A patient who visited Dr. Bernstein to learn about her hair loss authored an article on her experiences which appeared in the January 2014 issue of Cosmopolitan Magazine. In an article titled, “Thinning Hair Nightmare,” the patient wrote about her struggle in coping with thinning hair, the taboo of talking about women’s hair loss, and ways in which she attempted to overcome these physical and emotional difficulties.
On visiting Bernstein Medical – Center for Hair Restoration:
Dr. Bernstein ordered a blood test to rule out common hair loss causes, like thyroid disorders and hormone abnormalities, and he made sure my diet and any medications weren’t to blame. Everything came back normal.
On the diagnosis of hair loss in women:
During a follow-up visit, the doc broke out a densitometer — a crazy flashlight-looking tool that measures the changes in diameter between hair — dove into my mane, resurfacing moments later with a diagnosis: mild androgenetic alopecia, aka female pattern hair loss (FPHL). “It’s the most common type of hair loss in women, affecting perhaps one-third of the adult female population,” he explained. It occurs when a woman’s hair follicles shrink in response to her body’s own hormones.
On the taboo of female hair loss:
In search of solutions, I turned to the blogosphere… While the topic of female hair loss feels taboo, here were thousands of women talking openly — not just about the physicality of the issue but also its psychological toll. […] Whenever any conversation turns to hair, I push myself to talk openly about my issue. I’m determined not to let this condition make me feel ashamed. With more than 30 million U.S. women affected by FPHL, we should find strength in our numbers.
Dr. Bernstein was the featured guest on the Doctor Oz Show, where they discussed women’s hair loss and how the subject is often, unfortunately, considered taboo.
Q: Is it worth getting the genetic test for balding?
A: You’re referring to Hair DX (hairdx.com), which costs about $150 and came to market in January of 2008 as the first test for androgenetic alopecia, aka male pattern baldness.
The test screens for variations in the androgen receptor gene on the X chromosome, the gene that is associated with male pattern hair loss. The purpose of the test is to identify persons at increased risk of developing hair loss before it is clinically apparent – so that medical intervention can be started early, when it is most effective.
It is important to realize that, at this point, there is just an association with this gene and hair loss; the cause and effect has not been proven and the association is not anywhere near 100%. A danger is that patients may overreact to the relatively incomplete information that the test provides. It is best to have the test performed under a doctor’s supervision, so that it can be put in the context of other information that the physician gleans through a careful history, physical and a densitometry hair evaluation. As of this posting, genetic testing for hair loss is not permitted in New York State.
Q: I heard that a smaller per cent of women are candidates for hair transplants compared to men. Is this true?
A: Yes, that is true. Women more commonly have diffuse hair loss where the thinning is all over the scalp. This means that the donor area (the back and sides of the scalp) are thinning as well.
If the donor area is not stable, then there is no point in doing a hair transplant, since the transplanted hair will continue to fall out. Remember, the transplanted hair is no better than the area where is comes from.
On the other hand, women with stable donor areas can be great candidates for surgical hair restoration. The stability of the donor area can be assessed using a procedure called densitometry and should be part of the hair loss evaluation when you see your physician.
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.
To give hair restoration surgeons more precise diagnostic information in their evaluation for patients considering hair transplants, Dr. Bernstein uses the techniques of densitometry and video-microscopy to analyze the scalp under high-powered magnification.
The technique gives important information on hair density, the composition of the patient’s follicular units and the diameter of their hair shafts. The new instruments give doctors vital information for making decisions about whether patients are candidates for hair transplant surgery, the amount of donor tissue needed for the hair restoration, and to help them better predict how the results of hair transplants will ultimately look.
Baldness Detection Devices Featured in Medical Journal
Hair Transplant Forum International publishes new article on hand-held instruments used in hair loss detection and planning for hair transplants.
The lead article in the March/April issue of the journal published by The International Society of Hair Restoration Surgery (ISHRS) focuses on the latest tools available for assessing whether or not a person experiencing hair loss is a good candidate for hair transplant surgery.
The cover story: “Densitometry and Video-microscopy” written by Robert M. Bernstein, M.D. and William R. Rassman, M.D. explores the often overlooked diagnostic practice of analyzing the scalp under high-power magnification. Getting an extreme close-up of hair patterns at the base of the scalp allows hair transplant surgeons and dermatologists a chance to not only screen candidates for appropriateness for surgery, but can also predict future hair loss patterns.
Dr. Bernstein, founder of the New York based Bernstein Medical – Center for Hair Restoration, is known for his pioneering work in new hair transplantation techniques. When asked why he thought the article was given so much prominence in the Hair Transplant Forum, he suggested that “these simple hand held instruments should be essential tools of the hair transplant doctor.” He cautioned that without precise measurements doctors run the risk of performing surgery on persons who may is not suited for this procedure.
Dr. Bernstein has authored over 50 papers on hair transplantation including some of the most influential research on techniques used to repair badly performed hair transplants. In his seminal publications describing Follicular Unit Transplantation (FUT), Dr. Bernstein introduced a brand new method of hair restoration surgery which recognized follicular units (groups of naturally growing hair follicles) as the ideal element of donor tissue to be used in hair transplants. FUT is now considered to be the state-of-the-art in surgical hair restoration.
Dr. Bernstein and his colleague Dr. Rassman began utilizing the Densitometer to determine specific hair characteristics such as hair density, and changes in hair diameter that are important in both determining who are potential surgical candidates for the new hair transplant procedures and who may respond to medications.
The International Society of Hair Restoration Surgery (ISHRS), a non-profit organization of over 700 hair restoration doctors, publishes Hair Transplant Forum to keep the Society abreast of the most recent developments in the field of hair transplantation.
Dr. Bernstein is known to the general public from his appearances on NBC’s Today Show with Matt Lauer, CBS’s The Early Show, ABC’s Good Morning America, The Discovery Channel and other nationally syndicated programs.
Dr. Bernstein took part in a PRWeb podcast about hair transplantation in June 2007. Stream the discussion below or read the transcript:
Announcer: PRWebPodcast.com, visiting with newsmakers and industry experts.
Mario: This is Mario from PRWeb, and today it is a real pleasure to have with us Robert M. Bernstein, M.D. Dr. Bernstein is Associate Clinical Professor of Dermatology at Columbia University, and founder of New York City‑based Bernstein Medical – Center for Hair Restoration. Dr. Bernstein, it’s a pleasure to have you here on PRWeb.
Dr. Bernstein: Nice to be speaking with you.
Mario: Give us some understanding, sir, of your practice, the Bernstein Medical – Center for Hair Restoration. How long have you been around, where you guys are located, what is it you do there, please?
Dr. Bernstein: Bernstein Medical has evolved over the last ten years. It was set it up to do a specific procedure that I pioneered called “follicular unit hair transplantation.”
In this procedure, we dissect out hair follicles from the back of the scalp, exactly the way they grow in nature, so we are now able to perform hair transplants that essentially mimic nature.
This procedure is used by doctors around the world in hair restoration procedures. Our NY Hair Transplant Center is in midtown Manhattan and has been specifically designed for performing this hair transplantation technique.
Mario: You recently co‑authored an article, Dr. Bernstein, that appeared in the “Medical Journal of the International Society of Hair Restoration Surgery”. Now, you are well read and interviewed all over. This must be a bit exciting, something that was positive for you and your clinic. Tell us about the article, what it touched on, and some of the things that would be important for our listeners.
Dr. Bernstein: It sure was very exciting. The hair transplantation procedure has been around for many years, but a lot of it has been too much of an art and not enough of a science. What we’ve found is that doctors sometimes make these very general judgments about how bald the patient is going to become, how much hair they may need for the hair transplant or for the restoration.
We’ve found that by using a procedure called “densitometry”, where the hair is looked at under high magnification, we are able to get much more specific and useful information, both on the extent of how much someone is going to lose their hair, and also whether they are going to be a good candidate for hair restoration surgery.
One of the things that we’ve found is that when people start to thin, the hair first changes diameter before it’s lost, and this change in diameter may not necessarily be seen by the naked eye or be observed by another person.
But if you clip the hair very short and look at the base of the hair follicles under very high power, 30X magnification, you can actually see these very subtle, early changes, and these changes will anticipate future hair loss.
When we’re trying to decide whether a person should have hair transplant surgery, we can actually look at the donor area in the back and sides of the head, and see how stable these areas are. For example, someone that is becoming very bald, if the back and sides of their head show no change in the hair diameter, or no miniaturization, then we know that they may have very good hair for hair transplants; where a person with a similar degree of hair loss, whose sides and back are not stable, may not be a good hair transplantation candidate.
In a sense, by being able to measure things now, we’re able to have a much better sense of whether people are going to become very bald, possibly the rate of change of their hair loss, and then if they do need surgery, such as a hair transplant, we’re able to give much more specific information about what actually might be done.
Mario: We’re speaking to Dr. Robert M. Bernstein, M.D., an Associate Clinical Professor of Dermatology at Columbia University, and founder of New York‑based Bernstein Center for Hair Restoration.
Dr. Bernstein, give us some contact information where we can learn more about your services, and be able to end up taking advantage of them.
Mario: Dr. Bernstein, it’s been a pleasure having you here on PRWeb podcasting with us. The best of luck to you, and congratulations again for that article in the “Medical Journal of the International Society of Hair Restoration Surgery.”
Dr. Bernstein: Thanks a lot, nice talking to you.
Announcer: Produced by PRWeb, the online visibility company.
Q: I have read that in the evaluation of a patient for hair restoration surgery some doctors use a densitometer to measure miniaturization – the decrease in size of hair diameters. I read that miniaturization is a sign of genetic hair loss, but when there is miniaturization of greater than 20% in the donor area, a person may not be a good candidate for hair transplants. Is this correct and does 20% miniaturization mean that 20% of the population of terminal hairs have become fine vellus-like hairs or that there is a 20% decrease in the actual diameter of each of the terminal hairs? — B.A., New Albany, Ohio
A:Miniaturization is the decrease in hair shaft length and diameter that results from the action of DHT on healthy, full thickness terminal hairs. The hairs eventually become so small that they resemble the fine, vellus hair normally present in small numbers on the scalp and body. Miniaturized hairs have little cosmetic value. Eventually miniaturized hairs will totally disappear. Twenty percent miniaturization refers to the observation, under densitometry, that 20% of the hairs in an area show some degree of decreased diameter.
In the evaluation of candidates for hair transplantation, we use the 20% as a rough guide to include all hairs that are not full thickness terminal hairs. Of course we are most interested in the presence of intermediate diameter hairs — i.e. those whose diameters are somewhere between terminal and vellus and are clearly the result of DHT. I don’t know if one can tell the difference on densitometry between vellus hairs, fully miniaturized hairs and senile alopecia. The partially miniaturized population is most revealing.
Miniaturization in the recipient scalp (i.e. the balding areas on the front top and crown that we perform hair transplants into) is present in everyone with androgenetic hair loss. Miniaturization in the donor area, however, is less common (in men). It means that the donor area is not stable and will not be permanent. Men with more than 20% of the hair in the donor area showing miniaturization are generally not good candidates for hair transplant surgery.
Q: I am a Caucasian female that has experienced hair loss on the sides of my head from the height of the eyebrow to the ear due to traction. The hair loss has been present since my teen years. My job requires me to wear my hair up most of the time. Although I don’t wear it nearly as tight, I seem to continue to lose my hair in the front and on the top of my head. My hair also used to be very thick as a child and is now quite thin. I’m not sure if this is normal or something else is going on, but I am definitely interested in a hair transplant. — M.H., Larchmont, NY
A: It sounds like you are experiencing continued traction alopecia. Unless the underlying cause is corrected (the traction), you can expect to continue to lose your hair. People that have traction alopecia can have thinning even from mild pulling that might not be a problem for others. Once you stop the pulling, it can take up to two years for the hair to return, although there may be permanent hair loss.
Surgical hair restoration is the treatment of choice for permanent hair loss from traction. If you have significant thinning on the sides, you may not be a candidate for hair transplantation since in this procedure we often need to harvest hair from the permanent area in the sides of the scalp as well as the back.
An additional problem (that you allude to) is that you may have underlying female pattern hair loss. This would further complicate the surgical treatment.
A careful examination (including densitometry) can sort these problems out and allow for more specific recommendations.
Q: I underwent hair transplant surgery several years ago and was pleased with the results. However, over the last 2-3 years I’ve lost hair in the donor area with subsequent loss of hair in the transplanted area. Is this type of hair loss especially difficult to treat? What accounts for hair loss from the back of the head that is typically considered “permanent”? — F.D., Laude, Missouri
A: Less than 5% of patients have unstable donor areas, i.e. where the back and sides thin along with the front and top. We call this condition Diffuse Unpatterned Alopecia or DUPA. It is best to identify this condition before hair transplant surgery is contemplated as people with DUPA are not good candidates for hair transplantation. The diagnosis is made using densitometry by noting high degrees of miniaturized hair in the donor area.
At this point, I would use medications such as finasteride. I would not do further hair restoration surgery.
Q: I am 19 years old and seem to be thinning all over, including the sides. My father has all of his hair but my grandfather is totally bald. Should I have a hair transplant now or wait until I am older? — T.K., Garden City, NY
A: Most likely you have a type of androgenetic alopecia called Diffuse Unpatterned Alopecia (DUPA). In this hereditary condition, hair thins all over rather than just on the front, top and back as in the more common male pattern baldness. The fact that the back and sides of your scalp are thinning (the donor area) precludes you from being a candidate for surgery. The diagnosis can be made by observing a high degree of miniaturization (fine hair) in the donor area under a magnifier. This instrument is called a densitometer.