Bernstein Medical - Center for Hair Restoration - Coarse Hair
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Q: I am Hispanic and I have thick, black coarse wavy hair. Do you transplant Hispanics and are there any difficulties in performing hair transplants in them?

A: Yes, we treat Hispanic patients. There are no specific issues unique to Hispanics when performing hair restoration procedures. However, things to consider are:

  1. Hispanics have a slightly greater incidence of forming a thickened donor scar than Caucasians (but not as great as African-Americans)
  2. Hispanics often have coarse hair, but a low donor density, so fewer absolute numbers of grafts may be available for the restoration. The coarse hair, however, will make the restoration appear fuller.
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Q: I am in my early 20’s and I was told my hair loss pattern is a Norwood Class 6, on its way to becoming a Class 7. My hair is brown in color and medium to coarse and I was told I have high density in my donor area. Although I was told I could have hair transplants, do you think that I should based upon what I have told you? — D.W., Pleasantville, N.Y.

A: The main concern I would have is that when someone is already a Class 6 by their early 20’s, he may eventually be left with only a very thin see-through fringe as he ages. A high donor density now does not ensure that this will not occur – and coarse donor hair at age 22 does not ensure that it will not become fine over time. In fact, there is a significant chance that it will.

Since the hair restoration would require one or more large sessions, there is a risk that the donor scar(s) will not be hidden over time. If you had a widened linear donor scar from an FUE-strip procedure, you would need to grow your hair longer on the back and sides to cover it (if that is even possible). And this look of longer hair on the back and sides would not be a good one for a young person, especially if there was not enough donor hair to fill in the crown.

On the other hand, large FUE sessions leave a very wide band of small round scars in the back and sides of the scalp that can become visible if the anticipated permanent donor zone was not truly permanent and narrowed over time.

When we are younger, our decisions are often more emotion-based and impulsive. When one is older, and our tastes change, we may change our mind about having had surgical hair restoration, but the hair transplant, once performed, is not reversible.

Read about the Candidacy for a Hair Transplant

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Q: One of the things that I have noticed as a person who has needed to take thyroid medication for a long, long time, is that when my thyroid gets a little bit out of balance – when I’m not getting quite enough, I begin to notice is that my hair starts falling out. What about the role of thyroid for hair loss? — T.K., Mineola, NY

A: Both increases and decreases in thyroid levels can cause hair loss and changes in the levels of thyroid hormone can change the consistency of one’s hair. Elevated hormone levels cause scalp hair to be fine and soft, with diffuse thinning being relatively characteristic.

When thyroid hormone levels are low, the hair becomes dry, coarse, and brittle. Hair loss can be either patchy or diffuse (involving the entire scalp).

Low levels of thyroid hormone are associated with the loss of the outer 1/3 of the eyebrows and a decrease in body hair. When changes in thyroid hormone levels are abrupt, there can be dramatic shedding (telogen effluvium).

The most important thing to do if you have thyroid disease is to try to keep the levels within a normal range and keep them as steady as possible. If you are taking thyroid medications, try to use them on a regular basis, because alterations of ones in hair can be caused by large fluctuations in the levels, as much as by the absolute values.

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Q: Can you use beard hair for a hair transplant using Follicular Unit Extraction? — A.C., San Francisco, CA

A:It is possible to use beard hair for a hair transplant, but there are three main differences between harvesting from the donor area and harvesting from the beard that should be taken into account. These are: 1) scarring 2) ease of extraction and 3) hair quality. Let’s explore these differences in turn.

First, in FUE, although there is no linear scar, there are small white round scars from where the hair is harvested. Normally these marks are hidden in the donor area and are not visible, even if the hair is clipped very short. However, if the scalp is shaven, these marks will become visible. When the beard is used as the donor source for the hair transplant, the patient must continue to wear a beard after the restoration, even if it is tightly cropped, or the faint white marks will show. The tiny round scars from FUE will generally be visible on a clean shaven face. As each person heals differently, we would perform a test before doing the actual procedure to make sure the marks from the extraction are not noticeable at the length that the person wants to wear his beard.

Second, FUE performed on beard hair differs from extraction from the scalp because of the greater laxity — or looseness — of facial skin. This makes extraction with minimal transection more difficult in some cases. A test prior to the hair transplant is particularly important in beard FUE so that the ease of extraction may be determined in advance.

Third, beard hair is coarser than scalp hair. Although the hair seems to take on some of the characteristics of the original hair in the transplanted area, the transformation is not complete. This makes beard hair an imperfect substitute for scalp hair.

A solution to the problem is to transplant beard hair behind the hairline for volume and scalp donor hair at the hairline for naturalness.

Read about FUE Hair Transplants

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