Bernstein Medical Hair Transplant Blog

Scalp Reduction Scar

nospam@example.com (Robert M. Bernstein M.D.) — Mon, 29 Sep 2008 10:59:00 -0700

Q: Whats the best way to camouflage a scar left behind from a scalp reduction that I had in 2001? I am currently wearing DermMatch to cover the area, but the hair parts like the Red Sea on top around the scar so the makeup does not look so good. I would like to fill in the area with hair but I am not sure if a hair transplant will grow into scar tissue.

A: Hair will grow in the scar but, as you allude to, the problem is often the abnormal hair direction rather than the scar itself. Besides adding hair to the scar, if one transplants hair adjacent to the scar in a direction that causes it to lie over the scarred area, the visual affect of the Red Sea effect can be lessened. How much improvement you achieve with the hair restoration will, in part, depend upon the amount of hair available to be transplanted (and the skill of the surgeon).

Change in First vs. Second Procedure

nospam@example.com (Robert M. Bernstein M.D.) — Mon, 22 Sep 2008 11:42:39 -0700

Q: In which procedure do you generally more of a change, the first or the second?

A: It depends upon how bald a person is. If someone is very bald, the first session will be the most noticeable, since going from no hair to hair is much more dramatic than going from some hair to more hair. In addition, if someone is very bald, the first session is generally the largest, with less hair being transplanted in the second.

The situation is different if someone has had a hair transplant with only a limited amount of hair loss. In this case, the first session may be small (since that is all one needs at the time) and the second session, performed after the person has loss additional hair, may be significantly larger. In additiaon, the impact of the first session was lessened by the progression of the persons hair loss. However, the second session was superimposed on existing, permanently transplanted hair and may thus be more dramatic.

Lasers, Medications, Herbs and Surgery

nospam@example.com (Robert M. Bernstein M.D.) — Mon, 15 Sep 2008 10:00:59 -0700

Q: I am interested in a hair transplant, but am turned off by the apparent side effects of follow up Propecia. Could herbs serve the purpose of Propecia? Re laser treatments, do they work on their own, or do you need drugs to supplement? Can laser damage in some cases, rather than benefit? It seems odd that laser therapy has been undertaken in Europe for 10 years, yet there are no published studies on the results. Might this be because it doesnt work in the longer term?

A: Finasteride is the best medication. Herbs are not particularly effective for hair loss. You should consider trying finasteride. If you are in the 2% group that has side effects, just stop it. If you dont then there is no problem taking the medication long-term. Hair transplant surgery doesnt prevent the progression of hair loss. That is why it is used in conjunction with medication. Laser therapy can cause shedding initially (as can Propecia and Rogaine), but this means it is working. It does not cause actual hair loss. Your skepticism of the value of Laser therapy long tem is one we have as well; however, keep in mind that long-term studies, although extremely important, are very hard and costly to do and there is little incentive for companies to do this. It is interesting that the FDA does not require longer term data on medications or devices that need to be used on a continued basis.

Intermittent use

nospam@example.com (Robert M. Bernstein M.D.) — Sun, 10 Aug 2008 10:25:00 -0700

Q: Medical information suggests that Rogaine works for about 50% of the men who try it. Does Rogaine actually worsen hair loss in some men? The Rogaine website states that during the first three weeks of use Rogaine causes increased shedding. If true, would intermittent use of Rogaine make hair loss worse even in men for whom Rogaine would work if apply daily as directed?

A: Minoxidil doesnt worsen hair loss but can cause initial shedding (as it is working). The medication should be used on a continuous basis for the long-haul. Intermittent use makes no sense.

Which one to use?

nospam@example.com (Robert M. Bernstein M.D.) — Mon, 28 Jul 2008 12:41:48 -0700

Q: I have been trying to find some evaluation of which laser combs work best for hair restoration. I have seen some dermatologists speak about the Hair Max laser comb and its effectiveness (considering patient compliance, the amount of time the patient has been losing hair, the amount of total hair loss at time of treatment, etc.). I have also seen reference to the Sunetic laser comb which claims to have a superior technology to the Hair Max and offers a changeable head to allow treatment of the skin for healing, wrinkles, etc. A company in Michigan also offers a laser comb called the Hair Rejuvenator which it claims is superior to either of the other combs but I have not heard of any dermatologist who recommends this comb. A firm in Australia also offers a laser comb (the Aculas) which it claims is the most effective; however, the makers of the Hair Rejuvenator comb say it is too powerful and dangerous and could cause blindness. Amidst all these claims, the consumer (patient) is left wondering which best option is and which is merely hype or fraud. What do you suggest?

A: There are no comparative studies thus far, so for the hand-held devices I would stick with the Laser comb for now, since it is the only one that has cleared the FDA.
Some others may work as well (and are less expensive) but we just dont know at this time and how useful any of them are long-term is also still not known.

Change in semen

nospam@example.com (Robert M. Bernstein M.D.) — Mon, 21 Jul 2008 10:39:33 -0700

Q: Ive now been taking finasteride for just over 5 months. I have noticed is my sperm quality is changed just in the last 3 months, and it seems now much less in quantity and is quite watery and clear in color. I think the current problems are due to the finasteride, what do you think?

A: Finasteride can change the quality of the semen, since it is decreasing the component of seminal fluid that is secreted by the prostate. You may want to consider having your sperm counts checked, although a decreased sperm count is rare with finasteride. If the symptoms are not bothering you and the sperm counts are normal, it should be OK to continue the medication.

Transplanting actual hairs

nospam@example.com (Robert M. Bernstein M.D.) — Mon, 14 Jul 2008 11:49:00 -0700

Q: Can a hair transplant be done using the hair which has fallen out?
A: A hair transplant is really a misnomer, since it is the follicle (or root) that is transplanted, rather than the hair per se although the transplanted follicle usually contains a hair. Hair, like fingernails are dead and cannot grow once detached from the root.

Rogaine shock loss

nospam@example.com (Robert M. Bernstein M.D.) — Tue, 08 Jul 2008 10:04:00 -0700

Q: I recently had a hair transplant about a month ago. Currently Im on Propecia and I am a stickler to taking it at the same time every day. I dont, however, use Rogaine namely because I fear the irritation it can possibly cause will halter graft growth and because Ive heard that the grafts and post surgical shock loss hair will return without its use. Is it ok to use only Propecia post-surgically? Or would adding Rogaine be of any significant benefit?

A: I would definitely stay on Propecia and, if you like, you can add Rogaine it may have a little additional benefit. The new 5% foam formulation is less irritating and can be started a week after the hair transplant. The only problem with Rogaine is compliance. If you think that you will use it long-term is worth using. If, however, you think that you will get tired of it and stop, then it is not worth starting. Any shedding with either medication is temporary and usually indicates that the drug is working.

Charging by the graft

nospam@example.com (Robert M. Bernstein M.D.) — Thu, 03 Jul 2008 14:22:21 -0700

Q: I had a follicular unit hair transplant performed by another doctor that was scheduled for 2,500 grafts and I ended up paying for exactly that amount. I was supposed to be paying per graft, so it seems strange that it came out to be exactly 2,500? How do I know what I really got?

A: This is a question that should be addressed to the doctor that operated on you. If a doctor is charging by the graft, then you should know exactly how many grafts you are receiving. It is possible that he/she hit the number (2500) exactly on the head, but statistically that is extremely unlikely. In FUT, a strip is removed from the donor area and then dissected into individual follicular units, so although an experienced surgeon can remove a strip that contains close to the desired number of follicular units, it would be very rare to hit that number precisely.

More importantly, it is impossible to perform follicular unit transplantation properly without knowing both the exact number of follicular units harvested from the donor area and the exact number of hairs in each unit (i.e. the number of 1-, 2-, 3-, and 4-hair follicular unit grafts). This information is essential in determining both the distribution and density of the hair transplant and in creating transitional zones such as the frontal hairline, where single-hair follicular units are required.

In all hair transplants, the number of grafts harvested should equal the number of recipient sites, so the doctor must know the exact number of grafts so that he can make the appropriate number of recipient sites. (An exception is the stick and place technique, where each graft is inserted as soon as the site is made, but this technique is much less common than first making the recipient sites). The surgeon also needs to know the number of grafts so that he can make the sites in the appropriate distribution. For example, if the number of grafts harvested was less than anticipated, the doctor can space the sites further apart, cover less of an area (for example, not extend the restoration as far back into the crown) or harvest additional donor tissue each option having advantages and disadvantages.

It is equally important to know the exact composition of follicular units, so that different densities can be created in different areas, producing the most natural appearance. For example, the 3- and 4- hair follicular units should be placed in the central forelock area as this area normally has the most density. On the other hand, if these larger units are placed near the hairline, they will look distinctly unnatural.

So how can the patient really know? Obviously, trust in your doctor is the most important insurance. If you are skeptical about the way the doctor conducted the consult, i.e. used salesman to encourage a sale, skipped over important options such as medication, or if you felt pressured or rushed into making a decision to have surgery, you should be skeptical about other aspects of your care as well such as accurately counting grafts.

Although just a very general guide, here are some things you can do at your consult when trying to decide if a doctor can be trusted to give you accurate information regarding the number of grafts you receive.

Ask to see the operating room - see if there are plenty of microscopes (the larger the session, the more are needed).
Ask the doctor how he keeps count of the grafts that are dissected and how does he record how many hairs in each follicular unit graft.
Ask the doctor how he keeps track of the number of recipient sites that are made.
Ask to see how all this information is documented in the patients medical record.
Ask the doctor if he refunds money to the patient if he transplants less grafts than scheduled.
Speak with other staff members to confirm the use of dissecting microscopes for the entire surgery and confirm the procedure for tracking grafts.

In sum, knowing the exact number of grafts and their composition is extremely important, not only to ensure that you are being charged fairly, but in maximizing the aesthetic results of your follicular unit transplant procedure. Be certain that this information will be available to you (and of course your surgeon) before scheduling a procedure.

When do I get my staples out?

nospam@example.com (Robert M. Bernstein M.D.) — Tue, 01 Jul 2008 16:35:34 -0700

Q: How soon after the hair transplant procedure do I have to get them out?

A: We remove every other staple at 10 days post-op. The remaining staples are generally removed at 20 days post op. This varies based upon the patients scalp laxity and the width of the donor strip

Health Savings Accounts

nospam@example.com (Robert M. Bernstein M.D.) — Mon, 23 Jun 2008 10:28:52 -0700

Q: Can a health savings account dollars be used for a hair transplant procedure?

A: Generally yes, but I would check with your individual state and personal plan.

nospam@example.com (Robert M. Bernstein M.D.) — Mon, 16 Jun 2008 12:16:14 -0700

The Bernstein Medical Hair Transplant Blog

Welcome! This Weblog is devoted specifically to topics related to surgical hair restoration. Entries in the Blog cover a wide variety of subjects including new hair replacement techniques, repair of hair transplants, medical therapies, diagnostic problems and cloning hair.

Laser Comb post-op

nospam@example.com (Robert M. Bernstein M.D.) — Mon, 16 Jun 2008 10:44:00 -0700

Q: I am currently using the Hair Max Laser Comb. I am starting on my third week and am scheduled for a hair transplant in one week. My question is how long do I have to wait to restart the laser comb after my hair restoration procedure. This is not my first procedure and I understand the grafts are delicate for the first couple of weeks. If I keep the teeth away from the scalp and just let the light hit the grafts will this promote faster growth?

A: You can start using the comb again right after the surgery, as long as it doesnt touch the scalp. At 10 days you can use it normally, as the grafts pare permanent and there is no risk of dislodging them.

Hair Transplants, Medications and Pregnancy

nospam@example.com (Robert M. Bernstein M.D.) — Mon, 02 Jun 2008 11:23:19 -0700

Q: Is it necessary to take medications before, during or after the hair transplant? Will these medications affect pregnancy?

A: It is not necessary to take any medication for a hair transplant other than the local anesthesia used during the procedure. Although I would not have a hair transplant during pregnancy, the procedure will have no effect on future ones.

Taxes on a Hair Transplant

nospam@example.com (Robert M. Bernstein M.D.) — Mon, 19 May 2008 09:20:55 -0700

Q: Are state taxes applicable for hair restoration procedures?

A: There are no taxes on cosmetic procedures performed in New York State. Some states do have taxes. In New Jersey, for example, there is a cosmetic surgery tax of 6%, but not in NY.