Part 5
Minimizing Donor Scarring from a Hair Transplant
Interviewer: Has there been any progress made in terms of the technology to minimize the scar, appearance of the scar on the back from a hair transplant?
Dr. Bernstein: Yes, there have been huge advances. One of the things that is really encouraging is that over time the strips get more efficient to remove and the resulting line scar becomes less and less.
One of the problems has been that for many years people did plugs, scalp reductions and other hair restoration procedures that gave poor results – this is well, known to many. However, people don’t appreciate the fact that the old technology was applied to removing the donor tissue as well, so just as the results of the hair transplants were poor; the results in the donor area were poor often resulting in cosmetically unacceptable scars.
But just as the plugs have gotten smaller, eventually turning into follicular units, we’ve also made significant advances in the back as well.
A major advance is using staples instead of traditional sutures. With sutures, you have very good control over approximating the wound edges, but sutures cause inflammation in the scalp that can destroy hair follicles. Staples, on the other hand, are made out of stainless steel and they are inert and don’t react with the tissue. Therefore, no hair is lost from the staples – and that is very important.
In another advance, called a Trichophytic closure, the upper edge of the incision (and sometimes the lower edge) is trimmed away to actually allow the hair to go through the incision line and make the incision less visible.
Interviewer: Oh, interesting. Is that a relatively new technique within the last year or something?
Dr. Bernstein: Yes, within the last few years. Dr. Marzola in Australia had started working with it and it’s something that we use routinely in most of our patients now.
Interviewer: Is it more difficult to perform?
Dr. Bernstein: No, it’s actually quite simple. It’s not completely clear the advantage it has in staple closures, although it seems to be as useful in staples, to some degree, as it is in sutures. It’s particularly useful where people have had hair transplant procedures already and you’re making an incision through scar tissue so you can actually trim away the edge of the scar tissue and make the closure much tighter.
Interviewer: So people that go for multiple sessions can effectively look like they had just one.
Dr. Bernstein: Yes. There have been as many advances in the donor area as there have been in the front, which is really encouraging. And then again, if there’s ever a problem where there’s a line scar after the hair transplant or someone all of a sudden wants to keep their hair very short, we can take hair from around the scar with follicular unit extraction and just place it directly it into the scar. This can decrease the visibility very significantly.
Hair Cloning
Interviewer: What are your thoughts on hair cloning? Is it going to be available for hair restoration surgery anytime soon?
Dr. Bernstein: I have been criticized for my cautious view about declaring when hair cloning will become available, but again, I think it’s still about five to ten years away – probably closer to ten years. And I’ve actually been saying this for perhaps ten years now. But so far my predictions have been borne true. It has been kind of a moving target.
There are some very important steps that still have to be overcome before hair cloning comes to fruition and the major one is the fact that as you culture cells, they lose their ability to produce hair. They “de-differentiate” or revert to a more primitive less specialized cell that can’t produce hair. That obstacle has not yet been overcome. So the technology for hair cloning in not yet available. Then we have to have the clinical trials, get FDA approval, etc. So it’s still quite a ways off.
So even though I am a little bit cautious in proclaiming that in the next few years, hair cloning will be available, I think that it is absolutely inevitable that cloning will be with us. So I’m very, very encouraged and excited about it, although I think it’s still a ways off.
Interviewer: Very exciting.
Dr. Bernstein: One of the things that is important is that until we really have the technology in hand, I think it behooves us as physicians to plan the hair transplant surgery as if hair cloning is not available. You should not perform a hair transplant aggressively and use up all of a patient’s donor hair with the hope that you’ll be saved in the end by hair cloning. I think we have to plan all hair transplants at this point assuming that cloning is not at hand and also assuming that medications are not going to work. I think too many doctors do hair transplants based upon the hope that Propecia is going to permanently stop hair loss and that cloning will give us more hair in the future. I think all surgical hair restoration should be stand alone procedures with existing technology.
Interviewer: Well, that makes a lot of sense because you can’t predict how long, but eventually you may still lose the hair even from the medication, right?
Dr. Bernstein: Yes.
