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Bernstein Medical - Center for Hair Restoration
Hair Restoration Answers

What is the Difference Between “Hair Transplant Reversal” and “Hair Transplant Repair”?

Q: I have read a lot on the forums about hair transplant reversal and hair transplant repairs. Are they the same thing, if not, what is the difference? Can you reverse a hair transplant? — K.J. ~ Park Slope, N.Y.

A: A “hair transplant repair” refers to techniques that improve the appearance of a poorly executed procedure or one performed with outdated methods. A “hair transplant reversal” refers to techniques that enable the individual to appear as if no hair restoration surgery had been performed. Although the techniques in attempting to perform a repair or a reversal may be similar, the ultimate goals of each are quite different. It is important to understand that although significant improvement can often be achieved; perfect repairs and/or full reversals are generally not possible.

The main reasons for seeking a repair include; large grafts transplanted to the frontal hairline giving an unnatural, “pluggy” appearance, a frontal hairline placed too far forward, hair placed in the wrong direction, and donor and recipient site scarring. Outdated procedures such as scalp reductions and flaps also need to be repaired.

If the transplanted grafts are large (“hair plugs”), it is possible to surgically excise these grafts, microscopically dissect them into smaller follicular unit grafts, and re-transplant them into the scalp in a more natural-looking, aesthetic way. After these large grafts are removed, the sites are sutured closed and heal with very fine, often imperceptible, white scars. Hair plug removal is often followed by one or more sessions of FUT or FUE in order to harvest additional hair for use in camouflaging any remaining plugs or improving the appearance of the region where the plugs had previously been. These combined repairs can lead to excellent outcomes.

If the grafts at the hairline are not large, but are placed too low or too broadly, it is possible to use laser hair removal and/or tweezing to remove these hairs. Repeated treatments may be necessary until the hair ceases to grow back at these locations. Additionally, hair which was placed in a direction different from the way hair naturally grows will usually need to be removed.

Another challenge in hair transplant repair is fixing widened donor scars that had resulted from poorly performed FUT/strip procedures. These scars are permanent and may be visible if the hair is not worn long enough. Scars from FUT procedures can be repaired by harvesting hair from the surrounding donor area (using FUE) and transplanting these follicular unit grafts into the scarred tissue.

Scalp micropigmentation (SMP), a permanent micro-tattoo, may be useful to further camouflage these linear scars. SMP can also be used to improve the look of the stippled scars of FUE in patients. This can occur with over harvesting, when patients wear their hair too short, or when the balding is more extensive than anticipated and extends into the harvested area.

A hair transplant reversal, in theory, has the goal of having the person look as though a hair transplant had never been performed. While a complete reversal is not possible, the techniques previously discussed can be utilized to achieve a number of important things. The donor site scarring can be minimized and/or camouflaged and the smaller follicular unit grafts in the recipient zone can often be removed without leaving behind any visible scarring of the underlying skin. What is not possible is to restore the person’s density to a pre-procedure level as improperly performed transplants always result in wasted hair.

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Hair Restoration Answers

In Hair Transplant Repair, Do You Always Harvest Additional Hair Via FUT or FUE? Which is Better for Repair Procedures, FUT or FUE?

Q: In hair transplant repairs do you always harvest additional hairs to give the hair restoration a better result? Which is better for repair procedures, FUT or FUE? — E.Z. ~ Fairfield, C.T.

A: We do not always harvest additional hair in repair procedures, but we do if possible because it can improve the aesthetic outcome by adding additional density and camouflage. This is called Combined Repair. As for whether we use FUT or FUE in repair procedures, the answer depends on the clinical situation. For example, a loose scalp favors FUT. If the person wants to wear their hair short, that favors FUE. If donor scars from the plugs need to be removed, that favors FUT. If scarring in the donor area needs to be camouflaged rather than removed, that favors FUE.

See Patient ETI’s before/after repair photos
Read about Combined Repair techniques

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Hair Restoration Answers

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 there hair loss can be camouflaged for many years.

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Hair Restoration Answers

Can I Use Toppik if I Had a Hair Transplant?

Q: Can I use Toppik if I had a hair transplant?

A: Yes, but I would wait at least 5 to 7 days after the hair restoration procedure before applying Toppik, Couvre, Derm Match or other cosmetic camouflage products to the transplanted area. For the first 9 days after hair transplants, the cosmetic should be washed out very gently so as not to dislodge the grafts. At 10 days following the hair restoration, the grafts are permanently in place, so you may shampoo as vigorously as you would normally do when showering.

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Hair Restoration Answers

What is Toppik Made From?

Q: What are the fibers in Toppik made from? — A.P., Toronto, Canada

A: Toppik is made from an organic protein called keratin – the same protein that comprises one’s hair and nails. It works by thickening the hair and adding color to the scalp, making the hair appear fuller in those with hair loss or general thinning.

Read more about Toppik and other products on our Cosmetic Camouflage Products page.

Read more about Hair Loss page.

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Hair Restoration Answers

How Can I Make a Hair Transplant Less Obvious Post-op?

Q: I am considering a hair transplant and would like to have the procedure and not be overly obvious about it. What are my options in hiding or concealing any redness after a week or so after the hair restoration? — R.T., Manhattan, NY

A: There are a number of factors that can make a hair transplant obvious in the post-op period. These include the redness that you are asking about, but also crusting and swelling.

Redness after hair restoration surgery is easily camouflaged with ordinary make-up. At one week post-op, the grafts are pretty secure, so that make-up can be applied and then gently washed off at the end of the day. Since the recipient wounds are well healed by one week, using make-up does not increase the risk of infection. At 10 days after the hair transplant, the grafts are permanent and cannot be dislodged, therefore, at this time the makeup can be removed without any special precautions.

Usually, residual crusting (scabbing) presents more of a cosmetic problem than redness, but can be minimized with meticulous post-op care. Crusts form when the blood or serum that oozes from recipient sites after the procedure dries on the scalp. Although it is relatively easy to prevent scabs from forming with frequent washing of the scalp after the surgery, once the scabs harden they are difficult to remove without dislodging the grafts.

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Bernstein Medical In The News

Eyebrow Transplant And Restoration Article Seeks Dr. Bernstein’s Advice On Aesthetics

Eyebrow transplant and restoration article - New York TimesEyebrow transplant procedures are growing in popularity. More women are realizing how much damage they can cause to their appearance by overplucking, shaping, and over-styling their eyebrows. Today, the New York Times reports on the trend of repairing eyebrows with hair transplant techniques and the use of camouflage products to cover up eyebrows that have been “tamed into oblivion.”

As the article’s headline declares, it is time to call in the professionals. The author of the article, Ms. Catherine St. Louis, turns to hair transplant pioneer Dr. Robert M. Bernstein for guidelines on performing a cosmetically-pleasing eyebrow transplant.

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Bernstein Medical In The News

Dr. Bernstein Performs Hair Transplant on Fox News Hair Loss Special

Fox NewsDr. Bernstein discusses the technique of follicular unit hair transplantation in a Fox News segment on hair loss and hair transplantation.

In the video, he discusses the use of the follicular unit hair transplant (FUT) procedure to correct hair loss and camouflage scarring that resulted from the surgical removal of a large skin cancer on the patient’s scalp.

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Hair Restoration Answers

How do You Treat Early Hair Loss in Women?

Q: I am a 33 year old women and am just starting to thin on the top of my scalp behind my frontal hairline. What should I do? Should I have a hair transplant?

A: There are a number of things that you should consider that can be effective in early hair loss. These include minoxidil (Rogaine), laser therapy, and using cosmetics specifically made to make the hair appear fuller. Lightening or streaking the hair, as well as parting the hair off to the side, will also make the hair appear fuller.

If a surgical hair restoration is performed too early and there is still a lot of existing hair in the area, the hair transplant may actually accelerate hair loss. Surgery should not be performed prematurely.

Also, it is important that the doctor check the stability of the donor area, using densitometry, to make sure that the procedure is even possible. For those women who are good candidates, and if it is done at the appropriate time, a follicular unit hair transplant is a great procedure that can produce really natural results.

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Hair Restoration Answers

How Do You Treat Hair Loss from Pseudopelade or Scarring Hair Loss on the Scalp?

Q: I am suffering from Pseudopelade for four years now. I have lost a lot of hair & there are big bald patches on the top of my scalp that are difficult to hide. Is there any hair transplant surgery or follicle transplant surgery possible in my case, or anything else I can do? — T.L., Boston, MA

A: In general, hair transplantation does not work for Pseudopelade (a localized area of scarring hair loss on the top of the scalp) since the condition is recipient dominant rather than donor dominant.

With a donor dominant condition, such as androgenetic hair loss, the tendency to have the condition, or be resistant to it, is located in the hair follicle and moves with the hair follicle when the follicle is transplanted to a new area…

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Hair Restoration Answers

What are Styling Tips for Thinning Hair?

Q: I am a 45 year old women and I am beginning to thin on the top of my scalp. I don’t want to use medications and I don’t think that I am quite ready for surgery. Is there anything else I can do? — E.H., Rye, NY

A: There are a number of things that you can do that can make you hair look more full and help disguise the thinning. Lightening ones hair will allow the hair to reflect more light and appear thicker. In lighter-skinned races it will have the additional advantage of decreasing the contrast between the hair and skin and thus the skin will essentially act as a filler between the strands of hair.

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Hair Restoration Answers

Can Hair Loss Camouflage Products Damage My Hair?

Q: I have a question about one of the products referenced under the Camouflage section of your website. As you suggested, I have begun to use DermMatch as an alternative to a hair transplant as I have diffuse thinning and been told that hair restoration is not an option right now. I have been very impressed with the results of DermMatch. However, I am concerned that the product might be damaging my existing hair or impeding future growth. Should I have any concerns about this product?

A: None of the well-known cosmetic camouflage products will damage hair or inhibit its growth.

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