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

Can Hair Transplant “Plugs” be Repaired by Lasers or Electrolysis?

Q: After a bad hair transplant, can you use lasers or electrolysis to remove the transplanted hair? — N.C. ~ Newark, N.J.

A: You can remove the hair in plugs with electrolysis, but it is difficult since the scarring distorts the architecture of the hair shaft and makes it hard to insert the electrolysis needle. Laser hair removal is a far more efficient way of removing the hair, but takes multiple treatments. However, the problem with either of these techniques is that the hair is destroyed and the underlying scarred scalp is not improved. In fact, it is made more visible when the hair has been removed.

Our preferred method of repair is to completely remove the plugs, dissect out the individual follicular units from those plugs and then re-implant them in the proper location and direction. In this way the hair can be reused and the appearance of underlying scarred scalp can be improved, as well as camouflaged with new hair.

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Hair Restoration Research

Scalp Micropigmentation (SMP) is a Practical, Permanent Cosmetic Treatment for Hair Loss

Hair restoration physicians William R. Rassman, Jae P. Pak, and Jino Kim have outlined a practical, permanent cosmetic treatment for hair loss, called scalp micropigmentation (SMP) in a paper published in the journal Hair Transplant Forum International.

The paper discussed case studies of six hair loss patients of varying age and hair loss condition who used SMP to camouflage scalp scars or areas of hair loss:

  1. A man in his mid-30s, who was diagnosed with scarring alopecia in his teens, used SMP to camouflage his scarring.
  2. A 30-year-old male, who had worn a hat continually since being diagnosed with alopecia totalis in his teens, used SMP to frame his face and re-build his self-esteem.
  3. A 55-year-old man, who had large-graft (“hair plug”) hair transplants and several scalp reductions, used SMP to fill in plug scars and re-define his hairline.
  4. A 32-year-old man used SMP to cover donor area scars from previous FUT procedures, fill in his thinning crown, and create a smooth hairline.
  5. A 22-year-old man filled in scars from a previous FUE hair transplant using scalp micropigmentation.
  6. A 45-year-old man, who had always shaved his head and refused hair transplantation, used SMP to create a hairline with an overall look of a clean-shaven head.
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Hair Restoration Research

Scalp Micropigmentation (SMP): a Permanent Cosmetic Tattoo to Conceal Hair Loss and Camouflage Scalp Scars

According to an article published in the journal of Facial Plastic Surgery Clinics, scalp micropigmentation (SMP) has been found to be a useful cosmetic treatment for hair loss and scalp scars.

SMP is a scalp tattooing technique that uses fine dots – like a stippled painting – to mimic the appearance of extremely short hairs on an otherwise bald scalp.

SMP can create the appearance of a fuller head of hair on a scalp that is losing hair by softening the contrast between the hair that remains and the color of the scalp. It can also effectively camouflage a scalp scar, like the donor scar from a strip hair transplant procedure, the scar from a scalp reduction or scars from trauma to the scalp.

Finally, SMP can help augment the results from either a Follicular Unit Hair Transplant (FUT) or a Robotic FUE Transplant (R-FUE), especially for patients who do not have enough donor hair to give the appearance of full coverage.

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Hair Restoration Answers

How Long Do Stitches Stay in After a Hair Transplant?

Q: I’ve heard that healing after a hair transplant requires stitches. How long will they stay in? — S.R., Cresskill, N.J.

A: In a follicular unit hair transplant, the surgeon removes a thin strip of scalp from the patient’s donor area that supplies the follicular unit grafts for the hair transplant. After the strip is removed we use either sutures (stitches) or staples to close the wound. We now close most wounds in the donor area with staples, rather than sutures, because we have found that staples cause less injury to the remaining hair follicles compared to sutures; therefore, more hair will be available for future hair restoration sessions. See Why We Changed from Sutures to Staples in FUT Hair Transplants.

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Hair Restoration Answers

Are Scalp Exercises Before a Hair Transplant Necessary?

Q: I am scheduled to have a hair transplant next month and wonder if I should do scalp exercises before the procedure? — G.F., Providence, R.I.

A: For the majority of patients, scalp exercises are not necessary.

The scalp in the donor area has a fair amount of redundancy. With a properly planned hair transplant, the donor area will close relatively easily.

If a patient’s scalp is particularly tight, or if a very large session is planned (even in the face of an average scalp), vigorous scalp exercises are useful in increasing laxity.

The advantage of stretching one’s scalp prior to surgery is that it allows the doctor to remove a slightly wider strip and it decreases tension on the closure so the person will heal with a potentially finer scar.

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Hair Restoration Answers

Why Change from Sutures to Surgical Staples in FUT Hair Transplants?

Q: I recall that you wrote an article about Monocryl for the donor closure in hair transplants. Why are you now using staples? — R.S., Park Slope, NY

A: I have been using staples in almost all of our follicular unit hair transplants since the beginning of 2006. Continue reading for the detailed explanation as to why I made the switch from sutures to staples.

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Hair Restoration Answers

Do You Use Sutures or Staples in an FUT Hair Transplant?

Q: Can you please comment on the use of sutures verses staples in hair restoration procedures? — S.S., Prospect Park, NY

A: Sutures are great on non-hair bearing skin and allow perfect approximation of the wound edges, but on the scalp they can cause damage to hair follicles below the skin’s surface. The reason is that a running (continuous) suture traps hair follicles and when the skin swells (as it normally does after hair transplants) the trapped follicles can strangulate and die.

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Hair Restoration Answers

How Do You Treat Hair Loss from Pseudopelade or Scarring Hair Loss on the Scalp?

Q: I am suffering from Pseudopelade for four years now. I have lost a lot of hair & there are big bald patches on the top of my scalp that are difficult to hide. Is there any hair transplant surgery or follicle transplant surgery possible in my case, or anything else I can do? — T.L., Boston, MA

A: In general, hair transplantation does not work for Pseudopelade (a localized area of scarring hair loss on the top of the scalp) since the condition is recipient dominant rather than donor dominant.

With a donor dominant condition, such as androgenetic hair loss, the tendency to have the condition, or be resistant to it, is located in the hair follicle and moves with the hair follicle when the follicle is transplanted to a new area…

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Hair Restoration Answers

Can Hair Transplant be Harmed by Smoking Before or After Procedure?

Q: Is it true that smoking is bad for a hair transplant and why? P.P. – N.Y., N.Y.

A: Smoking causes constriction of blood vessels and decreased blood flow to the scalp, predominantly due to its nicotine content. Also, carbon monoxide in smoke decreases the oxygen carrying capacity of the blood.

These factors both contribute to poor wound healing after a hair transplant and can increase the chance of a wound infection and scarring. Smoking may also contribute to poor hair growth.

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Hair Restoration Answers

Can Hair be Transplanted into Scar Tissue from a Prior Transplant?

Q: I have had some surgical procedures on my head that left a fair amount of scar tissue. Can hair grow there? Is it a more difficult procedure? Are there any complications? – Darien, C.T.

A: Transplanted hair will grow in scar tissue as long as the tissue is not thickened. Thickened scar tissue can be flattened with local injections of cortisone.

Once the scar is smooth, the hair transplant procedure is relatively straightforward, however a few things must still be kept in mind.

  1. Since the blood supply of the scar tissue is less than in normal tissue, the grafts should not be placed as close.
  2. As the grafts from the hair transplant grow, new blood vessels are formed in the area.
  3. Additional density can then be achieved in a subsequent session by adding more grafts.
  4. After the hair restoration procedure, care must be taken with grafts transplanted into scar tissue, as the scarred scalp doesn’t hold onto grafts as well as normal tissue and they are more easily dislodged.

If grafts are packed too closely into scar tissue, poor growth can result. If sites are placed properly and the post-op care is diligent, good growth should be expected.

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Hair Restoration Answers

How Much Hair Can be Removed From the Donor Area?

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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