Q: What is more important against baldness, decreasing DHT in serum with oral finasteride or decreasing DHT in the scalp with topical finasteride? — A.G. ~ Brooklyn, N.Y.
A: Decreasing serum DHT with oral finasteride is more effective in combating hair loss, as the decreased blood levels decrease the DHT in follicles and seem to do it better than finasteride applied topically.
Like many women, Alden Wicker felt self-conscious about her naturally high hairline and burdened with the high-maintenance of trying to keep her bangs perfectly positioned to cover her forehead. Alden discovered an article on Dr. Robert M. Bernstein, founder of Bernstein Medical – Center for Hair Restoration and pioneer of Follicular Unit Transplantation, and decided to see if he could fix her hairline. In an article she contributed to Racked, an online magazine published by Vox Media, Ms. Wicker describes her experience with Bernstein Medical and how thrilled she is will the results of her hair transplant.
Bernstein Medical patient explains where his hair loss journey began and how he discovered Dr. Bernstein. He provides a detailed account of his hair restoration process, and discusses his experience.
Synopsis: Hair restoration has advanced dramatically in the past 25 years, most recently with the growing popularity of FUE. The challenge of FUE is that the grafts are more fragile compared to the follicular units generated in traditional FUT/strip procedures. Innovations such as the ARTAS Robot and other devices attempt to address this problem. With the increasing participation of ISHRS members – now 1,200 strong – progression in this field should continue at an accelerating pace.
In appreciation of National Hair Loss Awareness Month, Bernstein Medical has launched a fundraiser for the ISHRS’s pro bono program, ‘Operation Restore’. This program provides free hair transplants for those who experience localized hair loss due to trauma or illness.
Q: I was thinking of having an FUE procedure done in Turkey, but I am concerned that it will be done with just technicians. Any thoughts? — E.E. ~ Mount Vernon, N.Y.
A: I do not have first-hand information on the clinics in Turkey, but there is a recent “Letter to the Editor” in Hair Transplant Forum International, the official publication of the “International Society of Hair Restoration Surgery” that you might find informative. From the article:
“In Turkey, there are 300 FUE clinics in Istanbul alone, but unfortunately at only 20 of them operations are done by doctors. We do not exactly know how many of those 300 clinics have legal permissions, but we know very well that an average of 500-1,000 FUE operations are done per day.”
If you would like to read the entire article, the reference is: A Report from Turkey – the situation in a top FUE destination. Hair Transplant Forum International July/August 2017 p 162.
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.
Q: Is it true that performing FUE hair transplant procedures by hand is better because the physician can better adjust and feel the follicle when extracting? — M.H. ~ Great Neck, N.Y.
A: The ARTAS robot is a physician controlled, computerized device that uses a three-dimensional optical system to isolate follicular units from the back of the scalp in a hair transplant. The robotic system assists the physician in the extraction of grafts with precision and speed. Although there is some advantage to having “human feel” for the tissue, this is far outweighed by the fact that repetitive procedures performed manually thousands of times lead to operator fatigue and result in increased transection and damage to grafts. With the ARTAS robotic system, the quality of the first and the last graft harvested will be the same.
Q: I have read that some doctors perform something called a trichophytic closure. What is this? — M.S. ~ Thornwood, N.Y.
A: Trichophytic closure is a way to minimize the appearance of the donor scar in a hair transplant using a strip incision. The technique provides improved camouflage of a linear donor scar in Follicular Unit Transplantation (FUT). Normally, in FUT, the surrounding hair easily covers the scar. For some patients with very short hairstyles, the resulting donor scar may be visible. With the trichophytic closure technique, Dr. Bernstein trims one of the wound edges (upper or lower), allowing the edges to overlap each other and the hair to grow directly through the donor scar. This can improve the appearance of the donor area in patients who wear their hair very short.
The trichophytic donor closure can be used on patients who have had previous hair transplant procedures and are looking for improvement in the camouflage of their donor scar. It is particularly useful in hair transplant repair or corrective work. Trichophytic closures work best with sutured incisions. Stapled closures have their own advantages. The doctor will recommend which type is best in your case.
Robert M. Bernstein, MD, MBA, FAAD has been recognized by his peers with inclusion in his eighteenth consecutive edition of New York Magazine’s annual ‘Best Doctors in New York’ issue. Dr. Bernstein helped re-invent hair transplant surgery by pioneering the Follicular Unit Transplantation (FUT) procedure and by becoming an early proponent of robotic hair transplant surgery (Robotic FUE). He is the only hair restoration surgeon named to the prestigious “Best Doctors” list for as many years. Of being included in the 2017 issue, he said: “New York has some of the finest doctors in the world, so to be considered among the best by my peers is quite an honor. It is equally satisfying when a patient tells us that we helped change their life.”
