Bernstein Medical Blog

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

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How Much Hair Can be Removed From the Donor Area?

September 2nd, 2005

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.

The Effect of Propecia (Finasteride 1mg) on Hair Transplants

September 1st, 2005

The progressive decrease in hair shaft diameter that causes thinning (also called miniaturization) characteristic of male pattern baldness, can be decreased by the use of the DHT blocker Propecia (chemical name finasteride). Most men undergoing hair restoration surgery have some existing hair in the area that is to be transplanted that will thin over time and, in fact, may thin a bit more quickly as a result of the surgery. For men undergoing surgical hair restoration, the thinning of the surrounding hair can diminish the overall impact of the hair transplant. Even though Propecia has no effect on the transplanted hair, it can help to maintain the patient’s surrounding hair and is, therefore, useful as an adjunct to hair transplant surgery, to enable the patient to obtain a better overall result.

The present study looks to see if Propecia given from one month before surgical hair restoration until eleven months after, can increase hair growth in the area surrounding the hair transplant. In the study, consisting of almost eighty men divided into two groups in a double-blind fashion were either given Propecia or a placebo. Growth was recorded by hair counts and by photos.

The study showed that Propecia was substantially better than the control group in increasing hair counts and in increasing visible fullness when patients started Propecia a month before their hair transplant and were on the medication for one year.

Can a Hair Transplant Correct Balding from Discoid Lupus Erythematosus (DLE)?

August 25th, 2005

Q: I have a bald patch on my scalp diagnosed as DLE, can this be corrected with a hair transplant? – V.Q., Scarsdale, N.Y.

A: DLE or discoid lupus erythematosus is a type of autoimmune disease where the body produces an inflammatory reaction to components of the skin, causing it to scar and lose hair.

The skin in the area of hair loss generally has a smooth appearance with tiny empty hair follicles, redness, and altered pigmentation. These skin changes help to differentiate it from the more common condition alopecia areata where the underlying skin appears normal.

The diagnosis of DLE can be confirmed by biopsy. Because DLE may exhibit a property called Koebnerization, where direct trauma can make the lesions enlarge, surgical hair restoration risks making the condition worse and is, therefore, not indicated.

Does Hair Grow More Slowly After a Second or After a First Hair Transplant?

August 24th, 2005

Q: This is my second hair transplant and is seems like it is growing more slowly than my first. Is this normal? – J.D., Port Washington, N.Y.

A: It is common for a second hair transplant to take a bit longer to grow than the first, so this should be expected. It is also possible that there is some shedding from the procedure, or a continuation of your genetic hair loss.

Propecia may be helpful in this regard. It is important to wait at least a year for the transplant to grow in fully and to give a chance for any hair that was shed to regrow.

What is Graft Compression After a Hair Transplant and Why Does it Occur?

August 19th, 2005

Q: What is graft compression? — E.Z. Wayne, N.J.

A: Graft compression refers to a tufted look resulting from the contraction of grafts caused by the normally elastic skin that contracts around the graft as the hair transplant heals. This was a common occurrence with mini-micrografting where 5 or more hairs from two or more follicular units were placed into one recipient site.

With follicular unit hair transplantation, follicular units won’t show visible compression since they are already naturally compact.

How Many Grafts are in the Typical Donor Strip in an FUT Hair Transplant?

August 16th, 2005

Q: If I had a hair transplant using Follicular Unit Transplantation, how many grafts would be in a 15cm by 1cm donor strip, on average? — J.A. Point Pleasant, N.J.

A: In a person with average donor density there are approximately 100 follicular units per square centimeter. A 15cm long strip would have slightly less than 1500 grafts due to the tapering of the strip ends.

Therefore, in a hair transplant of 1500 follicular unit grafts, one should take out a 17 cm x 1cm strip (that includes the tapered ends). This is 15cm².

Read about the number of grafts in a hair transplant

Does an FUE Hair Transplant Leave a Scar?

August 15th, 2005

Q: Can you shave your scalp after a hair transplant with FUE without noticing scarring in the donor area? — A.A. Bronxville, N.Y.

A: Although there is no line scar in follicular unit extraction, there are tiny round ones. You can clip your hair very short after FUE, however, shaving your head will make the very fine white scarring visible.

There is a Lump Beneath My Donor Area After My Hair Transplant. What Is It?

August 12th, 2005

Q: I have developed a rather large, hard lump beneath the skin at the base of my scalp in the donor area that I first noticed this about two or three weeks after my hair transplant. What is this? — A.R. Bronx, N.Y.

A: You are describing an enlarged lymph node, a condition commonly seen as a normal part of the post-op course following hair transplants.

This is a normal part of healing in response to the surgery. It will resolve on its own in about 3-6 months. It doesn’t require any treatment and it should not be a cause for concern.

Hair Transplant for Thinning Hair on a Crown?

August 11th, 2005

Q: Should you perform a hair transplant on a crown that is just starting to thin? — R.R. Philadelphia, Pennsylvania

A: A “thin” crown should first be treated with Propecia, as it may thicken the hair to a cosmetically acceptable degree without the need for surgery. If Propecia is ineffective in restoring enough hair, then surgical hair restoration can be considered.

Instrumentation for Three-Step Follicular Unit Extraction

August 9th, 2005

Robert M. Bernstein, M.D. Associate Clinical Professor of Dermatology at the College of Physicians and Surgeons of Columbia University in New York Abstract of Dr. Bernstein’s presentation at the International Society of Hair Restoration Surgery, 2005 – Sidney, Australia Biography Robert M. Bernstein, M.D. is Associate Clinical Professor of Dermatology at the College of Physicians …

Instrumentation for Three-Step Follicular Unit Extraction Read More »

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