Bernstein Medical Blog

This page contains all posts in our News, Answers, Video, and Research sections.

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Should I Increase Dose of Propecia if Hair Loss Continues During Treatment?

June 12th, 2006

Q: I recently turned 22 and have been on Propecia for about 2.5 years. The amount of hair that de-miniaturized with daily 1 mg peaked about a year ago and I have seen steady thinning since. I feel that I am too young for a hair transplant. My question is whether or not an increase in dosage of Propecia is indicated here or if I should seek other options entirely? — N.W., Portland, Oregon

A: At 22 years old, I would increase the dose of Propecia before considering hair restoration surgery. However, it is important to realize that there is no scientific evidence that increasing the dose will have any additional effects. There are published data by Roberts et al in the JAAD in 1999 demonstrating that 5 mg is no better than 1 mg from controlled clinical trials.

What is Tumescent Anesthesia and is it Used in a Hair Transplant Procedure?

May 31st, 2006

Q: I have read about something called “tumescent anesthesia” but didn’t understand what it is. What exactly is it? — S.S., Hoboken, N.J.

A: Tumescent techniques were first popularized in liposuction surgery where large quantities of fluid containing adrenalin were injected into the person’s fat layer to decrease bleeding before the fat was literally sucked out of the body. Bleeding was minimized because the epinephrine (adrenaline) constricted blood vessels and the fluid compressed the blood flow in the smallest blood vessels called capillaries.

The technique allowed small liposuction procedures to be performed safely as an out-patient procedure. In surgical hair restoration, low concentrations of anesthetic fluid and adrenaline are injected into the fat layer in the back of the scalp.

In a hair transplant, besides decreasing the bleeding, the fluid makes the skin more rigid so that the incision can be more easily made without cutting hair follicles. It also helps the doctor avoid damage to the deeper blood vessels and nerves in the scalp.

Interview on Hair Loss and Hair Transplantation

May 17th, 2006

Part 1

Hair Loss in the Younger Person

Interviewer: I brought a fair number of questions related to aspects of androgenetic alopecia and hair transplantation, but I will also ask you some questions regarding two other types of hair loss, like alopecia areata and cicatricial alopecia. Most of our listeners are fairly educated about the different hair restoration options available to them, so I’ll tailor my questions primarily for this type of audience.

The first question that I want to direct here is the dilemma that many young people face when they’re losing their hair and are considering getting a hair transplant. They typically don’t know the degree to which their hair loss is going to progress. When you’re in your 20s and 30s, you want to have a decently low-running hairline and you want to have a crown that looks full. But given that you don’t know how far your hair loss is going to go, how would you address this scenario for people in that age range?

Dr. Bernstein: That is the main problem with treating younger people. We don’t really know how they’re going to progress. It is so important to wait, usually until the person is 23 to 25 before you can really get a sense of how much hair loss they are going to lose. And even at that age it’s sometimes very difficult to tell. That’s even after considering things such as family history.

A problem with treating a younger person with surgical hair restoration is that they often want things that are unrealistic. A person in their 20s is what we call “backward-looking.” They’re looking to when they were a teenager and they want their flat hairline back and all their old density. But hair transplants are forward-looking. We need to consider what they’re going to be like in ten or twenty years – not how they looked in the past.

Which Gives More Donor Hair: FUT or FUE Hair Transplant?

May 11th, 2006

Q: I am Norwood Class 6 and have read about both Follicular Unit Extraction (FUE) and Follicular Unit Transplantation (FUT). Which will give me more hair? — D.D., Highland Park, T.X.

A: In general, FUT will give you more hair since, in FUT, the best hair from the mid-portion of the permanent zone of the scalp (also called the “sweet spot”) can be utilized in the hair transplant.

With FUE, since only the hair follicles are extracted and not the surrounding bald skin, if too much hair is removed, the donor area will begin to look thin as hair is removed. This will limit the amount of hair that can be harvested.

Although in FUE additional areas of the scalp can be utilized to some degree, this will generally not compensate for the inability to access all of the hair in the mid-permanent zone and the total amount available for the hair restoration will be less.

Before Hair Transplant, How Long Should I Use Propecia?

April 14th, 2006

Q: I am 28 years old and was told that I have early Norwood Class 3 hair loss. I want to have a hair transplant but my doctor told me to use Propecia for 6 months and then come back to discuss surgery. I don’t want to wait that long, what should I do? — L.B., Oyster Bay Cove, NY

A: Actually, you should wait a full year.

If you are an Early Norwood Class 3, the Propecia can work so well (in actually growing hair back) that you may not even need a hair transplant.

The important point is that Propecia only starts working at 3-6 months and during this time there may actually be some shedding as the new growing hair literally pushes out the old.

Should I Get a Hair Cut Before My Hair Transplant?

April 6th, 2006

Q: Should I cut my hair prior to the hair transplant? — R.R., Poughkeepsie, N.Y.

A: It is easier for the hair transplant surgeon and his team to work when the existing hair in the area to be transplanted is cut short, but a skilled surgeon can work well in either situation. Most experienced surgeons are used to working without cutting the hair in the recipient area, since so few patients want their hair to be cut – particularly in New York.

Dr. Bernstein’s Lecture On FUT Hair Transplantation

March 27th, 2006

Dr. Bernstein, a renowned teacher, lecturer, and surgeon, is bringing his state-of-the-art hair restoration techniques directly to patients. His lecture on Follicular Unit Transplantation (FUT) includes a historical review of hair transplant techniques, from the out-dated “hair plugs” and “cornrows” to refined FUT procedures. Watch the lecture to see images of surgical tools, illustrations of surgical techniques, and before and after patient photos.

Dr. Bernstein Authors ‘Hair Transplant Blog’

March 25th, 2006

Hair transplant surgeon Robert M. Bernstein M.D. joins the blogosphere to discuss hair transplantation and help dispel the myths about hair loss and its treatment.

The blog serves as a clearinghouse for important concerns of both men and women suffering from hair loss.

NPR Interviews Dr. Bernstein on Hair Transplantation and Hair Loss

March 23rd, 2006

Here is one exchange from the interview:

Moderator: How one can tell the difference between hair loss from hormonal imbalances and common baldness?

Dr. Bernstein: Measuring hormone levels alone, although important for medical management, does not necessarily reveal whether the cause of the hair loss is actually hormone related or is genetic. The diagnosis is made by examining the scalp and looking at the hair under close magnification using an instrument called a “Densitometer.”

What is Graft Compression in a Hair Transplant?

March 22nd, 2006

Q: What exactly is compression in a hair transplant? — D.O., Short Hills, N.J.

A: Compression refers to the visible tufting of grafts due to the contraction of the grafts from the normal elasticity of skin around it, after it has been inserted into the recipient site.

Compression is most commonly seen when minigrafts are used in the hair restoration (minigrafts contain more than four hairs each).

Follicular units don’t show visible compression, since they are already naturally compact. However, if more than one follicular unit is placed into the same site, it can exhibit this phenomenon.

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