Robotic Hair Transplants & Hair Restoration
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Bernstein Medical - Center for Hair Restoration
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Hair Restoration Answers

Do Women Have Less Shock Loss Than Men?

Q: I have heard that shock loss is somewhat common after a hair transplant. Do women experience less shock loss than men? — N.R. ~ Mineola, N.Y.

A: The risk of shock hair loss is generally greater in women than in men since women usually have a more diffuse pattern of thinning. This is because females generally have more miniaturized hair, the hair that is most subject to post-op shedding.

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Hair Restoration Research

Study More Accurately Predicts Severe Balding Risk Using New Genetic Profile

What are the chances that I will go bald? How bald will I be? Can I know for sure? These are among the most common questions we get from patients in our hair loss consultations. Despite extensive knowledge about the mechanisms and causes of androgenetic alopecia (common baldness), the answers to these questions have been a bit hazy. New research has sharpened the focus on the genetic mix that results in hair loss and has enabled more accurate predictions. A study published in February 2017 in the journal PLoS Genetics identified over 250 gene locations newly linked to hair loss. Using this information, researchers more accurately predicted severe balding compared to previous methods.

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Hair Restoration Research

Study Identifies A Possible Cause of Age-Induced Hair Loss

We have known for decades that the incidence of male pattern baldness increases with age. New research published in the February 2016 edition of the journal Science has shed light on why this is the case. Researchers examining the role of hair follicle stem cells (HFSC) in the hair growth cycle have found that accumulated DNA damage in these cells results in the depletion of a key signaling protein and the progressive miniaturization of the hair follicle (and eventual hair loss). The study represents a breakthrough in our understanding of the cell aging process and could open new pathways for the treatment of not only hair loss, but other age-related conditions as well.

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Hair Restoration Research

Dr. Christiano Discovers JAK Inhibitors as Potential New Topical Treatment for Hair Loss

Dr. Angela Christiano and her team of researchers at Columbia University studying the autoimmune disease Alopecia areata, have shed new light on how to move hair follicles from their resting (telogen) stage into the anagen phase where they can produce normal hairs. Their study, published in the October issue of Science Advances, introduces the possibility of a new topical medication for hair growth. The finding has implications in the treatment of androgenetic alopecia (common hair loss) as well as Alopecia areata, which causes a non-scarring form of localized hair loss.

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Hair Restoration Research

Study Confirms Importance of Dermal Sheath Stem Cells in Hair Growth Cycle

Colony of self-renewing dermal sheath cellsColony of self-renewing dermal sheath cells

New research published in the journal Developmental Cell has confirmed the importance of dermal sheath stem cells in maintaining the hair growth cycle. These cells, located around the lower portion of growing follicles, form the basis of an experimental treatment, being developed by Replicel Life Sciences, Inc., to regenerate hair-producing follicles. If successful, the treatment will be a game-changer for the hair restoration industry.

Rahmani W, et al. 2014

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Hair Restoration Research

New Research Shows Laser Therapy (LLLT) is an Effective Treatment for Male and Female Pattern Hair Loss

Given the large number of people who are affected by androgenetic alopecia and for whom traditional treatments, like surgical hair restoration or hair loss medications, may not be indicated, could low-level laser therapy be a viable and effective treatment option? New research published this year, 2014, in the American Journal of Clinical Dermatology, says yes.

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Hair Restoration Answers

Do Propecia (Finasteride) and Rogaine (Minoxidil) Work on Front of the Scalp?

Q: Both Propecia and Minoxidil definitely can work in the front of the scalp as long as there is some hair in the area. Although their mechanisms of action are different, both Propecia (finasteride) and Rogaine (minoxidil) act to thicken miniaturized hair regardless of where it is on the scalp. In fact, there are published data (Leyden et. al., JAAD, 1999) demonstrating this improvement in a controlled clinical trial of men with frontal hair loss. — J.S., Great Falls, Virginia

A: Both Propecia and Minoxidil definitely can work in the front of the scalp as long as there is some hair in the area. Although their mechanisms of action are different, both Propecia (finasteride) and Rogaine (minoxidil) act to thicken miniaturized hair regardless of where it is on the scalp. In fact, there are published data (Leyden et. al., JAAD, 1999) demonstrating this improvement with finasteride in a controlled clinical trial of men with frontal hair loss.

The source of the confusion on this topic is the fact that the FDA limited the application of the drugs to the crown on the package inserts for both Propecia and Rogaine. The FDA did this because Upjohn (the company that introduced Rogaine) and Merck (Propecia) only tested the medications on the crown in the clinical trials. Logically, the fact that DHT causes frontal hair loss and Propecia works by blocking DHT gives a reasonable explanation for the efficacy of the drug on the front of the scalp. Also, a side effect of the use of minoxidil is facial hair, so how could it not also work on the front of the scalp? It is regrettable that some doctors and many patients think that these medications won’t work on the front of the scalp. Unfortunately, many hair restoration surgeons have done little to educate the public and dispel this myth.

To reiterate, yes, both of these medications can work on the front of the scalp to prevent hair loss and thicken a thinning hairline. However, it is important to note that neither of these medications can grow hair on a totally bald scalp or lower an existing hairline. Hair follicles must exist for the medications to work. It is also important to stress that the best results come from using both finasteride and minoxidil together.

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Hair Restoration Answers

After Hair Transplant Is There Shock Hair Loss In Donor Area?

Q: I have seen through forums that a hair transplant gives severe shock loss in the donor zone (especially behind ears) after the surgery. Doctors say it is temporary and can last about six months or more. Frankly, do you believe in this? Will the donor shocked hair recover? — M.D., Darien, C.T.

A: It depends if you are speaking about follicular unit hair transplantation using strip harvesting (FUT) or Follicular Unit Extraction (FUE). With FUT, it is extremely uncommon to have any shock hair loss in the donor area. This could occur if the hair transplant procedure was done improperly, i.e. the donor area was closed too tightly. In this case, some hair loss may be permanent. This is one of the reasons that very large hair transplant sessions are unwise. Shock hair loss in FUE is more common, but is generally not significant and should eventually recover completely.

That said, some shock hair loss in the recipient area is quite common with either hair restoration procedure (FUT or FUE). This is particularly the case if there is a lot of existing miniaturized hair (hair that is starting to thin) in the transplanted area.

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Hair Restoration Answers

What is Female Androgenetic Alopecia?

Q: What is female androgenetic alopecia?

A: Female androgenetic alopecia, also called female pattern hair loss, is caused by the shrinking of susceptible hair follicles in response to normal levels of hormones (androgens). It is the most common type of hair loss in women, affecting perhaps 1/3 of the adult female population. It is seen as a general thinning over the entire scalp, but can also present in a more localized pattern i.e. just limited to the front and top. The condition is characterized by a gradual thinning and shortening (miniaturization) of individual hair follicles, rather than their complete loss and, although the condition tends to be progressive, it rarely leads to complete baldness.

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Hair Restoration Answers

Why FUT Hair Transplant For One Person, FUE For Another?

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 Answers

What is Lichen planopilaris?

Q: What is Lichen planopilaris? — G.S., Pleasantville, NY

A: Lichen planopilaris (LPP) is a distinct variant of cicatricial (scarring) alopecia, a group of uncommon disorders which destroy the hair follicles and replace them with scar tissue. LPP is considered to have an autoimmune cause. In this condition, the body’s immune system attacks the hair follicles causing scarring and permanent hair loss. Clinically, LPP is characterized by the increased spacing of full thickness terminal hairs (due to follicular destruction) with associated redness around the follicles, scaling and areas of scarred scalp. Read more ».

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Hair Restoration Answers

Do You Perform Hair Transplants With Body Or Leg Hair?

Q: Dr. Bernstein, can you please comment on leg and body hair transplants? — J.R., Ridgewood, NJ

A: I’ve tried the technique in the past but have been dissatisfied with the results. Scalp hair, unlike the rest of the body, has multiple hairs rising out of each follicle. With leg and body hair, you have only one hair per follicle, not follicular units of multiple hairs. Leg hair is also very fine. It might thicken up a little bit after it is transplanted, but not enough to be clinically useful. In men you want full thickness hair, so fine hair can make it look like it is miniaturizing, as it does when you’re losing it.

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Hair Restoration Answers

Preventing Shock Hair Loss After Hair Transplant

Q: Can shock loss be eliminated by using special surgical techniques? — R.P., Short Hills, NJ

A: Although there have been no scientific studies proving this, shock hair loss can most likely be minimized by keeping the recipient sites parallel to the hair follicles, by not creating a transplanted density too great in areas of existing hair, and by using minimal epinephrine (adrenaline) in the anesthetic. We implement all of these techniques. Finasteride may also decrease shock hair loss, or at least help any (miniaturized) hair that is lost to re-grow. That said, some shock hair loss from a hair transplant is unavoidable regardless of the technique as it is a normal physiologic response to stress.

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Hair Restoration Research

Prostaglandin Discovery May Lead To Hair Loss Treatment For Men And Women

Miniaturized human hair follicle shows concentration of Prostaglandin D2 (in green). Credit: Garza and Cotsarelis/Penn Medicine)Researchers at the University of Pennsylvania, who were investigating the biological causes of androgenetic alopecia or common genetic hair loss, have discovered that levels of a certain inhibitor protein, called Prostaglandin D2 (PD2), are elevated in bald areas on the scalp. This discovery could be an important breakthrough in developing a medical hair loss treatment that regulates the production of the protein, or one that blocks it from attaching to its receptor protein.

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Hair Restoration Answers

Can Propecia After Hair Transplant Cause Shedding Of Normal Terminal Hair?

Q: I have been reading various articles and forum postings and it would seem that a person utilizing Propecia might experience increased “shedding” of hairs (outside of the normal hair cycle) around the 12 week mark after a hair transplant and lasting around 2-4 weeks. The forum postings suggest that one will see not only the miniaturized hairs being lost but also normal terminal hair in larger than expected levels. Does an explanation exist to explain this increase in shedding hairs?

A: Our understanding is that finasteride only affects miniaturized hairs — i.e. hair affected by DHT — and that this is all that should be shed. Remember, however, that much of the thinning a bald person experiences is due to thousands of partially miniaturized hair, and these can look very much like a full terminal hair in its early stages.

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Hair Restoration Answers

What Does Hair Transplant Procedure Do To Existing Hair?

Q: What does the hair transplantation process do to your existing hair? — R.V., London, UK

A: When we perform hair transplant surgery, we transplant into an area that is either bald or has some existing hair. The hair that is existing is undergoing a process called miniaturization. What this means is that the hairs are continuing to decrease in size – both in diameter and in length. When we perform a hair transplant, we don’t transplant around the existing miniaturized hair on your scalp, we transplant through it. And the reason why we do that is because the miniaturized hair, the fine hair that is being affected by DHT, is eventually going to disappear, so you don’t want there to be any gaps.

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Hair Restoration Answers

Does Scalp Med Prevent Hair Loss By Unclogging Pores?

Q: Scalp Med is supposed to unclog pores. How does this prevent hair loss?

A: The active ingredient of Scalp Med is Minoxidil, which will help reverse miniaturization, the process that causes androgenetic hair loss. Hair loss is not caused by clogged pores, so unclogging them will not prevent going bald. Minoxidil, which is also the active ingredient in Rogaine is over-the-counter so it is a less expensive way to use the active ingredient.

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Hair Restoration Answers

Is it Normal to be Shedding Three Months After a Hair Transplant?

Q: I am about 3 months post-op after my hair restoration procedure. I have noticed some hair shedding in the frontal part of my scalp. I have continued both Propecia and Minoxidil. Is there anything I can do and should I be concerned? — M.B., Chicago, IL

A: Shedding of some of the patient’s existing hair in, and around, the area of a hair transplant is a relatively common occurrence after a hair transplant and should not be a cause of concern. The mechanism appears to be a normal response of the body to the stress of the hair restoration surgery -– i.e., site creation, adrenaline in the anesthetic etc. Some doctors claim that their hair transplant techniques are so “impeccable” that their patients do not experience shedding. This is a false claim. Although using very small recipient sites and limiting the use of epinephrine may mitigate shedding somewhat, shedding is a normal part of the hair transplant process and the risk is unavoidable.

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Bernstein Medical In The News

Hair Loss Articles Feature Dr. Schweiger

Dr. Eric S. Schweiger, board-certified dermatologist, is quoted in a few recent articles on the effects of chemotherapy on hair, genetic testing for hair loss, and caring for a bald or balding scalp. The articles were published in Energy Times and HairLoss.com. View the full post to read what Dr. Schweiger has to say on these topics.

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Hair Restoration Research

Research Points to Decreased “Progenitor” Stem Cells as Cause of Male Pattern Baldness

Research published in the January 2011 issue of the Journal of Clinical Investigation (Vol. 121, issue 1) reveals another breakthrough in the medical community’s understanding of the causes of — and possible cure for — androgenetic alopecia, or common male pattern baldness. The new research shows that the presence of a certain type of cell, called a progenitor cell, is significantly reduced in men with common baldness compared to men who are not bald. Read on for more details on this breakthrough.

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Hair Restoration Answers

Does Sebum Cause Hair Loss By Blocking Pores On Scalp?

Q: I have been on finasteride for about 7 months. After my latest haircut I can see that my scalp is shiny. I read that is from sebum buildup and it can cause a layer that clogs the growth of hair. I was wondering if this is true and, if so, how can it be treated? — T.C., Philadelphia, PA

A: It is not true. Hair loss is caused by the miniaturizing effects of DHT on the hair follicle, not by blocked pores.

For more on this topic, view our pages on the causes of hair loss in men or the causes of hair loss in women.

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Hair Restoration Answers

Why Am I Losing Hair Despite Taking Avodart For Hair Loss?

Q: I am currently taking Avodart and have done so for around 8 months. Last night I had a significant loss of hair after taking a shower, nothing like I have ever seen before and found it very distressing. Can you tell me if this is hair loss or could it be something known as shedding and could you please tell me what is the difference between hair loss and hair shedding? — M.S., New York, NY

A: Hair loss is a very general term that can refer loss of hair for any reason. Genetic hair loss is caused by the effects of DHT on hair follicles that result in miniaturization -– i.e. a slowly progressive change in hair diameter that starts with visible thinning and that may gradually end in complete baldness. Hair shedding is more sudden where hair falls out due to a rapid shift of hair from its growth phase into the resting phase. The medical term for this is telogen effluvium. This process is usually reversible when the offending problem is stopped. It can be due to stress, medication, or other issues. You should see a dermatologist to figure out which process is going on. Dutasteride can cause some shedding when it first starts to work, but it would be unusual to do this after being on treatment for eight months.

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Hair Restoration Answers

Can Propecia Or Rogaine Restore My Original Hair Density?

Q: You mentioned that the hair at my crown and other areas where I now have baldness hasn’t really fallen off but has thinned to a great extent and that taking Rogaine and Propecia might help increase their thickness. If the medications do restore the hair thickness, I’m curious why you said that I could look like how I was 1 to 2 years ago. Technically, shouldn’t I be able to regain much more of my hair (and look like how I was longer than before that) since the follicles are all still there? — H.D., Park Slope, NY

A: Although Propecia is much more effective than Rogaine, even when used together, the medications are just not that effective in reversing the miniaturization process. They may bring you back to the way you were a few years ago, but will not restore your adolescent density.

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Hair Restoration Answers

What Happens To Hair Diameter As You Age?

Q: What happens to hair diameter when you age? — K.L., Greenville NY

A: From infancy to puberty, hair gets progressively thicker. From adulthood to old age the hair becomes thinner again and this is exacerbated by the effects of DTH in susceptible persons. The later process is called androgenetic alopecia (common baldness) and is characterized by miniaturization – the progressive decrease in hair diameter and lengths as a result of DHT.

However, even without the effects of DHT, hair gradually thins over time in many people.

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Hair Restoration Research

Dr. Christiano at Columbia University Identifies APCDD1, A Newly Discovered Gene Associated With Hair Loss

Dr. Angela Christiano of Columbia University in New York and a team of scientific researchers, have identified a new gene involved in hair growth. Their discovery may affect the direction of future research for hair loss and the diagnosis and ultimate prevention of male pattern baldness.

The condition, which leads to thinning hair, is called hereditary hypotrichosis simplex. Through the study of families in Pakistan and Italy who suffer from this condition, the team was able to identify a mutation of the APCDD1 gene located in chromosome 18. This chromosome has been linked to other causes of hair loss.

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Hair Restoration Answers

Why Does A Hair Transplant Work?

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.

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Hair Restoration Answers

Areas of Unethical Behavior Practiced Today

Note from Dr. Bernstein: This article, by my colleague Dr. Rassman, is such important reading for anyone considering a hair transplant, that I felt it should be posted here in its entirety.

Areas of Unethical Behavior Practiced Today
William Rassman, MD, Los Angeles, California

I am disturbed that there is a rise in unethical practices in the hair transplant community. Although many of these practices have been around amongst a small handful of physicians, the recent recession has clearly increased their numbers. Each of us can see evidence of these practices as patients come into our offices and tell us about their experiences. When a patient comes to me and is clearly the victim of unethical behavior I can only react by telling the patient the truth about what my fellow physician has done to them. We have no obligation to protect those doctors in our ranks who practice unethically, so maybe the way we respond is to become a patient advocate, one on one, for each patient so victimized.

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Hair Restoration Answers

Is a Hair Transplant to Recreate a Dense Hairline Too Good to be True?

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. 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.

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Hair Restoration Answers

After a Hair Transplant What are the Effects of DHT on Donor Hair?

Q: Hi! I wanted to ask if after a hair restoration surgery the transplanted hair will eventually fall out? Because the surgery is to restore hair mainly for people with genetic hair loss which results from DHT, won’t the DHT make the new follicles implanted fall out as well? — B.C., Stamford, C.T.

A: Hair loss is due to the action of DHT (a byproduct of testosterone) on hair follicles that cause them to shrink and eventually disappear (the process is called miniaturization). The follicles on the back and sides of the scalp are not sensitive to DHT and therefore don’t bald (miniaturize).

When you transplant hair from the back and sides to the bald area on the front or top of the scalp the hair follicles maintain their original characteristics (their resistance to DHT) and therefore they will continue to grow.

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Hair Restoration Answers

Dr. Bernstein Answers Questions On HairDX Genetic Test To Predict Hair Loss

The HairDX genetic test for hair loss offers information that can aid you and your doctor in making an informed decision about the treatment of your hair loss. It offers one more bit of information that, in the context of other data (such as hair loss pattern, scalp miniaturization and family history) can help guide you and your doctor to formulate an appropriate treatment plan. How does it work? How accurate is the test? How does the test compare to information obtained from a history and physical exam by your physician? Dr. Bernstein answers these questions and more on the HairDX genetic test for hair loss.

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Hair Restoration Research

Research Groups Explore Genetics Of Balding

We all have seen that some bald sons have bald fathers, even when no one on the mother’s side of the family has any hair loss. This suggests that the genetics of male pattern alopecia is more complicated, with multiple genes influencing hair growth. And it is likely that the inheritance of baldness is polygenetic, with relevant genes coming from both the x-chromosome of the mother and non-sex chromosomes of either parent. So where are the other genes?

Two independent research groups, one from England and the other Germany, both published in the journal Nature Genetics, have identified a gene locus p11 on chromosome 20 that seems to be correlated with male pattern hair loss, and since the gene is on a non-sex chromosome, it offers an explanation for why the inheritance of common baldness can be from either side of the family.

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Bernstein Medical In The News

Oprah, Dr. Oz Inspect Hair Transplant Patient, Interview Dr. Bernstein on Oprah Winfrey Show

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.

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.

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Hair Restoration Answers

Do You Recommend Avodart (Dutasteride) Hair Loss Medication?

Q: I heard that there is a new drug on the market called Avodart for prostate enlargement which might help with hair loss as it blocks the conversion of testosterone to DHT better than Finasteride and is more effective than Propecia. Do you recommend taking it and if so what is the dose? — Y.B., Orlando, Florida

A: I am currently not recommending that patients take Dutasteride for hair loss, although it is more effective than Propecia, finasteride 1mg. (Dutasteride 0.5, the dose generally used for hair loss, seems to be slightly more effective than finasteride 5m in reversing miniaturization.)

The reasons that I am hesitant to prescribe it at present are outlined in the Hair Restoration Answers question, “Is Avodart Safe?

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Hair Restoration Answers

Will Second Hair Transplant Session be Different than First Session?

Q: My first hair transplant was a breeze. Will a second procedure be any different than the first? — B.B., Murray Hill, N.Y.

A: Generally in a second procedure, a patient can expect less swelling post-up although the reason for this is not known.

There will also generally be less shedding in the second hair transplant session since the weak miniaturized hair that will be shed is often lost in the first session and the previously transplanted hair is generally more resistant to shedding.

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Hair Restoration Answers

Can Stress Cause Diffuse Unpatterned Hair Loss (DUPA)?

Q: Can stress produce diffuse unpatterned hair loss (DUPA), or was it bound to happen anyway? — D.D., Park Slope, Brooklyn

A: Both DPA (diffuse patterned hair loss) and DUPA (diffuse unpatterned hair loss) are genetic conditions, unrelated to stress and would have happened anyway. These types of hair loss are characterized by a high percentage of mininiaturized hair in broad areas of the scalp. See the Classification of Hair Loss in Men and Classification of Hair Loss in Women pages on the Bernstein Medical – Center for Hair Restoration website for more information on this topic.

In contrast, stress generally presents as increased hair shedding, a reversible condition referred to as telogen effluvium. It is called this because the normal growing hair is shifted to a resting (telogen) phase before it temporarily falls out. Increased miniaturization is not associated with telogen effluvium.

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Hair Restoration Answers

Will Increasing the Dosage of Propecia Stop the Miniaturization Process?

Q: I have been using Propecia since it was released to the public in 1998 and have found it to work very well. Recently, its effectiveness has stopped and my hairs are miniaturizing again. I am going to increase the dosage to 1/2 a pill Proscar every day. How long will the increased dosage take to stop the miniaturizing process? — T.U., Chappaqua, N.Y.

A: It seems to take the same time to work as when you initially started Propecia.

When patients increase their dose, I rarely see re-growth, but rather the expectation is that further hair loss will be decreased. When it does work to actually re-grow hair, we sometimes see an initial period of shedding, similar to when finasteride was first started.

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Hair Restoration Answers

Hair Loss Causes: What is Miniaturization and What is Effect of DHT on Hair Follicles?

Q: I have read that in the evaluation of a patient for hair restoration surgery some doctors use a densitometer to measure miniaturization – the decrease in size of hair diameters. I read that miniaturization is a sign of genetic hair loss, but when there is miniaturization of greater than 20% in the donor area, a person may not be a good candidate for hair transplants. Is this correct and does 20% miniaturization mean that 20% of the population of terminal hairs have become fine vellus-like hairs or that there is a 20% decrease in the actual diameter of each of the terminal hairs? — B.A., New Albany, Ohio

A: Miniaturization is the decrease in hair shaft length and diameter that results from the action of DHT on healthy, full thickness terminal hairs. The hairs eventually become so small that they resemble the fine, vellus hair normally present in small numbers on the scalp and body. Miniaturized hairs have little cosmetic value. Eventually miniaturized hairs will totally disappear. Twenty percent miniaturization refers to the observation, under densitometry, that 20% of the hairs in an area show some degree of decreased diameter.

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Hair Restoration Answers

Does Rogaine Only Work on Crown?

Q: I heard that Rogaine only works on the crown and not on the front or top of the scalp. Is this true? — D.D., New Haven, Connecticut

A: Rogaine (Minoxidil) has the potential to work where ever there is miniaturized hair, either the front, top or crown (however, it will not work in areas that are completely devoid of hair).

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Hair Restoration Answers

Could Low Level Laser Therapy (LLLT) Benefit Women?

Q: I am a 33 year old woman and have been told my hair is too thin on the sides for me to have a hair transplant. Could I benefit from laser treatments?

A: Although the long-term benefits on hair growth are not known, Low Level Laser Therapy (LLLT) is able to stimulate hair to become fuller in appearance in the clinical trials that have been carried out for six month periods.

Since the laser light serves to thicken fine, miniaturized hair, it is particularly suitable to areas of diffuse thinning, rather than areas of complete baldness.

Since hair loss in women commonly has a diffuse pattern, because women can’t take Propecia (finasteride), and the fact that women are less often candidates for surgery (as compared to men), laser therapy in females is particularly appealing.

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Hair Restoration Answers

How Does the Laser Therapy (LLLT) Hair Loss Treatment Work?

Q: I heard about the laser comb and other lasers for hair loss, how do they work?

A: Low Level Laser Therapy (LLLT) is based on the scientific principle of photobiotherapy. Photobiotherapy occurs when laser light, absorbed by cells, causes stimulation of cell metabolism and improved blood flow.

Although the exact mechanism by which lasers promote hair growth is still unknown, they appear to stimulate the follicles on the scalp by increasing energy production and partially reversing the miniaturization process leading to thicker hair shafts and a fuller look.

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Hair Restoration Answers

Can My Hair be Thinning Without Shedding?

Q: I seem to be thinning, but I never shed hair as such in the shower. I cannot see my hair falling out. Can it be androgenetic hair loss? — R.C., Cambridge, MA

A: In androgenetic hair loss one rarely sees hair falling out in mass, but rather the thinning is due to the hair decreasing in diameter and length (a process called “miniaturization”).

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Hair Restoration Answers

How Effective is Laser Comb in Regrowing Hair?

Q: How effective is the HairMax Laser Comb?

A: It is difficult to tell since there are no long-term studies using the LaserComb.

From the data we have available, it seems to be about as effective as Rogaine (Minoxidil). As most who have used Minoxidil know, it only works in areas where there is a fair amount of miniaturized hair and over time loses its effectiveness.

The HairMax LaserComb is not as effective as Propecia (Finasteride) and, of course, is not a substitute for surgical hair restoration.

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Hair Restoration Answers

Which is More Effective: Rogaine or Propecia?

Q: Will Propecia and Minoxidil reverse some of the miniaturization going on with someone with thinning hair? If I do need a hair transplant will I have to stay on these medications? — C.C., — Fairfield County, Connecticut

A: Yes, both minoxidil (Rogaine) and finasteride (Propecia, Proscar) affect the miniaturization of the hair follicles and help restore the shrunken follicles to cosmetically viable hair.

Minoxidil works by directly simulating miniaturized follicles to grow, whereas finasteride blocks DHT, the hormone that causes hair to miniaturize and eventually fall out.

Finasteride is much more effective than minoxidil in preventing or reversing the miniaturization process and it is so much more convenient to use that we generally suggest finasteride after a hair transplant procedure, but rarely recommend minoxidil.

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