Bernstein Medical - Center for Hair Restoration - Follicular Unit Transplant
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A female hair transplant patient recounts her experience at Bernstein Medical.

Hair Transplant Racked Article by Bernstein Medical Patient

Like many women, Alden Wicker felt self-conscious about her naturally high hairline and burdened with the high-maintenance of trying to keep her bangs perfectly positioned to cover her forehead. Alden discovered an article on Dr. Robert M. Bernstein, founder of Bernstein Medical – Center for Hair Restoration and pioneer of Follicular Unit Transplantation, and decided to see if he could fix her hairline. In an article she contributed to Racked, an online magazine published by Vox Media, Ms. Wicker describes her experience with Bernstein Medical and how thrilled she is will the results of her hair transplant.

Since the age of 13, Alden wanted full, voluminous hair and a lower hairline. After 16 years of covering her forehead with bangs, she started researching how to fix her naturally high hairline. In the course of her research, she stumbled on a 2009 article in the New York Times that featured Dr. Bernstein’s work in treating women with receding hairlines. She decided to come to his NY office for a consultation.

After Dr. Bernstein explained that she was a good candidate for a hair transplant, Alden scheduled her procedure for a cold Friday in January. Alden describes the entire procedure, including how Dr. Bernstein removed the strip and made sure the aesthetic plan was followed to a “T”.

She speaks about her post-op recovery and positive lifestyle changes that resulted from her procedure:

“By Tuesday, I was easily able to cover my forehead with my bangs and use BB cream to cover the yellowish cast to my forehead, the last remnants of the swelling and bruising.”

“When I went in for a trim before Memorial Day weekend and showed my hairdresser the new hairline, he was thrilled and started plotting with me to grow out my bangs.”

Alden even recollects how the transformation affected her self-esteem on a very important day, her wedding day. She says, “My new hairline had grown in enough to let my hairdresser pull the new hair back on the sides into a loose half-up style.”

Her bottom line:

“I bought myself aesthetic freedom, a carefree attitude, more minutes in my day that I could focus on living instead of ironing my hair and cringing at photos. And in that sense, it was totally worth it. My only regret is that I didn’t do this earlier.”

The article is titled, “I Hated My Hairline, So I Got a New One.”

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Q: I have read that some doctors perform something called a trichophytic closure. What is this? — M.S. ~ Thornwood, N.Y.

A: Trichophytic closure is a way to minimize the appearance of the donor scar in a hair transplant using a strip incision. The technique provides improved camouflage of a linear donor scar in Follicular Unit Transplantation (FUT). Normally, in FUT, the surrounding hair easily covers the scar. For some patients with very short hairstyles, the resulting donor scar may be visible. With the trichophytic closure technique, Dr. Bernstein trims one of the wound edges (upper or lower), allowing the edges to overlap each other and the hair to grow directly through the donor scar. This can improve the appearance of the donor area in patients who wear their hair very short.

The trichophytic donor closure can be used on patients who have had previous hair transplant procedures and are looking for improvement in the camouflage of their donor scar. It is particularly useful in hair transplant repair or corrective work. Trichophytic closures work best with sutured incisions. Stapled closures have their own advantages. The doctor will recommend which type is best in your case.

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Dr. Robert M. Bernstein, a Clinical Professor of Dermatology at Columbia University and one of the leading pioneers in modern hair transplant surgery, is recognized for his leadership in the field of hair restoration with inclusion in his 18th consecutive edition of New York Magazine’s ‘Best Doctors of New York.’

Best Doctors 2017 - New York Magazine

New York, NY — Robert M. Bernstein, MD, MBA, FAAD, FISHRS, has been recognized by his peers with inclusion in his eighteenth consecutive edition of New York Magazine’s annual ‘Best Doctors in New York’ issue. Dr. Bernstein, a Clinical Professor of Dermatology at Columbia University and founder of Bernstein Medical – Center for Hair Restoration, helped re-invent hair transplant surgery by pioneering the Follicular Unit Transplantation (FUT) procedure and by becoming an early proponent of robotic hair transplant surgery (Robotic FUE). He is the only hair restoration surgeon named to the prestigious “Best Doctors” list for so many consecutive years.

Dr. Bernstein said:

“New York has some of the finest doctors in the world, so to be considered among the best by my peers is quite an honor. It is equally satisfying when a patient tells us that we helped change their life.”

The ‘Best Doctors of New York‘ issue is an annual edition of New York Magazine that contains a more select version of the Top Doctors: New York Metro Area list published each year by Castle Connolly Medical, Ltd. New York Magazine’s list of 1,341 doctors represents about the top 2% of doctors in the region. In each list, the area’s top physicians are organized by specialty. Dr. Bernstein is listed under dermatology with expertise in robotic hair transplantation, surgical hair restoration, and hair loss treatment. To be included, doctors in New York, New Jersey, and Connecticut are nominated by their peers then subjected to a physician-led review of their skill in diagnosis and treating patients, qualifications, and reputation. Castle Connolly Medical also publishes the America’s Top Doctors directory, which has included Dr. Bernstein in all sixteen annual editions.

Dr. Bernstein has earned top accolades from the hair restoration industry, including the International Society of Hair Restoration Surgery’s Platinum Follicle Award, for his medical contributions to the field. Renowned for developing FUT hair transplants and introducing follicular unit extraction (FUE) procedures, Dr. Bernstein became one of the first in the world to incorporate the ARTAS Robotic Hair Transplant System into his practice in 2011. He has continued innovating through his collaboration with Restoration Robotics, Inc.; the company that developed the image-guided, physician-assisted robot. Recently, he announced a major upgrade to the robot with the release of ARTAS 9x. This latest version of the robot provides improved accuracy, quicker donor healing, and a faster overall procedure.

Dr. Bernstein’s hair restoration facility, Bernstein Medical – Center for Hair Restoration, is dedicated to the treatment of hair loss in men and women using the most advanced treatments and technologies. The state-of-the-art facility is located in midtown Manhattan, New York City and treats patients who visit from 58 countries and all 50 states. The board-certified physicians and highly-trained clinical assistants at Bernstein Medical take pride in providing the highest level of treatment and care for all patients.

About Robert M. Bernstein, M.D.

Dr. Robert M. Bernstein is a Clinical Professor of Dermatology at Columbia University in New York and is the founder and lead surgeon at Bernstein Medical – Center for Hair Restoration. He was the first to describe Follicular Unit Transplantation and Follicular Unit Extraction in the medical literature, and his more than 70 medical publications have fundamentally transformed the field of hair restoration surgery. Dr. Bernstein has appeared as a hair restoration expert on many notable television programs and in many news and lifestyle publications over the years. Examples include The Oprah Winfrey Show, The Dr. Oz Show, The Today Show, Good Morning America, ABC News, CBS News, GQ Magazine, Men’s Health, Vogue, Interview Magazine, Columbia Business, The Columbia Journalist, The Wall Street Journal, and The New York Times. He is a co-author of Hair Loss & Replacement for Dummies. Dr. Bernstein graduated with honors from Tulane University, received the degree of Doctor of Medicine at the University of Medicine and Dentistry of NJ, and did his training in Dermatology at the Albert Einstein College of Medicine. Dr. Bernstein also holds an M.B.A. from Columbia University.

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Q: Why go to a hair restoration practice that specializes in both FUT and FUE? — L.P., Bayside, NY

A: This is a great question, but the answer may be counterintuitive in today’s age of specialization. The answer is that you should always go to the practice that offers both. To deliver the best care, hair restoration physicians should have expertise in both Follicular Unit Transplantation (FUT) and Follicular Unit Extraction (FUE) techniques and should offer both in their practices. There are at least five good reasons why:

1. FUT and FUE are both excellent techniques, but have different indications for their use; therefore, a patient might benefit from one technique over the other. If the doctor offers both procedures, the physician will be able to choose the best one for the specific patient rather than treating everyone with a single type of procedure.

The main advantage of FUT is that it typically gives the highest yield of hair. Therefore, when the patient’s primary goal is to achieve maximum fullness, FUT should be performed. There are many well-described reasons for this, including the precision of stereo-microscopic dissection (which helps preserve follicles and the protective tissues around them) and the ability to harvest efficiently from a more select area of the donor zone.

The main advantage of FUE is no linear scar. Therefore, when the patient’s primary goal is to be able to wear his hair very short, FUE should be performed. FUE is also indicated when there is an increased risk of a widened scar or when scalp laxity does not permit a strip excision. The patient may sometimes choose FUE simply to avoid the stigma of a linear donor scar.

2. The same patient may benefit from both procedures

There are situations in which both procedures are useful in the same patient. For example, FUT may first be used to maximize yield, but then, after several sessions, the scalp may become too tight to continue to perform FUT, or the donor scar may become wider than anticipated. In the former case, the physician can switch to FUE to obtain additional grafts; in the latter case, FUE may be used to camouflage the scar of the FUT procedure.

3. There is a cross-over set of skills from FUT to FUE

To do an FUE procedure well, the follicular unit grafts that are extracted should be examined carefully under a stereomicroscope and, when needed, trimmed and sometimes subdivided into individual hair follicles (such as for hairlines, eyebrows, temples, etc.). Stereo-microscopic dissection is basic to FUT and is a skill that is second-nature to the staff of hair restoration practices that regularly perform FUT procedures, so this critical step will not be hit or miss. A doctor and staff who perform only FUE will often lack this skill.

4. Practices that offer both procedures are usually more experienced

It is easier to learn and train one’s staff in just one hair transplant technique. In particular, FUE procedures require a smaller staff than FUT and, thus, many doctors entering the field of hair restoration surgery will perform FUE, but not master the skill or make the commitment (financial, time, and infrastructure) to hire and train the staff to perform FUT.

5. Better decision making

One could argue that if a doctor performed only one procedure, but the patient needed the other, then he/she would refer the patient to a colleague. Although this sounds nice in theory, it is very rare for a doctor to refer a surgical case to a colleague if it is a condition that he/she actually treats. More likely, the doctor will convince the patient (and probably himself) that the procedure he offers is the appropriate one, even though it may not be the case.

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Dr. Robert M. Bernstein, pioneer of modern hair transplant procedures and a Clinical Professor of Dermatology at Columbia University in New York, was selected for the 17th consecutive time to be included in New York Magazine’s annual ‘Best Doctors’ issue.

New York Magazine Best Doctors 2016New York, NY — Robert M. Bernstein, MD, MBA, FAAD, FISHRS, a Clinical Professor of Dermatology at Columbia University in New York and distinguished pioneer of modern hair transplant surgery, was included for the seventeenth consecutive time in the ‘Best Doctors’ edition of New York Magazine. Dr. Bernstein was selected by his peers as one of New York’s top doctors on account of his prominent work in developing Follicular Unit Transplantation (FUT), Follicular Unit Extraction (FUE), and Robotic Hair Transplantation (Robotic FUE).

Dr. Bernstein said: “It is exciting to be part of the continuing progress made in the treatment of hair loss as technological advances in both robotics and traditional surgery converge to improve the care of our patients.”

Bernstein Medical – Center for Hair Restoration, founded by Dr. Bernstein in 2005, is a center of innovation for the hair restoration industry. So far in 2016, Dr. Bernstein has patented a modified FUE procedure and published research on improvements to the ARTAS® Robotic Hair Transplant System. Each of these advances is designed to enhance surgical outcomes for hair transplant patients. Bernstein Medical is a beta-test site for Restoration Robotics, Inc.; the company that produces the ARTAS robot and Dr. Bernstein is a medical advisor to the company.

The ‘Best Doctors’ issue is a special annual edition of New York Magazine that contains a peer-nominated list of 1,300 of New York City’s top physicians. The list of doctors is cultivated by Castle Connolly, Ltd., through a survey of physicians in the New York Tri-State area, which includes New York, New Jersey, and Connecticut. Doctors who are nominated must pass a rigorous physician-led review of their qualifications, skill in diagnosis and treating patients, and reputation. Castle Connolly also publishes America’s Top Doctors, which has included Dr. Bernstein in all fifteen editions, and Top Doctors: New York Metro Area, which has included Dr. Bernstein in fifteen consecutive editions.

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NYCityWoman.com

Dr. Bernstein was interviewed for an article in NYCityWoman.com that ran the gamut of available treatments for hair loss in women. Read below for some select quotes on a wide range of topics related to hair loss in women and treatments for female patients with androgenetic alopecia (common genetic hair loss).

On the fading stigma of hair loss in women:

“Women today are more comfortable talking about their hair loss.”

On indicators of hormone-driven female hair loss:

“It is typical to have a positive family history of hair loss and the presence of miniaturization (short, fine hairs) in the thinning areas.”

On minoxidil for regrowth of thinning hair:

Rogaine (minoxidil) can increase the quality (length and diameter) of hair that is just starting to thin.”

On the different strengths of Rogaine (minoxidil):

I generally recommend the 5 percent for women and men. Although it’s sold in separate packages for men and women, the basic ingredients are essentially the same.”

On Rogaine Foam:

“It is an elegant mixture, made for compliance,” says Dr. Bernstein. “It is an aerosolized foam, so it is less irritating than liquid Rogaine, but can be more difficult to get directly on the scalp.”

On LaserComb vs. cap-based Low Level Laser Therapy (LLLT) devices:

“The cap is both easier to use and more effective for very thin hair, due to the greater number of lasers. But for higher-density hair, a laser comb or the LaserBand82 may be more effective, as it’s probably better at getting the laser therapy beam to the scalp.”

On Follicular Unit Transplant (FUT) surgery:

FUT hair transplants allow many women to have a completely natural hair restoration, producing a dramatic change in their appearance.”

On Robotic FUE hair transplants:

Robotic FUE allows for unparalleled precision, without any line scars in the donor area and no post-operative limitations on physical activity.”

See before and after photos of some of our female hair transplant patients
Read about the causes, classification, diagnosis and treatment of hair loss in women

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The 2015 hair restoration practice census, published by the International Society of Hair Restoration Surgery (ISHRS), showed that hair transplantation is an increasingly popular treatment for hair loss. The biennial survey found that 397,048 procedures were performed in 2014, an estimated increase of 28% over the previous survey, published in 2012. Three prior surveys found increases of up to 12%, so the rate of surgical hair restoration seems to be accelerating.

Since 2006, the number of procedures worldwide has increased 76%, with the estimated global hair restoration market now valued at approximately $2.5 billion annually.

Age
Over half of all men and women treated were younger than 50. Men aged 30-39 made up the biggest percentile at 31.7%, followed by those aged 40-49 (26.9%). It was the inverse for women, however, with those aged 40-49 making up the biggest percentile at 27.7%, followed by women in the 30-39 year old bracket (27.0%).

Gender
In 2014, 84.7% of surgical patients were men and the rest (15.3%) were women. The number of women receiving a hair transplant increased by 12% since 2012. There was also a 21% increase in non-surgical female patients.

Procedure
While Follicular Unit Transplant (FUT) procedures accounted for over half of all hair transplants, Follicular Unit Extraction (FUE) is gaining rapidly, with a 51% increase over the 2012 results (from 32.2% in 2012 to 48.5% in 2014). See the chart:

FUT vs FUE (2004-2014)
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New York Post

Dr. Bernstein was quoted in a New York Post article on the growing popularity of surgical hair restoration. In the article, Dr. Bernstein explained how celebrity hair transplants have become a driving factor behind the fading of the decades-long stigma of hair transplants.

“Soccer players, football players — they’re admitting they’ve had the surgery. Patients bring in pictures of [George] Clooney, Brad Pitt. The stigma of the old plugs is fading,” [said Dr. Bernstein.]

While celebs aren’t writing signed confessions, there’s plenty of speculation about which high-profile men may have gotten procedures — such as LeBron James, Kevin Costner, John Travolta and Jeremy Piven.

Advancement in hair transplant technology may also be lending a hand. Follicular Unit Transplant (FUT) surgery and newer techniques, such as Robotic FUE, have all but eliminated the old corn-row style “hair plugs” that were commonplace twenty years ago.

The article discusses how the hair restoration industry saw a 27% increase in hair transplant procedures worldwide since 2012. The newest data released by the International Society of Hair Restoration Surgery (ISHRS) values the global surgical hair restoration market at nearly $2.5 billion.

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Dr. Robert M. Bernstein, pioneer of modern hair transplant procedures and a Clinical Professor of Dermatology at Columbia University in New York, was included in New York Magazine’s ‘Best Doctors’ issue for the 16th consecutive year.

Best Doctors 2015 - New York Magazine

New York, NY — Robert M. Bernstein, MD, MBA, FAAD, a Clinical Professor of Dermatology at Columbia University in New York and renowned pioneer of Follicular Unit Transplantation (FUT) and Robotic Follicular Unit Extraction (Robotic FUE) hair transplant procedures, was included in New York Magazine’s annual ‘Best Doctors’ issue for the sixteenth consecutive year.

On being chosen for his sixteenth consecutive ‘Best Doctors’ issue, Dr. Bernstein said: “I am honored to be considered among the best doctors in New York and it is a credit to the hardworking staff at Bernstein Medical that, after two decades of incredible progress, we are still making significant advances in the surgical treatment of hair loss.”

Recognition of Dr. Bernstein and his contributions to the field of surgical hair restoration comes as he continues to push the envelope with advances in Robotic FUE hair transplants, improving more traditional hair restoration techniques and exploring adjuvant treatments.

Among the improvements Dr. Bernstein has made to the robotic hair transplant procedure include: automated selection of follicular unit grafts, robotic creation of recipient sites, reducing wound size, and a “long-hair” FUE technique that allows a patient to have an FUE hair transplant without the donor area being visible in the post-op period. Collectively these improvements make the robot more efficient, reduce scarring from the procedure, and improve the outcome for patients. Dr. Bernstein’s internationally renowned hair restoration facility, Bernstein Medical – Center for Hair Restoration, is a beta-testing site for Restoration Robotics, Inc., the company that produces the ARTAS® robot. Dr. Bernstein is a medical advisor to the company.

New York Magazine’s ‘Best Doctors’ issue is a special annual edition of the acclaimed magazine which contains a directory of the New York City area’s best physicians. The directory is created by Castle Connolly, Ltd., through a survey of doctors in the New York Tri-State area. To be included, doctors in New York, New Jersey and Connecticut are nominated by their peers and then must pass a rigorous physician-led review of their qualifications, reputation, and skill in diagnosis and treating patients. Castle Connolly also publishes America’s Top Doctors, which has included Dr. Bernstein in all fourteen editions.

About Robert M. Bernstein, M.D., F.A.A.D.

Dr. Robert M. Bernstein is a Clinical Professor of Dermatology at Columbia University in New York, founder and lead surgeon at Bernstein Medical – Center for Hair Restoration, and renowned pioneer of Follicular Unit Transplantation (FUT) and Robotic Follicular Unit Extraction (Robotic FUE) hair transplant procedures. Dr. Bernstein was the first to describe Follicular Unit Transplantation and Follicular Unit Extraction in the medical literature, and his more than 60 medical publications have fundamentally transformed surgical hair restoration. Dr. Bernstein has received the Platinum Follicle Award, the highest honor in the field given by the International Society of Hair Restoration Surgery (ISHRS), and has appeared as a hair restoration expert on many notable television programs and news and lifestyle publications over the years. Examples include: The Oprah Winfrey Show, The Dr. Oz Show, The Today Show, Good Morning America, ABC News, CBS News, New York Times, Wall Street Journal, Men’s Health Magazine, and more. He is co-author of Hair Loss & Replacement for Dummies. Dr. Bernstein graduated with honors from Tulane University, received the degree of Doctor of Medicine at the University of Medicine and Dentistry of NJ, and did his training in Dermatology at the Albert Einstein College of Medicine. Dr. Bernstein also holds an M.B.A. from Columbia University.

About Bernstein Medical – Center for Hair Restoration

Bernstein Medical – Center for Hair Restoration, founded by Dr. Bernstein in 2005, is dedicated to the diagnosis and treatment of hair loss in men and women using the most advanced technologies. The state-of-the-art facility is located in midtown Manhattan, New York City and treats patients who visit from 58 countries and all 50 states. The board-certified physicians and highly-trained clinical assistants at Bernstein Medical take pride in providing the highest level of treatment and care for all patients. In 2011, Bernstein Medical became one of the first practices in the world to offer Robotic FUE hair transplant procedures using the image-guided, computer-driven technology of the ARTAS Robotic System. Bernstein Medical is a beta-testing site for this technology.

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Q: It seems that some doctors offer only FUT and others only FUE. What is your opinion on that? — D.E., Portland, M.E.

A: Both FUT and FUE are excellent techniques, but have different indications. To deliver the best care for our patients, hair restoration physicians should have expertise in both procedures, and they should offer both in their practices.

Update: I have expanded the answer to this question in a new Answers post.

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Q: How Many Hair Transplants Will I Need? — E.E., New York, N.Y.

A: The first session of a hair transplant should be designed as a stand-alone procedure with the following three goals:

  1. Establishing a permanent frame to the face by creating, or reinforcing, the frontal hairline.
  2. Providing coverage to the thinning, or bald, areas of the scalp with the hair transplant extending at least to the vertex transition point.
  3. Adding sufficient density so that the result will look natural.

Achieving all of these goals will allow the first procedure to stand on its own.

Because of this, many people feel one hair transplant is sufficient.

Reasons for Second Hair Transplant

While the first session of a hair transplant is designed to stand on its own, there are several reasons why one would want a second hair transplant, such as increasing the density in a previously transplanted area; refining the hairline created in the first transplant; focusing on increased crown coverage, when appropriate; or addressing further hair loss that’s occurred after the first transplant.

Because of this last reason, addressing further hair loss, careful patient evaluation and surgical planning is needed to take into account your donor reserve and the likely extent of any future balding in the planning of your first transplant session.

Wait at least 10 to 12 months Before Getting a Second Hair Transplant

If a second transplant is warranted, patients are advised to wait at least 10 to 12 months after the first transplant before considering a second. This is because over the course of the first year, the first transplanted hairs have grown in and the progressive increase in a hair’s diameter, texture and length can markedly change the look of the hair restoration — this may influence the way a patient wants to groom his/her hair, and only after the hair has reached styling length can the patient and physician make the best aesthetic judgments regarding the placement of additional grafts.

For patients having an FUT (strip) procedure, another reason to delay a second hair transplant session for this time period is that scalp laxity will continue to improve making the donor hair easier to harvest.

You can view our Hair Transplant Photos by the number of sessions each patient has had:

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Dr. Bernstein was interviewed by Spencer Kobren on The Bald Truth, the critically acclaimed broadcast on hair loss and hair restoration. They discussed the latest in robotic hair transplant surgery, the ARTAS® Robotic System, FUE and FUT hair transplant procedures, and the future of hair restoration.

Spencer Kobren: It’s great to have you back. And I know you only have about a half an hour – actually about 20 minutes now… Let’s get straight to the point. You heard my opening, you kind of know how I feel about the way that the industry is moving, the direction the industry is moving in, and also my concern about now that these devices are really starting to become a bigger part of the market, I believe that these devices are getting into the wrong hands. Now let’s just start with why you’ve embraced it and then we can go into how the industry is evolving.

Dr. Bernstein: Follicular Unit Transplantation via strip was a pretty straight-forward procedure, and once we figured out how to use microscopes to dissect out the follicular units and train the staff on microscopic dissection, it was pretty much a slam dunk. It was just a question of other doctors embracing it and patients understanding what it is and demanding the procedure. With Follicular Unit Extraction it’s really a much different animal. The technique is very, very tricky. And the reason why it’s tricky is because the dissection is done essentially blind. The hair follicle changes direction as it goes deeper in the skin, and also the hairs that comprise a follicular unit splay outward — they fan outwards — so it’s very tricky to get a very small punch around an intact follicular unit. When you do this by hand thousands of times, it’s really, really hard for a physician to concentrate and be consistent and not get bored out of his mind. Also, you don’t have all the visual cues that you have under a microscope. So this repetitive procedure lends itself to robotics. For years we worked on the technique, first with a sharp punch, then a dull punch, then a two-step technique where we used a sharp punch to score the skin and then a deeper [duller] punch under it. Each got better and better, but it never was really consistent, and it certainly was very, very dependent on the user, the patient, and how you’re feeling that day. So this procedure lends itself to robotics. I first learned about the robotic procedure very early in 2011 and when I first saw the robot it made total sense to me.

The Bald Truth is America’s longest running self help radio show for men’s hair loss. Kobren is the Founder and President of the American Hair Loss Association and a founder of the International Alliance of Hair Restoration Surgeons (IAHRS).

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Q: I know Dr. Bernstein is one of the leading hair restoration surgeons in the country, but what about his medical assistants? How experienced are the hair restoration technicians that help him during surgery? — E.N., Redding, C.T.

A: My medical assistants and technicians are full time employees, and many of them have worked closely with me for many years. In fact, many of them have been with me since the inception of FUT, the procedure I pioneered way back in 1995. I do not hire, nor have I ever hired, per diem technicians.

All my hair restoration technicians are highly skilled and experienced in stereo-microscopic dissection and follicular unit graft placement. Even with Robotic FUE, being highly skilled and experienced in stereo-microscopic dissection is important since every graft that the robot harvests is examined, counted, and, when necessary, trimmed to ensure they are of the highest quality before being implanted into the scalp.

Because of the intense in-house training of our staff, we have received national accreditation from the “Accreditation Association for Ambulatory Health Care” (AAAHC/Accreditation Association) for maintaining rigorous standards in patient care.

Read more about how we train our surgical staff.

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Q: I received radiation therapy to my scalp two years ago to treat a brain tumor. I lost my hair during treatment and it has not grown back. The doctors said that this treatment might result in permanent hair loss. Is a hair transplant a viable option after radiation treatment? — K.G., Darien, C.T.

A: Unlike chemotherapy which generally causes a reversible shedding of hair (called anagen effluvium), radiation therapy can cause both reversible shedding and the permanent loss of hair follicles (scarring alopecia).  Hair can be successfully transplanted into these scarred areas – but there must be enough donor hair to do so. If the radiotherapy was localized, a hair transplant procedure is often quite effective – although several procedures may be required to achieve adequate coverage of the irradiated areas.

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ARTAS Robotic System display monitor showing parameters for the creation of recipient sitesARTAS Robotic System display monitor showing parameters for the creation of recipient sites

New York, NY (PRWEB) — Robert M. Bernstein, M.D., F.A.A.D., A.B.H.R.S., founder of Bernstein Medical – Center for Hair Restoration, introduced new technology that allows the ARTAS Robotic System to accomplish a critical step in hair transplant surgery, the creation of recipient sites. Presenting at the 2nd ARTAS User Group Meeting, Dr. Bernstein previewed the recipient site creation technology that brings the robotic system one step closer to performing critical aspects of the labor-intensive, hair transplant procedure.

The ARTAS System is currently able to harvest intact follicular unit grafts from the permanent area in back of one’s scalp using precise robotic technology. This is the most difficult aspect of a follicular unit extraction hair transplant – the newer type of hair restoration procedure that avoids a linear scar in the back of the scalp. Now that site creation can also be done robotically, only one step remains – graft placement.

The ARTAS Robotic System maps the surgeon's hairline design onto a 3-D model of the patient's headThe ARTAS Robotic System maps the surgeon’s hairline design onto a 3-D model of the patient’s head

For the recipient site creation, the doctor first draws a hairline and other markings directly onto the patient’s scalp to delineate the surgical plan. Next, multiple photographs are taken and fed into software, called the ARTAS™ Hair Studio, which converts the images into a 3-D model of the actual patient. This computer model can be manipulated and saved for the patient’s procedure. Using the ARTAS™ Hair Studio software, the physician then specifies the angle, direction, density, and randomness of the recipient site incisions to create the most natural look. During the procedure, the robot uses image-guided technology to avoid existing hairs while it creates up to 1,500 recipient sites per hour. In performing recipient site creation, the robot automates a process that can be physically demanding and prone to human error.

On the advancement, Dr. Bernstein said:

“This development is a crucial step towards a robotic system that can perform every aspect of a hair transplant. A great deal of credit goes to the engineers of Restoration Robotics who have worked to make automated recipient site creation a reality. I am proud that this work not only improves hair transplants for patients, but adds to the increasingly important trend of using robotic technology in medicine.”

The site creation technology that Dr. Bernstein debuted at the ARTAS User Group Meeting; which was held in California (Laguna Niguel, CA) on February 7th and 8th, 2014; will be available to hair restoration physicians in the fall of 2014. Gabe Zingeratti Ph.D, head of R&D at Restoration Robotics, Inc., presented details of the technology, which was beta-tested at Bernstein Medical – Center for Hair Restoration. With the next generation ARTAS® Robotic System rolling out in the coming months, the focus of research will then be on the final phase of robotic hair transplantation, the robotic insertion of follicular unit grafts into recipient sites. This last step will take several more years to develop.

The ARTAS Robotic System, developed by Restoration Robotics, is currently in use by hair restoration physicians around the world to automate the extraction of grafts of skin and hair called follicular units.. Follicular units, which are natural groupings of one to four hair follicles, form the biological basis of the modern hair transplant procedure. Once extracted from the back of the patient’s scalp, the follicular unit grafts are then inserted into recipient sites in the balding area of the scalp where they grow hairs that are immune to the effects of common hair loss.

No stranger to innovative advances in hair transplant surgery, Dr. Bernstein introduced Follicular Unit Transplantation (FUT) to medical literature in a 1995 publication. FUT transformed hair transplants from the use of large grafts of skin and hair, known colloquially as “hair plugs,” to a more medically-oriented procedure that produces completely natural-appearing results. Dr. Bernstein with his colleague Dr. Bill Rassman again broke new ground with his 2002 publication that introduced the concept of Follicular Unit Extraction (FUE) to scientific literature. Dr. Bernstein was the first physician on the East Coast of the United Sates, and one of the first in the world, to use the ARTAS System to perform FUE using the new robotic technology.

About Robert M. Bernstein, M.D., F.A.A.D.

Dr. Robert M. Bernstein is a Clinical Professor of Dermatology at Columbia University and founder of Bernstein Medical – Center for Hair Restoration. His landmark scientific papers are considered seminal works in the field of hair transplant surgery. Other publications include textbook chapters on dermatologic surgery and books, like Hair Loss and Replacement for Dummies, aimed at the consumer audience. He has been selected as one of New York Magazine’s “Best Doctors” for fourteen consecutive years and has appeared as a hair loss and hair transplantation expert on The Oprah Winfrey Show, The Dr. Oz Show, Good Morning America, The Today Show, CBS News, Fox News, and The Discovery Channel. Dr. Bernstein has been interviewed or featured in articles in the New York Times, GQ Magazine, Men’s Health, Interview Magazine, Vogue, and others.

About Bernstein Medical – Center for Hair Restoration

Bernstein Medical – Center for Hair Restoration, founded in 2005, is a state-of-the-art facility and international referral center for the treatment of hair loss that is located in midtown Manhattan, New York City. Hair transplant surgery, hair repair surgery, and eyebrow restoration are performed using Dr. Bernstein’s pioneering techniques of Follicular Unit Transplantation (FUT) and Follicular Unit Extraction (FUE).

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Q: Can you do a hair transplant using someone else’s hair? — K.K., Garden City, N.Y.

A: Unfortunately, this is not possible because your body would reject the hair transplant without the use of immunosuppressive drugs. The problem with immune suppressants is that they will lower your natural immune response, increasing your susceptibility to infections and even cancer, and you’ll have to take them for the rest of your life.

A transplant using someone else’s hair is also not desirable for aesthetic reasons. There’s the style of the hair, its texture, thickness, color, etc. Trying to find the perfect donor whose hair would complement and flatter your particular features and blend in with your remaining hair would be a significant, if not impossible, challenge. It would be possible, however, to transplant the hair from one identical twin to another, but most likely if one went bald, so would the other.

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Columbia BusinessDr. Bernstein is featured in Columbia Business, the alumni magazine of the Columbia Business School, for having “revolutionized the field of hair restoration.” Dr. Bernstein, who received an MBA from the renowned university in 2004, is quoted as having seen an opportunity in 1995 to transform hair transplantation from a procedure using “hair plugs” to one with significantly more natural results. In collaboration with Dr. William Rassman he introduced Follicular Unit Transplantation (FUT) which, the article notes, is now the “gold standard” for modern surgical hair restoration.

Also mentioned in the article, which is titled “Hair Hero,” are his pioneering work in robotic hair transplant procedures, his receiving the Platinum Follicle Award, and his appearances in the popular media including a feature on Good Morning America.

Dr. Bernstein is a Clinical Professor of Dermatology at the College of Physicians & Surgeons of Columbia University, where he instructs residents in general dermatology and the specialized art of hair restoration surgery.

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Journal of the American Academy of DermatologyDr. Bernstein is credited with introducing the “follicular unit” to surgical hair restoration, the innovation that allowed for a “completely natural-looking hair transplant” to be achieved. The commentary on Dr. Bernstein’s contributions to the field of hair transplantation are outlined in an historical review of dermatologic surgery that appeared in the Journal of the American Academy of Dermatology.

Dr. Bernstein is noted as being responsible for moving the field of hair restoration surgery away from large graft “plugs” and mini-micrografts to follicular units:

The following year, dermatologists Bernstein et al laid down the conceptual framework for follicular unit transplantation in their 1995 article, “Follicular transplantation.” In 1997, they detailed its clinical application in the paired articles, “Follicular transplantation: patient evaluation and surgical planning” and “The aesthetics of follicular transplantation.”

The 2 advances, the application of the stereomicroscope to follicular dissection and the use of follicular units as the basic element of hair transplantation, arose from a background in dermatology. They moved the field of hair restoration surgery from plugs and mini-micrografting, where this basic anatomical feature of the hair follicle was ignored, to follicular unit transplantation, where the follicular unit became sacrosanct. These 2 ideas, when put to clinical use, allowed the once elusive goal of a completely natural-looking hair transplant to finally be achieved.

Dr. Bernstein’s pioneering of the Follicular Unit Transplant (FUT) procedure still resonates, almost two decades later, as the follicular unit continues to be the anatomical structure that is transplanted in hair transplant surgeries worldwide.

The article then describes how Dr. Bernstein, along with his colleague Dr. Rassman, laid the foundation for the next major developments in hair restoration; first with his description of the Follicular Unit Extraction (FUE) technique and more recently with innovation in robotic hair restoration technology.

With the publication of the article, “Follicular unit extraction,” in 2002, the follicular unit extraction procedure gained popular appeal and was rapidly adopted by doctors worldwide. The authors cautioned on the limitations of this harvesting technique and the risk of follicular damage. Dermatologists Berman, Zering, and Bernstein, along with their colleagues in other specialties, continue to work on the problem of harvesting in follicular unit extraction, with the application of robotic technology showing particular promise.”

Taken together, these passages underscore how Dr. Bernstein’s research and medical publications have fundamentally transformed the field of hair restoration to the benefit of patients and physicians alike. While many other very talented physicians have had a substantial impact on hair restoration procedures ever since the hair transplant concept was first proposed by Dr. Norman Orentreich in the 1950s, Dr. Bernstein has contributed the key innovations that have made modern, natural-looking hair transplant surgery a medical and aesthetic possibility.

The article is titled, “Current status of surgery in dermatology.” The Journal of the American Academy of Dermatology is the official journal of The American Academy of Dermatology (AAD), the largest, most influential and most representative dermatology group in the United States.

Reference

C. William Hanke, Ronald L. Moy, Randall K. Roenigk, Henry H. Roenigk Jr., James M. Spencer, Emily P. Tierney, Cynthia L. Bartus, Robert M. Bernstein, Marc D. Brown, Mariano Busso, Alastair Carruthers, Jean Carruthers, Omar A. Ibrahimi, Arielle N.B. Kauvar, Kathryn M. Kent, Nils Krueger, Marina Landau, Aimee L. Leonard, Stephen H. Mandy, Thomas E. Rohrer, Neil S. Sadick, Luitgard G. Wiest, Current status of surgery in dermatology, Journal of the American Academy of Dermatology, Volume 69, Issue 6, December 2013, Pages 972-1001, ISSN 0190-9622, http://dx.doi.org/10.1016/j.jaad.2013.04.067.

Read more about Dr. Bernstein’s history of innovation in hair transplant surgery

Read Dr. Bernstein’s landmark medical publications

Download and read ‘Current status of surgery in dermatology’ (pdf)

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Dr. Bernstein Presenting ‘Follicular Unit Extraction: Then and Now’

Dr. Bernstein was honored to deliver the keynote address at the ARTAS International Users Forum in San Francisco, California. Dr. Bernstein’s presentation, “Follicular Unit Extraction: Then and Now,” was a review of the evolution of surgical hair restoration from Follicular Unit Transplantation (FUT) through Follicular Unit Extraction (FUE) to the cutting edge technique of Robotic-FUE.

The presentation described the steps that resulted in the use, and growth in popularity, of the state-of-the-art ARTAS Robotic System for FUE. Dr. Bernstein pointed out that with the introduction of each procedure — FUT, FUE, and Robotic-FUE — there was initially a rocky reception with physicians. In each instance, however, the surgeons’ concerns were overcome first by strong, patient interest and then by clinical studies that confirmed the procedures’ usefulness.

Dr. Bernstein discussed how FUE procedures progressed from the use of hand-held instruments to the computer-assisted, image-guided ARTAS Robot. One of the initial hurdles of FUE procedures using hand-held devices was a high rate of follicular unit transection (cutting of the follicles). Restoration Robotics, Inc., the company that developed the ARTAS system, used a “sharp/blunt” punch technique that was introduced by Jim Harris in his 2004 publication on the SAFE System for FUE. The sharp/blunt technique, that was validated in 2006 by Dr. Bernstein’s research publication, “New Instrumentation for Three-Step Follicular Unit Extraction,” reduced transection of follicles when compared to older instrumentation. Dr. Bernstein then detailed modifications to the system that he proposed in order to improve the ARTAS robot. These improvements include: a smaller tip for the sharp/blunt punch, selection of larger over smaller follicular units, tensioner placement, ‘feathering’ the ends of the tensioner, and pre-making recipient sites before extracting the follicular unit grafts.

Looking to the future, Dr. Bernstein mapped out the further evolution of the Robotic FUE procedure and the tasks it will be required to perform. In future procedures, the physician will not only guide the robot on extracting follicular units, but also in creating recipient sites and, further down the road, placing grafts into the recipient sites. Graft placement will represent the most significant challenge to the robotic system as this step is the most sensitive to patient to patient variability. Once this last step is accomplished, a fully automated hair transplant should be possible, eliminating much of the human error in the mechanical aspects of the hair restoration process.

More photos from the event:

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New York Magazine’s 2013 ‘Best Doctors’ issue includes Dr. Robert M. Bernstein, a pioneer of modern hair transplant procedures, making this the 14th consecutive year Dr. Bernstein has appeared in the special annual issue.

New York Magazine 'Best Doctors' 2013New York, NY — Robert M. Bernstein, M.D., F.A.A.D., Clinical Professor of Dermatology at Columbia University in New York and a pioneer of modern hair transplant procedures, was included in the ‘Best Doctors’ issue of New York Magazine for the fourteenth consecutive year.

Dr. Bernstein earned his placement in the Best Doctors issue, and his reputation as world-renowned hair restoration physician, through a 20 year career of developing surgical techniques and adopting and guiding technological advances in the industry. His more than 60 medical publications on Follicular Unit Transplantation (FUT), Follicular Unit Extraction (FUE), and Robotic FUE (R-FUE) have revolutionized the field of hair restoration and provide the foundation for hair transplant surgeons worldwide.

The New York Magazine ‘Best Doctors’ issue is an annual issue of the magazine that contains a directory of the New York area’s best physicians. The directory is based on the results of a peer-reviewed survey that is conducted by Castle Connolly, Ltd. The company also publishes the guidebook “Top Doctors: New York Metro Area,” based on the same survey of doctors. As part of the survey, physicians are nominated from across the New York metropolitan area including Manhattan, Brooklyn, Queens, The Bronx, Staten Island, Westchester County, Long Island, and counties in New Jersey and Connecticut. The recommendations are based on the nominated doctor’s qualifications, reputation, skill in diagnosis, skill in treating patients, and other criteria. A physician-led research team at Castle Connolly tabulates and vets the nominations and compiles the final list.

Bernstein Medical – Center for Hair Restoration, the facility Dr. Bernstein founded in 2005, is a state-of-the-art hair loss treatment facility in New York City that serves men and women from around the world. The center specializes in FUT, FUE and R-FUE hair transplants, and also performs corrective hair transplants and offers medical treatments for hair loss patients who are not indicated for a transplant. In 2011, Bernstein Medical became the first hair restoration facility on the East Coast to offer Robotic FUE procedures using the ARTAS Robotic System. Dr. Bernstein has worked closely with Restoration Robotics, Inc. to improve both the robotic technology and the R-FUE procedure protocol.

Dr. Bernstein has appeared on many notable media programs and publications over the years. Some of these include: The Oprah Winfrey Show, The Dr. Oz Show, The Today Show, Good Morning America, ABC News, CBS News, The Early Show, Fox News, National Public Radio, NY1, New York Times, Wall Street Journal, Men’s Health Magazine, GQ Magazine, Telemundo, “O” the Oprah Magazine, and more. He is co-author of Hair Loss & Replacement for Dummies and has received the Platinum Follicle Award, Surgeon of the Month, and Pioneer of the Month honors from the International Society of Hair Restoration Surgery (ISHRS).

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Q: A while ago I saw you and you recommended FUT hair transplantation, but my friend came in and you recommended FUE. How come? — C.T., Hackensack, N.J.

A: I think that both procedures are excellent, which is why I do them both. My recommendations are determined by the individual patient. His or her age, desire to wear hair cut very short, athletic activities, donor density and miniaturization, extent of hair loss, and potential future balding are all important aspects in the decision process.

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Hair Restoration in Women, Dr. Bernstein Featured in 'New You' Magazine

Dr. Bernstein and Bernstein Medical – Center for Hair Restoration were featured in New You magazine’s article “My Hair Lady.” The main topic of the article is hair transplantation in women, however it also touches on hair loss in women, Follicular Unit Transplantation (FUT), medication and other products.

On Bernstein Medical – Center for Hair Restoration:

The Manhattan office of Bob Bernstein, just steps from Park Avenue, is the kind of space that makes successful men feel at home — a good thing for one of the country’s foremost specialists in hair restoration (and the co-author of Hair Loss for Dummies). The layout is part design statement, part science lab, slick with granite, slate, and glass and full of microscopes and high tech gizmos. Among the space’s most noteworthy gadgets is one of only twelve robots in the world programmed to help perform hair transplants, which has a home in Dr. Bernstein’s office.

A female patient of ours discussing the “taboo” of hair transplantation in women:

Sara Lyles, 62, whose hair loss was caused by a styling technique, said that when Dr. Bernstein performed her hair transplant 12 years ago, the subject was taboo. “Women never talked about it, and I was so embarrassed that I avoided all social functions,” she recalls. “I’m African American and I slept in large tight rollers to keep frizzing under control. The traction destroyed my frontal hairline.”

At the time, she would have been mortified if someone found out she had undergone a transplant. “Even my hairdresser had no clue,” she says. “Dr. Bernstein not only gave me my hair back, he gave me my life back.”

Dr. Bernstein on the amazing progress of the hair restoration industry:

As Dr. Bernstein emerges from his operating room, sporting green scrubs and green Nikes that match the room’s tiles, he shakes his head and sighs. “When I went into practice back in the eighties, transplantation was almost barbaric and Rogaine was the only alternative,” he remembers. He marvels at the advances and choices he and others now have to over. “I never would have thought I would be working with robots, lasers, and cloning.”

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Q: What is the Origin of the Term DUPA? — Z.Z., Darien, CT

A: The terms DPA and DUPA were first described by O’tar Norwood in his seminal 1975 publication: Male Pattern Baldness: Classification and Incidence. ((Norwood OT. Male pattern baldness: classification and incidence. So. Med. J 1975;68:1359-1365. Download)) In the paper, Dr. Norwood defined the two terms as:

Diffuse, Unpatterned Alopecia (DUPA). In this type there is a general decrease in the density of hair without any definite pattern, although it is usually more marked over the top and front. This type is common in women.

Diffuse, Patterned Alopecia (DPA). The patterns in this type of hair loss are essentially the same as in more common male pattern baldness, but the areas involved do not become totally bald; the hair only decreases in density. This also occurs in women.

Dr. Norwood’s realization that all hair loss did NOT follow his own Norwood patterns was a great insight, as well as his observation that DUPA was a common pattern in women and uncommon in men. The terms went relatively unnoticed and were not seen again in the medical literature until Drs. Bernstein and Rassman wrote about them again when they were developing Follicular Unit Transplantation. ((Bernstein RM, Rassman WR: Follicular Transplantation: Patient Evaluation and Surgical Planning. Dermatol Surg 1997; 23: 771-84. Download)) The importance of identifying these conditions is that that DUPA (either in men or women) is a relative contra-indication for hair transplantation and, with densitometry, can be readily detected in individuals at a relatively young age. Patients with DPA can be transplanted as if they were early Norwood Class 6’s.

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Q: I am currently 8 days post op. I started to massage my hair in the shower to get rid of the scabs. When I was done I looked in the mirror and saw two of my transplanted hairs were slightly bleeding but still intact. What does that mean? Did I lose the grafts? — B.G., Stamford, C.T.

A: If they bleed, but were not dislodged (i.e. did not come out), they should grow fine. Just be gentle for the next week. Generally, when follicular unit transplantation is performed with tiny sites (19-21 gauge needles) the grafts are permanent at 10 days. Since I did not perform your procedure and am not familiar with the technique your doctor actually used, I would give it the extra few days.

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New York, NY (PRWEB) — Robert M. Bernstein, M.D., F.A.A.D., A.B.H.R.S., a world-renowned hair transplant surgeon, presented a series of improvements to hair transplant procedures which use the ARTAS Robotic System for Follicular Unit Extraction (FUE). These updates include revisions to the FUE surgical protocol and technical adjustments to the robotic extraction system. He presented his refinements at the first user meeting held by the developers of the system; Restoration Robotics, Inc.; on September 14 – 16 in Denver, Colorado.

Dr. Bernstein receives recognition from Restoration RoboticsDr. Bernstein receives recognition from Restoration Robotics

Dr. Bernstein described his series of improvements in a lecture to an elite group of physicians who are among the first adopters in the industry of the image-guided, robotic-assisted system. The updates are designed to improve the results of FUE hair transplantation by enhancing both the surgical protocols of the procedure as well as the functionality of the robotic system. In FUE, small groups of one to four hairs, called follicular units, are extracted individually from the back and sides of the scalp and are then implanted into recipient sites, which are tiny holes that the surgeon creates in a balding area of the scalp.

Dr. Bernstein discussing robotic-assisted FUE at Restoration Robotics' first user meetingDr. Bernstein discussing robotic-assisted FUE at Restoration Robotics’ first user meeting

The most important update to the FUE procedure that Dr. Bernstein proposed is for surgeons to create recipient sites before they extract the grafts, rather than create the sites after grafts are extracted. Drawing on his decades of experience in hair transplantation, Dr. Bernstein developed this technique of “pre-making” recipient sites in order to maximize survival of the grafts during the hair transplant. Using this technique, extracted grafts are outside the body for a shorter duration of time. It also minimizes instances of “popping,” in which grafts are exposed to desiccation (drying) and hypoxia (low oxygen) before they are inserted back into the scalp. By “pre-making” the recipient sites, these harmful factors are mitigated and a greater number of the grafts grow into viable, hair-producing follicular units. Dr. Bernstein encourages surgeons to use this technique on all FUE procedures, whether using manual methods or robotic instrumentation.

When asked to comment on his improvements to the robotic FUE procedure, Dr. Bernstein said:

“It was fortuitous timing that the ARTAS Robot became available just as I was developing my refinements to the FUE procedure. The combination of the automated robot for graft extraction with the technique of pre-making recipient sites has led to a significant improvement in hair transplant surgery.”

Dr. Bernstein is the founder of Bernstein Medical – Center for Hair Restoration, and he is recognized world-wide for his innovative work in the treatment of hair loss. He is among the first hair transplant surgeons in North America to utilize the ARTAS Robot for FUE in his practice.

Being an early adopter of the advanced follicular unit extraction system has enabled him to work with Restoration Robotics to refine it to his exacting standards. Dr. Bernstein has, again, put his fingerprints on a revolutionary upgrade to the hair transplantation industry. He was the first to describe FUT and FUE procedures in the medical literature, in 1995 and 2002 respectively. In contrast to FUE, where follicular units are extracted individually, in FUT procedures a strip of skin is removed from the back of the scalp, it is then dissected into follicular units, and those follicular unit grafts are then implanted into recipient sites in the patient’s scalp.

About Dr. Bernstein

Robert M. Bernstein, M.D., F.A.A.D., A.B.H.R.S. is a Clinical Professor of Dermatology at Columbia University and a pioneer in the field of hair restoration. His landmark scientific papers are considered seminal works in the field of hair transplant surgery, and he is the most widely published author on the topic having published more than sixty articles, editorial reviews, books, and textbook chapters.

Dr. Bernstein has been selected as one of New York Magazine’s “Best Doctor’s” for thirteen consecutive years and he has appeared as a hair loss and hair transplantation expert on The Oprah Winfrey Show, The Dr. Oz Show, Good Morning America, The Today Show, The Discovery Channel, CBS News, Fox News, and National Public Radio. Dr. Bernstein has been interviewed or featured in articles in GQ Magazine, Men’s Health, Interview Magazine, Vogue, the New York Times, and others.

About Bernstein Medical – Center for Hair Restoration

Bernstein Medical – Center for Hair Restoration is a state-of-the-art hair restoration facility and international referral center, located in midtown Manhattan, New York City. The center is dedicated to the diagnosis and treatment of hair loss in men and women. Hair transplant surgery, hair repair surgery, and eyebrow restoration are performed using Dr. Bernstein’s pioneering techniques of Follicular Unit Transplantation (FUT) and robotic Follicular Unit Extraction (R-FUE).

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Dr. Robert M. Bernstein — pioneer of the follicular unit transplantation (FUT), follicular unit extraction (FUE), and Robotic FUE hair transplant procedures — was selected for the 13th consecutive year to be included in New York Magazine’s ‘Best Doctors’ issue.

New York Magazine - Best Doctors 2012New York, NY — Robert M. Bernstein, M.D., F.A.A.D., the world-renowned hair transplant physician, pioneer of the Follicular Unit Transplantation (FUT) and Follicular Unit Extraction (FUE) and founder of Bernstein Medical – Center for Hair Restoration, was included in New York Magazine’s ‘Best Doctors‘ issue for the thirteenth consecutive year.

When asked of his inclusion in this annual peer-reviewed list, Dr. Bernstein, a Clinical Professor of Dermatology at Columbia University in New York City, said:

“It is such an honor to be recognized by New York Magazine. Our passion for providing the best hair loss treatments has served as the impetus for pushing the envelope in utilizing new state-of-the-art hair restoration techniques such as Robotic assisted hair transplants.”

New York Magazine’s Best Doctors issue is a directory of physicians that is compiled through a peer-review survey conducted by Castle Connolly Medical Ltd. The company also publishes “Top Doctors: New York Metro Area,” a guidebook based on the results of the same survey of doctors. Each year, physicians in the New York metropolitan area — including Manhattan, Brooklyn, Queens, The Bronx, Staten Island, Westchester County, Long Island, and counties in New Jersey and Connecticut — nominate their choice of the best doctors in a specific field. The physicians make their recommendations based on criteria including: qualifications, reputation, skill in diagnosis, and skill in treating patients.

Dr. Bernstein, a native New Yorker, has spent two decades developing new hair transplant techniques. His medical publications on FUT and FUE hair transplantation have revolutionized the field of hair restoration surgery and provide the basis for modern techniques used by hair transplant surgeons worldwide. Bernstein Medical – Center for Hair Restoration is a state-of-the-art hair restoration facility in New York City. Located in midtown Manhattan since 2005, the center is dedicated to the diagnosis and treatment of hair loss in men and women and specializes in both corrective hair transplants as well as the traditional restorative FUT and FUE techniques. Dr. Bernstein is the first hair transplant doctor on the East Coast to offer Robotic FUE hair transplantation to hair loss patients.

Dr. Bernstein has regularly appeared in notable media programs and publications over the years. Some highlights include: The Oprah Winfrey Show, The Dr. Oz Show, The Today Show, Good Morning America, CBS News, The Early Show, Fox News, National Public Radio, NY1, New York Times, Men’s Health Magazine, GQ Magazine, Telemundo, “O” the Oprah Magazine, and more. He is co-author of Hair Loss & Replacement for Dummies.

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Dr. Bernstein Featured With "First Of Its Kind" Robotic Hair Transplant System On NY1
Dr. Bernstein with ARTAS System for Robotic FUE

Dr. Bernstein not only pioneers hair transplant procedures, but hair restoration technology as well. The NY1 television station, based in New York City, visited Bernstein Medical to see a demonstration and talk about the newest tool in the hair restoration toolkit, the ARTAS Robot for Hair Restoration.

The NY1 piece shows the robotic FUE system in action at Bernstein Medical, with views of the robotic arm, the image-guided system, the punch tool, and the user interface.

The segment also reports that Dr. Bernstein is among the first hair transplant physicians to use the technology:

Removing those units has always proved to be the toughest part of this method, but the robot changes that, which is why even Dr. Robert Bernstein — the man who’s widely credited with developing follicular unit transplantation and follicular unit extraction — jumped to be among the first in the U.S. to use the device.

Dr. Bernstein speaks to one of the main benefits of the robot, the increased efficiency in extracting follicular unit grafts.

NY1 serves 2.1 million people in the tri-state area, including all five boroughs — Manhattan, Brooklyn, Queens, Staten Island, and The Bronx –– parts of Westchester and Hudson Valley, as well as cities and towns in Bergen County and Hudson County in New Jersey.

Read more about Robotic Hair Transplantation

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Departures - The State of Plastic Surgery 2012The January/February issue of Departures Magazine contains a feature called “The State of Plastic Surgery 2012”. The magazine covers topics such as how to find the best plastic surgeon, the use of cells in plastic surgery and the best hair loss therapies. The section on hair loss offers a timeline of the major advances in the treatment of hair loss since its inception over 75 years ago.

Here is the list of the milestones presented in the article:

1939: Japanese doctor Shoji Okuda is the first to publish the results of clinical hair-transplant experiments.
1952: Dermatologist Norman Orentreich, M.D., uses four-millimeter punches to perform the first hair transplants, popularizing “hair plugs” to treat male-pattern baldness. Each plug of some 20 hairs is taken from a “donor site” on the scalp (usually toward the back, where there’s adequate growth). They are bulky and, more often than not, the results look like a poorly hoed garden.
1984: Mini-grafting — the use of grafts containing up to six hairs — is introduced.
Late ’80s: Mini-micrografting, the combination of mini-grafts and smaller micro-grafts containing one or two hairs, becomes popular as a more natural alternative.
1995: New York dermatologist Robert M. Bernstein, M.D., and New Hair Institute founder William Rassman, M.D., develop Follicular Unit Transplantation (FUT), which uses a special microscope to identify individual units of one to four hairs, plus nerves, blood vessels and a tiny muscle called the erector pilorum (the same muscle that makes a cat’s hairs stand on end). Transplanting these intact units ensures their maximum survival and a much more natural look.
2002: Dr. Bernstein and Dr. Rassman offer even more refinement with Follicular Unit Extraction (FUE). With FUT, the donor hair is harvested in a single strip, leaving a linear incision; with FUE, the hair is harvested with a tiny punch that leaves lots of tiny circular incisions-a noticeable advantage for patients who want to wear their hair short. The disadvantage is that FUE requires a much larger donor site, and the results may not all be permanent.
2007: The FDA clears low-level lasers, which promise that the absorbed light will stimulate cell metabolism and protein synthesis to regrow hair.
2008: Latisse, a prescription treatment to grow thicker and longer eyelashes, is cleared by the FDA. Now Allergan, the company behind Latisse, is doing a clinical study about a new formulation of bimatoprost (the active ingredient in Latisse) for male-pattern baldness and moderate female-pattern hair loss. The world waits with bated breath.

Read more about the history, milestones, and innovations in the modern hair transplant techniques that Dr. Bernstein pioneered

Reference
“Personal Best: The State of Plastic Surgery” Departures Magazine, Jan/Feb 2012

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Dr. Bernstein is quoted extensively in an article on robotic hair transplantation in the online magazine American Health & Beauty.

ARTAS Robotic FUE Imaging System
ARTAS Robotic FUE Imaging System
Click for larger version

In “ARTAS: A Faster and More Accurate Hair Transplant Using Robotics?” Dr. Bernstein explains the benefits of robotic FUE over traditional FUE hair transplant procedures. He describes how the new robotic device overcomes some important limitations of FUE when performed manually. To better understand the role of the new instrument, Dr. Bernstein simplifies the FUE procedure into four basic steps and discusses where the image-guided robotic system fits into this process.

Dr. Bernstein explains how the new technology enables the robotic device to preserve follicular units and minimize damage to grafts though its image-guided system.

“ARTAS allows us to do the FUE procedure with much less damage to the graft which means much healthier grafts. Grafted follicles extracted by ARTAS are not cut, which has been a problem with FUE, but the grafted follicular units are actually chunkier with more protective tissue around them, resulting in a better graft survival with the robotic FUE vs. doing FUE manually,” says Dr. Bernstein.

Follicular Unit Grafts Removed by ARTAS Robotic System

Follicular Unit Grafts Removed by
ARTAS Robotic System

Click for larger version

In addition to extracting grafts that have a higher chance of surviving the extraction and transplantation process, the article discusses the increased speed and accuracy of the automated procedure, as well as the safety mechanisms built into the robotic unit.

Always with an eye towards the future of hair transplantation, Dr. Bernstein predicts what he sees as an inevitable rise in the use of robotics in the field:

“I imagine that within a relatively short time, everybody will be offering the robot-assisted device when considering FUE procedures, because it’s just a better way of doing it: more accurate, quicker extraction and healthier grafts.”

The ARTAS System, developed by the California-based Restoration Robotics, Inc., will be available for FUE hair transplant procedures at Bernstein Medical – Center for Hair Restoration in November 2011.

Read the full version of the article.

You can read much more about the ARTAS System for FUE or Robotic FUE hair transplantation.

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Dr. 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.

NY Magazine - Best Doctors - 2011

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

Dr. Bernstein, a Clinical Professor of Dermatology at Columbia University in New York, said that he is honored to be recognized again for the Best Doctors issue. He 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.”

The New York Magazine Best Doctors issue is an annual compilation of physicians that is based on a peer-review survey conducted by Castle Connolly Medical Ltd., a research company that publishes Top Doctors: New York Metro Area. Each year, medical professionals in the New York metropolitan area nominate their choice of the best doctors in a field. The physicians make their recommendations based on several criteria including: professional qualifications, reputation, skill in diagnosis, and skill in providing treatment for patients.

Dr. Bernstein, a New York native, is a true innovator in the field of hair restoration. His medical publications on follicular unit transplantation (FUT) and follicular unit extraction (FUE) have revolutionized hair transplantation and provide the foundation for techniques in use by hair transplant surgeons across five continents. His medical practice has been solely devoted to the treatment of hair loss since 1995 and he has provided hair loss treatments and hair restoration surgery at his state-of-the-art hair restoration facility in New York City since 2005. The Bernstein Medical – Center for Hair Restoration, located in midtown Manhattan, is dedicated to the diagnosis and treatment of hair loss in men and women and specializes in both restorative and corrective hair transplants.

Dr. Bernstein has appeared on a wide variety of notable media programs and publications. Some of these include: The Oprah Winfrey Show, The Dr. Oz Show, The Today Show, Good Morning America, ABC News, CBS News, Fox News, National Public Radio, New York Times, Men’s Health Magazine, GQ Magazine, Univision, Telemundo, “O” the Oprah Magazine, and more. He is co-author of Hair Loss & Replacement for Dummies and The Patient’s Guide to Hair Restoration.

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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.

View our page on the Pros & Cons of FUE hair transplantation

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Dr. 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.

Best Doctors 2010 - NY MagazineNew 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.

Dr. Bernstein, a Clinical Professor of Dermatology at Columbia University in New York, said he was honored to be chosen by his peers for the magazine’s special annual issue. He said, “It is a privilege to be involved in the care of treating patients struggling with hair loss and an honor to be recognized by my peers for contributions that I have made to the rapidly evolving field of surgical hair restoration.”

Dr. Bernstein has performed hair transplant surgery at his state-of-the-art Center for Hair Restoration in New York City since 1995. The practice is solely devoted to the diagnosis and treatment of hair loss in men and women and specializes in both restorative and corrective hair transplants.

The list of physicians in the Best Doctors issue is based on an annual peer-review survey conducted by Castle Connolly Medical Ltd., a research company that publishes Top Doctors: New York Metro Area. Each year, Castle Connolly distributes 12,000 nomination forms to medical professionals in New York metropolitan area. These medical industry peers are asked to nominate their choice of best doctors in a particular field and to take into account not only professional qualifications and reputation, but also skill in diagnosing and treating patients.

Dr. Bernstein has appeared on such notable programs and channels as The Oprah Winfrey Show, The Dr. Oz Show, The Howard Stern Show, The Today Show, Good Morning America, ABC News, Fox News, Discovery Channel, and National Public Radio. He also appeared in New York Magazine’s special issue Best Beauty Docs in New York, where he was included for his pioneering work in Follicular Unit Transplantation and Follicular Unit Extraction. He is co-author of Hair Loss & Replacement for Dummies: The Patient’s Guide to Hair Restoration, and numerous medical publications.

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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.

With very low donor hair density the strip will yield so little hair that further sessions eventually become impractical. To say it another way, since a hair transplant decreases the donor density, in each succeeding hair transplant session, you need an increasingly larger donor strip to remove the same number of grafts.

This effect also explains why, in most instances, FUE will not allow the doctor to obtain any significant amount of additional hair, since the donor area is already too thin, and FUE would thin it further.

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Howard Stern ShowDr. Bernstein was interviewed on the Howard Stern Show for a Howard 100 News Brief about hair transplantation.

George Takei — originally of Star Trek fame and currently an announcer for the show — had recently described his ‘pluggy’ transplant from 1980s in an interview on the show.

Stream the clip below (2 mins, 19 seconds):

Stream the clip from the Howard Stern Show

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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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Q: Dr. Bernstein, I think that you have established a great monument in the history of hair transplantation. Especially, your historical works about Follicular Unit Transplantation, which you published about 15 years ago, have contributed greatly to the spread of modern hair transplant technique in the whole world.

In the past days, there might have been many physicians who did not care much about the importance of the follicular unit and they have only cut the grafts to size. Now, every hair transplant physician believes the importance of follicular unit, and there is no one who cut the grafts to size ignoring each follicular unit.

However, there are some physicians who shout that a hair transplant procedure can be called FUT only when people use all single FU exclusively, and the procedure cannot be called FUT, if mixture of single FU and double FU are used in a session.

I would like to ask you, if you could accept the usage of combination of single FU and double FU under the name of FUT, as long as the grafts were cut according to each FU and intact FU are used throughout the procedure. Could you accept easing of the very strict definition of FUT, which you published about 15 years ago? Could you agree to use mixture of single FU and double FU under the name of FUT? — N.W., Huntington, N.Y.

A: Thank you for the kind words. In thinking about hair transplantation in general, it is important to consider that a hair restoration procedure spreads hair around and, as a result, the transplanted hair will be less dense than the person’s original hair. Therefore, one would never want grafts larger than the largest original follicular units or the results will not look natural. The artificially large grafts will stand out in relatively thin surroundings. If one were to try to fix this by transplanting the doubled FUs very close together (over one or more sessions) one risks running out of grafts for other areas of the scalp. In other words, you can’t fool mother nature.

For example, if a person has thin hair and has only 1-, 2- and 3-hair units occurring naturally in his scalp, then creating 4-hair grafts (by combining two 2’s or 1’s and 3’s) can result in an unnatural, tufted look. Doubling larger follicular units also necessitates larger wounds to receive the grafts which defeats one of the main advantages of FUT, namely to minimize recipient wounding.

That said, it is not unreasonable to place two 1-hair FUs in a single site (if there are extra 1s from the FU dissection) in order to increase density in an area and to eliminate an extra wound.) We do this for crown hair transplants when we are not doing a hairline and there is no need for 1-hair grafts. However, this is the exception.

Technically speaking, anything other than transplanting individual, naturally occurring follicular units is not FUT. However, a physician should make modifications to the procedure for the specific needs at hand. This is the art of medicine. By understanding and applying the underlying principles of Follicular Unit Transplantation, rather than being limited by its nomenclature, the physician will serve his patient best.

In addition to exploring Hair Restoration Answers to learn more about this topic, visit the Follicular Unit Transplant (FUT) section of our website and read detailed information about the hair transplant evaluation, the hair restoration procedure, follicular unit grafts, the donor area, and more.

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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.

With FUE it is important to sort out the grafts under a microscope, to make sure that all of the grafts placed at the hairline are 1-hair grafts and that the larger grafts are place behind the hairline. They should not be planted without first being sorted under a microscope.

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Q: It’s a question that greatly concerns me because I’m investigating getting a transplant sometime next year. I’m 28 and thought I started balding at 26, but photographic evidence suggests it had started somewhere around age 24. I’m roughly a Class 2 now, and thanks to finasteride, I’ve stayed almost exactly where I was at 26 with some improvement (not really cosmetically significant though). However, I am convinced I have some crown and top of the scalp thinning too, but not to a visible degree.

These people getting these miraculous jobs from Canada – it is a trick, right? They can’t honestly expect to be able to get away with what they’ve done over the course of their entire lives, can they? — L.M., Great Falls, V.A.

A: I think you have better insights into hair loss than many hair transplant surgeons. Patient ABI was the “rare” patient who seems to be a stable Class 3. I made that judgment due to: almost no miniaturization at the border of his Class 3 recession, no crown miniaturization, and his unusual family history. He had several older family members who stayed at Class 3 their whole lives.

Since we only have about 6,000 movable follicular units on average in our donor area, placing 3,000 at the hairline is obviously a joke and/or the doctor is playing “Russian Roulette” with the patient’s future.

As you point out, in most patients the hair loss will progress and the person will be out of luck. It is similar to the way flap patients were stuck without additional donor hair as their hair loss progressed. An additional problem was that the flaps were low on the forehead and very dense. The situation is analogous to placing 100 grafts per sq cm2 to create a low, broad hairline in a young person.

If you do the math you can see how ridiculous this tactic is. A person’s original density is only 90-100 follicular units cm2. Patient with Class 6 hair loss lose hair over an area of about 300 cm2.

This consists of:

  • 50cm2 in the front (including a 15cm2 hairline)
  • 150 cm2 for the mid-scalp
  • 100 cm2 for the crown

Therefore, 6000 FUs transplanted to this area = 6000/300 = 20 FU per cm2. This is the number we often work with. We put up to 50cm2 at the very most in the mid-frontal forelock area and then proportionately less in other areas.

However, if you put 3,000 FUs at the hairline, in a density of 100/cm2, then you have covered only 30cm. This leaves only 3,000 FUs for the remaining 270cm2 of balding scalp for a density of a little over 11 FU/cm2.

Now, transplanting 11FU cm2 over the back part of the scalp is not a disaster EXCEPT if the front was transplanted at 100 per cm2. In this situation (as you have accurately pointed out) the patient will look very, very front heavy, with an aggressively placed, dense, broad, hairline and little hair to support it towards the back.

The gamble is that the patient’s baldness doesn’t progress, that finasteride or dutasteride can halt the process if it does progress, or that hair cloning methods will be available to save the day.

In my opinion, elective surgery should not be performed when its success depends upon these uncertainties – and particularly since a cosmetically disfiguring hair transplant can be so debilitating (and avoidable).

The reality is that doctors who claim to perform these procedures may not even be performing follicular unit transplantation. In FUT, the surgeon transplants naturally occurring intact FUs of 1-4 hairs. The extreme dense packing techniques preclude the use of 4- and sometimes even 3-hair grafts. What happens is that the larger FU are spit up. This doubles the graft counts (and the cost to the patient) without giving the patient any more hair. It also increases the risk of follicular damage and poor growth.

Patients in whom 10,000 follicular units are available to transplant are very rare and when they are shown on the internet, should be viewed as the exception rather than the rule.

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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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Fox NewsDr. 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.

Watch a 1-minute video clip of the program:

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Q: When can I wash my hair after a hair restoration procedure?

A: If a follicular unit hair transplant is performed so that there is a “snug fit” between the graft and the incision into which it is placed, the grafts are reasonably secure the day after the procedure.

At this time, gently washing your scalp with lightly flowing water and a patting (rather than rubbing) motion is permitted. Vigorous rubbing, however, will dislodge the grafts.

Over the course of the week the grafts become more secure, and at 10 days post-op they are permanent. At this time, normal scrubbing of the scalp is permitted.

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Q: I just started to lose my hair but it’s just in one spot, like a circle on the left side of my head. Do you ever do a hair transplant just into a bald spot and not the whole head? — D.F., Esher, U.K.

A: It is possible to have a hair restoration procedure into a single bald spot. However, it would be most beneficial to first determine the cause of the condition.

Bald spots caused by alopecia areata (an autoimmune disease) are best treated with injections of steroids into the scalp, rather than with a hair transplant. In fact, the transplanted hair can be rejected in patients with this condition.

Traumatic scars (i.e. from an accident) can be treated with follicular unit hair transplantation as the hair grows quite well in scar tissue, as long as the scar is not thickened (hypertrophic).

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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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Dr. Bernstein, pioneer of Follicular Unit Hair Transplantation, was a featured guest on The Oprah Winfrey Show. In addition to discussing his hair transplant technique, Dr. Bernstein showed Oprah and Dr. Mehmet Oz the results of a hair transplant on one of his patients. They also showed a video montage of Dr. Bernstein performing a hair restoration procedure.

Please read the full Bernstein Medical – Center for Hair Restoration press release below:

New York, NY (PRWEB) October 7, 2008 – The Oprah Winfrey Show features Dr. Bernstein discussing his pioneering follicular unit hair transplant procedure, focusing on the newest diagnostic and treatment techniques for hair restoration. The Oprah Winfrey Show aired Tuesday, October 7th at 4:00PM EST on ABC.

Dr. Bernstein is a Clinical Professor of Dermatology at the College of Physicians and Surgeons of Columbia University in New York. He is recognized world-wide for his pioneering work in the treatment of hair loss. Dr. Bernstein is known for developing the revolutionary Follicular Unit Transplantation procedure for hair restoration.

Dr. Bernstein with Dr. Oz and a Patient on the Oprah Winfrey ShowDr. Bernstein with Dr. Oz and a Patient on the Oprah Winfrey Show

After introducing Dr. Bernstein to Oprah, Dr. Mehmet Oz (health expert on The Oprah Winfrey Show) presents video footage of Dr. Bernstein performing a hair transplant and then invites the patient live onstage to be inspected by Oprah. In addition to engaging with the audience about baldness and hair transplant procedures, Dr. Bernstein examines a person from the audience who is experiencing early hair loss using an instrument known as a densitometer.

The densitometer is a self-contained, portable, device that houses a magnifying lens for viewing hairs close to the scalp. The idea behind densitometry is to determine the degree of miniaturization, or shrinking of the hair’s diameter, which contributes to hair loss. This information is used to evaluate whether the patient is a good candidate for hair transplant or medical treatment, as well as to predict future hair loss.

“Follicular Unit Transplantation is a procedure where hair is transplanted exclusively in its naturally occurring groups of 1-4 hairs. It is the logical end point of over 30 years of evolution in hair transplantation surgery,” explained Dr. Bernstein. “However, this by no means implies our work is complete. We are obsessed with making the procedure as perfect as possible.”

View the original press release at PRWeb.

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Q: I had a follicular unit hair transplant performed by another doctor that was scheduled for 2,500 grafts and I ended up paying for exactly that amount. I was supposed to be paying per graft, so it seems strange that it came out to be exactly 2,500? How do I know what I really got? — J.R., Westport, C.T.

A: This is a question that should be addressed to the doctor that operated on you.

If a doctor is charging by the graft, then you should know exactly how many grafts you are receiving. It is possible that he/she hit the number (2500) exactly on the head, but statistically that is extremely unlikely. In a Follicular Unit Hair Transplant (FUT) procedure, a strip is removed from the donor area and then dissected into individual follicular units, so although an experienced surgeon can remove a strip that contains close to the desired number of follicular units, it would be very rare to hit that number precisely.

More importantly, it is impossible to perform follicular unit transplantation properly without knowing both the exact number of follicular units harvested from the donor area and the exact number of hairs in each unit (i.e. the number of 1-, 2-, 3-, and 4-hair follicular unit grafts). This information is essential in determining both the distribution and density of the hair transplant and in creating transitional zones such as the frontal hairline, where single-hair follicular units are required.

In all hair transplants, the number of grafts harvested should equal the number of recipient sites, so the doctor must know the exact number of grafts so that he can make the appropriate number of recipient sites. An exception to this rule is the stick and place technique, where each graft is inserted as soon as the site is made, but this technique is much less common than first making the recipient sites. The surgeon also needs to know the number of grafts so that he can make the sites in the appropriate distribution. For example, if the number of grafts harvested was less than anticipated, the doctor can space the sites further apart, cover less of an area (for example, not extend the restoration as far back into the crown) or harvest additional donor tissue – each option having advantages and disadvantages.

It is equally important to know the exact composition of follicular units, so that different densities can be created in different areas, producing the most natural appearance. For example, the 3- and 4- hair follicular units should be placed in the central forelock area as this area normally has the most density. On the other hand, if these larger units are placed near the hairline, they will look distinctly unnatural.

So how can the patient really know? Obviously, trust in your doctor is the most important insurance. If you are skeptical about the way the doctor conducted the consult (i.e. used a salesman to encourage a sale), if he or she skipped over important options such as medication, or if you felt pressured or rushed into making a decision to have surgery; you should be skeptical about other aspects of your care as well – such as an accurate graft count.

Although just a very general guide, here are some things you can do at your consult when trying to decide if a doctor can be trusted to give you accurate information regarding the number of grafts you receive.

  1. Ask to see the operating room – see if there are plenty of microscopes (the larger the session, the more are needed).
  2. Ask the doctor how he keeps count of the grafts that are dissected and how does he record how many hairs in each follicular unit graft.
  3. Ask the doctor how he keeps track of the number of recipient sites that are made.
  4. Ask to see how all this information is documented in the patient’s medical record.
  5. Ask the doctor if he refunds money to the patient if he transplants less grafts than scheduled.
  6. Speak with other staff members to confirm the use of dissecting microscopes for the entire surgery and confirm the procedure for tracking grafts.

In sum, knowing the exact number of grafts and their composition is extremely important, not only to ensure that you are being charged fairly, but in maximizing the aesthetic results of your follicular unit transplant procedure.

Be certain that this information will be available to you (and of course your surgeon) before scheduling a procedure.

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Q: I am female and thinning can I be a candidate for a Follicular Unit Hair Transplant?

A: If it turns out that you have female pattern hair loss, you may be a candidate a hair transplant, but would need to be evaluated by a doctor who specializes in surgical hair restoration.

In the evaluation, you should have your degree of hair loss assessed and donor supply measured, using an instrument called a densitometer, to be certain that you have enough permanent donor hair to meet your desired goals. For more information about hair loss in women, please see the Diagnosis of Hair Loss in Women page of the Bernstein Medical – Center for Hair Restoration website.

If you are thinking about your hair loss and would like to be evaluated, go to the physician consult page to schedule a consultation.

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Q: I am a 33 year old women and am just starting to thin on the top of my scalp behind my frontal hairline. What should I do? Should I have a hair transplant?

A: There are a number of things that you should consider that can be effective in early hair loss. These include minoxidil (Rogaine), laser therapy, and using cosmetics specifically made to make the hair appear fuller. Lightening or streaking the hair, as well as parting the hair off to the side, will also make the hair appear fuller.

If a surgical hair restoration is performed too early and there is still a lot of existing hair in the area, the hair transplant may actually accelerate hair loss. Surgery should not be performed prematurely.

Also, it is important that the doctor check the stability of the donor area, using densitometry, to make sure that the procedure is even possible. For those women who are good candidates, and if it is done at the appropriate time, a follicular unit hair transplant is a great procedure that can produce really natural results.

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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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