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

Hair Transplant Pioneer Dr. Robert M. Bernstein in New York Magazine “Best Doctors” for 12th Consecutive Year

NY Magazine - Best Doctors - 2011Dr. Robert M. Bernstein, pioneer of the follicular unit transplantation and follicular unit extraction hair transplant procedures, was selected as one of New York metropolitan area’s top physicians.

Of his being selected in the 2011 issue, Dr. Bernstein said, “My inclusion in the Best Doctors issue for the twelfth year in a row is a testament to the hard work and dedication of my staff, our consistently high quality of care, and our passion for treating patients who are struggling with hair loss.”

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Hair Restoration Answers

What Part of FUE Hair Transplant is Performed by ARTAS Robotic System?

Q: With the ARTAS robotic system, by Restoration Robotics, what part of the FUE hair transplant procedure can actually be done by the robot? — A.M., Los Angeles, CA

A: The ARTAS System is a computer guided method of harvesting follicular units in the donor area during FUE. The initial phase of FUE, where the follicles are selected, scored and separated from the surrounding scalp is done by the ARTAS System. All other phases of the procedure including; actual follicular unit graft removal from the scalp, hairline design, recipient site creation and placement of the grafts into the balding scalp are done by the surgical team.

In the near future, improvements in the ARTAS System should allow it to be able to actually extract the separated grafts from the scalp. Eventually, the engineers hope to be able to increase the capability of the system so that it can create recipient sites and implant the extracted grafts into them.

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Hair Restoration Answers

How Does the ARTAS Robot Work?

Q: How does the ARTAS robotic hair transplant system actually work? — J.N., Fort Lee, NJ

A: The ARTAS System for Follicular Unit Extraction (FUE) combines several features including an interactive, image-guided robotic arm, special imaging technologies, small skin punches of two different sizes, and a computer monitor. After the system is positioned over the patient’s donor area of the scalp, ARTAS is capable of identifying and isolating follicular units from the surrounding scalp.

After the robotic arm is aligned with the follicular unit, a sharp 1-mm punch is used to cut through the upper part of the skin (the epidermis and upper dermis).

Immediately following this, a duller, 1.3mm punch is used to separate the deeper part of the follicular unit from the remainder of the dermis and subcutaneous fat. Once separated by the robot, the follicular units are manually removed from the scalp and stored until they are implanted into the patient’s recipient area.

Read about robotic FUE hair transplantation

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Hair Restoration Answers

What Does the ARTAS Robotic System for Follicular Unit Extraction (FUE) Actually Do?

Q: What does the ARTAS robotic system for Follicular Unit Extraction (FUE) actually do? — E.J., Plainsboro, NJ

A: ARTAS is a computer assisted system, made by a company called Restoration Robotics, that utilizes image-guided robotics to increase the quality of the hair follicles harvested during FUE. It aids in the initial part of the FUE procedure where follicular units are separated from the surrounding tissue. The system is operated under direct physician supervision.

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Hair Restoration Answers

What is Restoration Robotics?

Q: What is Restoration Robotics? — L.N., East Brunswick, NJ

A: Restoration Robotics is a medical device company, based in Mountain View, California, that has developed a computerized instrument to assist in the graft extraction phase of follicular unit extraction (FUE) hair transplant procedures. Their patented device, called “ARTAS,” is an image-guided system for FUE. Their website is: www.restorationrobotics.com.

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Hair Restoration Answers

What is the Latest in Hair Transplant Robotics?

Q: I have read your page on robotics in hair restoration and am interested in learning more. Are there any updates in the development of the system you mentioned? — W.T., London, UK

A: Restoration Robotics, Inc. — based in Mountain View, CA — has spent the last few years developing and testing a robotic hair transplant device for follicular unit extraction (FUE). The ARTAS robot system has recently received 510(k) approval from the Food and Drug Administration, meaning that the company may now begin marketing the system for use in hair restoration clinics.

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Bernstein Medical In The News

Press Release: Hair Transplant Pioneer Studies Hair Cloning, Hair Restoration Procedures Using ACell’s Extracellular Matrix

Hair Cloning with ACell MatriStemRobert M. Bernstein, M.D., F.A.A.D., the renowned hair transplant surgeon and founder of Bernstein Medical – Center for Hair Restoration in New York, is studying four different applications of ACell MatriStem™ extracellular matrix in a type of hair cloning, called hair multiplication, as well as current hair restoration procedures. Click the link to read the whole press release.

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Hair Restoration Answers

Do I Need a Hair Cut Before My Hair Transplant?

Q: I am considering having a hair transplant. Does my hair need to be cut? — I.S., New York, NY

A: In all hair transplant procedures, we are able to transplant into areas of existing hair without it having to be cut. The question of whether hair needs to be cut in the donor area depends upon the way the donor hair is obtained (harvested).

With a Follicular Unit Hair Transplant procedure using single strip harvesting method (FUT), only the strip of hair that is removed needs to be cut. When the procedure is finished, the hair above the incision lays down over the sutured area and it becomes undetectable.

In Follicular Unit Extraction (FUE), particularly in sessions over 600 grafts, large areas of the donor area must be clipped short (to about 1-2mm in length) in order to obtain enough donor hair.

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Hair Restoration Answers

Should I Have an FUT or FUE Hair Transplant, or Should I Wait for Hair Cloning?

Q: I heard that there have been some new advances in hair cloning and that it may be available sooner than we thought. I was planning on doing a hair transplant soon. Considering that hair cloning may be available at some point in the future, should I do FUE or FUT, or wait for cloning? — K.R., Fort Lee, NJ

A: Although there has been a major development in hair cloning with the use of ACell, an extracellular matrix to simulate hair growth, the model, at this point, is still in its earliest stages of development. It is hard to know when the technology will reach a state where it can be useful in hair restoration.

With respect to which you should do FUE or FUT if, theoretically, cloning is around the corner, the answer would be FUT, since FUT will give you the fuller look.

If the goal is to eliminate any trace of the traditional hair transplant, again FUT will most likely be the best choice, since the single linear scar would be easy to camouflage with cloned hair. With FUE, this would be much more difficult, since there are literally thousands of tiny scars. However, neither FUE nor FUT will preclude a patient from fully benefiting from cloning if, and when, it becomes available.

Read more:

Hair Cloning

Pros & Cons of FUE

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Hair Restoration Answers

What Is Best Way To Remove Hair Plugs: FUE, Electrolysis, Or Graft Excision?

Q: I had a hair transplant in 2004 of mostly plugs. The plugs are in an angle which doesn’t really look natural, far from it. I have lost a lot more hair since I did the hair restoration procedure. I regret ever doing a hair transplant. I prefer to reverse the surgery. I have read a lot about repair work on the net, and I have come to the conclusion that using FUE to take the plugs out, and put them back into the scar might be an option, but it may just make it worse on top. Also I can do electrolysis to remove the plugs, might be better because the possibility of scarring is smaller, and as I already have a lot.

A: If you had plugs, then a graft excision with suturing will generally give a better result than FUE, since a graft excision removes the underling scar tissue as well as the plug. FUE only removes the follicles, but leaves the underlying scar tissue. In addition, the shape of the follicles in scar tissue is often distorted, making extraction difficult and leading to more transaction (damage to follicles).

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Hair Restoration Answers

On Rachel Ray Show Dr. Youn Implies Neograft FUE Machine Is Painless and Non-Surgical

Q: I recently saw an episode of the Rachel Ray Show where her guest, Dr. Anthony Youn, said that the Neograft machine for Follicular Unit Extraction is painless and uses a vacuum rather than surgery to remove the grafts. Can this be true? — A.B., Old Greenwich, C.T.

A: Follicular Unit Extraction (FUE) using the Neograft machine is not painless and, while it does not produce a linear scar, it is surgery and there is significant scarring in the form of thousands of tiny holes that heal with round white marks.

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Bernstein Medical In The News

NYC Hair Transplant Surgeon Named “Best Doctor” in New York Magazine for 11th Consecutive Year

Best Doctors 2010 - NY MagazineDr. Robert M. Bernstein, founder of Bernstein Medical – Center for Hair Restoration, was selected by Castle Connolly as one of the New York metropolitan area’s top physicians through a peer-review survey of medical professionals.

New York, NY — Robert M. Bernstein, M.D., F.A.A.D., world-renowned pioneer of the hair transplant techniques, Follicular Unit Transplantation and Follicular Unit Extraction, and founder of Bernstein Medical – Center for Hair Restoration in Manhattan, has been included in New York Magazine’s “Best Doctors” issue for the eleventh consecutive year.

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Hair Restoration Answers

Does Strip Harvesting In Hair Transplant Make Donor Area Smaller?

Q: I have been reading about hair transplantation and I have a question concerning FUT (strip-harvesting). I understand, in this method, a strip is excised from the back of the scalp, the wound then closed. I wonder, then, is not the overall surface of the scalp reduced in this procedure? After two or three procedures, especially, (or even after one large session) will not a patient’s hairline also be shifted? That is, the front hairline would move back by the amount of scalp excised, or, more likely, the “rear hairline” (which ends at the back of the neck) must certainly be “moved upward.” At least, this is how I imagine it would be. Is my logic flawed? I’ve been trying to understand this in researching the procedure, but the point still evades me. — M.M., Great Falls, V.A.

A: The hair bearing area is much more distensible (stretchable) than the bald area and just stretches out after the procedure. As a result, the density of the hair in the donor area will decrease with each hair transplant session, but the position of the upper and lower margins of the donor area don’t move much – if at all. As a result, the major limitation of how much donor hair can be removed is the decreasing hair density, rather than a decrease in the size of the donor area.

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Hair Restoration Answers

After an FUE Hair Transplant at the Hairline, Will Bumps Go Away?

Q: I have had a hair transplant done in the hairline of 1,000 or so FUE grafts. However, as the hair sheds, under natural light the recipient skin seems bumpy with incisions and holes that are noticeable. Do these tend to go away with time once they have healed? — S.S., Glencoe, I.L.

A: If a follicular unit transplant is performed properly (using either extraction or a strip) there should be no bumps or surface irregularities. When the hair restoration is totally healed, the recipient area should be appear as normal looking skin.

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Hair Restoration Answers

Can an FUE Hair Transplant Repair a Scar on My Scalp?

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.

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Hair Restoration Answers

After Hair Transplant, When Can I Resume Physical Training Or Exercise Regimen?

Q: When can patients resume physical training? — T.M., Mineola, N.Y.

A: Moderate exercise may be resumed two days after the hair transplant.

The main limitation is to avoid putting direct pressure on the donor area and to avoid stretching the back of the scalp (neck flexion) as this will increase the chance of stretching the donor scar after a strip procedure.

There is no such limitation with follicular unit extraction (FUE). However, in general, contact sports should be avoided for at least 10 days with FUE and a month after a strip procedure.

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Hair Restoration Answers

Is Donor Area Thinning Common After an FUE Hair Transplant?

Q: I recently had a follicular unit extraction procedure of 320 grafts to fix an old strip scar. The donor area where the FUE’s were taken looks very diffuse – worse than the original scar ever was, it looks horrible. My doctor said this was just shock loss. Have you seen that happen where the donor area gets all diffuse from shock? If not, have you seen it where the FUE’s are taken in an illogical pattern resulting in new scarring that is noticeable? — E.O., Providence, R.I.

A: You can have shedding in the donor area from an FUE procedure, although it is not common. In FUE, the hair must be taken from the permanent zone and if there is too much wastage in the extraction process, too large an area may be needed to obtain the hair. This can leave a thin look even without shock loss (shedding).

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Hair Restoration Answers

What Are Differences Between Follicular Unit Transplantation, Follicular Unit Extraction, and Ultra-refined FUHT?

Q: What is the difference between the following ways of doing hair transplants: Follicular Unit Transplantation (FUT), Ultra-refined FUHT, and Follicular Unit Extraction (FUE)? — N.D., Meatpacking, N.Y.

A: Please see the Bernstein Medical – Center for Hair Restoration website as it explains Follicular Unit Transplantation (FUT) and Follicular Unit Extraction (FUE) in detail.

In brief, with FUT, follicular units are obtained from the microscopic dissection of a donor strip that has been removed from the back of the scalp. In FUE, the doctor attempts to remove intact follicular units directly from the scalp via a small round instrument called a punch.

Ultra Refined FUHT (Follicular Unit Hair Transplantation) is term that Pat Hennessey uses on his Hair Transplant Network. It refers to using very tiny recipient sites, carefully dissected follicular unit grafts, and large hair transplant sessions in FUHT procedures.

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Hair Restoration Answers

After Hair Transplant, How Long Before Grafts Permanently Root?

Q: I had hair transplant surgery 10 days ago and have since developed what looks like big, dry flakes in the transplant area. How long does it take for the grafts to root, and is it okay that some of the grafts fall out when brushing my hair back carefully at this point? Also, the area that was worked on has not fallen out yet, so should I shave this area before the new hair comes in or should this be a natural process? — N.N., Easton, C.T.

A: Grafts are generally permanent 9 days following a follicular unit hair transplant procedure, so you may shampoo the flakes off at this time. If larger grafts were placed (with correspondingly larger recipient sites), the grafts will be subject to being lost for a slightly longer period of time. After 9 days, you may shave or clip the hair in the transplanted area if you like, but this will not affect the success of the hair restoration one way or the other.

Visit: Graft anchoring following a hair transplant

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Hair Restoration Answers

Why Should Hair Transplant Doctor Measure Miniaturization in Donor Area Before Transplant?

Q: Why should a doctor measure miniaturization in the donor area before recommending a hair transplant? — E.B., Key West, F.L.

A: Normally, the donor area contains hairs of very uniform diameter (called terminal hairs). In androgenetic hair loss, the action of DHT causes some of these terminal hairs to decrease in diameter and in length until they eventually disappear (a process referred to as “miniaturization”). These changes are seen initially as thinning and eventually lead to complete baldness in the involved areas.

These changes affect the areas that normally bald in genetic hair loss, namely the front and top of the scalp and the crown. However, miniaturization can also affect the donor or permanent regions of the scalp (where the hair is taken from during a hair transplant). If the donor area shows thinning, particularly when a person is young, then a hair transplant will not be successful because the transplanted hair would continue to thin in the new area and eventually disappear. It is important to realize that just because hair is transplanted to another area, that doesn’t make it permanent – it must have been permanent in the area of the scalp it initially came from.

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Hair Restoration Answers

What is Follicular Unit Extraction and What Other Terms are Associated with the Procedure?

Q: I am considering having an FUE procedure and have heard the phrases topping, capping, and tethering as part of the procedure. What do all these terms mean? — C.C., Hell’s Kitchen, N.Y.

A: These are all terms that refer to the types of injury that can occur to grafts during a follicular unit extraction procedure.

In FUE, a sharp instrument (or sharp instrument followed by a blunt one) is used to separate follicular units from the surrounding donor tissue. Forceps are then used to remove the follicular units from the scalp.

Topping occurs in the first step when the doctor accidentally cuts off the top of the graft so that the remainder of the graft cannot be removed.

Capping occurs when the doctor grabs a graft with forceps and the top of the graft (the epidermis and upper dermis) pulls off, leaving the rest of the graft behind.

Tethering occurs when the bottom of the graft is still attached to the deeper tissues after the first step causing the follicular unit to pull apart during extraction.

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Hair Restoration Research

New Methodology and Instrumentation for Follicular Unit Extraction

In this paper, Dr. James Harris presents a blunt tip instrument to be used in a 3-step FUE hair transplant procedure. The instrument is described as a 1-mm dissecting punch that has a tapered blunt edge. After scoring the skin with a sharp punch, the dissecting punch is advanced to a depth of approximately 4-mm.

This instrument is similar to the one recently described by Bernstein and Rassman in New Instrumentation for Three-Step Follicular Unit Extraction, recently published in Hair Transplant forum International New Instrumentation. Dr. Bernstein’s instrument was, in turn, based upon ideas presented in a paper written by Dr. Harris in 2004.

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Hair Restoration Answers

What is Cost of Hair Plug Removal?

Q: I was looking at your prices for repair work and you mentioned that you charge $85 per graft removed. I had a hair transplant and received follicular unit grafts (one-hair follicles) but I think my hair loss is going to continue so I might in the future want to remove them. Am I interpreting your fees correctly, or does this price apply to people who have had the plug like transplants?

A: The fee applies to the removal of plugs and includes graft (plug) excision, suturing of the site, dissection of the plug into individual follicular units and re-implantation.

Generally the best way to reverse a procedure of follicular unit transplantation is with laser hair removal. This is particularly true if the hair restoration was done properly and the underlying skin is normal. Alexandrite and diode lasers are the best for hair removal. Typically, there are too many small grafts in FUT procedures to make excision practical.

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Hair Restoration Answers

After FUE Hair Transplant, Why are there Pimples and Redness?

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.

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Hair Restoration Answers

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

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

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

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

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Hair Restoration Answers

After an FUE Hair Transplant Can I Shave My Head?

Q: I am trying to have my donor scar repaired after a 1000 graft hair transplant. I was told the FUE’s placed into the scar would conceal it enough to shave my head? I would like to shave my head completely bald with a razor. — N.R., Poughkeepsie, N.Y.

A: In general, after a scar correction with follicular unit extraction you can clip your hair very short, but not shave your head. If you shaved your hair completely bald, you would generally see a vague outline of the linear scar as well as the small scars from FUE.

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Hair Restoration Answers

Why is Strip Harvesting in Hair Transplant Procedure Still Popular?

Q: Why are strips used so much in a hair transplant when there is now Follicular Unit Extraction (FUE)? — E.N., Long Island, N.Y.

A: Strip harvesting is used in the majority of hair transplant procedures because it allows the surgeon the ability to perform hair transplant sessions using large numbers of grafts while minimizing injury to the patient’s hair follicles.

This is possible because once a strip is removed from the back of the scalp, the tissue can be placed under a stereomicroscope where dissection is accomplished using direct visualization of the follicular units. This allows the grafts to be dissected with minimal trauma.

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Hair Restoration Answers

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

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

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

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

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

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Bernstein Medical In The News

New Instrument for Follicular Unit Extraction Introduced By Drs. Bernstein and Rassman

Follicular Unit Extraction (FUE) Instrument

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.”

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Hair Restoration Answers

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

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

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

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Hair Restoration Answers

How Did Follicular Unit Transplantation and Follicular Unit Extraction Get Their Names?

Q: How did Follicular Unit Transplantation and Follicular Unit Extraction get their names? N.D. – Bergen, New Jersey

A: The first paper on Follicular Unit Hair Transplantation was published by Dr. Bernstein and Rassman in 1995 in the International Journal of Aesthetic and Restorative Surgery. The title of the paper used the abbreviated name Follicular Transplantation. The longer name “Follicular Unit Transplantation” was formalized by Bernstein et. al. in the paper “Standardizing the classification and description of follicular unit transplantation and mini-micrografting techniques.” This paper appeared in Dermatologic Surgery in 1998.

Follicular Unit Extraction derived its name from Rassman and Bernstein’s publication “Follicular Unit Extraction: Minimally invasive surgery for hair transplantation” that appeared in Dermatologic Surgery in 2002.

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Hair Restoration Answers

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

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

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

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

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

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Hair Restoration Answers

Is There a Second Scar with a Second FUT Hair Transplant?

Q: When a second hair transplant is performed, should there be a second incision or should it be incorporated into the first? – D.V., Inwood, N.Y.

A: It is a very common practice to make a second separate scar in the second hair restoration procedure. This is done to maximize the hair in the second session, and it is technically the easiest to perform. If you incorporate the old scar in the new incision, there will obviously be less hair. As long as the upper incision is still in the permanent zone, the hair quality will be good.

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Bernstein Medical In The News

Bernstein Medical Launches FollicularUnitForum.Com, A New Website Where Hair Transplant Questions are Answered by Actual Patients

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.

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Bernstein Medical In The News

Dr. Bernstein Presents at ISHRS 13th Annual Scientific Meeting in Sydney, Australia

Dr. Bernstein - Presenting on Hair Transplantation in Sydney, AustraliaSome 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.

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Hair Restoration Answers

What is "Shock Fall Out" After a Hair Transplant?

Q: What is “shock fall out”? – D.B., Chappaqua, N.Y.

A: Shedding after a hair transplant is also referred to by the very ominous sounding term “shock fall out.” The correct medical term is “effluvium” which literally means shedding. It is usually the miniaturized hair (i.e. the hair that is at the end of its lifespan due to genetic balding) that is most likely to be shed. Less likely, some healthy hair will be shed, but this should re-grow.

Interestingly, if transplants are spaced less than one year apart, one often notices some shedding of the hair from the first transplant, but this hair grows back completely. For most patients, effluvium is not a major issue and should not be a cause for concern.

Typically, when shedding occurs, a patient looks a little thinner during the several month period following the transplant, before the transplanted hair has started to grow. The thinning is often more noticeable to the patient than to others. Shedding is generally noted as a thinning, rather than of “masses of hair falling out,” as the term “shock fall out” erroneously suggests.

In general, the more miniaturization one has and the more rapid the hair loss, the more likely shedding will be from the hair restoration surgery. Young, actively balding patients would be at the greatest risk. Older patients with stable hair loss would have the least risk. In either situation, since miniaturized hair is eventually going to be lost, the effluvium has no long-term effect on the outcome of the procedure.

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Hair Restoration Answers

How Much Hair Can be Removed From the Donor Area?

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

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

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

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

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Hair Restoration Answers

Does an FUE Hair Transplant Leave a Scar?

Q: Can you shave your scalp after a hair transplant with FUE without noticing scarring in the donor area? — A.A. Bronxville, N.Y.

A: Although there is no line scar in follicular unit extraction, there are tiny round ones. You can clip your hair very short after FUE, however, shaving your head will make the very fine white scarring visible.

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Hair Restoration Research

Instrumentation for Three-Step Follicular Unit Extraction

Robert M. Bernstein, M.D. Associate Clinical Professor of Dermatology at the College of Physicians and Surgeons of Columbia University in New York Abstract of Dr. Bernstein’s presentation at the International Society of Hair Restoration Surgery, 2005 – Sidney, Australia Biography Robert M. Bernstein, M.D. is Associate Clinical Professor of Dermatology at the College of Physicians […]

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Bernstein Medical In The News

Dr. Bernstein Is Lead Author Of Follicular Unit Transplantation Article In ‘Dermatologic Clinics’

Follicular Unit Transplantation - Dermatologic Clinics“Dermatologic Clinics” is a hard-cover quarterly peer review publication with comprehensive, state-of-the-art information by experts in the field of dermatology. In a 2005 issue entitled “Advanced Cosmetic Surgery”, Dr. Bernstein is lead author of the article: “Follicular Unit Transplantation: 2005.”

This valuable contribution to the field of surgical hair restoration explores techniques and best practices of the surgical procedure known as Follicular Unit Transplantation that Dr. Bernstein pioneered and is now considered the state-of-the-art in hair transplant surgery.

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What are Follicular Unit Transplantation and Follicular Unit Extraction, and How do They Differ?

Q: What is Follicular Unit Transplantation and how is it different from Follicular Unit Extraction? — H.L., White Plains, NY

A: Follicular Unit Hair Transplantation, called FUT for short, is a procedure where hair is transplanted in the naturally occurring groups of one to four hair follicles. These individual groups of hair, or units, are dissected from a single donor strip using a stereo-microscope. The area where the donor strip was removed is sutured closed, generally leaving a thin, fine, line scar.

In Follicular Unit Extraction, or FUE, the individual units are removed directly from the back or sides of the scalp through a small round instrument called a punch. There is no linear scar. There is, however, scarring from the removal of each follicle. Although the scars of FUE are tiny and round, the total amount of scarring is actually more than in FUT.

In addition, since in FUE the bald skin around each follicular unit is not removed, the total amount of hair that can be removed in FUE is substantially less than in FUT. This is because if one were to remove all the hair in an area, it would be bald. In FUT, the intervening bald tissue is removed along with the follicles in the strip.

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