Bernstein Medical - Center for Hair Restoration - Line Scar
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Q: I heard that for someone who has had several strip procedures, the ARTAS robot for FUE does not work because it is programmed to work with “textbook male pattern baldness”, which I no longer have. I thought the scars from previous procedures, as well as the large amount of already transplanted hair, might throw off the robot’s programming (it wouldn’t quite know what to do). But if I am wrong about this then the robot may in fact be the best approach for me. Please advise. — N.C., Paris, France

A: When performing robotic hair transplants on patients with prior surgery, I program the robot to avoid scarred areas – just as we would do visually when performing manual FUE.

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Q: If I have no linear scar and I can exercise right away, why would you ever recommend FUT instead of FUE? — H.T., Dover, M.A.

A: I advise FUT because the grafts are of better quality (less transaction and more support tissue surrounding the follicle) and because more hair can be obtained from the mid-portion of the permanent zone –- which is where the hair is the best quality and most permanent. For the majority of patients a linear scar buried in the donor hair is not an issue. Each patient has to weigh the pros and cons of each procedure when making a decision.

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Q: What are the chances of the donor scarring being visible long-term in FUT compared to FUE? — M.M., Altherton, C.A.

A: Both FUT and FUE produce donor scarring; FUT, in the form of a line and FUE in the shape of small, round dots. With FUT hair transplantation, the line is placed in the mid-portion of the permanent zone, whereas in FUE the dots are scattered all over the donor area.

If a patient becomes extensively bald (i.e. the donor fringe becomes very narrow), the line of FUT will generally still remain hidden, whereas the dots of FUE will be seen above the fringe of hair. In the less likely scenario of the donor hair actually thinning significantly, both the line (of FUT) and the dots (of FUE) may become visible.

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CBS News Report On Robotic FUE Features Dr. BernsteinDr. Bernstein was featured in a CBS News report on robotic hair transplantation. During Dr. Max Gomez’s visit to the Bernstein Medical – Center for Hair Restoration, Dr. Bernstein discusses with Dr. Gomez the difference between FUT and FUE hair transplants, how the robotic system works, and the benefits of extracting hair follicles using robotic FUE rather than by traditional hand-held methods.

Read a transcript of the piece:

CBS 2 News Anchor Chris Wragge: These days we’ve seen robots doing everything from vacuuming our floors to building cars. You may have even had surgery done with the help of a robot. But what about something personal and cosmetic like a hair transplant? Our Dr. Max Gomez tells us about a robot doing just that.

Dr. Max Gomez: Well that’s right Chris. Now first we should make clear that robots in medicine don’t act alone, at least not yet. They’re always under the direction of a doctor. Now, that said, what robots are really good at are tedious, repetitive tasks that need to be done quickly and accurately. Something like a hair transplant.

Dr. Gomez: A full head of hair is called a person’s “crowning glory”. Sure, going bald is a common fashion statement, but most people are like Sam.

Sam, Hair Transplant Patient: I wanted more hair on my head, obviously, and I didn’t want to be bothered with any of the other treatments that are available.

Dr. Gomez: For Sam that meant a hair transplant, where donor hair follicles are taken from the back of the head and transplanted to the thinning areas, usually on top or the former hairline.

Dr. Robert M. Bernstein: The hair on the back and sides of the scalp are not effected by the same genetic process that the hair on the top of the scalp is.

Dr. Gomez: That donor hair is typically taken from a strip of scalp that is cut out and then sutured closed, but that’s not the best choice for everyone.

Dr. Bernstein: Some patients, who want to wear their hair very short, that line can be a problem. Also, there are some people who are at risk of having a wider scar.

Dr. Gomez: The solution is to randomly extract individual follicular units, small groups of one to four hairs.

Dr. Bernstein: The procedure is very labor intensive and you have to do thousands of these in a single session.

Dr. Gomez: Enter the ARTAS robot. It’s a sophisticated hair mapping and extraction system. Once the donor area is identified, the robot maps all of the follicles, and then randomly extracts them with a series of punches. It can even tell the angle the hair is growing at to avoid damaging it.

Dr. Bernstein: It is much more precise than the human hand. It doesn’t tire if you’re doing thousands of grafts. It’s the same every single time.

Dr. Gomez: And here’s the result a few weeks later. Even with short hair, the random extraction means it’s virtually impossible to tell where the donor hairs came from.

Now, the rest of the transplant procedure is pretty much the same as without the robot. That’s where the art comes in. Deciding where, how many, how dense, and at what angle the donor hairs are inserted, that’s what makes a hair transplant look natural. And a well-done transplant is amazingly natural.

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Q: I had an old hair transplant and I’m hoping to remove these plugs and of course am concerned how much additional scarring would result. I’m wondering if removal of the total hair plugs (which are perhaps 2 or 3 mm in diameter) by coring them out would result in a lot of additional scarring.

A: It will significantly reduce the scarring.

The reason is that the round disc of scar tissue at the bottom of the graft from prior plug hair transplants will be removed and the normal skin edges will be brought together resulting in a barely perceptible fine line scar.

See the Graft Excision in Hair Transplants page.

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

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

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Q: I understand that even if you have multiple hair transplants you will only be left with one scar in the donor area. — T.J., Yonkers, N.Y.

A: If the closure is performed without tension, each procedure should result in the same fine scar.

The best-placed incision is in the mid-portion of the permanent donor area. Since there is only one mid-point, there is one best position for the scar. All incisions should lie on this plane leaving one scar.

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

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

That said, in my practice I almost always use only one scar. The subsequent procedure would incorporate the first and extend the scar to one side or the other (or both). I generally use the old scar as one edge of the new strip so that there is only one incision into virgin scalp (rather than two).

There are a number of reasons for this technique.

  1. The hair will always be taken from the mid-portion of the permanent zone, so we utilize the thickest, most stable hair
  2. A line scar in this location is generally the least visible and most easily camouflaged with the persons existing hair
  3. One avoids making a scar too low that increases the risk of widening the scar
  4. One scar will be easier to camouflage with Follicular Unit Extraction (if this is ever necessary)
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Q: Can you shave your scalp after a hair transplant with FUE without noticing scarring in the donor area? — A.A. Bronxville, N.Y.

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

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