Q: While I was lying awake last night your approach of making sites the day before implantation came to mind. It takes guts to have spearheaded that! I am not aware that that precedent has been set in hair transplant surgery. I would have been timid about infection; it’s a lot like closing a wound with a foreign body in it the next day. As with most things, I am a little slow to jump on board something new so I’m glad you’ve paved the way. Do you have any hesitance about this or do you have enough experience that you no longer hesitate? I would be concerned that variations of the local flora might make a difference and that, accordingly, a large sample size would be necessary to get comfortable. Glad for all of us that you are still blazing trails. — S.S., Shanghai, China
A: Thanks for your kind words. No hesitancy whatsoever. We find no increased risk. Think of it as if you did a hair transplant and ran out of grafts. The remaining sites don’t get infected, they just close up. In the process, all those chemotactic factors involved in the healing process move toward the wounds, so if a graft is placed into them, they would be less likely to get infected than a graft placed into a fresh (non-primed) wound, not more. It is like applying the surgical dressing Duoderm to a wound that helps it auto-sterilize. Putting the speculative science aside, we have not seen one single issue with it. Give it a try with an FUE or FUT procedure. Make the sites, have the patient takes his normal shower that night and you will be pleasantly surprised how little bleeding there is the next day and how easy it is to place the grafts.
GQ Magazine includes a quotation by Dr. Bernstein in their November 2010 issue. In the magazine’s “Manual” section, which outlines the latest style trends for men, there is a two-page article on hair transplant surgery. Dr. Bernstein’s help was recruited in discussing old hair transplant techniques where multiple follicular units were transplanted in “plugs.”
“In the old days, up until the early ’90s, they used to transplant multiple follicular units at once,” says Robert Bernstein, M.D., clinical professor of dermatology at Columbia University, “so what you got were those plugs, which look completely unnatural and gave the surgery a bad reputation.”
The article’s main protagonist is 27 year-old New Yorker, and hair transplant patient, Jordan Blackmore, but it also drops a few celebrity hair transplant names (Marc Jacobs, Ted Danson, Kevin Costner, and Matthew McConaughey). To read the article you’ll have to find the November 2010 issue at your local newsstand.
Q: Is it correct that the hair transplant surgery lasts about eight hours or if there is a range, what is that generally? — M.R., Montclair, NJ
A: The range is about 5 to 8 hours. For a completely bald person, it would be in the higher range. Keep in mind that the person is just relaxing, watching TV or dozing off. The time goes by quickly for the patient. Since there is no general anesthesia, there is no medical risk for this relatively long procedure.
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.
Dr. Bernstein was interviewed on the Fox News program “Fox and Friends” over the weekend. He discussed hair loss, hair transplant surgery, propecia hair loss medication, hair plugs, and more.
Watch the full video here:
If you like the video, please give it a 5-star rating!
John Wiley & Sons – creators of the hugely-popular For Dummies series of books – published on December 3 the definitive book on hair restoration: Hair Loss & Replacement For Dummies, written by internationally-respected hair transplant pioneers Dr. William R. Rassman and Dr. Robert M. Bernstein with Dr. Eric Schweiger.
Hair Loss & Replacement for Dummies is filled with important information for men and women of virtually all ages anxious to preserve their full head of hair, put the brakes on balding, or explore the safest and most reliable hair replacement techniques currently available. The book offers readers not only the full gamut of modern-day hair-care options but crucial tips on how to avoid unscrupulous hair transplant doctors and potentially harmful products as well.
Topics include:
Getting To Know Your Hair – What Causes Hair Loss; The Devastation Of Hair Loss In Women; Undergoing Hair Restoration Surgery
Splitting Hairs – How Hair Grows; Aging Hair; Hair & Ethnicity, Maintaining Self-Esteem in the Face of Hair Loss;
Taking Better Care Of Your Hair – Washing & Drying Your Hair Correctly; Avoiding Hair Damage; Caring For Childrens’ Hair
Understanding The How & Why Of Hair Loss – Stress & Hair Loss; Environmental Issues; Male Pattern Thinning In Men and Women; Diseases & Disorders That Cause Hair Loss
Creative Techniques For Concealing Hair Loss – A Brief History of “Rugs”; Today’s Toupees
Taking Prescription Medications For Hair Loss – Being Aware of Side Effects
Supplementing Your Diet To Help Slow Hair Loss – Pumping Up Proteins; Minding Your Mineral Intake
Hair Transplant Surgery – Do You Really Need A Hair Transplant; Psychological Considerations; Choosing A Doctor; Possible Complications; Heading Home With A New Head Of Hair!
Dr. Bernstein took part in a PRWeb podcast about hair transplantation in June 2007. Stream the discussion below or read the transcript:
Announcer: PRWebPodcast.com, visiting with newsmakers and industry experts.
Mario: This is Mario from PRWeb, and today it is a real pleasure to have with us Robert M. Bernstein, M.D. Dr. Bernstein is Associate Clinical Professor of Dermatology at Columbia University, and founder of New York City‑based Bernstein Medical – Center for Hair Restoration. Dr. Bernstein, it’s a pleasure to have you here on PRWeb.
Dr. Bernstein: Nice to be speaking with you.
Mario: Give us some understanding, sir, of your practice, the Bernstein Medical – Center for Hair Restoration. How long have you been around, where you guys are located, what is it you do there, please?
Dr. Bernstein: Bernstein Medical has evolved over the last ten years. It was set it up to do a specific procedure that I pioneered called “follicular unit hair transplantation.”
In this procedure, we dissect out hair follicles from the back of the scalp, exactly the way they grow in nature, so we are now able to perform hair transplants that essentially mimic nature.
This procedure is used by doctors around the world in hair restoration procedures. Our NY Hair Transplant Center is in midtown Manhattan and has been specifically designed for performing this hair transplantation technique.
Mario: You recently co‑authored an article, Dr. Bernstein, that appeared in the “Medical Journal of the International Society of Hair Restoration Surgery”. Now, you are well read and interviewed all over. This must be a bit exciting, something that was positive for you and your clinic. Tell us about the article, what it touched on, and some of the things that would be important for our listeners.
Dr. Bernstein: It sure was very exciting. The hair transplantation procedure has been around for many years, but a lot of it has been too much of an art and not enough of a science. What we’ve found is that doctors sometimes make these very general judgments about how bald the patient is going to become, how much hair they may need for the hair transplant or for the restoration.
We’ve found that by using a procedure called “densitometry”, where the hair is looked at under high magnification, we are able to get much more specific and useful information, both on the extent of how much someone is going to lose their hair, and also whether they are going to be a good candidate for hair restoration surgery.
One of the things that we’ve found is that when people start to thin, the hair first changes diameter before it’s lost, and this change in diameter may not necessarily be seen by the naked eye or be observed by another person.
But if you clip the hair very short and look at the base of the hair follicles under very high power, 30X magnification, you can actually see these very subtle, early changes, and these changes will anticipate future hair loss.
When we’re trying to decide whether a person should have hair transplant surgery, we can actually look at the donor area in the back and sides of the head, and see how stable these areas are. For example, someone that is becoming very bald, if the back and sides of their head show no change in the hair diameter, or no miniaturization, then we know that they may have very good hair for hair transplants; where a person with a similar degree of hair loss, whose sides and back are not stable, may not be a good hair transplantation candidate.
In a sense, by being able to measure things now, we’re able to have a much better sense of whether people are going to become very bald, possibly the rate of change of their hair loss, and then if they do need surgery, such as a hair transplant, we’re able to give much more specific information about what actually might be done.
Mario: We’re speaking to Dr. Robert M. Bernstein, M.D., an Associate Clinical Professor of Dermatology at Columbia University, and founder of New York‑based Bernstein Center for Hair Restoration.
Dr. Bernstein, give us some contact information where we can learn more about your services, and be able to end up taking advantage of them.
Dr. Bernstein: The best information can be found on our web site. The web address is www.BernsteinMedical.com.
Mario: Dr. Bernstein, it’s been a pleasure having you here on PRWeb podcasting with us. The best of luck to you, and congratulations again for that article in the “Medical Journal of the International Society of Hair Restoration Surgery.”
Dr. Bernstein: Thanks a lot, nice talking to you.
Announcer: Produced by PRWeb, the online visibility company.
NY Japion — a weekly newspaper in the Japanese language, published in the New York tri-state area, and distributed for free in the Japanese community — has featured Robert M. Bernstein, MD, in their series on hair loss in men and women. In the series, TV producer, Hideo Nakamura, who is bald himself, goes on a mission on behalf of fellow bald men. His column hopes to help others with hair loss to have a more fulfilled, fun life and to raise their self-esteem.
Nakamura interviewed Dr. Bernstein for this weekly series that began in October 2006. In issues No. 1 and 2, Dr. Bernstein explained the basic mechanism of balding for both men and women which are quite different in its causes, balding types, and progression of hair loss. The NY Japion’s readers were all very surprised by the fact that balding for men is actually related to genes on both the mother’s side as well as the father’s side of the family. Dr. Bernstein also shared his unique theory of why Japan’s Samurai had the uniformed bald look.
The column discussed post-op care after hair restoration surgery and explained the drug Propecia, a men’s oral hair growth treatment, minoxidil and some cosmetic hair products.
Reporter Nakamura was also examined by Dr. Bernstein and with the patient’s permission was allowed to observe a hair transplant surgery. Issues No. 3, 4, 5 are about the surgical hair restoration procedure known as Follicular Unit Hair Transplantation (FUT), a method that Dr. Bernstein helped to pioneer. By using the patient’s own hair, FUT can give totally natural looking results. The patient’s own hair starts growing where there was no hair before.
You can download a PDF version of the original series (in Japanese) at the link below:
Q: Hair transplantation sounds like a really time-consuming procedure. How long does the hair transplant actually take? — S.M., Hell’s Kitchen, N.Y.
A: An average hair transplant, that involves the movement of 1,500 to 2,500 grafts, can take a team of up to six people, five to eight hours.
Surgical hair restoration is a very time-consuming, labor intensive process, where every aspect of the surgery must be precisely controlled to get maximum growth and an optimum cosmetic result.
Q: I have heard that staples are uncomfortable after the hair transplant, why do doctors use them? — B.E., Great Falls, V.A.
A: Staples are used for two main reasons.
The first is that being made of stainless steel; they don’t react with the skin and, therefore, cause little inflammation.
The second is that, unlike sutures which are used with a continuous spiral stitch, each staple is separate and this causes minimal interruption to the blood supply. The combination of little inflammation and minimal interference with the blood flow facilitates healing and minimizes damage to hair follicles.
Although sutures are generally more comfortable after the hair transplant, the doctors who choose to use staples do so because they are the least injurious to the hair in the donor area.
Q: What can be done if I want to have a hair transplant and my scalp is very tight from prior surgeries? — R.R., Long Island, N.Y.
A: Follicular Unit Extraction is ideal in very tight scalps, provided that there is enough hair to extract without leaving the donor area too thin and provided that the follicles are not too distorted from the scarring.
With strip harvesting, undermining techniques may be helpful to close the wound edges once the strip is removed.
In undermining, the surgeon uses either a sharp instrument (scalpel) or blunt instrument (the dull edge of scissors) to separate the upper layers of the scalp (dermis and epidermis) from the lower part of the scalp (fascia). The hair transplant surgeon accomplishes this by spreading apart the fat layer of the skin or by cutting through scar tissue.
Undermining allows the upper layers of skin to literally slide over the lower layers and can significantly increase the ability to close a tight wound. However, if not done carefully, it may increase the risk of bleeding and injury to nerves and occasionally may damage hair follicles.
Undermining is usually used with a layered closure where the deeper tissues are brought together first with a layer of absorbable sutures before the surface of the skin is sutured closed with sutures that are removed.
A: In general, FUT will give you more hair since, in FUT, the best hair from the mid-portion of the permanent zone of the scalp (also called the “sweet spot”) can be utilized in the hair transplant.
With FUE, since only the hair follicles are extracted and not the surrounding bald skin, if too much hair is removed, the donor area will begin to look thin as hair is removed. This will limit the amount of hair that can be harvested.
Although in FUE additional areas of the scalp can be utilized to some degree, this will generally not compensate for the inability to access all of the hair in the mid-permanent zone and the total amount available for the hair restoration will be less.
Follicular Unit Forum is unique in that it affords visitors an opportunity to anonymously ask questions about the “ins and outs” of hair transplant surgery, of those who actually have had the state-of-the-art Follicular Unit Hair Transplant procedures.
Questions are posted to people who have actually undergone hair restoration procedures. Individuals who are considering a surgical solution to their hereditary baldness are able to search through “threads” or conversations that will answer their most pressing concerns such as; what to expect before, during and after a hair transplant, and what kind of procedure one should have.
The focus of this new online health resource is Follicular Unit Transplantation and Follicular Unit Extraction, two procedures that are universally considered to be the most up-to-date approach to surgical hair restoration. Follicular Unit Transplantation is a surgical technique that transplants hair in naturally occurring groups of 1-4 hairs. These groups (called follicular units) are taken from a single donor strip of skin and dissected using a microscope. Follicular Unit Extraction is a method that obtains the tiny follicular unit grafts from the donor area by using an instrument which removes them one-by-one directly from the scalp.
Patients who have received hair transplants with undesirable results (such as the typical pluggy “dolls hair” look) can also benefit from monitoring the site. FollicularUnitForum.com has posts from patients who have had unnatural looking grafts removed and re-implanted in a more natural way – as follicular units – to produce the most best results.
“We wanted to create a consumer-to-consumer forum that exclusively addressed the topic of Follicular Unit Hair Transplantation – the procedure that is now considered to be the gold standard in surgical hair restoration” said Robert M. Bernstein M.D., founder of Bernstein Medical – Center for Hair Restoration and sponsor of the site. “There are some great forums for hair loss out there but we felt that there was room for one that was created specifically for people who had done their preliminary research but now wanted to hear more first hand experience with FUT or FUE”.
Leavitt M, Perez-Meza D, Rao N, Barusco M, Kaufman K, Ziering C. Effects of Finasteride (1mg) on Hair Transplant. Dermatol Surg 2005; 31: 1268-1276.
SUMMARY
The progressive decrease in hair shaft diameter that causes thinning (also called miniaturization) characteristic of male pattern baldness, can be decreased by the use of the DHT blocker Propecia (chemical name finasteride). Most men undergoing hair restoration surgery have some existing hair in the area that is to be transplanted that will thin over time and, in fact, may thin a bit more quickly as a result of the surgery. For men undergoing surgical hair restoration, the thinning of the surrounding hair can diminish the overall impact of the hair transplant. Even though Propecia has no effect on the transplanted hair, it can help to maintain the patient’s surrounding hair and is, therefore, useful as an adjunct to hair transplant surgery, to enable the patient to obtain a better overall result.
The present study looks to see if Propecia given from one month before surgical hair restoration until eleven months after, can increase hair growth in the area surrounding the hair transplant. In the study, consisting of almost eighty men divided into two groups in a double-blind fashion were either given Propecia or a placebo. Growth was recorded by hair counts and by photos.
The study showed that Propecia was substantially better than the control group in increasing hair counts and in increasing visible fullness when patients started Propecia a month before their hair transplant and were on the medication for one year.
Comments by Dr. Bernstein: The present study confirms scientifically what has already been widely observed, that treatment with finasteride is an important adjunct to hair restoration surgery, for those with androgenetic hair loss. The authors appropriately state their conclusion based upon the parameters studied. As a result, the paper does not stress enough the importance of continuing Propecia for an extended period of time after the hair transplant. At the conclusion of the paper, the authors state that Propecia, taken for a year (i.e. one month before and eleven months after surgery) will increase the density of the surrounding hair. Some may interpret this as indicating that one only needs to take Propecia for a year in order for it to be a useful complement to hair transplant surgery. Of course, this is not the case, as one must continue to use Propecia for it to be beneficial.
“Hair Transplantation” is one in a series of medical textbooks published by Elsevier Saunders. The textbook — part of a series entitled Procedures in Cosmetic Dermatology — is written by Robert S Haber and Dowling B. Stough and edited by Jeffrey S. Dover. “Hair Transplantation” offers a step-by-step, practical guide to performing cutaneous surgical procedures.
The book’s editors selected Robert M. Bernstein as a major contributor, writing in two chapters. As pioneer of the advanced surgical hair restoration procedure known as Follicular Unit Transplantation (FUT), and as Associate Clinical Professor of Dermatology at Columbia University, Dr. Bernstein was uniquely qualified to provide medical professionals with insight and training on the state-of-the-art in hair transplant surgery.
Dr. Bernstein is lead author of the chapter entitled “Follicular Unit Transplantation” and co-author of “Follicular Unit Extraction”. The text details how to best achieve natural results, donor area diagnosis, aesthetic principles, tumescent technique, and more.
The purpose of this volume in the Dover series is to cover the tenets of hair transplant surgery by considering the philosophy, basic science, and techniques in a practical clinical text.
Succinctly written and lavishly illustrated, “Hair Transplantation” presents current, to-the-point guidance with a focus on procedural how-to’s and offers step-by-step advice on proper techniques, pitfalls, and tricks of the trade.
“Hair Transplantation” is shipped with a comprehensive DVD, containing video clips of techniques and procedures, as well as the hints and tips for surgical hair restoration. It features a wealth of color illustrations and photographs that depict cases as they appear in a hair restoration practice.
The following is a portion of “An Idea Whose Time Has Come,” an editorial written by O’Tar T. Norwood, MD — founder of the Norwood Classification System for Hair Loss — and published in the May/June 1997 issue of “Hair Transplant Forum International”:
I just returned from visiting Dr. Bob Bernstein in New York, and was impressed with his operation and even more impressed with his thoughts, observations, and insights into hair transplant surgery. He applies scientific methods to his work, is academically honest, and has an almost eerie instinctive knowledge of hair transplant surgery. Of course he has Dr. Bill Rassman to work with, but it is still remarkable. Dr. Bernstein is best known for introducing follicular transplantation to hair transplant surgery, an idea Bob Limmer has been pushing for ten years with the use of the binocular microscope, but no one would listen to him. Dr. Limmer, however, never used the term follicular transplantation. Using the microscope, you automatically dissect the follicular units. It can’t be avoided if done properly.
To read the full article, visit “An Idea Whose Time Has Come” in the Hair Restoration Papers section of our website.
Reference
Norwood O. “An Idea Whose Time Has Come,” Hair Transplant Forum International 1997; 7(3): 10-11.