O, The Oprah Magazine has a feature on hair loss in women in their March 2010 issue. Dr. Bernstein was consulted for the article and discussed female hair transplantation.
“Since female hair loss is often diffuse, only about 20 percent of female patients with thinning hair are candidates, says Robert Bernstein, MD, a New York City dermatologist who specializes in these surgeries.”
Q: Why does a hair transplant grow – why doesn’t the transplanted hair fall out? — J.F., Redding, C.T.
A: Hair transplants work because 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. The reason is that the genetic predisposition for hair to fall out resides in the hair follicle itself, rather than in the scalp. This predisposition is an inherited sensitivity to the effects of DHT, which causes affected hair to decrease in diameter and in length and eventually disappear – a process called “miniaturization.” When DHT resistant hair from the back of the scalp is transplanted to the top, it will continue to be resistant to DHT in its new location and grow normally.
Q: Can the crown be transplanted first instead of frontal area? Why is the crown the last choice? Any reasons behind it? — H.H., Ladue, M.I.
A: The crown can be transplanted first in patients who have very good donor reserves (i.e., high density and good scalp laxity). Otherwise, after a hair restoration procedure to the crown you may not be left with enough hair to complete the front and top if those areas were to bald.
Cosmetically, the front and top are much more important to restore than the back. A careful examination by a trained hair restoration surgeon can tell how much donor hair there is available for a hair transplant.
Q: I would like to have the donor area from an old hair transplant repaired so it does not show the scar when I cut my hair shorter. What are my options?
A: Widened scars can be improved in two ways: they can be re-excised to make the scar finer, or hair can be placed into the scar to make it less visible.
Q: I had hair transplant surgery 10 days ago and have since developed what looks like big, dry flakes in the transplant area. How long does it take for the grafts to root, and is it okay that some of the grafts fall out when brushing my hair back carefully at this point? Also, the area that was worked on has not fallen out yet, so should I shave this area before the new hair comes in or should this be a natural process? — N.N., Easton, C.T.
A: Grafts are generally permanent 9 days following a follicular unit hair transplant procedure, so you may shampoo the flakes off at this time. If larger grafts were placed (with correspondingly larger recipient sites), the grafts will be subject to being lost for a slightly longer period of time. After 9 days, you may shave or clip the hair in the transplanted area if you like, but this will not affect the success of the hair restoration one way or the other.
In 1995, a surgeon just entering the field of hair transplantation became aware of these natural “follicular units” and came to believe that they should be the building blocks for all hair transplants. His name was Bob Bernstein.
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 Discovery Channel interviewed Dr. Bernstein for a piece on hair transplant repair. Below is an excerpt from the interview:
Dr. Bernstein: When I first saw Ken in 1995. He still had the traditional plugs, and I would say on a scale of one to ten, he was maybe a seven, with ten being the worst. We performed a procedure called follicular unit transplantation where hair is transplanted in exactly the way it grows in nature, which are little tiny groups of one to four hairs.
Ken Gold: After the first surgery I was just ecstatic because I was actually able to look at myself in the mirror.
Cosmetic Surgery Times features Dr. Bernstein’s presentation to the 55th annual meeting of the American Academy of Dermatology in their April 1997 issue.
The article describes Dr. Bernstein’s introduction of the concept of Follicular Unit Transplantation to the academy as well as the keys to making the technique successful. From the article:
“‘Hair doesn’t grow singly it grows in naturally occurring groups of from one to four hairs. In follicular transplantation, we use these naturally occurring groups as the unit of the transplant,’ he told CST.
Although the procedure is highly labor intensive, it can actually be less expensive than conventional hair replacement surgery, because it can be performed in a single, but lengthy, session.
‘It is also much more efficient and conserves donor hair much better than conventional hair transplants. Every time you make an incision in the person’s scalp you waste some hair and make the remaining hair more difficult to remove. Accessing the donor area just once or twice will increase the total amount of hair that is available for the transplant,’ Dr. Bernstein told CST.”