Hair Transplant

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.

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.

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.

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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.

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.

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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.

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.

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.

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.

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.

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.

Robert M. Bernstein, MD, New York, NY and William R. Rassman, MD, Los Angeles, CA Dermatol Surg 2006; 32: 198-204. Background Since it is not known precisely how long it will take for grafts to be securely anchored after a hair transplant, the advice that the medical profession has offered patients regarding post-op care has …

Graft Anchoring in Hair Transplantation: Summary Read More »

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.

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.

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.

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.

Synopsis: This writing is the textbook version of the paper; “Limiting Epinephrine in Hair Transplant Sessions.”

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.

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.

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.

Minimally Invasive Surgery for Hair Transplantation William R. Rassman, MD*, Robert M. Bernstein, MD*,**, Robert McClellan, MD*, Roy Jones, MD*, Eugene Worton, MD*, Hendrik Uyttendaele, MD, PHD** Dermatologic Surgery 2002; 28: 720-728. *New Hair Institute Medical Group, A Professional Corporation, Los Angeles, California and **Department of Dermatology, Columbia University, College of Physicians and Surgeons, New …

Follicular Unit Extraction: Summary Read More »

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.

Robert M. Bernstein, MD,*† William R. Rassman, MD, ‡ Nazia Rashid, and Richard C. Shiell, MBBS Dermatologic Surgery 2002; 28(10): 873-93. © 2002 The American Society for Dermatologic Surgery *College of Physicians and Surgeons, Columbia University, New York, New York †New Hair Institute Medical Group, A Professional Corporation, New York, New York and ‡Los Angeles, …

Art of Repair in Surgical Hair Restoration – Part II: Summary Read More »

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.

Robert M. Bernstein, MD,*† William R. Rassman, MD, ‡ Nazia Rashid, and Richard C. Shiell, MBBS *College of Physicians and Surgeons, Columbia University, New York, New York †New Hair Institute Medical Group, A Professional Corporation, New York, New York and ‡Los Angeles, CA Dermatologic Surgery 2002; 28(9): 783-94. © 2002 The American Society for Dermatologic …

Art of Repair in Surgical Hair Restoration – Part I: Summary Read More »

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.

SUMMARY of Dr. Bernstein’s editorial commentary on Hwang SM et al. Does the Recipient Site Influence Hair Growth Characteristics in Hair Transplantation? The original article appeared in Dermatol Surg 2002; 28(9): 798-99. The field of hair transplantation in the United States began with Dr. Norman Orentreich’s famous 1959 paper on Donor Dominance. In it, he …

Donor Dominance Revisited: Summary Read More »

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.

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.

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.

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.

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.

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Robert M. Bernstein, MD, William R. Rassman, MD, and Nazia Rashid Dermatologic Surgery 2001; 27(1): 5-11. College of Physicians and Surgeons, Columbia University, New York, New York Background The most common type of donor closure in hair transplantation is with non-absorbable, running sutures, usually of nylon or polypropylene. This is accomplished with, or without, buried …

A New Suture for Hair Transplantation: Poliglecaprone 25: Summary Read More »

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.

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.