Bernstein Medical - Center for Hair Restoration - Eyebrow Transplant
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New You - Spring 2016Gone are the days when women plucked their eyebrows to a tiny strip of hair. Thicker, more full eyebrows are “in,” reports New You magazine in “A Vision of Youthful Loveliness.” Women with eyebrows that are severely thin — from over plucking, aging, trauma, or dermatological conditions — have turned to physicians for help, and Dr. Bernstein, for one, has an answer: eyebrow transplantation.

In the Spring 2016 issue of the magazine, Dr. Bernstein discusses surgical eyebrow restoration, a procedure that has grown in popularity in recent years. Whether the increased demand for eyebrow transplant procedures has been a response to fashion and style trends or increased awareness that the procedure exists, the fact is that more women than ever are inquiring about the procedure at hair restoration clinics like Bernstein Medical – Center for Hair Restoration.

In the article, Dr. Bernstein describes the procedure:

“We take hair from behind the ear or closer to the middle of the scalp if someone’s brows are coarser,” he explains of the process, which takes about five hours, and grows in gradually and then permanently after a year.

Then he touches on the appearance of the eyebrow after the procedure:

First [the transplanted hairs] have to be trimmed, but eventually they mimic the growth pattern of the eyebrows.

Eyebrow Transplant - New You MagazineThe Eyebrow Transplant section of our website contains some important tips for how to aesthetically optimize the results of the procedure:

  1. Use single-hairs in the transplant, not grafts of multiple hairs
  2. Hairs should be rotated to follow the natural curve of the brow
  3. The transplanted hair must be planted to lie as flat to the skin surface as possible
  4. The transplanted grafts should account for changes in the natural direction of the hair in different parts of the eyebrow, with the upper hairs of the eyebrow pointing out and slightly downward and the lower ones pointing out and slightly upward, creating an interlocking ridge that gives eyebrows their fullness

Visit the Eyebrow Transplant page for more detail on the technique behind the procedure, the typical cosmetic result of the procedure, the anatomy of an eyebrow, and more.

View before after photos of some of our eyebrow transplant patients.

Images c/o New You Magazine

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Q: How do you make the recipient sites in a hair transplant? — N.P., New Delhi, India

A: I make the recipient sites using 19-, 20-, 21- and 22-gauge needles. The higher the number, the finer the needle. The hairline is done with a 21-gauge, which is really very tiny. Eyebrow sites are created with a 22-. When one draws blood in a routine blood test, an 18-g needle is used and, of course, there are no residual marks. The instruments we use are significantly finer than this.

For further reading on this topic, please visit our page on recipient sites in a hair transplant.

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Dr. Robert M. Bernstein was interviewed for a segment on The Today Show on the subject of eyelash enhancement and use of the eyelash medication Latisse.

Dr. Bernstein first appears about two minutes into the clip.

View the complete video:

For more on eyelash and eyebrow restoration, visit our eyebrow transplant page or our Latisse page.

You can view this video and others on hair transplantation and hair restoration in our Hair Transplant Video section.

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Bizymoms.com, the premier work-at-home community on the Internet with more than 5 million visitors per year, has interviewed Dr. Robert M. Bernstein in order to answer readers’ common questions about hair restoration and hair loss.

Below is a sample of the interview:

Q: Who would be a good candidate for hair transplant surgery?

In general, men and women age 30 and older can be candidates, but there are a host of factors that determine if a person is a good candidate…

Q: How does hair transplantation work?

Hair removed from the permanent zone in the back and sides of the scalp continues to grow when transplanted to the balding area in the front or top of one’s head…

Q: What can be done for people dissatisfied with previous mini/micrograft procedures?

If the grafts are too large they can be removed, divided into smaller units under a microscope, and re-implanted back into the scalp (the same day)…

Q: What are the possible harmful effects of Propecia and Rogaine?

The main side effect of Propecia (finasteride 1%) is sexual dysfunction, which occurs in about 2-4% of men taking the drug. Fortunately, these side effects are completely reversible when the medication is stopped. […] The main side effect of Rogaine (minoxidil) is scalp irritation. […] Both Propecia and Minoxidil can produce some hair shedding at the beginning of treatment, but this means that the medications are working…

Q: How many grafts/hairs are needed for hair transplant surgery?

An eyebrow restoration can require as few as 200 grafts, a hairline 800 and a scalp, with significant hair loss, 2,500 or more grafts. An equally important consideration is the donor supply…

Q: What are the advanced hair transplant techniques?

Follicular Unit Transplantation (FUT), where hair is transplanted exclusively in naturally occurring follicular units, is the state-of-the art. […] A more recent means of obtaining the donor hair, the follicular units are extracted individually from the back of the scalp. This procedure, called Follicular Unit Extraction (FUE) eliminates the need for a line-scar, but is a less efficient procedure for obtaining grafts…

Q: What are the new hair restoration treatments available for men and women?

Low-Level Laser Therapy (LLLT) utilizes cool lasers to stimulate hair growth and reduce shedding of hair. […] Latisse (Bimatoprost) is an FDA approved topical medication for eyelash growth.

Go to Bizymoms.com to read the full interview.

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Eyebrow transplant and restoration article - New York TimesEyebrow transplant procedures are growing in popularity. More women are realizing how much damage they can cause to their appearance by overplucking, shaping, and over-styling their eyebrows. Today, the New York Times reports on the trend of repairing eyebrows with hair transplant techniques and the use of camouflage products to cover up eyebrows that have been “tamed into oblivion.”

As the article’s headline declares, it is time to call in the professionals. The author of the article, Ms. Catherine St. Louis, turns to hair transplant pioneer Dr. Robert M. Bernstein for guidelines on performing a cosmetically-pleasing eyebrow transplant.

Here is a portion of the article:

Chronic repeated plucking is now a common reason why women have eyebrow transplants, which entail using hair from the scalp, arms or pubic area. A more timeless reason that spans the sexes is the gradual thinning, especially on the outer parts, as we age.

AND the number of such transplants is growing. In 2008, 3,484 eyebrow transplants were performed nationwide, up from 2,544 in 2004, the International Society of Hair Restoration Surgery says.

Dr. Robert M. Bernstein, a hair restoration specialist in Manhattan, said that the most natural-looking transplants for eyebrows followed a few rules. Hair has to lie flat; single-hair transplants, not units of multiple hairs, are used; hairs should follow a curve and be planted to account for changes in direction. (In general, Dr. Bernstein said, the upper hairs point down and lower ones face up slightly to create an interlocking ridge that gives brows their body.)

Visit our eyebrow transplant page for more information on eyebrow transplant and restoration procedures.

See another article by Ms. St. Louis on the topic of hair restoration and hair loss in women.

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Q: I wanted you to determine if I would be a candidate for FUE (to camouflage a scar). After reading through your vastly informative website, I had become aware that the Fox test is necessary to determine patient viability for FUE. When I mentioned the test, I believe I heard you say it was unnecessary. Unfortunately, I can’t help but think there was miscommunication between us, as your letter states that I should schedule a Fox test if I am considering FUE. Please confirm if a Fox test is, in fact, necessary. — N.S., Garden City, N.Y.

A: I perform FOX tests on all patients when I am considering a FUE hair transplant. I do not routinely perform FOX tests before repairs (or on eyebrow transplants) where the number of grafts is relatively small.

The purpose of FUE is to identify those patients in whom FUE is inefficient — i.e. there is a greater than average risk of damage during the harvest. If this is the case, I would not perform the hair transplant since even slight inefficiencies create a significant problem when thousands of grafts are transplanted.

Remember, compared to Follicular Unit Transplant (FUT), FUE is a relatively inefficient procedure. Even when a small FUE hair transplant is performed (i.e., in a Norwood Class 3) we have to anticipate that eventually the person will need a large amount of grafts, so a FOX test is still important.

However, when the total number of grafts is small, such as in scar revisions or eyebrow restoration, small inefficiencies are not as important.

In addition, with repairs, the donor area is altered so that extraction in different areas may be very be different, rendering a FOX test in scar revisions far less useful.

Finally, if a FUE hair transplant is started, but then aborted due to extraction difficulties, the patient must either be reverted to a strip (which was not the preferred means of harvesting or a FUT would have been planned to begin with) or the patient will be left with a partial procedure – both less than ideal situations. However, if a FUE repair has to be aborted due to the inability to efficiently harvest hair, no harm was done; we just won’t be able to achieve our goal.

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Q: I have had thinning eyebrows since my early twenties (I am now 32) and they have gotten to the point that I can’t make them look good with mascara anymore. I am considering an eyebrow hair transplant, how is it different from other hair transplants? — C.C., Williamsburg, N.Y.

A: Eyebrow hair restoration procedures are similar to hair transplants to the scalp in that the hair, once transplanted, is permanent. They differ both in the techniques used to perform them and in the results.

In eyebrow transplants, only individual hairs should be used, whereas follicular units containing from 1 to 4 hairs are used in a hair transplant to the scalp. In eyebrow transplants, the hairs must be positioned to lie as flat as possible to the surface of the skin. In hair transplantation to the scalp, the angle between the hair and the scalp surface can be as much as 45 degrees or more.

As with hair transplants to the scalp, the hair transplanted to eyebrows will continue to grow and must therefore be cut. However, in contrast to hair transplants where the donor hair is generally a perfect match for scalp hair, in eyebrow transplants the hair is taken from a different part of the body and will have slightly different characteristics both in growth rate and in appearance.

Visit our eyebrow transplant page for more information on eyebrow transplant and restoration procedures.

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Q: What are the major obstacles for scientists to cloning hair?

A: The main problem is that the cultured cells may lose their phenotype with multiple passages, i.e. lose their ability to differentiate into hair follicles after they have been multiplied.

Another problem of hair cloning is that the orientation of hair direction must be controlled. With mouse experiments, the hairs grow at all different directions. Scientists need to find a way to align the hair so that it grows in the right direction. Hair, of course, must also be of a quality that is cosmetically acceptable and matches the patient existing hair. And the hair should grow in follicular units. Individual hairs will not give the fullness or natural look of follicular units.

Another problem is the issue of safety. Are we sure that cultured cells may not turn into something else – such as malignancy cells with uncontrolled growth?

Finally, FDA approval would be required and this takes time. It is true that you do not need FDA approval for using your own hair, such as a hair transplant; however, when you take cells from the body and manipulate it in the lab, this requires FDA approval.

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Q: I had a hair transplant of over 600 grafts using Follicular Unit Extraction (FUE) to my frontal hairline and the frontal part of my scalp. The procedure was done less than a year ago by another doctor. Since then I have had persistent pimples and redness in the area that the grafts were placed. Also, the surface of the skin in the area is irregular. — E.Z., Long Island, N.Y.

A: One of the causes of having pimples and redness following Follicular Unit Extraction may be buried hair fragments and there are significantly more hair fragments generated with the two-step FUE technique than with the three-step method.

In the three-step procedure, we use blunt dissection which minimizes transection (cutting of hair follicles) and thus reduces the incidence of hair fragments. See the Three-Step FUE page at the Bernstein Medical – Center for Hair Restoration website.

In our practice, we also place every extracted graft under the microscope. This serves a number of purposes:

  1. It gives me immediate feedback on transection rates, so that I can adjust my technique in real-time (using a stereo-microscope is much better than visual inspection for this purpose)
  2. It enables us to trim away excess tissue and hair fragments (we use the same judgment as we do with strip harvesting, so that a “viable looking” fragment would be left attached
  3. It allows us to accurately count the number of hairs in each follicular unit graft, as it is particularly important to have pure 1-hair grafts for the frontal hairline. This also allows us to better anticipate the end cosmetic result.
  4. It allows us to dissect larger follicular units into smaller ones for specific cosmetic purposes, i.e. eyebrows, hairlines, temples etc.

One of the ironies of FUE is that it is more efficient to extract the larger FUEs, since this gives us a greater hairs/hole ratio, but this often leaves us with an inadequate number of 1-hair units, which must be obtained though traditional stereo-microscopic dissection of the larger extracted grafts.

Other causes of folliculitis (manifested by pimples and redness) can result from placing the grafts too deep in the recipient site (where they may get buried) and secondary infection. A mild, transient folliculitis is often seen after a hair transplant without any precipitation factors.

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