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Robotic Hair Transplants & Hair Restoration
Flagship: 110 East 55th Street, New York, NY
212-826-2400 - [email protected]
Bernstein Medical - Center for Hair Restoration
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Hair Restoration Answers

Can I Have a Hair Transplant if My Scalp is Tight from Prior Surgery?

Q: What can be done if I want to have a hair transplant and my scalp is very tight from prior surgeries? — R.R., Long Island, N.Y.

A: Follicular Unit Extraction is ideal in very tight scalps, provided that there is enough hair to extract without leaving the donor area too thin and provided that the follicles are not too distorted from the scarring.

With strip harvesting, undermining techniques may be helpful to close the wound edges once the strip is removed.

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Hair Restoration Answers

How Do You Determine Size of Hair Transplant Donor Strip?

Q: I am interested in FUT. How do you figure out how large a strip to use for the hair restoration when transplanting all follicular units? — P.K., New York City, N.Y.

A: The length of the donor strip incision is determined by the number of follicular unit grafts required for the hair restoration.

There are slightly less than 100 follicular units/cm2, so if a 1cm wide strip is used, a hair restoration procedure requiring 1800 grafts would need a strip that measured slightly more than 18cm in length.

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Hair Restoration Answers

Where is Optimal Donor Incision for FUT Hair Transplant?

Q: I have heard that the hair for a hair transplant is taken from the back and sides of the scalp. Where exactly is the best place to remove the hair from? — L.L., Rivington, C.T.

A: You are correct. The best place to put the donor incision is in the mid-part of the permanent zone located in the back of the scalp. As more hair is needed the incision is extended towards the sides.

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Hair Restoration Answers

Does the Donor Area Decrease in Size Over Time?

Q: I am 22 and want to go for hair transplantation. I want hair restoration surgery now because I have a concern about my donor area that it might diminish if I postponed my transplantation. Could this be the case? — T.J., Westchester County, N.Y.

A: The logic is not correct. Having a hair transplant at an early age does not protect the donor supply.

If your donor area diminishes over time, then the transplanted grafts will fall out as well. Hair does not become permanent just because is moved in a hair transplant. It is never any better than the hair in the area where it came from.

The longer you wait – i.e. the older you are when a hair transplant is performed – the more information we will have about the stability of your donor area and this will allow for optimal planning of the hair restoration.

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Hair Restoration Answers

Which Gives More Donor Hair: FUT or FUE Hair Transplant?

Q: I am Norwood Class 6 and have read about both Follicular Unit Extraction (FUE) and Follicular Unit Transplantation (FUT). Which will give me more hair? — D.D., Highland Park, T.X.

A: In general, FUT will give you more hair since, in FUT, the best hair from the mid-portion of the permanent zone of the scalp (also called the “sweet spot”) can be utilized in the hair transplant.

With FUE, since only the hair follicles are extracted and not the surrounding bald skin, if too much hair is removed, the donor area will begin to look thin as hair is removed. This will limit the amount of hair that can be harvested.

Although in FUE additional areas of the scalp can be utilized to some degree, this will generally not compensate for the inability to access all of the hair in the mid-permanent zone and the total amount available for the hair restoration will be less.

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Hair Restoration Answers

Will Multiple FUT Hair Transplants Leave Multiple Donor Scars?

Q: I understand that even if you have multiple hair transplants you will only be left with one scar in the donor area. — T.J., Yonkers, N.Y.

A: If the closure is performed without tension, each procedure should result in the same fine scar.

The best-placed incision is in the mid-portion of the permanent donor area. Since there is only one mid-point, there is one best position for the scar. All incisions should lie on this plane leaving one scar.

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Hair Restoration Answers

Before an FUE Hair Transplant What is the Recommended Hair Length?

Q: Is it possible to do a hair transplant using follicular unit extraction without shaving the donor area? — V.S., Syracuse, N.Y.

A: In follicular unit extraction, the area that is extracted is clipped to about 1-mm in length. However, if the session is not too large, then the clipped area can be long and thin so that the patient’s existing hair will cover it. The person’s hair should be left long for the procedure.

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Hair Restoration Answers

What Factors Determine Hair Transplant Graft Count?

Q: Is it possible to tell me roughly how many grafts would be left from donor area if one had a hair transplant of 2,500 grafts and had a density of around 2.0? G.H. – New York, NY

A: How much hair can be harvested in total depends upon a number of factors besides donor density. These include: scalp laxity, hair characteristics (such as hair shaft diameter, color and wave), and the actual dimensions of the permanent zone.

Every person is different, so all of these factors would need to be taken into account to determine the total number of grafts that would be available for the hair restoration.

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Hair Restoration Answers

Do You Recommend Hair Transplant for Hair Thinning Over Entire Scalp?

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.

For further information, please read the article:

Bernstein RM, Rassman WR: Follicular Transplantation: Patient Evaluation and Surgical Planning, published in the journal Dermatologic Surgery in 1997. Specifically, read the last part of the article.

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Hair Restoration Answers

What is the Effect of Multiple Hair Transplant Procedures on the Scalp?

Q: I have had 4 hair transplants with strips taken out for a total of 2600 grafts over 15 years. The last one was 1,650 grafts. My doc says my donor site is good for a few more but I think it has been probably stretched to its max. Is it believable that the skin can be stretched to such extremes safely? – Murray Hill, N.Y.

A: The scalp is very resilient to stretching, particularly in those with a loose scalp to begin with. After removing a strip, the laxity often returns to normal or very close to it within 6 months to a year.

The problem with multiple hair transplant procedures is not only that scalp laxity may decrease, but that the donor density decreases as well. If too much hair is harvested, the donor area may eventually appear too thin. This may happen with either Follicular Unit Transplantation (FUT) or Follicular Unit Extraction (FUE).

Therefore, it is important the doctor not only assess the scalp laxity, but the residual donor density.

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Hair Restoration Answers

How Much Hair Can be Removed From the Donor Area?

Q: When harvesting donor hair, how does the surgeon know when to stop? – D.D., Pleasantville, N.Y.

A: The patient must first decide the shortest length he/she is comfortable wearing his/her hair.

Donor hair can be removed — whether through Follicular Unit Transplantation (FUT) or Follicular Unit Extraction (FUE) — as long as, at this length, the back and sides do not look too thin (i.e. do not have a transparent look) and the donor scars are not visible. The surgeon needs to use his judgment when harvesting, so that this endpoint is not crossed.

Additionally, the surgeon must anticipate that the caliber of hair in the donor area will decrease slightly over time as a normal course of events. The actual number of grafts that can be harvested varies greatly from person to person. It depends on the patient’s donor density, scalp laxity, hair characteristics and size of the donor area.

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Hair Restoration Answers

There is a Lump Beneath My Donor Area After My Hair Transplant. What Is It?

Q: I have developed a rather large, hard lump beneath the skin at the base of my scalp in the donor area that I first noticed this about two or three weeks after my hair transplant. What is this? — A.R. Bronx, N.Y.

A: You are describing an enlarged lymph node, a condition commonly seen as a normal part of the post-op course following hair transplants.

This is a normal part of healing in response to the surgery. It will resolve on its own in about 3-6 months. It doesn’t require any treatment and it should not be a cause for concern.

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Hair Restoration Answers

Can a Hair Transplant Restore Original Hair Fullness?

Q: Can you get your original density back with a hair transplant? — C.C. Scarsdale, New York

A: Although the cosmetic benefit can be dramatic, a hair transplant only “moves” rather than creates new hair. In surgical hair restoration, a limited amount of hair from the donor area is transplanted to a much larger area in the front and top of the scalp, so that we can never reach the original density.

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Bernstein Medical In The News

Dr. Bernstein Writes Chapters for ‘Hair Transplantation’ Textbook

Procedures in Cosmetic Dermatology: Hair Transplantation - Elsevier Saunders“Hair Transplantation” is a part of a series of medical textbooks — Procedures in Cosmetic Dermatology, published by Elsevier Saunders — which offers step-by-step, practical guides to performing cutaneous surgical procedures.

In “Hair Transplantation,” Dr. Bernstein co-authored the chapters on Follicular Unit Transplantation and Follicular Unit Extraction, covering the philosophy, basic science, and techniques in a practical clinical format.

The book’s editors selected Robert M. Bernstein as a major contributor, as Dr. Bernstein was uniquely qualified to provide medical professionals with insight and training on the state-of-the-art in hair transplant surgery.

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Hair Restoration Answers

Can an FUE Hair Transplant Use Donor Hair from Outside the Permanent Zone?

Q: If someone doesn’t have enough donor hair, do you ever perform a hair transplant using FUE, using donor hair from outside the permanent hair zone? — M.V., Nashville, TN

A: No. If hair was taken from outside the permanent zone as the surrounding hair continued to bald, the scars from FUE, although small, would become visible.

In addition, the transplanted hair would not be permanent, and over time would eventually fall out.

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Bernstein Medical In The News

Follicular Hair Transplantation Makes Splash After Bernstein Introduces Procedure To American Academy of Dermatology

Cosmetic Surgery Times
Cosmetic Surgery Times - April 1997

Cosmetic Surgery Times features Dr. Bernstein’s presentation to the 55th annual meeting of the American Academy of Dermatology in their April 1997 issue.

The article describes Dr. Bernstein’s introduction of the concept of Follicular Unit Transplantation to the academy as well as the keys to making the technique successful. From the article:

“‘Hair doesn’t grow singly it grows in naturally occurring groups of from one to four hairs. In follicular transplantation, we use these naturally occurring groups as the unit of the transplant,’ he told CST.

Although the procedure is highly labor intensive, it can actually be less expensive than conventional hair replacement surgery, because it can be performed in a single, but lengthy, session.

‘It is also much more efficient and conserves donor hair much better than conventional hair transplants. Every time you make an incision in the person’s scalp you waste some hair and make the remaining hair more difficult to remove. Accessing the donor area just once or twice will increase the total amount of hair that is available for the transplant,’ Dr. Bernstein told CST.”

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