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Dr. Robert M. Bernstein

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Hair Loss & Replacement for DummiesJohn 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:

  • Getting To Know Your Hair – What Causes Hair Loss; The Devastation Of Hair Loss In Women; Undergoing Hair Restoration Surgery
  • Splitting Hairs – How Hair Grows; Aging Hair; Hair & Ethnicity, Maintaining Self-Esteem in the Face of Hair Loss;
  • Taking Better Care Of Your Hair – Washing & Drying Your Hair Correctly; Avoiding Hair Damage; Caring For Childrens’ Hair
  • Understanding The How & Why Of Hair Loss – Stress & Hair Loss; Environmental Issues; Male Pattern Thinning In Men and Women; Diseases & Disorders That Cause Hair Loss
  • Creative Techniques For Concealing Hair Loss – A Brief History of “Rugs”; Today’s Toupees
  • Taking Prescription Medications For Hair Loss – Being Aware of Side Effects
  • Supplementing Your Diet To Help Slow Hair Loss – Pumping Up Proteins; Minding Your Mineral Intake
  • Hair Transplant Surgery – Do You Really Need A Hair Transplant; Psychological Considerations; Choosing A Doctor; Possible Complications; Heading Home With A New Head Of Hair!

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.

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Q: 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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New York Magazine - Best Doctors 2007 - Dr. BernsteinRobert 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.

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Densitometry - Hair Transplant Forum International - March/April 1997To 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.

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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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New Hair Transplant Center in NY - Bernstein Medical - Center for Hair RestorationBernstein 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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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.

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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.

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PRESS 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

Follicular Unit Extraction (FUE) InstrumentIn 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 - Bernstein Medical - Center for Hair RestorationFollicular 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”.

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Follicular Unit Transplantation - Dermatologic Clinics“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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Procedures in Cosmetic Dermatology: Hair Transplantation - Elsevier Saunders“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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Follicular Transplantation - Hair Transplant Forum International - July/August 1997Dr. 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.

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by O’Tar T. Norwood, MD, Oklahoma City, Oklahoma, USA

Hair Transplant Forum International (July/August 1997 issue)

NOTES FROM THE EDITOR EMERITUS

Hair Transplant Forum International - July/August 1997The 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.

This photo from Dr. Seager has appeared in the Forum before, illustrating better growth with follicular transplantation. Right side cut with microscope into intact follicular units of 1-2 hairs, whereas the left side was planted as 1-2 haired micrografts split away from larger intact follicular clumps.

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.

Follicular units cut with 3 microscope containing 2-4 hairs. NOTE: They contain shafts, follicles, sebaceous gland and perifolliculum.

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.

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by O’Tar T. Norwood, MD, Oklahoma City, Oklahoma, USA
Hair Transplant Forum International (May/June 1997 issue)

Hair Transplant Forum International - May/June 1997I 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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An Idea Whose Time Has Come - O'tar NorwoodThe 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.

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