Robotic Hair Transplants & Hair Restoration
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Bernstein Medical - Center for Hair Restoration
Hair Restoration Answers

What Does Hair Transplant Procedure Do To Existing Hair?

Q: What does the hair transplantation process do to your existing hair? — R.V., London, UK

A: When we perform hair transplant surgery, we transplant into an area that is either bald or has some existing hair. The hair that is existing is undergoing a process called miniaturization. What this means is that the hairs are continuing to decrease in size – both in diameter and in length. When we perform a hair transplant, we don’t transplant around the existing miniaturized hair on your scalp, we transplant through it. And the reason why we do that is because the miniaturized hair, the fine hair that is being affected by DHT, is eventually going to disappear, so you don’t want there to be any gaps.

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Hair Restoration Answers

Which is Better Hair Loss Treatment: Minoxidil With Retin-A or Without Retin-A?

Q: Is using Minoxidil combined with Retin-A better than regular Minoxidil for Hair Loss? — L.W., Gowanus, New York

A: Minoxidil has been prescribed (off-label) in combination with other medications, such as topical retinoic acid (Retin-A), to enhance its penetration into the skin and thus increase its effectiveness. This combination of medications can increase the absorption of minoxidil into the bloodstream and may increase the risk of potential side effects, including changes in blood pressure and scalp irritation. It is important to use combination therapy under the supervision of a physician.

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Hair Restoration Answers

When Can I Resume Smoking After a Hair Transplant?

Q: I had my hair transplant done 10 days back, I was a regular smoker (8-10) cigarettes every day from last 10 years. I have stopped smoking from the day of my surgery, how long should I stop smoking after surgery? — E.D., Glendale, N.Y.

A: I would wait a minimum of 10 days, but the longer the better. The nicotine in the smoke constricts blood vessels and decreases the oxygen to the tissues and the carbon dioxide in smoke displaces the oxygen. Both chemicals retard healing.

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Hair Restoration Answers

Do You Use Megasessions or Very Large Graft Sessions In Your Hair Transplant Procedures?

Q: Some surgeons are doing hair transplants using 5,000 to 6,000 grafts in a single surgery. Looking at the cases in your photo gallery, it seems like your hair transplants involve many fewer grafts per surgery. Do you do such large graft numbers in a single hair restoration procedure? — H.P., Cranston, R.I.

A: The goal in surgical hair restoration should be to achieve the best results using the least amount of donor hair (the patient’s permanent reserves) and not simply to transplant the most grafts in one session. In my opinion, although large sessions are very desirable, the recent obsession with extremely large numbers of grafts in one session is misplaced. The focus should be on results.

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Hair Restoration Answers

Do You Use Sutures or Staples in an FUT Hair Transplant?

Q: Can you please comment on the use of sutures verses staples in hair restoration procedures? — S.S., Prospect Park, NY

A: Sutures are great on non-hair bearing skin and allow perfect approximation of the wound edges, but on the scalp they can cause damage to hair follicles below the skin’s surface. The reason is that a running (continuous) suture traps hair follicles and when the skin swells (as it normally does after hair transplants) the trapped follicles can strangulate and die.

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Hair Restoration Answers

Is Success of Hair Transplant Affected by Age or Scalp Fibrosis?

Q: It is my understanding that as a person loses his or her hair, the skin of the scalp undergoes a number of changes, namely there is a loss of fat, an increase in cellular atrophy, and of course the dreaded perifollicular fibrosis (now that’s a mouthful). It seems to me that these changes, in particular the fibrotic scarring, are the main obstacles in the way of regrowth, and the reason Propecia does not work for extensively bald men. What can be done about this demon we call fibrosis? Can it be slowed, stopped, prevented, reversed? If we could somehow counteract collagen formation, wouldn’t our baldness problems be solved for good? If a bald scalp is atrophic, how does it have the capacity to hold a whole new head of transplanted hair? Is there a limitation to the number of hairs we can transplant (outside of donor limitations)? — R.L., Rivington, C.T.

A: The findings that you are describing are well documented; however, it is not clear if these changes are the cause of the hair loss or are the result of having lost one’s hair. Most likely, the DHT causes the hair follicles to miniaturize and eventually disappear. This, in turn, causes the scalp to thin and lose its abundant blood supply (whose purpose is to nourish the follicles). The changes in the scalp are also affected by normal aging, which causes alterations in connective tissue including the breakdown of collagen and other components of the skin. The changes seen with aging are greatly accelerated by chronic sun exposure.

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Hair Restoration Answers

What is Tumescent Anesthesia and is it Used in a Hair Transplant Procedure?

Q: I have read about something called “tumescent anesthesia” but didn’t understand what it is. What exactly is it? — S.S., Hoboken, N.J.

A: Tumescent techniques were first popularized in liposuction surgery where large quantities of fluid containing adrenalin were injected into the person’s fat layer to decrease bleeding before the fat was literally sucked out of the body. Bleeding was minimized because the epinephrine (adrenaline) constricted blood vessels and the fluid compressed the blood flow in the smallest blood vessels called capillaries.

The technique allowed small liposuction procedures to be performed safely as an out-patient procedure. In surgical hair restoration, low concentrations of anesthetic fluid and adrenaline are injected into the fat layer in the back of the scalp.

In a hair transplant, besides decreasing the bleeding, the fluid makes the skin more rigid so that the incision can be more easily made without cutting hair follicles. It also helps the doctor avoid damage to the deeper blood vessels and nerves in the scalp.

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Hair Restoration Answers

What Causes ‘Graft Popping’ During Surgical Hair Restoration?

Q: What causes graft popping during a hair transplant? G.K. – Carle Place, N.Y.

A: Popping, or the tendency for grafts to elevate after they have been placed into the recipient area, is caused by a number of factors including:

  • Packing the grafts too closely, particularly when they are placed on a very acute (sharp) angle with the skin
  • Rough placing techniques
  • Bleeding
  • Poor fit between the graft and recipient site
  • Natural characteristics of the patient’s skin, including the elasticity and stickiness of wound edges

The problem with popping is that it exposes grafts to drying (while they are elevated on the skin surface) and trauma (when they have to be re-inserted).

The judgment and experience of the surgeon performing hair transplants is extremely important in minimizing popping. It is important that the surgeon customize the site size to the different size follicular unit grafts and to test the recipient sites as they are made, to make sure that the “fit” is perfect.

Although it is important to place grafts close together to get the best cosmetic result possible, over-packing of the grafts risks popping and other factors (such as overwhelming the blood supply) that may lead to poor growth.

In the end, maximum growth of the transplanted hair should be the primary goal.

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Hair Restoration Answers

Can Hair Transplant be Harmed by Smoking Before or After Procedure?

Q: Is it true that smoking is bad for a hair transplant and why? P.P. – N.Y., N.Y.

A: Smoking causes constriction of blood vessels and decreased blood flow to the scalp, predominantly due to its nicotine content. Also, carbon monoxide in smoke decreases the oxygen carrying capacity of the blood.

These factors both contribute to poor wound healing after a hair transplant and can increase the chance of a wound infection and scarring. Smoking may also contribute to poor hair growth.

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Hair Restoration Answers

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 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 exacerbates the popping and exposes 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.

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