In a new article appearing on the cover of Hair Transplant Forum International, the official publication of The International Society of Hair Transplant Surgeons (ISHRS), pioneering hair transplant surgeon Robert M. Bernstein MD, along with his colleague Dr. William R. Rassman, recently revealed details about a “New Instrumentation for Three-Step Follicular Unit Extraction.”
Q: What is your opinion on having a hair transplant to restore the hairline and then wearing a hair system behind it to regain the appearance of a full head of hair? K.Y. – Hackensack, New Jersey
A: It is my personal feeling that one should not use a hair transplant to supplement a hair system, especially at a young age. We have occasionally performed this procedure in older men and women.
In my view, a main purpose of a hair transplant is for it to be low maintenance. The combination of a hair transplant and a hairpiece is extremely fussy.
Synopsis: Three-step FUE is a hair transplant technique that uses blunt dissection to prevent damage during the process of separating the follicular unit from the surrounding tissue. The 3 steps are: scoring, blunt dissection, and extraction. Performing Follicular Unit Extraction with a 3-step technique allows the surgeon to minimize damage to follicles and to keep follicular units intact. A disadvantage is the development of buried grafts, but this can be reduced by modifying the technique and using specially designed instrumentation.
Synopsis: The partial or complete loss of one’s eyebrows is a relatively common problem and can be caused by disease, accidents, the normal aging process, or can be been self-induced. This paper discusses the importance of eyebrows to one’s appearance and explains the special techniques and surgical skills required for eyebrow restoration.
Robert M. Bernstein, MD, New York, NY and William R. Rassman, MD, Los Angeles, CA Dermatol Surg 2006; 32: 198-204. Background Since it is not known precisely how long it will take for grafts to be securely anchored after a hair transplant, the advice that the medical profession has offered patients regarding post-op care has …
Graft Anchoring in Hair Transplantation: Summary Read More »
Synopsis: This study determined exactly how long it takes after a hair transplant for the grafts to be securely anchored in the recipient area, so that they cannot be dislodged. This information is important in guiding the patient’s post-op care after a hair restoration procedure. The study also showed that preventing the formation of crusts following a hair transplant would shorten the time patients are at risk of dislodging grafts. It would also allow them to return to their normal hair care routines more rapidly.
Synopsis: This paper discusses the state-of-the-art in follicular unit extraction. It focuses on the new Three-Step Technique in which a sharp punch is used to cut the epidermis and then a dull punch is used to dissect the follicular unit from the surrounding tissue. The third step being the extraction itself. The “blunt” step significantly reduces follicular transaction, but creates a potential new problem, that of buried grafts. The Three-Step technique increases the number of patients in whom FUE is possible; however, other limitations of the procedure – particularly the lower total yield compared to strip harvesting – remain.
Synopsis: This writing discusses the current status of Follicular Unit Transplantation and some controversial issues regarding this procedure. These issues include: strip harvesting vs. follicular unit extraction, lateral vs. vertical slit recipient sites, which holding solution is best for grafts, the ideal density and the optimal number of grafts that should be performed in one hair transplant session.
Q: I understand that even if you have multiple hair transplants you will only be left with one scar in the donor area. — T.J., Yonkers, N.Y.
A: If the closure is performed without tension, each procedure should result in the same fine scar.
The best-placed incision is in the mid-portion of the permanent donor area. Since there is only one mid-point, there is one best position for the scar. All incisions should lie on this plane leaving one scar.
Q: Is it possible to do a hair transplant using follicular unit extraction without shaving the donor area? — V.S., Syracuse, N.Y.
A: In follicular unit extraction, the area that is extracted is clipped to about 1-mm in length. However, if the session is not too large, then the clipped area can be long and thin so that the patient’s existing hair will cover it. The person’s hair should be left long for the procedure.
