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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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Robert M. Bernstein, M.D., F.A.A.D., Renowned Hair Transplant Surgeon and Founder of Bernstein Medical – Center for Hair Restoration in New York, is Studying Four Applications of ACell MatriStem™ Extracellular Matrix in a Type of Hair Cloning, Called Hair Multiplication, as well as in Current Hair Restoration Procedures.

New York, NY (PRWEB) March 15, 2011 – Robert M. Bernstein, M.D., F.A.A.D., Clinical Professor of Dermatology at Columbia University in New York and founder of Bernstein Medical – Center for Hair Restoration, has been granted approval by the Western Institutional Review Board (WIRB) to study four different applications of the ACell MatriStem extracellular matrix (ECM) in hair restoration.

Hair Cloning with ACell MatriStemHair Cloningwith ACell MatriStem

Two of the studies include its use in a type of hair cloning, called hair multiplication, where plucked hairs and transected follicular units are induced to generate new hair-producing follicles. The other two areas of study include evaluating the use of the ECM in current hair transplant procedures to enhance hair growth and facilitate wound healing.

Approval by the WIRB allows the researchers to conduct double-blinded, bilateral controlled studies. Controlled studies are the best way to increase the objectivity of the research and insure the validity of the results.

“The medical research we are performing is important because it may lead to hair multiplication as a way to increase a person’s supply of donor hair. In this way, patients would no longer be limited in the amount of hair which can be used in a hair restoration procedure,” said Dr. Bernstein. “Additionally, in the near-term, the extracellular matrix may be able to improve the cosmetic benefit of current hair transplant procedures. We are simultaneously pushing the boundaries of hair cloning methods and follicular unit transplantation.”

Hair multiplication, a variation of what is popularly known as hair cloning, is a procedure where partial hair follicles are stimulated to form whole follicles. These parts can either be from hairs derived from plucking or from follicles which have been purposely cut into sections. Generally, damaged follicular units will stop growing hairs. However, there is anecdotal evidence that an extracellular matrix applied to partial follicles may stimulate whole follicles to grow and, when applied to wounds, may stimulate the body’s cells to heal the damaged tissue.

This new medical research also attempts to show that ACell can improve the healing of wounds created when follicular units are harvested for hair transplant surgery. Currently, in follicular unit hair transplant procedures, a linear scar results when a surgeon incises the patient’s scalp to harvest follicular units. Occasionally, this scar can be stretched, resulting in a less-than favorable cosmetic result. If ECM can induce the wound to heal more completely, the linear scar may be improved. The extracellular matrix may also benefit general hair growth in hair transplantation in that the sites where hair is transplanted, called recipient sites, can be primed with ECM to encourage healthy growth of the hair follicle.

Dr. Bernstein is known world-wide for pioneering the hair restoration procedures of follicular unit transplantation (FUT) and follicular unit extraction (FUE). Follicular units are the naturally-occurring groups of one to four hair follicles which make up scalp hair. These tiny structures are the components which are transplanted in follicular unit hair transplants.

While hair cloning has been of great interest to hair restoration physicians and sufferers of common genetic hair loss, the method by which this can be achieved has yet to be determined. The use of ACell’s extracellular matrix to generate follicles is a promising development in achieving this elusive goal. In addition to the longer term implications of using ECM in hair multiplication, its impact on hair restoration will be more immediate if it can be proven effective when used in current FUT procedures.

About Dr. Robert M. Bernstein:

Dr. Bernstein is a certified dermatologist and pioneer in the field of hair transplant surgery. His landmark medical publications have revolutionized hair transplantation and provide the foundation for techniques used by hair transplant surgeons across five continents. He is respected for his honest and ethical assessment of a patient’s treatment options, exceptional surgical skills, and keen aesthetic sense in hair transplantation. In addition to his many medical publications, Dr. Bernstein has appeared as a hair loss or 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; and he has been interviewed for articles in GQ Magazine, Men’s Health, 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 transplant surgery are performed using the follicular unit transplant (FUT) and follicular unit extraction (FUE) surgical hair restoration techniques.

Contact Bernstein Medical – Center for Hair Restoration:

If you are a journalist and would like to discuss this press release, please email us or call us today (212-826-2400) to schedule an appointment to speak with Dr. Bernstein.

View the press release at PRWeb.

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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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New York Times - Hair TransplantThe New York Times interviewed Dr. Bernstein for a full-length article on hair loss and hair transplant options for women interested in hair restoration. The article – titled, “Tricks and Transplants for Women’s Hair Loss” – covered modern hair transplantation techniques, hair transplant costs, camouflage techniques, and more.

Read below for some excerpts of the article:

Exploring Your Options:

Hairstylists, impressed with how realistic the “new” transplanted hair looks, recommend doctors to clients who are tired of hiding their hair loss with layers or high- and lowlights. “I’ve seen bad jobs,” said Seiji Kitazato, the creative director at Frédéric Fekkai on Fifth Avenue, who refers clients to a few surgeons. “But now you can’t even tell.”

Still, not every woman of the millions who suffer from hair loss is a candidate. Underlying conditions, including anemia and thyroid problems, that are temporary, treatable or affect the scalp rather than the hair, must be dealt with before a transplant can be considered. If a transplant is ruled out, sufferers must rely on wigs, hairpieces or styling tricks.

What’s more, “most medications can cause hair loss, some more frequently than others,” said Dr. Robert M. Bernstein, a clinical professor of dermatology at Columbia University who has a restoration center in Manhattan.

A transplant is an option only for a woman who has a thick enough area of hair from the back and sides to “donate” to a more paltry part of her scalp. But many women don’t experience this kind of localized balding; instead their entire head of hair thins out during menopause or as they age.

Buyer Beware:

So the incentive to treat any and all comers is high. “It’s a big problem,” Dr. Bernstein said. “You shouldn’t go to someone who will give a transplant to anyone who walks in the door.” If your condition is not properly assessed, you could permanently shed more hair after surgery than you gained, he warned, or if the hair transplanted wasn’t stable, “it would disappear.”

Before Hair Transplant Surgery:

If you’re suffering hair loss, see a dermatologist first, not hair transplant surgeons, said Dr. Robert M. Bernstein, a dermatologist in Manhattan who specializes in hair restoration. After determining a cause, dermatologists can offer advice about options from the medical to the surgical. Many women with hair loss try Women’s Rogaine, a solution with 2 percent minoxidil that is applied to the scalp, twice daily. Others prefer Rogaine’s foam for men, because it has 5 percent minodixil, dries quickly and feels less greasy. (But even the women’s formulation warns to discontinue use if facial-hair growth occurs.)

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Q: What’s the best way to camouflage a scar left behind from a scalp reduction that I had in 2001? I am currently wearing DermMatch to cover the area, but the hair parts like the “Red Sea” on top around the scar so the makeup does not look so good. I would like to fill in the area with hair but I am not sure if a hair transplant will grow into scar tissue.

A: Hair will grow in the scar but, as you allude to, the problem is often the abnormal hair direction rather than the scar itself.

Besides adding hair to the scar, if one transplants hair adjacent to the scar in a direction that causes it to lie over the scarred area, the visual affect of the “Red Sea” effect can be lessened.

How much improvement you achieve with the hair restoration will, in part, depend upon the amount of hair available to be transplanted (and the skill of the surgeon).

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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: Should I cut my hair prior to the hair transplant? — R.R., Poughkeepsie, N.Y.

A: It is easier for the hair transplant surgeon and his team to work when the existing hair in the area to be transplanted is cut short, but a skilled surgeon can work well in either situation. Most experienced surgeons are used to working without cutting the hair in the recipient area, since so few patients want their hair to be cut – particularly in New York.

The main advantage of having a closely clipped scalp is that one has better visibility and therefore the procedure moves along faster. This has little bearing in moderately sized sessions, but becomes very important in sessions over 2,400 grafts, when working through existing hair can make the duration of the procedure excessively long. Of course, the disadvantage of clipping the hair is that it is more difficult to “hide” the procedure.

I prefer for the patient to arrive the morning of the scheduled hair restoration with his/her hair having some length so that I can better see the demarcation of the area of thinning. Once the area is marked, the hair can be clipped to the appropriate length in the operating room. Although the hair transplant will be more visible post-op if the hair is clipped short, it is much easier for the scalp to be kept free of crusts.

It is important to differentiate between a closely clipped scalp, which is an advantage, and a shaved head, which makes performing the hair transplant more difficult. When there is some existing hair, the distribution and angle of the original hair is easy to discern and this allows the new grafts to be placed in a direction that follows the existing hair and in a distribution that complements that hair.

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PRESS RELEASE

World renown hair transplant surgeon introduces a new surgical tool that improves the way hair transplantation can be performed.

New York, NY March 21, 2006

Follicular Unit Extraction (FUE) InstrumentIn a new article appearing on the cover of Hair Transplant Forum International, the official publication of The International Society of Hair Transplant Surgeons (ISHRS), pioneering hair transplant surgeon Robert M. Bernstein MD, along with his colleague Dr. William R. Rassman, recently revealed details about a “New Instrumentation for Three-Step Follicular Unit Extraction.”

Dr. Bernstein is known throughout the world of medicine as author of the landmark publication; “Follicular Transplantation” which described a new hair replacement transplant technique in which he was able to transplant hair exactly as it grows – in naturally occurring groups called follicular units. That paper, together with two dozen other major publications, has revolutionized the way hair transplants are now performed – moving away from “doll’s hair” like plugs and into the realm of natural, undetectable hair patterns.

Follicular Unit Extraction (FUE) is a further refinement of this technique where follicular units are literally removed, one-by-one, directly from the scalp. In the traditional procedure, a strip of tissue is removed from the back of the head and placed under a microscope in order to remove the follicles.

The latest FUE instrument design is based upon Dr. J. A. Harris’ concept of using a blunt tool to prevent damage to hair follicles during extraction. The new device improves on the old method by re-conceiving the shape of the tool’s edge in order to minimize injury to hair follicles. “Our new instrument is made in the shape of a cylindrical tube with a bull-nosed edge. This allows us to capture the entire follicular unit (naturally groups of 1-4 hairs) without damage to the hair bulbs.” We also found that the incidence of buried grafts decreased significantly with the new instrument from about 9% to 1.8% with this new device” said Dr. Bernstein from his Center for Hair Restoration in New York.

In a recent study conducted by Leever Research Services, it is estimated that over 360,000 patients sought help from doctors for their hair loss last year. With ground-breaking work by surgeons like Robert M. Bernstein M.D., the impressive aesthetic results from new hair transplantation techniques are helping men and women who suffer from baldness to get a renewed outlook on their lives.

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PRESS RELEASE

Dr. Bernstein - Presenting on Hair Transplantation in Sydney, AustraliaSome of the world’s most renown hair transplant surgeons gathered this month to hear about the latest cutting edge methods in surgical hair restoration. Speakers included Robert M. Bernstein. M.D. founder of Bernstein Medical – Center for Hair Restoration, New York, NY

The International Society of Hair Restoration Surgery (ISHRS) recently held their 13th annual scientific meeting. A broad range of topics were explored including; the most recent research in cloning, the latest proven medical therapies to prevent hair loss, and the newest concepts in the harvesting of donor hair follicles used for transplanting. The event was capped off with a live hair transplant surgery workshop.

As the largest non-profit voluntary organization comprised of over 650 hair restoration physicians, the ISHRS is the first international society created to promote continuing quality improvement and education for professionals in the field of surgical hair restoration.

The purpose of the annual event is to bring together the world’s best minds in hair restoration surgery for an interchange of ideas, knowledge and experience. The meeting is aimed at enhancing, to the highest possible level, the skills and artistry of the members.

One of this years exciting presentations was given by Robert M. Bernstein M.D., Associate Clinical Professor of Dermatology at the College of Physicians and Surgeons of Columbia University in New York. Dr. Bernstein is recognized world wide for his pioneering work in Follicular Unit Extraction (FUE) and Follicular Unit Transplantation (FUT), considered to be the state-of-the-art in surgical hair restoration techniques.

Dr. Bernstein introduced a new instrument for FUE that enables hair to be removed directly from the back of the scalp without the need for a linear incision. The instrument increases ones ability to remove the hair in its naturally occurring groups with minimal damage. According to Dr. Bernstein, “FUE has been most useful for camouflaging the scars produced by hair transplants performed with older techniques.”

The International Society of Hair Restoration Surgery brought together a lively collection of panels led by doctors who were well-known and highly-respected professionals from the surgical hair restoration industry. Doctors such as Robert M. Bernstein M.D. shared their expertise in order to cover the issues and advances in medical and surgical hair restoration and the latest research developments in the field. The intention being better treatment and treatment options for patients.

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

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

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

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

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Robert M. Bernstein M.D. was asked to provide expert medical commentary in two hair transplant videos produced by Healthology. The topics included “Hair Transplantation Techniques” and “Using Cloning Techniques in Hair Transplantation”.

Healthology, the leading producer of broadcast and webcast programming that provides consumers with direct access to top medical experts, produced an important series of videos on hair loss. As Associate Clinical Professor of Dermatology, Columbia University College of Physicians and Surgeons, Dr. Bernstein was a vital part of the interview series.

Hair Transplantation Techniques

The first video that Dr. Bernstein was invited to take part in, focused on the various techniques used in surgical hair restoration. As a pioneer of Follicular Unit Transplantation, the filmmakers were eager to hear Dr. Bernstein’s thoughts on FUT:

“A major breakthrough in hair restoration came via identification that hair didn’t grow individually, but actually in small groups called follicular units. And these follicular units are naturally occurring groups of hair from one to four” Dr. Bernstein explained, “in modern hair transplantation, a procedure we call Follicular Unit Transplantation is used; we transplant the hair the way it actually grows in nature.”

This Healthology segment explored how the Follicular Unit Transplantation technique is also helping patients who want to improve the appearance of old transplants or scars.

“What we can do now is remove the old grafts, sew the holes closed where they’re transplanted, place those grafts under a microscope, divide them into individual follicular units and then place them back in the scalp the same day.” said Dr. Bernstein.

In addition to covering surgical hair restoration, the segment touched on the issue of medications for hair loss. Though some patients think getting a hair transplant means they can stop taking hair loss medications, Dr Bernstein illustrated why most physicians recommend using medicine along with surgery:

“Hair transplantation and medications do essentially different things. The main benefit of a transplant is to restore hair that’s been lost. The main benefit of medication is to prevent further hair loss.”

Using Cloning Techniques in Hair Transplantation

In this second Healthology video segment, on hair cloning, they invited Dr. Bernstein to take part in the discussion along with other distinguished guests; including Angela Christiano, PhD an Associate Professor of Dermatology and Genetics & Development at Columbia University.

This interesting segment explored how researchers are trying to find ways to make more follicles for hair transplant surgeons to work with. Research into cloning techniques shows it may be possible to create a virtually limitless supply of new follicles in the not too distant future. Dr. Bernstein provided some insights as to how hair restoration doctors might approach hair cloning in the future:

“The actual role of cloning in hair transplantation will depend upon how the cloning technology actually evolves. Initially, cloning may be used to supplement a regular hair transplant. We would use Follicular Unit Transplantation to give definition to a hairline and frame the face. Cloning would then be used to give the hair transplant bulk, by placing the cloned hair (which may not look as natural as normal hair) behind the transplanted hair.”

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Q: Does dense packing hurt grafts? — P.L., Rye, NY

A: There is no absolute answer to this question. In a hair transplant, dense packing of grafts has a risk of decreasing yield if there is a significant amount of photo damage to the scalp (which alters the blood supply) and if there is a tendency for the grafts to pop (this is difficult to predict pre-operatively). Very closely spaced grafts exacerbate the popping and expose the grafts to desiccation (drying), hypoxia (lack of oxygen) and mechanical trauma from the necessary re-insertion.

That said, the skill of the hair transplant surgeon and placing team, the size of the recipient sites, and the way the grafts are dissected and trimmed all play important roles in determining graft survival in dense packing.

Read a thorough analysis of the “pros” and “cons” of large hair transplant sessions
Read answers to more questions on dense packing of grafts

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Dr. Bernstein received the 2001 HairSite.com award for excellence in hair transplantation. Here is the statement they made in giving Dr. Bernstein the annual award:

Dr. Bernstein is one of the most sought after hair transplant surgeons in the United States. He is one of the very few in the industry who is still involved in scientific and clinically related hair restoration research while engaging in hair transplant practice.

Dr. Bernstein is the author of numerous scientific journals related to hair restoration, currently the most widely published author on the subject of Follicular Unit Transplantation. Since HairSite was founded in 1997, we have no received one single email or correspondence from a dissatisfied patient of Dr. Bernstein.

Dr. Bernstein’s passion in hair restoration research has substantially elevated the standards in hair transplant industry over the years. Dr. Bernstein is also named one of the best hair transplant doctors by New York magazine and is the recipient of the 2001 “Platinum Follicle Award” at the International Society of Hair Restoration Surgery 9th Annual Meeting in Puerta Vallarta Mexico.

Dr. Bernstein performs surgical hair restoration at his offices in New York, NY and Fort Lee, NJ.

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Dr. Bernstein was interviewed by Skin & Allergy News in their article, “Microscopic Dissection Offers Superior Yield” The complete article is below:

Skin & Allergy News
February 1999

Skin & Allergy News - Microscopic Dissection Offers Superior Yield

Microscopic Dissection Offers Superior Yield
Articles by Anna Nidecker
Senior Writer

Washington — The dissecting microscope takes some getting used to, but using it makes more efficient use of donor hair during follicular unit transplantation than magnifying loupes with transillumination, reported Dr. Robert Bernstein of Columbia University Microscopic Dissection of follicular unitsCollege of Physicians and Surgeons, New York.

“A limiting factor in all hair restoration surgery is the patient’s finite donor supply. […] Meticulous stereomicroscopic dissection should help preserve the supply and ultimately provide the patient with the most transplantable hair,” he said at the annual meeting of the International Society of Hair Restoration Surgery.

Dr. Bernstein compared the follicular unit graft yields of dissections performed with stereoscopic microscopes and with loupes and backlighting. Initial sectioning of the intact strip was done with loupes, as the staff had not yet mastered the skill of slivering that is needed to section the intact strip under microscopic guidance.

“This method may be useful for a team in transition, a model for staffs in transition to using the microscope,” the hair transplant surgeon suggested.

Tips on Transition to Microscopes

The microscope offers a better yield with follicular transplantation, but some doctors feel that abruptly switching from loupe magnification may send an office into turmoil.

Microscopes will be well received by staff if they clearly understand the benefits and are eased into the transition, Dr. Bernstein said.

Dr. David Seager advised physicians planning the transition to the use of microscopes to let staff observe microscopic dissection at another clinic with an established program, and to send them somewhere to be trained before they start. The Toronto hair transplant surgeon also advised buying a couple of microscopes and letting the staff “play” with them for a while, cutting at their own leisurely rate before entering into a high-pressure transplant session.

Dr. Bernstein also recommended easing slowly into the transition by first training a small portion of staff, which will not affect the overall time of surgery.

Another option is to hire a couple of new technicians and train them from the beginning with microscopic dissection, Dr. Seager suggested.

“You’ll be amazed at the beautiful grafts they will be cutting in a couple of weeks. […] It may be only 40 grafts an hour, but these newcomers will be cut­ting better grafts than even your 8-year veterans,” he said. “Old staff will look at these new technicians and their grafts, and, if they take pride in their work, they will be quite jealous and will be re­ally eager to catch up.”

Dr. Bernstein agreed: “The value of the microscope may be more significant in the hands of less experienced dissectors. […] There’s some advantage even at the outset.”

Continued resistance from staff should be met with a deadline: ‘Anyone who can’t or won’t fit in, tell them they can do something else in the office, but they won’t be doing transplanting,” Dr. Seager said.

In 41 patients, the donor strip was harvested with a double-bladed knife from the midportion of the permanent zone in the back of the scalp.

The strip was divided into two equal parts along the midline; these were further divided into 2- to 3-mm wide vertical sections using loupes and a straight razor. Sections from one of these donor strip halves were further dissected into follicular units using a 10x power microscope; sections from the other donor strip half were dissected using magnifying loupes.

Follicular units cut using the microscope contained an average of 2.41 hairs; those cut using loupe magnification yielded 2.28 hairs. Use of the microscope also yielded 10% more follicular units and 17% more hair overall, compared with use of loupes.

The grafts were dissected and sorted into follicular units containing one to four hairs, and all hair and hair fragments judged to be potentially viable were counted towards the yield (Dermatol. Surg. 24[8]:875-80, 1998).

Microscopic dissection took from two to four times as long as loupe magnified dissection when technicians first began using the microscopes. After 3 months, the procedure still took twice as long with the microscopes. But by the end of the study 1 year later, it took only 10% longer, a rate they currently maintain, Dr. Bernstein said.

Hand-eye coordination was a factor which automatically improved, and the inefficient movement of grafts in and out of the microscopic field was solved with better organization, he said. Technicians with a tendency to obsessively sculpt grafts under the microscope can be educated to limit this sculpting, which does not affect the quality of the transplant.

Use of the microscope also led to fewer reports of back and neck strain by assistants. They also reported easier dissection when there was donor scarring, and with blond or light-colored hair.

Besides the benefit at the stage of dissecting the sections—as shown in this study—microscopes can improve yield by 5%-10% at the “slivering” stage. Yield can be improved an additional 15%-20% by avoiding use of the multibladed knife at the donor harvesting stage.

Loupe advocates argue that microscopes unduly slow down the procedure and that staff resistance to this new technology may be an insurmountable problem in some practices. They also lament the higher economic cost of purchasing the microscopes, training the staff, and slowing down dissection time with no clear benefits.

Dr. Bernstein said that the benefits of microscopic dissection far outweigh these minor inconveniences and should be incorporated into hair transplant procedures.

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