Dr. 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 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. You can see this patient’s before and after photos in our Women’s Gallery.
Q: I heard Dr. Bernstein held a webinar this month, but I wasn’t able to attend. Is there anywhere I can hear it?
A: Yes, the webinar was titled “Hair Transplant Today” and it covered new concepts in the diagnosis of hair loss, the follicular unit hair transplant procedure, follicular unit extraction, hair cloning, and other aspects of hair transplantation.
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Bernstein Medical patient before (left) and after (right) hair transplant
We all know that hair loss is common among both men and women, and that hair transplant and hair restoration procedures are becoming more and more popular around the world. But what thoughts go through the head of your average hair loss sufferer before, during, and after a hair transplant?
The answer to that question may now be revealed. ABC News correspondent Cari Nierenberg and associate producer Ryan Stevenson take us directly into the mind and life of Bernstein Medical patient Adam Khoudja in a diary and feature on hair loss and hair restoration.
View each article at ABCNews.com:
You can also see the patient’s full before/after photoset in our Hair Transplant Photos gallery
Learn more about the hair transplant procedure and visit our own hair transplant photo journal.
Posted byQ: Why did you write another book on hair loss? — K.L., Greenville NY
A: Hair Loss and Replacement for Dummies is the first book that we have written that is specifically geared for the lay public. Besides hair restoration, it covers a wide range of topics including: the diagnosis and treatment of medical conditions that can cause hair loss, tips on hair care, information on hair systems, and a number of other topics not stressed in our other books.
Our prior books, The Patient’s Guide to Hair Restoration and The Guide to Hair Restoration focused on medical treatments and surgical hair restoration. Although very easy to understand, they are most helpful for someone that already has a basic understanding of hair loss or that had a consultation.
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John Wiley & Sons – creators of the hugely-popular For Dummies series of books – published on December 3 the definitive book on hair restoration: Hair Loss & Replacement For Dummies, written by internationally-respected hair transplant pioneers Dr. William R. Rassman and Dr. Robert M. Bernstein with Dr. Eric Schweiger.
Hair Loss & Replacement for Dummies is filled with important information for men and women of virtually all ages anxious to preserve their full head of hair, put the brakes on balding, or explore the safest and most reliable hair replacement techniques currently available. The book offers readers not only the full gamut of modern-day hair-care options but crucial tips on how to avoid unscrupulous hair transplant doctors and potentially harmful products as well.
Topics include:
For further reading see the transcript of an interview with Dr. Bernstein about the book, the original press release, or purchase the book at Amazon.com.
Posted byQ: Heard you were on Oprah with a hair transplant patient of yours. Is this true? — V.B., Chappaqua, N.Y.
A: Yes. Oprah wanted to know if hair transplants really worked, so I was asked to be on The Oprah Winfrey Show to explain the latest in hair restoration techniques.
They showed a film of me performing a follicular unit hair transplant and then brought the actual patient in the video on stage for a look at the results of his procedure.
Watch a video clip of Dr. Bernstein discussing hair restoration with Oprah Winfrey and Dr. Mehmet Oz in our Hair Transplant Video section.
For more information on Dr. Bernstein’s appearance, read the press release, “Pioneering Hair Transplant Doctor Explains Procedure on Oprah Winfrey Show“.
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Robert M. Bernstein, MD has been selected as one of New York Magazine’s “Best Doctors” for the eighth year in a row.
The annual issue of New York Magazine, published on June 11, 2007, presents the findings of Castle Connolly Medical Ltd. — publishers of the guidebook, Top Doctors: New York Metro Area.
Dr. Bernstein is the only hair restoration surgeon honored to be included in this list of prominent physicians for eight consecutive years.
Posted byQ: Dr. Bernstein, why have you not had a hair transplant? I’m sure this question gets asked a lot. Thanks. — I.L., Kentfield, CA
A: Yes, all the time.
My donor area is very thin (so I am not a good candidate) and I have gotten used to being bald. It has been years.
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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.
For more information, please see Dr. Bernstein’s publication on densitometry, a podcast on hair transplantation that discusses densitometry, and the Bernstein Medical – Center for Hair Restoration press release on the news below:
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.
Posted byQ: Dr. Bernstein, I saw you on TV where you explained why you haven’t had a hair transplant. If you had better donor hair and you could do the surgery on yourself, then would you consider having a hair transplant? — M.U., Westport, CT
A: Yes.
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The Trustees of Columbia University have named Dr. Bernstein, hair transplant pioneer, the Clinical Professor of Dermatology. This promotion was based on Dr. Bernstein’s teaching, lectures, research, original scientific papers, and outstanding patient care.
Robert M. Bernstein, MD, FAAD, is an Attending at the New York Presbyterian Hospital and specializes in surgical hair restoration. Dr. Bernstein is the founder and director of Bernstein Medical – Center for Hair Restoration. His current research focuses on the refinement of Follicular Unit Transplantation, the revolutionary hair restoration procedure that he pioneered.
Dr. Bernstein graduated with honors from Tulane University in 1973, achieving the status of Tulane Scholar. In 1979 he received the degree of Doctor of Medicine at the University of Medicine and Dentistry of N.J. where he was given the Dr. Bleiberg Award for “Excellence in Dermatology”. Dr. Bernstein joined the staff at Columbia in 1982 as an Assistant in Clinical Dermatology, after completing his training as Resident and Chief Resident in Dermatology at the Albert Einstein College of Medicine, New York, N.Y. Dr. Bernstein was promoted to Associate Clinical Professor of Dermatology at Columbia University in 2000. Dr. Bernstein also holds an MBA from Columbia, a degree he received in 2004.
Dr. Bernstein is Board Certified in Dermatology and is a Diplomat of the American Board of Hair Restoration Surgery. He is a fellow of the American Academy of Dermatology. For his for his pioneering hair transplant techniques, Dr. Bernstein received the Platinum Follicle Award, the highest honor bestowed by the International Society of Hair Restoration Surgery.
Columbia University bestows honor upon its physicians in the form of new appointments and promotions within each department. The department of dermatology at the College of Physicians & Surgeons of Columbia University was one of the first academic units established in New York City and is a major center for basic science and clinical research. Its faculty has made numerous contributions to the development of dermatology including pioneering work in the early use of ionizing radiation, advancing the technique of photopheresis for cutaneous T-cell lymphoma and discovering the first human gene associated with hair loss.
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Bernstein Medical – Center for Hair Restoration has moved to a new, state-of-the-art facility in mid-town Manhattan. The office is centrally located in the Park 55 building at 110 East 55th Street.
The new office is specially engineered for performing our pioneering follicular unit hair transplant procedures and innovative corrective surgery with custom surgical suites for patient comfort and operational efficiency.
The full Bernstein Medical – Center for Hair Restoration press release is below:
State-of-the-Art Hair Transplant Facility Opens in Mid-Town Manhattan
Bernstein Medical – Center for Hair Restoration, led by pioneering hair transplant surgeon Robert M. Bernstein M.D., has completed construction of their new state-of-the-art surgical facility in midtown Manhattan.
Occupying the entire 11th floor at 110 E. 55th Street (between Park and Lexington Avenues), this sleek new office has been designed exclusively for performing Dr. Bernstein’s pioneering surgical procedure known as Follicular Unit Hair Transplantation.
The only facility in New York designed specifically for Follicular Unit Transplantation; Bernstein Medical’s new center boasts the latest techniques in hair restoration. Special features include ergonomically designed equipment used by the surgical team to make the painstakingly detailed process of stereo-microscopic dissection go smoothly and efficiently. New techniques, such as vibratory anesthesia, custom surgical chairs and special lighting, maximize patient comfort.
In his seminal publications, Dr. Bernstein introduced a novel method of hair restoration surgery which recognized follicular units (groups of naturally growing hair follicles) as the ideal way that donor tissue should be used in hair transplant procedures. FUT, as it is popularly referred to, is now considered by many to be the single most important advance in surgical hair restoration in the last decade.
On the new center Dr. Bernstein stated, “Though our previous Manhattan location and our New Jersey facility both have had the latest technologies and instrumentation, it has always been our dream to design a surgical facility that had Follicular Unit Transplantation in mind from its architectural conception.”
Working closely with his architecture and interior design team, Dr. Bernstein oversaw all aspects of the project from its inception to insure that this new environment would be one to put patients at ease. From the use of natural sunlight and soothing colors, to the shapes of glass, stone and wood, all design elements were chosen to maximize the patient experience.
Dr. Bernstein has been named for the seventh consecutive year as one of New York Magazine’s Best Doctors for his pioneering work in 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.
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The November 2006 issue of Gotham Magazine featured Dr. Bernstein in their article on cosmetic surgery and hair transplantation. Read below for a selection from the article, titled “A Cut Above,” which includes the portion about Dr. Bernstein.
Gotham Magazine / November 2006 Issue
A CUT ABOVE
by Beth Landman • Illustration by Barbara McGregor
Once the province of wealthy older women, cosmetic surgery has gone mainstream, with everyone from teenage girls to investment bankers and politicians going under the knife, needle, or laser in the name of aesthetic self-improvement.
WHATEVER HAPPENED TO AGING GRACEFULLY?
Some of us do value natural beauty at any age, of course, and bemoan the prevalence of what can be considered extreme vanity. However, an increasing number of us see nips, tucks, and injections as reasonable measures to take in order to stay “fresh and competitive in a youth-oriented society,” as one of the converted put it. According to the American Society for Aesthetic Plastic Surgery, the number of surgical cosmetic procedures performed has more than doubled in the past 10 years; and, due to the rising popularity of Botox and a wide range of injectibles, the incidence of non-surgical treatments has increased by 726 percent.
Many of New York’s leading physicians have been at the forefront of the beauty battle, developing new techniques and technology while defining the field’s cutting edge. Here’s a rundown of who to see before you snip, suck, fill, or implant.
Dr. Bernstein
The shameless plug: We all know that bad hair plugs can be spotted from across a room, so this job should not be left to chance. Bernstein, who founded the Bernstein Center for Hair Restoration, has made great headway with what’s called “follicular unit transplantation.” Instead of using single plugs, he works with clusters of hair that continue to grow in natural patterns. The results appear more natural, and his patients need fewer sessions than with the traditional method of hair transplant surgery. Dr. Bernstein is researching the possibility of cloning hair so that individuals will have an unlimited supply of donor follicles. “The idea is to clone them and inject them into the scalp,” he explains.
Dr. Bernstein, a renowned teacher, lecturer, and surgeon, is bringing his state-of-the-art hair restoration techniques directly to patients. His lecture on Follicular Unit Transplantation (FUT) includes a historical review of hair transplant techniques, from the out-dated “hair plugs” and “cornrows” to refined FUT procedures. Watch the lecture below to see images of surgical tools, illustrations of surgical techniques, and before and after patient photos. Running commentary by one of the eminent authorities on the subject makes it easy to grasp, even for newbies.
Dr. Bernstein has conducted presentations on his innovative hair transplant techniques at medical conferences around the world including Barcelona, Spain; Vancouver, Canada; Sydney, Australia; and Washington D.C. Many have learned about the nuances of hair transplant surgery from one of the pioneers of surgical hair restoration.
Hair transplant surgeon Robert M. Bernstein M.D. was recently interviewed on the National Public Radio program The People’s Pharmacy. Invited to speak about hair loss, Dr. Bernstein offered insights about the causes of hereditary baldness and it’s solutions, including hair transplantation.
The show was entitled “Dealing with Hair Loss” and addressed issues such as the importance of hair to our sense of well being.
The full hour radio interview was filled with informative facts about male pattern baldness, cultural attitudes toward hair loss and surgical hair restoration. For example, Dr. Bernstein was asked about his pioneering work in follicular unit hair transplantation and host of other questions ranging from the causes of hair loss to the psychological effects of balding. Here is one exchange from the interview:
Moderator: How one can tell the difference between hair loss from hormonal imbalances and common baldness?
Dr. Bernstein: Measuring hormone levels alone, although important for medical management, does not necessarily reveal whether the cause of the hair loss is actually hormone related or is genetic. The diagnosis is made by examining the scalp and looking at the hair under close magnification using an instrument called a “Densitometer.” If the hair shafts are of different calibers, this is relatively diagnostic of female patterned genetic hair loss and in this case hormone levels are often normal. Hormonal changes or imbalances, on the other hand, may cause alterations in hair texture (such as in thyroid disease) or a generalized shedding that can occur after childbirth (called telogen effluvium). In telogen effluvium, the hair can l actually fall out in clumps – you can literally get handfuls of hair, but the hair often returns over time. In genetic hair loss, however, it is not a question of the hair falling out any faster, but the hair being replaced with thinner, finer hair in each hair cycle, until the hair gradually disappears.
Posted byPRESS RELEASE
World renown hair transplant surgeon introduces a new surgical tool that improves the way hair transplantation can be performed.
New York, NY March 21, 2006
In a new article appearing on the cover of Hair Transplant Forum International, the official publication of The International Society of Hair Transplant Surgeons (ISHRS), pioneering hair transplant surgeon Robert M. Bernstein MD, along with his colleague Dr. William R. Rassman, recently revealed details about a “New Instrumentation for Three-Step Follicular Unit Extraction.”
Dr. Bernstein is known throughout the world of medicine as author of the landmark publication; “Follicular Transplantation” which described a new hair replacement transplant technique in which he was able to transplant hair exactly as it grows – in naturally occurring groups called follicular units. That paper, together with two dozen other major publications, has revolutionized the way hair transplants are now performed – moving away from “doll’s hair” like plugs and into the realm of natural, undetectable hair patterns.
Follicular Unit Extraction (FUE) is a further refinement of this technique where follicular units are literally removed, one-by-one, directly from the scalp. In the traditional procedure, a strip of tissue is removed from the back of the head and placed under a microscope in order to remove the follicles.
The latest FUE instrument design is based upon Dr. J. A. Harris’ concept of using a blunt tool to prevent damage to hair follicles during extraction. The new device improves on the old method by re-conceiving the shape of the tool’s edge in order to minimize injury to hair follicles. “Our new instrument is made in the shape of a cylindrical tube with a bull-nosed edge. This allows us to capture the entire follicular unit (naturally groups of 1-4 hairs) without damage to the hair bulbs.” We also found that the incidence of buried grafts decreased significantly with the new instrument from about 9% to 1.8% with this new device” said Dr. Bernstein from his Center for Hair Restoration in New York.
In a recent study conducted by Leever Research Services, it is estimated that over 360,000 patients sought help from doctors for their hair loss last year. With ground-breaking work by surgeons like Robert M. Bernstein M.D., the impressive aesthetic results from new hair transplantation techniques are helping men and women who suffer from baldness to get a renewed outlook on their lives.
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Follicular Unit Forum is unique in that it affords visitors an opportunity to anonymously ask questions about the “ins and outs” of hair transplant surgery, of those who actually have had the state-of-the-art Follicular Unit Hair Transplant procedures.
Questions are posted to people who have actually undergone hair restoration procedures. Individuals who are considering a surgical solution to their hereditary baldness are able to search through “threads” or conversations that will answer their most pressing concerns such as; what to expect before, during and after a hair transplant, and what kind of procedure one should have.
The focus of this new online health resource is Follicular Unit Transplantation and Follicular Unit Extraction, two procedures that are universally considered to be the most up-to-date approach to surgical hair restoration. Follicular Unit Transplantation is a surgical technique that transplants hair in naturally occurring groups of 1-4 hairs. These groups (called follicular units) are taken from a single donor strip of skin and dissected using a microscope. Follicular Unit Extraction is a method that obtains the tiny follicular unit grafts from the donor area by using an instrument which removes them one-by-one directly from the scalp.
Patients who have received hair transplants with undesirable results (such as the typical pluggy “dolls hair” look) can also benefit from monitoring the site. FollicularUnitForum.com has posts from patients who have had unnatural looking grafts removed and re-implanted in a more natural way – as follicular units – to produce the most best results.
“We wanted to create a consumer-to-consumer forum that exclusively addressed the topic of Follicular Unit Hair Transplantation – the procedure that is now considered to be the gold standard in surgical hair restoration” said Robert M. Bernstein M.D., founder of Bernstein Medical – Center for Hair Restoration and sponsor of the site. “There are some great forums for hair loss out there but we felt that there was room for one that was created specifically for people who had done their preliminary research but now wanted to hear more first hand experience with FUT or FUE”.
Posted byPRESS RELEASE
Some of the world’s most renown hair transplant surgeons gathered this month to hear about the latest cutting edge methods in surgical hair restoration. Speakers included Robert M. Bernstein. M.D. founder of Bernstein Medical – Center for Hair Restoration, New York, NY
The International Society of Hair Restoration Surgery (ISHRS) recently held their 13th annual scientific meeting. A broad range of topics were explored including; the most recent research in cloning, the latest proven medical therapies to prevent hair loss, and the newest concepts in the harvesting of donor hair follicles used for transplanting. The event was capped off with a live hair transplant surgery workshop.
As the largest non-profit voluntary organization comprised of over 650 hair restoration physicians, the ISHRS is the first international society created to promote continuing quality improvement and education for professionals in the field of surgical hair restoration.
The purpose of the annual event is to bring together the world’s best minds in hair restoration surgery for an interchange of ideas, knowledge and experience. The meeting is aimed at enhancing, to the highest possible level, the skills and artistry of the members.
One of this years exciting presentations was given by Robert M. Bernstein M.D., Associate Clinical Professor of Dermatology at the College of Physicians and Surgeons of Columbia University in New York. Dr. Bernstein is recognized world wide for his pioneering work in Follicular Unit Extraction (FUE) and Follicular Unit Transplantation (FUT), considered to be the state-of-the-art in surgical hair restoration techniques.
Dr. Bernstein introduced a new instrument for FUE that enables hair to be removed directly from the back of the scalp without the need for a linear incision. The instrument increases ones ability to remove the hair in its naturally occurring groups with minimal damage. According to Dr. Bernstein, “FUE has been most useful for camouflaging the scars produced by hair transplants performed with older techniques.”
The International Society of Hair Restoration Surgery brought together a lively collection of panels led by doctors who were well-known and highly-respected professionals from the surgical hair restoration industry. Doctors such as Robert M. Bernstein M.D. shared their expertise in order to cover the issues and advances in medical and surgical hair restoration and the latest research developments in the field. The intention being better treatment and treatment options for patients.
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“Dermatologic Clinics” is a quarterly review with comprehensive, state-of-the-art information by experts in the field of dermatology. The industries most highly knowledgeable medical professionals provide current, practical information on the diagnosis and treatment of conditions affecting the skin. Each issue of Dermatologic Clinics focuses on a single topic. The July 2005 issue, entitled “Advanced Cosmetic Surgery”, published an article authored by Robert M. Bernstein M.D, and co-authored by William R. Rassman M.D. entitled “Follicular Unit Transplantation: 2005.”
In their article on FUT, the authors helped the dermatologic community to better understand the best practices of surgical hair restoration. Follicular Unit Transplantation (FUT) focuses on recognizing that the follicular unit is a discrete, anatomic and physiologic entity, and that preserving it through stereomicroscopic dissection is the best way to ensure the natural appearance of the hair restoration. Dr. Bernstein explains why this major step has brought hair transplantation into the twenty-first century.
This chapter also points out that the issues yet to be resolved in hair transplantation include determining the maximum density and number of grafts that can be used safely in a single session, deciding whether it is preferable to pre-make recipient sites or immediately place grafts into sites as they are made, and defining the precise role of Follicular Unit Extraction (FUE).
The authors conclude by stressing that the essence of providing the best care for hair transplant patients rests on proper patient selection, establishing realistic expectations, and using non-surgical management for young persons who are just starting to thin. When surgery is indicated, Follicular Unit Hair Transplantation is the ideal hair restoration procedure.
Read the publication Follicular Unit Transplantation: 2005
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“Hair Transplantation” is one in a series of medical textbooks published by Elsevier Saunders. The textbook — part of a series entitled Procedures in Cosmetic Dermatology — is written by Robert S Haber and Dowling B. Stough and edited by Jeffrey S. Dover. “Hair Transplantation” offers a step-by-step, practical guide to performing cutaneous surgical procedures.
The book’s editors selected Robert M. Bernstein as a major contributor, writing in two chapters. As pioneer of the advanced surgical hair restoration procedure known as Follicular Unit Transplantation (FUT), and as Associate Clinical Professor of Dermatology at Columbia University, Dr. Bernstein was uniquely qualified to provide medical professionals with insight and training on the state-of-the-art in hair transplant surgery.
Dr. Bernstein is lead author of the chapter entitled “Follicular Unit Transplantation” and co-author of “Follicular Unit Extraction”. The text details how to best achieve natural results, donor area diagnosis, aesthetic principles, tumescent technique, and more.
The purpose of this volume in the Dover series is to cover the tenets of hair transplant surgery by considering the philosophy, basic science, and techniques in a practical clinical text.
Succinctly written and lavishly illustrated, “Hair Transplantation” presents current, to-the-point guidance with a focus on procedural how-to’s and offers step-by-step advice on proper techniques, pitfalls, and tricks of the trade.
“Hair Transplantation” is shipped with a comprehensive DVD, containing video clips of techniques and procedures, as well as the hints and tips for surgical hair restoration. It features a wealth of color illustrations and photographs that depict cases as they appear in a hair restoration practice.
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Robert M. Bernstein M.D. was asked to provide expert medical commentary in two hair transplant videos produced by Healthology. The topics included “Hair Transplantation Techniques” and “Using Cloning Techniques in Hair Transplantation”.
Healthology, the leading producer of broadcast and webcast programming that provides consumers with direct access to top medical experts, produced an important series of videos on hair loss. As Associate Clinical Professor of Dermatology, Columbia University College of Physicians and Surgeons, Dr. Bernstein was a vital part of the interview series.
Hair Transplantation Techniques
The first video that Dr. Bernstein was invited to take part in, focused on the various techniques used in surgical hair restoration. As a pioneer of Follicular Unit Transplantation, the filmmakers were eager to hear Dr. Bernstein’s thoughts on FUT:
“A major breakthrough in hair restoration came via identification that hair didn’t grow individually, but actually in small groups called follicular units. And these follicular units are naturally occurring groups of hair from one to four” Dr. Bernstein explained, “in modern hair transplantation, a procedure we call Follicular Unit Transplantation is used; we transplant the hair the way it actually grows in nature.”
This Healthology segment explored how the Follicular Unit Transplantation technique is also helping patients who want to improve the appearance of old transplants or scars.
“What we can do now is remove the old grafts, sew the holes closed where they’re transplanted, place those grafts under a microscope, divide them into individual follicular units and then place them back in the scalp the same day.” said Dr. Bernstein.
In addition to covering surgical hair restoration, the segment touched on the issue of medications for hair loss. Though some patients think getting a hair transplant means they can stop taking hair loss medications, Dr Bernstein illustrated why most physicians recommend using medicine along with surgery:
“Hair transplantation and medications do essentially different things. The main benefit of a transplant is to restore hair that’s been lost. The main benefit of medication is to prevent further hair loss.”
Using Cloning Techniques in Hair Transplantation
In this second Healthology video segment, on hair cloning, they invited Dr. Bernstein to take part in the discussion along with other distinguished guests; including Angela Christiano, PhD an Associate Professor of Dermatology and Genetics & Development at Columbia University.
This interesting segment explored how researchers are trying to find ways to make more follicles for hair transplant surgeons to work with. Research into cloning techniques shows it may be possible to create a virtually limitless supply of new follicles in the not too distant future. Dr. Bernstein provided some insights as to how hair restoration doctors might approach hair cloning in the future:
“The actual role of cloning in hair transplantation will depend upon how the cloning technology actually evolves. Initially, cloning may be used to supplement a regular hair transplant. We would use Follicular Unit Transplantation to give definition to a hairline and frame the face. Cloning would then be used to give the hair transplant bulk, by placing the cloned hair (which may not look as natural as normal hair) behind the transplanted hair.”
Posted byHair transplantation was introduced in the United States by Dr. Norman Orentreich in 1959. He demonstrated that hair taken from one area of the scalp would continue to grow even if it were transplanted to a balding area of the head.
The problem with this scientific breakthrough was that hair was being transplanted in clumps or “plugs” that did not appear natural. And although patients who had hair transplants were indeed growing hair on what was once a balding pate, the appearance was akin to that of a doll’s head and hardly much of a cosmetic improvement for their baldness.
In 1995, Drs. Bernstein and Rassman presented a paper describing a new procedure surgical hair restoration called Follicular Unit Transplantation or FUT. In this new technique, hair would be transplanted using only naturally occurring, individual units of 1, 2, 3 or 4 follicles. These perfectly intact “follicular units” would be obtained by removing a single, thin strip of skin from the back of the scalp and then using a dissecting stereomicroscope to isolate the tiny naturally occurring groups of hair.
Since the publication of “Follicular Transplantation” hair transplantation has undergone an “extreme makeover” itself, in part due to the incredibly natural results that this powerful procedure can produce. FUT is now considered to be the state-of-the-art in hair transplant surgery and is currently the most widely used surgical hair restoration technique.
Robert M. Bernstein M.D., Clinical Professor of Dermatology at Columbia University in New York City, sat with us for a Q&A on hair transplant surgery and its future.
In order to safely remove and preserve the follicular units without causing any damage to them, the donor tissue is removed in one thin piece. This technique is called Single Strip Harvesting and it is an essential component of follicular unit hair transplants.
The average session for a moderately bald person, who has lost most of the hair on the top of his scalp is around 2,500 grafts. Although it is best to complete the hair restoration in as few large sessions as possible, there are limits. When too large a strip is removed, it can cause undue tension in the donor area and cause a stretched scar or loss of hair. Excessively long hair transplants, where the grafts are kept outside the body for an extended period of time, may compromise graft survival.
Another issue with very large sessions is that a hair transplant doctor has less flexibility if problems arise during the surgery. Patient variability is an intrinsic part of hair transplants. In some patients, the grafts tend to pop up above the skin surface as they are inserted into the scalp. Popping also occurs when a graft placed in the skin causes an adjacent one to lift. The closer you put the grafts and the more grafts you transplant at one time, the greater the chance that these problems will occur and the more difficult they will be to manage. The goal is to always maximize what you get from the back and what grows in the front and top. It’s not a race where we have to do 3,000 or 4,000 grafts in every patient. When I hear people say, “Oh, I had 5,000 grafts.” I think “How many of those actually grew?”
Yes, the hair on the back and sides of the scalp is permanent and it retains this characteristic even when moved to the front and top of the scalp.
The genetic tendency of hair to grow is dependent upon the donor area where the hair comes from. We call this “donor dominance.” However, the character of the hair, the wave, the rate of growth, is affected by the area where it is transplanted into. For example, we discovered that when we take scalp hair and transplant it to the eyebrows, over time, the growth rate actually slows down to match the growth of eyebrows. In this case, the recipient area has an influence on the growth of the eyebrow hair.
You cannot perform hair transplants with hair taken from someone else. It has to be your own hair or it will be rejected by the body.
The next big improvement to the field of surgical hair restoration will be hair multiplication – commonly but erroneously referred to as hair cloning. This technique will dramatically increase a person’s limited donor supply, an issue that frustrates many patients wanting hair restoration.
The mechanism for cloning is based on the multiplication of the cells that surround a hair follicle. These cells, called fibroblasts are readily multiplied outside the body. Once multiplied, the “fibroblasts” could be injected into the skin to induce hairs to form. The problem is that when you multiply these fibroblasts, they lose their ability to stimulate hair to grow – a major roadblock that still needs to be overcome.
Another concern with hair cloning is that if you’re inducing hair to grow, what will it look like? Is it going to be wild and uncontrollably wiry? Will it look like the person’s normal hair? Because the recipient area plays a factor in the way a follicle grows, it’s reasonable to assume that even if you inject these fibroblasts to induce a hair to form, that hair will start to take on the characteristics of a person’s original hair.
It is exciting to think of the possibilities that improvements in the science of hair transplants will afford to those suffering from the effects of hair loss. Perhaps someday any baldness in men and women will be a result of choice and not a genetic constraint, but will unlikely be available for at least 5-10 years.
Watch video Q&A with Dr. Bernstein
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Dr. O’tar Norwood discusses the origin of follicular transplantation, and the influence that Dr. Bernstein’s research and publications have had on the evolution of the hair transplant procedure. Read a segment of the article:
The evolution of “follicular transplantation” can be attributed to three people. Dr. Robert Bernstein coined the phrase and advanced the concept. Dr. Bob Limmer introduced the use of the binocular microscope, providing the technology, and Dr. David Seager showed by direct hair counts, comparing the growth of grafts cut with and without the microscope, how the hair growth was improved when the follicular unit was kept intact.
Read the full article in the Hair Restoration Papers portion of our website.
Posted byby O’Tar T. Norwood, MD, Oklahoma City, Oklahoma, USA
Hair Transplant Forum International (July/August 1997 issue)
NOTES FROM THE EDITOR EMERITUS
The evolution of “follicular transplantation” can be attributed to three people. Dr. Robert Bernstein coined the phrase and advanced the concept. Dr. Bob Limmer ((Limmer B: Forum, Vol. 2, #2, 1991.)), ((Limmer B: J Dermatol Surg Oncol, 1994; 20:789-793.)) introduced the use of the binocular microscope, providing the technology, and Dr. David Seager showed by direct hair counts, comparing the growth of grafts cut with and without the microscope, how the hair growth was improved when the follicular unit was kept intact. ((4th Annual Meeting of the International Society of Hair Restoration Surgery September 19, 1996, “Does the size of the graft matter?”)), ((Seager, DJ: Micrograft size and subsequent survival — accepted for publication — Journal of Dermatologic Surgery.))
“What then is follicular transplantation?” I quote Dr. Robert Bernstein because he states it so completely and succinctly in his 1995 article “Follicular Transplantation:”
“Follicular Transplantation is the logical end point of over thirty years of evolution in hair restoration surgery beginning with the traditional large plugs and culminating in the movement of one, two and three hair units, which mirror the way hair grows in nature. The key to follicular transplantation is to identify the patient’s natural hair groupings, dissect the follicular units from the surrounding skin and place these units in the recipient site in a density and distribution appropriate for a mature individual. The critical elements of follicular transplantation are an accurate estimation of the donor supply of hair, meticulous dissection of the follicular units, and careful design of the recipient area to maximize the cosmetic impact of the transplant, use of large numbers of implants in fewer rather than more sessions, a long-term master plan that accounts for the progression of male pattern alopecia, and realistic expectations on the part of the patient.” ((Bernstein, RM: Follicular Transplantation. Int J of Aesthetic and Restoration Surg. 1994 Vol.3 #2 pp 119-132.))
By combining the concept of follicular transplantation with the use of the binocular microscope, hair transplant surgery has reached a new level of excellence.
Note, however, the grafts at the top of photo done several years earlier. They contain 4-5 hairs but more importantly they don’t look nearly as natural as the ones where follicular units were specifically kept intact.
Follow-Up
I am beginning to see my first patients back since I began follicular transplantation using the binocular microscope. Growth is better, particularly in single hair grafts which is exactly what I was told would happen. I have seen about ten patients, and every one of them is growing earlier and better.
X-factor
I refer to Dr. Jose Greco’s article in the last Forum about X-factor. I have had patients similar to his that grew only about 10% of the hair and I had repeated it usually at no charge and was very careful and still got poor growth. I have one of those patients now that wants some more grafts and I am going to do follicular transplantation and maybe in another four months we will know the answer.
Postoperative Ointment
Also in the last Forum, an article by Dr. Bernstein on ointment following hair transplants. Over the years I have gotten to where I did not use any ointment but there is a lot of evidence in the dermatology literature encouraging the use of post-op ointment. Ointments appear to speed up the healing process. I asked Dr, Blaine Lehr, my associate, to comment on this and he gave me the following statement “Postoperative ointment maintains moist wounds and increased surface humidity, which greatly increases the rate of re-epithelization. By decreasing crust formation, migrating epithelial cells do not face a barrier to their movement. With improved healing there is less potential for scarring and residual pigmentary abnormalities.”
Since I have been using ointment, patients look much better sooner. Sometimes there are hardly any crusts.
Why does it take so long?
Also in the last issue, Dr. Shiell commented on how it is interesting to read old Forums and specifically mentioned Bob Limmer’s use of the dissection microscope. Since I had not read the last issue of the Forum, I called Bob Limmer to get the first reference on the binocular microscope, and he said it was probably the one mentioned in the last Forum by Richard Shiell in his Editor’s Notes. What a coincidence!
I wonder why it took us so long to recognize how important that work was. I also wonder why it took us so long to recognize follicular bundles as the most logical unit for hair transplanting.
Posted byby O’Tar T. Norwood, MD, Oklahoma City, Oklahoma, USA
Hair Transplant Forum International (May/June 1997 issue)
I just returned from visiting Dr. Bob Bernstein in New York, and was impressed with his operation and even more impressed with his thoughts, observations, and insights into hair transplant surgery. He applies scientific methods to his work, is academically honest, and has an almost eerie instinctive knowledge of hair transplant surgery. Of course he has Dr. Bill Rassman to work with, but it is still remarkable. Dr. Bernstein is best known for introducing follicular transplantation ((R. Bernstein and W. Rassman Follicular Transplantation, International Journal of Aesthetic and Restoration Surgery. Vol. 3: No 2,1995, 119-132.)) to hair transplant surgery, an idea Bob Limmer has been pushing for ten years with the use of the binocular microscope, but no one would listen to him. Dr. Limmer, however, never used the term follicular transplantation. Using the microscope, you automatically dissect the follicular units. It can’t be avoided if done properly.
The follicular transplantation concept is based on the observation that hair naturally grows in follicular units of one to four hairs, so probably the best way to transplant them is to keep them in this natural anatomical and physiological state. Dr. David Seager ((DJ Seager, Micrograft Size and Subsequent Survival, accepted for publication, Dermatologic Surgery.)) has recently shown that when the integrity of the follicular unit is maintained up to 20%, better growth occurs, making this concept of truly major importance.
We discussed many other topics, and it is interesting how he has a fresh, new look at the fundamentals of hair transplant surgery, hair growth, and anatomy and physiology of the hair follicle. Many of these ideas and concepts will appear in the upcoming special issue of Dermatologic Surgery. ((R. Bernstein and W. Rassman, The Art of Follicular Transplantation, accepted for publication, Dermatologic Surgery.))
His views on the following special subjects I find interesting:
1. Donor density: He emphasizes the importance of density, describes how to measure it, and explains how precious donor hair is. He shows that in the average patient, we can safely transplant about 50% of the available “permanent” donor hair. He does this mathematically. Dr. Bernstein and Dr. Rassman have brought measurement of density to a scientific level by using the densitometer and counting numbers of hairs in each square centimeter. I have started using this and it really works. I believe the importance of density cannot be over-emphasized. It is actually as important as the classification in patient selection and design.
2. Caliber of hair: Coarse vs. fine diameter. He believes coarse hair covers much better than fine hair. He considers not only the number of hairs but the total value of hair mass that is available for transfer. He believes that coarse hair creates the illusion of fuller coverage than fine hair can achieve.
3. Scalp – thin vs. thick: He emphasizes the importance of thickness of scalp. I have preferred thick scalps to thin scalps for years, but never was quite sure why.
4. Delayed growth: His analysis of the natural hair cycle and its relation to hair transplant surgery, I think, is brilliant. It explains what we see on a daily basis. ((R. Bernstein and W. Rassman, Delayed Hair Growth, Hair Transplant Forum International. Vol. 7: No 3, 1997.))
5. Diffuse patterned alopecia (DPA) and diffused unpatterned alopecia (DUPA):
Although I first described these years ago, I failed to recognize their importance. They are quite common in men and women. Although they have received some recognition in women, their study in men has been completely ignored. It is important to distinguish DUPA and DPA because hair transplants should probably never be done on a patient with DUPA.
6. Aging alopecia: This occurs in everyone and occasionally occurs extremely early in life, so that is important to recognize. I have watched my own hair thin over the years, and I have watched my patients’ donor hair and their transplanted hair thin over the years. Sometimes you can see through the remaining donor fringe. Dr. Bernstein describes the differences of senile alopecia, androgenic alopecia, and diffuse alopecia and their importance.
I really haven’t had time to “digest” all the new ideas I obtained from Dr. Bernstein. I haven’t had time to try all of the techniques I saw, but I am sure his influence on hair transplant surgery is going to be considerable.
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The following is a portion of “An Idea Whose Time Has Come,” an editorial written by O’Tar T. Norwood, MD — founder of the Norwood Classification System for Hair Loss — and published in the May/June 1997 issue of “Hair Transplant Forum International”:
I just returned from visiting Dr. Bob Bernstein in New York, and was impressed with his operation and even more impressed with his thoughts, observations, and insights into hair transplant surgery. He applies scientific methods to his work, is academically honest, and has an almost eerie instinctive knowledge of hair transplant surgery. Of course he has Dr. Bill Rassman to work with, but it is still remarkable. Dr. Bernstein is best known for introducing follicular transplantation to hair transplant surgery, an idea Bob Limmer has been pushing for ten years with the use of the binocular microscope, but no one would listen to him. Dr. Limmer, however, never used the term follicular transplantation. Using the microscope, you automatically dissect the follicular units. It can’t be avoided if done properly.
To read the full article, visit “An Idea Whose Time Has Come” in the Hair Restoration Papers section of our website.
Reference
Norwood O. “An Idea Whose Time Has Come,” Hair Transplant Forum International 1997; 7(3): 10-11.
