp and newly designed needles for more accurate harvesting.Read: Full Article | View PDF
Robotic Follicular Unit Graft Selection
Bernstein RM, Wolfeld MB: Robotic follicular unit graft selection. Dermatologic Surgery 2016; 42(6): 710-14.
Synopsis: The current robotic system harvests follicular unit grafts in a random manner. A new capability of the ARTAS robot is to select follicular units based on the number of hairs they contain, in order to increase the hair/wound yield. This bilateral controlled study of 24 patients was designed to evaluate this functionality. Results showed that, compared to random follicular unit harvesting, robotic follicular unit graft selection produced more hairs per harvest attempt (2.60 vs. 2.22) and more hairs per graft (2.72 vs. 2.44). The clinical benefit was statistically significant at p<.01.Read: Full Article | View PDF
Follicular Unit Hair Transplantation
Bernstein RM, Follicular Unit Hair Transplantation. In: Robinson JK, Hanke CW, Siegel DM, Fratila A, editors: Surgery of the Skin: Procedural Dermatology, Chapter 30. Mosby Elsevier Inc., London UK. 2015: 503-533.
Synopsis: Follicular Unit Hair Transplantation in “Surgery of the Skin: Procedural Dermatology,” is Dr. Bernstein’s third update of the chapter in the core surgical textbook for dermatologic training programs. The chapter covers a range of topics including: the basics of hair transplantation, detailed descriptions of both follicular unit transplantation (FUT) and follicular unit extraction (FUE), the importance of patient evaluation in advance of surgery, and aesthetic considerations in hair transplant design. Robotic FUE is included in the chapter for the first time as a hair transplant technique.Read: Full Article | View PDF
Long-Hair Robotic FUE
Bernstein RM. Long-Hair Robotic FUE. Restoration Robotics White Paper. May 2015.
Synopsis: A limitation of FUE procedures is the short-term cosmetic problem of clipping the entire donor area in the back and sides of the scalp. The long-hair robotic technique avoids this problem by harvesting through a broad band of clipped hair that is covered with longer hair combed down over the harvested area. This technique enables the physician to harvest relatively large amounts of donor hair without shaving the patient’s entire scalp.Read: Full Article | View PDF
Commentary on Robotic FUE in Hair Transplantation
Bernstein RM: Commentary on Robotic Follicular Unit Extraction in Hair Transplantation. Dermatol Surg 2015;41(2):279.
Synopsis: In their excellent article, “Robotic Follicular Unit Extraction in Hair Transplantation,” Avram and Watkin give a review of the salient aspects of the newly evolving field of robotic hair transplantation. As the authors state, the appeal of robotic FUE is part of the “inexorable trend” toward minimally invasive surgical procedures. As with any new technology, it is up to the practicing physician to make sure that it is used appropriately and to the maximum benefit of our patients.Read: Full Article | View PDF
ARTAS Robotic System Provides Minimized Donor Area Scarring
Bernstein RM. ARTAS Robotic System provides a comprehensive suite of tools to minimize donor area scarring following hair transplantation. Restoration Robotics White Paper. September 2014.
Synopsis: The ARTAS® Robotic System provides a unique, comprehensive suite of tools that physicians can use to minimize donor area scarring and offer the patient greater styling options post-surgery. Factors that influence scarring in the donor area include: dissection punch size, density of harvest sites, distribution of the harvest sites, total number of sites, and the ‘blending in’ of harvest zones with un-harvested areas.Read: Full Article | View PDF
Robotic Recipient Site Creation in Hair Transplantation
Bernstein RM, Wolfeld MB, Zingaretti G. Robotic recipient site creation in hair transplantation. Hair Transplant Forum Intl. 2014; 24(3): 95-97.
Synopsis: The initial application of the ARTAS® robotic system (robot), released in the fall of 2011, was the separation of follicular units from the surrounding scalp tissue, the first step in a follicular unit extraction procedure. Subsequent steps in FUE include removal of the follicular unit grafts from the donor scalp, site creation, and graft placement. With its new hardware and software capabilities, the robot can now perform one more step in this process, making recipient sites. Preliminary observations suggest that it can accomplish this function with greater precision and consistency than when performed manually.Read: Full Article | View PDF
Current Status of Surgery In Dermatology: Hair Transplantation
Hanke CW, et.al. Current status of surgery in dermatology. Bernstein RM. Section on Hair Transplantation. J Am Acad Dermatol. 2013 Dec;69(6): 20-22.
Synopsis: Every few decades, the American Academy of Dermatology publishes a comprehensive survey of the state of dermatology and dermatologic surgery. Dr. Bernstein was asked to contribute to this historical overview. The paper describes important developments in the field of hair restoration surgery over a period of more than twenty years. Dr. Bernstein’s pioneering articles on FUT and FUE are highlighted as key advances in the field, along with contributions by more than a dozen dermatologists. The section on hair transplantation includes a look towards the future with mentions of both robotic graft harvesting and the promise, and challenges, of hair cloning techniques.Read: Full Article | View PDF
Age and the Donor Zone in FU Hair Transplants
Bernstein RM. Controversies: Age and the donor zone in FU hair transplants. Hair Transplant Forum International 2013; 23(3): 91-92.
Synopsis: When considering Follicular Unit Transplantation (FUT) and Follicular Unit Extraction (FUE) procedures, a person’s age and the ability to assess the permanence of the donor area are important variables in determining surgical candidacy. This FUT case study examines the importance of these variables in the patient evaluation.Read: Full Article | View PDF
Robotic Hair Transplants
Bernstein RM. Robotic Hair Transplants. The Link 2013; 5: 6-7.
Synopsis: A major advance in Follicular Unit Extraction is the introduction of a robotically controlled, image guided system to remove intact follicular units directly from the scalp. The robotic device increases the accuracy of graft harvesting, which in turn minimizes damage to hair follicles and reduces harvesting time. Each of these factors potentially contributes to increased graft survival. The technology also enables FUE to be performed on a wider variety of patients. This paper discusses this new robotic technology.Read: Full Article | View PDF
Integrating Robotic FUE into a Hair Transplant Practice
Bernstein RM. Integrating Robotic FUE into a hair transplant practice. Hair Transplant Forum Intl. 2012; 22(6): 228-229.
Synopsis: In addition to acquiring a robotic device, performing FUE hair transplant procedures using a robotic image-guided system requires special surgical facilities, staff training, and modification of the FUE procedure itself. This paper reviews some of the key elements that go into successful implementation of R-FUE into a physician’s practice.Read: Full Article | View PDF
Pre-Making Recipient Sites in FUE and R-FUE Procedures
Bernstein RM, Rassman WR. Pre-making recipient sites to increase graft survival in manual and robotic FUE procedures. Hair Transplant Forum Intl. 2012; 22(4): 128-130.
Synopsis: In FUT procedures, once the donor strip is removed, follicular unit dissection and graft insertion can be performed simultaneously. In FUE procedures, graft extraction must be completed before placement can begin, increasing the time grafts are out of the body and subjecting them to hypoxic injury. Waiting for recipient sites to be made adds to this time. These authors suggest creating recipient sites prior to extraction to decrease the time the grafts are outside the body. Other potential advantages of pre-making recipient sites are discussed.Read: Full Article | View PDF
Bimatoprost for the Treatment of Thinning Eyebrows
Schweiger ES, Pinchover L, Bernstein RM. Topical Bimatoprost for the Treatment of Eyebrow Hypotrichosis. J Drugs Dermatol. 2012;11(1): 106-108.
Synopsis: Topical bimatoprost was FDA approved in December 2008 for the treatment of eyelash hypotrichosis (thinning eyelashes). Since its approval, there has been interest in its “off label” for hair growth in other areas, such as the scalp or eyebrows, but there has yet to be published scientific evidence to support this use. We report one of the first cases of significant eyebrow hair growth in a patient after use of topical bimatoprost for eyebrow hypotrichosis.Read: | View PDF
Hair Loss & Replacement for Dummies
Rassman WR, Bernstein RM, Pak J, Schweiger ES: Hair Loss & Replacement for Dummies. Hoboken, NJ, John Wiley & Sons, Inc. 2011.
Synopsis: This is a newly revised edition of the popular Hair Loss & Replacement for Dummies. The 2011 edition presents the latest information on a variety of topics of interest to those suffering from hair loss. The updated edition book discusses the latest in laser light and medical treatments for hair loss, the recent advances in Follicular Unit Hair Transplantation and the new, minimally-invasive hair transplant technique, Follicular Unit Extraction.
Update on the Cause and Medical Treatment of Patterned Hair Loss
Schweiger E, Boychenko O, Bernstein RM. Update on the pathogenesis, genetics and medical treatment of patterned hair loss. J of Drugs in Dermat 2010; 9(11): 1-8.
Synopsis: This publication reviews the major advances in the science of hair loss that have occurred over the past decade. These include advances in the diagnosis of androgenetic alopecia, advances in our understanding of the mechanisms behind genetic hair loss, studies in the efficacy of medical treatment of hereditary baldness, the development and FDA-approval of the lasercomb device for hair restoration, and the development of a screening test for hair loss.Read: | View PDF
Follicular Unit Hair Transplantation
Bernstein RM, Follicular Unit Hair Transplantation. In: Robinson JK, Hanke CW, Siegel DM, Fratila A, editors: Surgery of the Skin: Procedural Dermatology, Chapter 29. Mosby Elsevier Inc., London UK. 2010: 485-512.
Synopsis: Dr. Bernstein’s newly revised chapter, Follicular Unit Hair Transplantation, in “Surgery of the Skin: Procedural Dermatology,” a core surgical textbook for dermatologic training programs, covers a wide range of standard topics including; patient evaluation, surgical planning, operating techniques and aesthetic considerations in hair transplant design. New topics include: follicular unit extraction, eyebrow and eyelash transplantation, long-hair transplants, trichophytic closures, automation and hair cloning.Read: Full Article | View PDF
Hair Loss For Dummies
Rassman WR, Bernstein RM, Pak J, Schweiger ES: Hair Loss & Replacement for Dummies. Indiana, Wiley Publishing, Inc. 2008.
Synopsis: Important information for men and women of virtually all ages anxious to preserve their full head of hair, put the brakes on balding, or explore the safest and most reliable hair replacement techniques currently available. The book offers readers not only the full gamut of modern-day hair-care options, but crucial tips on how to avoid unscrupulous hair transplant doctors and potentially harmful products as well.Full Article
Avoiding Pitfalls in Planning a Hair Transplant
Bernstein RM: Avoiding pitfalls in planning a hair transplant. Expert Rev. Dermatol. 2008; 3(4): 501-508.
Synopsis: The ability to achieve full cosmetic benefit in follicular unit hair transplantation depends upon a number of factors including proper patient selection, accurately assessing the patient’s donor supply, appropriately designing the hair line and correctly distributing the grafts. This paper reviews the major mistakes that doctors make in these key aspects of the hair restoration process and advises the practitioner on how to avoid them so that the patient will achieve the best possible results.Read: Full Article | View PDF
Staples Revisited: Surgical Staples in Hair Transplantation
Bernstein RM: Staples Revisited. Hair Transplant Forum International 2008; 18(1): 10-11.
Synopsis: Running, continuous sutures and metal staples are the two most common closures used by hair restoration surgeons today. This commentary discusses the pros and cons of various suture and stapling methods and makes an argument that, with new advances in techniques, staples are possibly the best means of closing the donor wound during a hair transplant procedure.Read: Full Article | View PDF
Follicular Unit Plain Speak: Hair Transplant Terminology
Bernstein RM, Rassman WR, Limmer B, Follicular Unit Plain Speak. Hair Transplant Forum International 2007; 17(6): 201-203.
Synopsis: In 1998, a group of hair restoration surgeons proposed a classification for follicular unit hair transplantation and mini-micrografting techniques, to improve communication between physicians and their patients. With recent advances in techniques, a number of new terms are being used that do not have clear definitions. This paper expresses the author’s opinions on which of these terms are useful and should be incorporated into the original classification and which are confusing and should be abandoned. The authors also suggest concise definitions for these new terms.Read: Full Article | View PDF
Densitometry and Video-Microscopy
Bernstein RM, Rassman WR: Densitometry and Video-microscopy. Hair Transplant Forum International 2007; 17(2): 41, 49-51.
Synopsis: Densitometry and video-microscopy are techniques that analyze the scalp under high-power magnification to give information on hair density, follicular unit composition and degree of miniaturization. They can be used to help evaluate a patient’s candidacy for hair transplantation and help predict future hair loss. The measurements will enable the physician to better estimate the size of the donor strip and anticipate the aesthetic outcome of the hair restoration procedure. This paper describes the value of these techniques in the hair transplant evaluation.Read: Full Article | View PDF
New Instrumentation for 3-step Follicular Unit Extraction
Bernstein RM, Rassman WR: New Instrumentation for Three-Step Follicular Unit Extraction. Hair Transplant Forum International 2006; 16(1): 229, 237-9.
Synopsis: Three-step FUE is a hair transplant technique that uses blunt dissection to prevent damage during the process of separating the follicular unit from the surrounding tissue. The 3 steps are: scoring, blunt dissection, and extraction. Performing Follicular Unit Extraction with a 3-step technique allows the surgeon to minimize damage to follicles and to keep follicular units intact. A disadvantage is the development of buried grafts, but this can be reduced by modifying the technique and using specially designed instrumentation.Read: Summary | Full Article | View PDF
Eyebrow Transplants: From Scalp to Brow
Rassman WR, Bernstein RM: From Scalp to Brow. Plastic Surgery Products 2006; 34-8.
Synopsis: The partial or complete loss of one’s eyebrows is a relatively common problem and can be caused by disease, accidents, the normal aging process, or can be been self-induced. This paper discusses the importance of eyebrows to one’s appearance and explains the special techniques and surgical skills required for eyebrow restoration.Read: Full Article | View PDF
Graft Anchoring in Hair Transplantation
Bernstein RM, Rassman WR: Graft anchoring in hair transplantation. Dermatol Surg 2006; 32: 198-204.
Synopsis: This study determined exactly how long it takes after a hair transplant for the grafts to be securely anchored in the recipient area, so that they cannot be dislodged. This information is important in guiding the patient’s post-op care after a hair restoration procedure. The study also showed that preventing the formation of crusts following a hair transplant would shorten the time patients are at risk of dislodging grafts. It would also allow them to return to their normal hair care routines more rapidly.Read: Summary | Full Article | View PDF
Follicular Unit Extraction
Rassman WR, Harris J, Bernstein RM: Follicular Unit Extraction. In: Haber RS, Stough DB, editors: Hair Transplantation, Chapter 17. Elsevier Saunders, 2006: 133-137.
Synopsis: This paper discusses the state-of-the-art in follicular unit extraction. It focuses on the new Three-Step Technique in which a sharp punch is used to cut the epidermis and then a dull punch is used to dissect the follicular unit from the surrounding tissue. The third step being the extraction itself. The “blunt” step significantly reduces follicular transaction, but creates a potential new problem, that of buried grafts. The Three-Step technique increases the number of patients in whom FUE is possible; however, other limitations of the procedure – particularly the lower total yield compared to strip harvesting – remain.Read: Full Article | View PDF
Follicular Unit Transplantation
Bernstein RM, Rassman WR: Follicular Unit Transplantation. In: Haber RS, Stough DB, editors: Hair Transplantation, Chapter 12. Elsevier Saunders, 2006: 91-97.
Synopsis: This writing discusses the current status of Follicular Unit Transplantation and some controversial issues regarding this procedure. These issues include: strip harvesting vs. follicular unit extraction, lateral vs. vertical slit recipient sites, which holding solution is best for grafts, the ideal density and the optimal number of grafts that should be performed in one hair transplant session.Read: Full Article | View PDF
Instrumentation for Three-Step Follicular Unit Extraction
Robert M. Bernstein, M.D. Associate Clinical Professor of Dermatology at the College of Physicians and Surgeons of Columbia University in New York Abstract of Dr. Bernstein’s presentation at the International Society of Hair Restoration Surgery, 2005 – Sidney, Australia Biography Robert M. Bernstein, M.D. is Associate Clinical Professor of Dermatology at the College of Physicians …Full Article
Follicular Unit Transplantation
Bernstein RM, Rassman WR: Follicular Unit Transplantation – 2005, Issue on Advanced Cosmetic Surgery. Dermatologic Clinics 2005; 23(3); 393-414.
Synopsis: This paper reviews the core concepts of Follicular Unit Transplantation, including basing the surgical planning on the follicular unit constant, using only individual, naturally occurring units in the transplant and accomplishing the restoration in a few number of large sessions. The section then describes the techniques of follicular unit hair transplantation as the procedure enters its second decade.Read: Full Article | View PDF
Follicular Unit Hair Transplantation
Bernstein RM, Follicular Unit Hair Transplantation. In: Robinson JK, Hanke CW, Siegel DM, Sengelmann RD, editors: Surgery of the Skin, Elsevier Mosby, London UK. 2005.
PUBLISHERS NOTE: Single copies of this article can be downloaded and printed only for the reader’s personal research and study.
Synopsis: “Surgery of the Skin: Procedural Dermatology,” covers the entire range of dermatologic surgical procedures. It was conceived to be used as the core surgical textbook for dermatologic training programs. Dr. Bernstein’s chapter on follicular unit hair transplantation covers a wide range of subjects including the history of follicular unit hair transplantation, evaluating the patient, planning the surgery, setting-up the operating room, and maximizing the cosmetic outcome of the hair restoration. Specific topics include the techniques of Follicular Unit Transplantation including density assessment, single-strip harvesting, follicular unit extraction, anesthetic use, aesthetic design and many other important topics.Read: Full Article | View PDF
Techniques for Limiting Epinephrine
Bernstein RM, Rassman WR: Techniques for Limiting the Amount of Epinephrine in Large Hair Restoration Surgeries. In: Unger WP, editor: Hair Transplantation, 4th Ed. New York: Marcel Dekker, Inc., 2004:245-250.
Synopsis: This writing is the textbook version of the paper; “Limiting Epinephrine in Hair Transplant Sessions.”
Rationale for Follicular Unit Transplantation
Bernstein RM, Rassman WR: The Rationale for Follicular Unit Transplantation. In: Unger WP, editor: Hair Transplantation, 4th ed. 4 New York: Marcel Dekker, Inc., 2004: 388-406.
Synopsis: This is the textbook version of the important 1999 paper; “The Logic of Follicular Unit Transplantation” that was instrumental in making follicular unit transplantation a mainstream hair restoration procedure.
Follicular Unit Extraction Megasessions
Bernstein RM, Rassman WR, Anderson KW: FUE Megasessions: Evolution of a technique. Hair Transplant Forum International 2004; 14(3): 97-99.
Synopsis: This paper describes the technical and organizational skills needed for performing Follicular Unit Extraction Megasessions. It also points out some of the important long-term implications of FUE, especially regarding its inefficient use of donor area which potentially limits the ultimate donor supply.Read: Full Article | View PDF
Back to the Future with the “Dissected–Punch” Technique
Rassman WR, Bernstein RM, Jones RG, McClellan RE, et. Al. Back to the future with the “dissected–punch” technique. Hair Transplant Forum International 2003; 13(5): 409.
Synopsis: This paper proposes that the old punch-graft technique may have a place in modern hair transplant surgery, particularly in patients with significant donor scarring and when further linear incisions are not possible. In these cases, punch harvesting (with subsequent microscopic division of the punch grafts) may be better than FUE, since extracting individual follicular units can be difficult in areas of scarring.
Follicular Unit Extraction: Minimally Invasive Surgery for Hair Transplantation
Rassman WR, Bernstein RM, McClellan R, Jones R, et al. Follicular Unit Extraction: Minimally invasive surgery for hair transplantation. Dermatol Surg 2002; 28(8): 720-7.
Synopsis: This paper introduced Follicular Unit Extraction into the hair transplant literature. The article describes a procedure in which individual follicular units are removed directly from the donor region through very small round incisions. It identifies significant patient variability and describes a test to determine which patients are potential candidates for this procedure. It also explores the nuances, limitations and practical aspects of Follicular Unit Extraction.Read: Summary | Full Article | View PDF
Art of Repair in Surgical Hair Restoration – Part II
Bernstein RM, Rassman WR, Rashid N, Shiell R: The art of repair in surgical hair restoration – Part II: The tactics of repair. Dermatol Surg 2002; 28(10): 873-93.
Synopsis: Together with Part I, Basic Repair Strategies, these paired articles define the state-of-the-art in correcting the cosmetic problems that resulted from outdated hair restoration techniques and/or poor surgical planning. This section emphasizes the importance of graft excision and re-implantation prior to camouflage in order to achieve the best outcome. It details the specific techniques needed for the graft excision and explains the aesthetic nuances of the camouflage.Read: Summary | Full Article | View PDF
Art of Repair in Surgical Hair Restoration – Part I
Bernstein RM, Rassman WR, Rashid N, Shiell R: The art of repair in surgical hair restoration – Part I: Basic repair strategies. Dermatol Surg 2002; 28(9): 783-94.
Synopsis: The first of two paired articles, this paper focuses on the strategic planning that is necessary to optimize hair transplant repair procedures. The paper identifies the underlying problems that lead to poor cosmetic results and the limitations of the donor supply that limit its correction. It explains how to establish priorities to get the best results in the face of the constraints caused by outdated hair replacement techniques.Read: Summary | Full Article | View PDF
Donor Dominance Revisited
Bernstein RM: Editorial Commentary: Donor Dominance Revisited. Editorial Commentary on Hwang SM et al. Does the Recipient Site Influence Hair Growth Characteristics in Hair Transplantation? Dermatol Surg 2002; 28(9): 798-99.
Synopsis: In 1959, Orentreich stated that, in a hair transplant, the transplanted grafts maintained the characteristics of the donor area and were independent of the recipient site. However, new evidence suggests that that the recipient site can influence the rate of hair growth, graying, and the formation of wavy hair. The editor points out that, although these observed effects may violate the principle of donor dominance, they will have positive implications for the success of cloning.Read: Summary | Full Article | View PDF
Scalp Laxity Paradox
Bernstein RM, Rassman WR: The scalp laxity paradox. Hair Transplant Forum International 2002; 12(1): 9-10.
Synopsis: Patients with tight scalps and snug donor closures often heal with fine scars, whereas patients with loose scalps occasionally heal with wide scars. A patient with the rare condition Ehlers-Danlos Syndrome shed light on this phenomenon. After studying his case, the authors conclude that the integrity of the scalp’s connective tissue was more important than scalp laxity in determining who would heal with a fine donor scar.Read: Full Article | View PDF
Automation of Hair Transplantation
Rassman WR, Bernstein RM: The Automation of Hair Transplantation: Past, Present, and Future. In: Harahap M, ed. Innovative Techniques in Skin Surgery. New York, Marcel Dekker, Inc., 2002: 489-502.
Synopsis: This paper reviews the current status and future of automated devices in surgical hair restoration. Specifically, it discusses the Hair Implanter Pen, the Rapid Fire Hair Inserter, the Calvitron, and the Choi Hair Transplanter.
Follicular Unit Graft Yield Using Three Different Techniques
Bernstein RM, Rassman WR: Follicular unit graft yield using three different techniques. Hair Transplant Forum International 2001; 11(1): 1, 11-13.
Synopsis: This study compares the hair replacement techniques of mini-micrografting, vertical sectioning and single-strip harvesting with stereo-microscopic dissection for the generation of follicular unit grafts. It validated the superiority of the latter technique and supported the idea that if one wants to perform Follicular Unit Transplantation properly, single strip harvesting and microscopic dissection should be required.Read: Full Article | View PDF
The Patient’s Guide to Hair Restoration – 6th Edition
Rassman WR, Bernstein RM: The Patient’s Guide to Hair Restoration, 6th Edition, Los Angeles, A New Hair Institute Publication, 2001.
Synopsis: This popular guide on hair restoration is revised to include the latest advances in medical and surgical treatments for hair loss and an expanded section of before and after photos.
A New Suture for Hair Transplantation: Poliglecaprone 25
Bernstein RM, Rassman WR, Rashid N: A new suture for hair transplantation: Poliglecaprone 25. Dermatol Surg 2001; 27(1): 5-11.
Synopsis: This paper introduces a new synthetic suture for surgical hair restoration called Poliglecaprone 25 or Monocryl. It is a strong, absorbable, suture with low tissue reactivity that can be used in hair transplantation to close the donor wound with a single, running stitch. This suture can provide a donor closure that ensures hemostasis, has little risk of infection and is comfortable for the patient, and generally results in a fine surgical scar.Read: Summary | Full Article | View PDF
Importance of Accurate Nomenclature
Bernstein RM: What’s in a name? Hair Transplant Forum International 2000; 10(2): 59.
Synopsis: This editorial emphasizes that an accurate representation of a hair transplant technique is important, even if it is with respect to how it is named, so that the public may make informed decisions about the procedures they choose.
Graft Injury from Dehydration: H2O and the X-factor
Bernstein RM: Commentary: H2O and the X-factor. Editorial Commentary on Gandelman M, et al: Light and electron microscopic analysis of controlled injury to follicular unit grafts. Dermatol Surg 2000; 26(1): 31.
Synopsis: This editorial discusses the important observation of Gandelman that the drying of grafts during a hair transplant is a common denominator for other forms of injury, as it makes the grafts more subject to damage due to crushing and warming during the procedure.Read: Full Article | View PDF
Limiting Epinephrine in Large Hair Transplant Sessions
Bernstein RM, Rassman WR: Limiting epinephrine in large hair transplant sessions. Hair Transplant Forum International 2000; 10(2): 39-42.
Synopsis: The risks of using too much adrenaline in a hair transplant are discussed and a number of alternative methods of establishing hemostasis are offered including; body positioning, florescent lighting, ring-block anesthesia, tumescence, pre-making recipient sites, applying bi-manual traction, and creating a snug fit between the recipient site and graft.Read: Full Article | View PDF
In Support of Follicular Unit Transplantation
Bernstein RM, Rassman WR, Stough D: In support of follicular unit transplantation. Dermatologic Surgery 2000; 26(2): 160-2.
Synopsis: When follicular unit transplantation was still in its infancy, there were many detractors in the hair transplant community. This paper defended the procedure and explained its superiority over other hair replacement techniques in producing the best short and long-term cosmetic results.Read: Full Article | View PDF
Hair Transplantation – Section in Textbook for Estheticians
Bernstein RM, Rassman WR: Hair Transplantation. In: Gerson J, editor: Milady’s Standard Textbook for Professional Estheticians, 8th Ed. New York, Delmar Publishers, 1999.
Synopsis: This section, published in a textbook for professional estheticians, explains basic concepts of follicular unit hair transplantation in easy-to-understand terms.Read: Full Article
A Slot By Any Other Name
Bernstein RM: A slot by any other name. Hair Transplant Forum International 1999; 9(6): 175.
Synopsis: This article uncovers an attempt by the proponents of slot grafting to rename this technique (which produces poor cosmetic results) and call it “follicular unit coupling,” so that unwary patients will think that it is actually a variation of follicular unit transplantation.Read: Full Article | View PDF
Hemostasis with Minimal Epinephrine
Bernstein RM, Rassman WR: Hemostasis with minimal epinephrine. Hair Transplant Forum International 1999; 9(5): 153.
Synopsis: This short paper summarizes the article that advises to physicians to limit the use of adrenaline when performing large hair transplant sessions and it explains various practical ways to accomplish this.Read: Full Article
Unified Terminology for Hair Transplantation
Bernstein RM: Unified terminology for hair transplantation. Hair Transplant Forum International 1999; 9(4): 121-3.
Synopsis: This paper argues for standardization in the classification of various hair transplant techniques in order to facilitate communication between hair restoration surgeons and their patients and to aid in scientific research.
Logic of Follicular Unit Transplantation
Bernstein RM, Rassman WR: The logic of follicular unit transplantation. Dermatologic Clinics 1999; 17 (2): 277-95.
Synopsis: This paper discusses the evolution and rationale for follicular unit hair transplantation, as well as the logic for the various techniques used in its implementation. The central role of the follicular unit constant in the surgical planning is discussed, as well as the importance of keeping recipient sites small, using microscopic dissection and performing large hair transplant sessions.Read: Full Article | View PDF
Future in Hair Transplantation
Bernstein RM, Rassman WR, Seager D, Unger WP, et al. The future in hair transplantation. Journal of Aesthetic Dermatology and Cosmetic Dermatologic Surgery 1999; 1(1): 55-89.
Synopsis: As the twentieth century drew to a close, this paper looked into the future to try to discern the direction that hair transplantation was headed in the next millennium. Particular areas of interest were; the follicular unit/mini-micrograft controversy, graft storage mediums, how to maximize the donor supply, methods to enhance wound healing, automated devices, lasers, new medications, cloning and genetic engineering.Read: Full Article | View PDF
Blind Graft Production: Value at What Cost?
Bernstein RM: Blind graft production: Value at what cost? Hair Transplant Forum International 1998; 8(6): 28-29.
Synopsis: This editorial cautions that new instruments made to cut the donor strip rapidly, by placing the strip on a grid of knives, cause unacceptable levels of graft damage. The author advises that these devices should not be used in surgical hair restoration.Read: Full Article | View PDF
Rapid Fire Hair Implanter Carousel
Rassman WR, Bernstein RM. Rapid Fire Hair Implanter Carousel: A new surgical instrument for the automation of hair transplantation. Dermatol Surg 1998; 24: 623-7.
Synopsis: The “Carousel” is an automated device used for hair transplantation that simultaneously makes recipient sites and inserts grafts. The instrument can hold up to 100 grafts at time. In theory, the instrument could decrease the total operative time and eliminate some human factors that contribute to graft injury during the hair restoration process. The Carousel, however, was limited in that very close graft placement was not possible and it could not account for the great variability in the human scalp that sometimes rendered the device ineffective.Read: Summary | Full Article | View PDF
Classification of Hair Transplantation
Bernstein RM, Rassman WR, Seager D, Shapiro R, et al. Standardizing the classification and description of follicular unit transplantation and mini-micrografting techniques. Dermatol Surg 1998; 24: 957-63.
Synopsis: Dr. Bernstein heads a group of twenty-one hair restoration surgeons in an attempt to standardize the classification of follicular unit transplantation and other small graft procedures, including various technical aspects of graft harvesting, graft dissection, and placement. The goal is to standardize the nomenclature, and formally describe other factors in the surgery, so that communication between physicians and patients may be enhanced and different hair replacement procedures may be examined and compared.Read: Full Article | View PDF
The Patient’s Guide to Hair Restoration – 5th Edition
Rassman WR, Bernstein RM: The Patient’s Guide to Hair Restoration, 5th Ed. Los Angeles, A New Hair Institute Publication, 1998.
Synopsis: This book explains, in layman’s terms, the causes of hair loss, the way it is diagnosed and how androgenetic alopecia is treated – using medical therapy or surgical hair restoration. The book focuses on Follicular Unit Transplantation, but covers a wide range of topics from the emotional aspects of hair loss to steps one should take when considering hair transplant surgery.
A Neighbor’s View of the “Follicular Family Unit”
Bernstein RM: A neighbor’s view of the “Follicular Family Unit.” Hair Transplant Forum Intl. 1998; 8(3): 23-25.
Synopsis: This article acknowledges the wide variability in the anatomy of follicular units, but challenges the notion that using grafts larger than naturally occurring follicular unit is advantageous, if it necessitates using larger recipient wounds.Read: Full Article | View PDF
Dissecting Microscope in the Preparation of Follicular Unit Grafts
Bernstein RM, Rassman WR. Dissecting microscope versus magnifying loupes with transillumination in the preparation of follicular unit grafts. A bilateral controlled study. Dermatol Surg 1998; 24: 875-80.
Synopsis: This was the first objective study that showed that using stereo-microscopic techniques to dissect follicular unit grafts, was superior to loop magnification in preserving follicular units and reducing the transection of follicles.Read: Summary | Full Article | View PDF
New Storage Medium for Hair Transplantation
Bernstein RM: Commentary: New Models, Methods, and Possibilities. Editorial Commentary on Raposio E, et al: Metabolic Enhancement of Grafts: Evaluation of a New Storage Medium for Hair Transplantation. Dermatol Surgery 1998; 24(12):1346.
Synopsis: This editorial reviews a study suggesting that ATP can be used to increase the life of grafts while they are being held outside the body during a hair transplant.Read: Full Article
On the Origin of Follicular Unit Transplantation
Bernstein RM: Commentary on “The Origin of Follicular Unit Transplantation.” Dermatol Surg 1998; 24(8): 929-32.
Synopsis: This paper traced the beginnings of Follicular Unit Hair Transplantation from Headington’s histologic description of the follicular unit, Limmer’s single strip harvesting and stereo-microscopic dissection and then Bernstein’s idea to use the follicular unit as the sole graft type in the hair restoration process.Read: Full Article
Measurements in Hair Restoration
Bernstein RM: Measurements in Hair Restoration. Hair Transplant Forum Intl. 1998; 8(1): 27.
Synopsis: This writing stresses the importance of objective scientific measurements in patient evaluation and surgical planning prior to a hair transplant. Specifically, it explains, in mathematical terms, the greater contribution of hair shaft diameter as compared to the number of hairs in the appearance of fullness.Read: Full Article | View PDF
Blood Supply and Delayed Growth: “Seek and Ye Shall Find”
Bernstein RM: “Seek and Ye Shall Find” Dr. Robert Bernstein replies to Dr. Unger. Hair Transplant Forum Intl. 1997; 7(6): 13-14.
Synopsis: This editorial challenges those who claim to not have seen delayed growth to look more carefully, since large-graft hair transplants interrupt the blood supply to a greater extent than using large sessions of very small grafts.Read: Full Article
Aesthetics of Follicular Transplantation
Bernstein RM, Rassman WR: The Aesthetics of Follicular Transplantation. Dermatol Surg 1997; 23: 785-99.
Synopsis: This article focuses on various aesthetic aspects of follicular unit hair transplants including hair distribution, density, hairline design, and temple and crown restoration. It also examines racial variations that can affect the hair restoration. Together with the 1995 paper, these paired articles laid the foundation for Follicular Unit Hair Transplantation.Read: Summary | Full Article | View PDF
Follicular Transplantation: Patient Evaluation and Surgical Planning
Bernstein RM, Rassman WR: Follicular Transplantation: Patient Evaluation and Surgical Planning. Dermatol Surg 1997; 23: 771-84.
Synopsis: This landmark paper details how a patient should be evaluated for Follicular Unit Transplantation, stressing densitometry as a means of assessing both miniaturization and donor supply. It also provides guidelines for the planning of the first and subsequent hair transplant sessions and discusses the management of patients with diffuse androgenetic hair loss.Read: Summary | Full Article | View PDF
Wall Mounted Placing Stand for Hair Transplant Grafts
Bernstein RM, Rassman WR: Wall Mounted Placing Stand. Hair Transplant Forum Intl. 1997; 7(4): 17-18.
Synopsis: This short article describes the design for a wall-mounted placing stand that can store, chill and protect grafts while they are waiting to be placed into the scalp during the hair restoration procedure.Read: Full Article
What is Delayed Growth After a Hair Transplant?
Bernstein RM, Rassman WR: What is delayed growth? Hair Transplant Forum Intl. 1997; 7(2): 22.
Synopsis: Hypothesizes the possible causes of delayed growth following a hair transplant procedure. It differentiates between physiologic factors that cause normal variations in the growth cycle and those due to graft injury that can possibly be prevented by meticulous surgical techniques.Read: Full Article | View PDF
To Itch or Not to Itch After a Hair Transplant?
Bernstein RM: To itch or not to itch: Is this an option? Hair Transplant Forum Intl. 1997; 7(2):14-15.
Synopsis: A short paper that describes the cause and treatment of the occasional itching that follows a hair transplant procedure.Read: Full Article
Hair Restoration Megasessions: Answered Questions
Bernstein RM: Hair Restoration: Answered questions, Letters to the editor. Dermatologic Surgery 1996; 22: 97-98.
Synopsis: This writing explains the rationale for using large numbers of grafts in surgical hair restoration. It discusses the advantage of megasessions in conserving the donor supply, increasing patient satisfaction, and providing greater flexibility to the surgeon in sorting and distributing small grafts.Read: Full Article
Laser Hair Transplantation: Is It Really State-of-the-Art?
Bernstein RM, Rassman WR: Laser hair transplantation: Is it really state of the art? Lasers in Surgery and Medicine 1996; 19: 233-5.
Synopsis: This was the first paper to challenge those promoting laser hair transplants and who claimed that lasers would be the future in surgical hair restoration. The publication stressed that lasers caused damage to the recipient area and could result in scarring and poor growth. It explained why lasers were, in fact, inferior to cold steel techniques in making recipient sites.Read: Full Article | View PDF
Are Scalp Reductions Still Indicated?
Bernstein RM: Are scalp reductions still indicated? Hair Transplant Forum Intl. 1996; 6(3): 12-13.
Synopsis: This publication, written when scalp reductions were at the height of their popularity, cautioned that scalp reductions caused unnecessary scarring, used up precious donor reserves and caused more cosmetic problems than they solved. It suggested that, with the advent of the more robust follicular unit hair transplantation, scalp reductions should not be used in the treatment of androgenetic hair loss. This publication, along with the 1993 paper of O’Tar Norwood, played a critical role causing the rapid decline in the use of scalp reductions in hair restoration surgery. Fortunately, this once common procedure for male pattern alopecia is now rarely used.Read: Full Article | View PDF
Bernstein RM, Rassman WR, Szaniawski W, Halperin A: Follicular Transplantation. Intl J Aesthetic Restorative Surgery 1995; 3: 119-32.
Synopsis: This was the first paper on Follicular Unit Transplantation. This publication introduced into the medical literature the idea of using individual, naturally occurring follicular units exclusively in the hair transplant procedure and stressed using large sessions to maximize the aesthetic outcome. The paper defined the various components of Follicular Unit Hair Transplantation, explained the anatomic and physiologic advantage of using follicular units in the procedure and described how follicular units could be used safely in large numbers to complete the hair restoration as quickly as possible. This publication was instrumental in having hair restoration surgeons shift from the older mini-micrografting techniques to the cosmetically superior technique of using follicular units.Read: Summary | Full Article | View PDF
Hair Casts or Pseudonits Acquired Following Psychological Trauma
Held JL, Bernstein RM, Kohn SR: Hair Casts or Pseudonits Acquired Following Psychological Trauma. Cutis 1989; 43: 380-1.
Synopsis: This paper describes a case where severe psychological stress caused a patient’s hair shaft to be altered so that it mimicked an infestation of head lice. The correct diagnosis was made by microscopic examination of the deformed hair shafts.Read: Full Article