Q: I am preparing for FUT surgery and read about scalp laxity exercises. Will they better prepare me for my hair transplant? – O.U.
A: For the majority of patients, there is enough scalp laxity so that exercises are unnecessary. If a patient’s scalp becomes too tight for FUT, we would switch to FUE. On occasion, after multiple FUT procedures, if the scalp is snug and FUT is still desirable, then scalp laxity exercises can be useful.
Posted byQ: I have heard that shock loss can occur after a hair transplant. Do women experience less shock loss than men? — N.R. ~ Mineola, N.Y.
A: Actually, the risk of shock hair loss is usually greater in women than in men since women generally have a more diffuse pattern of thinning. This is because females often have more miniaturized hair, the hair that is most subject to post-op shedding.
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Dr. Bernstein creating recipient sites using the ARTAS robotHair transplant pioneer Dr. Robert M. Bernstein and his colleague Dr. William R. Rassman have received a patent on a new method that improves the outcome of Follicular Unit Extraction (FUE) — the type of procedure used in half of all hair transplants performed world-wide. The key invention is the addition of a delay between the creation of recipient sites and the insertion of follicular units into those sites. The delay allows the healing process to commence before grafts are inserted, resulting in increased success of the transplant and an improved outcome.
Dr. Bernstein introduced the concept of “pre-making recipient sites” into medical literature in a 2012 publication in Hair Transplant Forum International, has discussed the idea extensively, and presented findings at the 2015 ISHRS Annual Scientific Meeting. However, this is the first time he has patented a hair restoration technique.
The first 24 hours after any wound to the skin is a critical period of time in the healing process. Dr. Bernstein describes this initial period in his 2012 publication:
During the first 24 hours following recipient wound creation, a flurry of biologic activities take place that facilitate healing. These include: the migration of platelets with subsequent release of cytokines, growth factors and pro-inflammatory proteins (histamine, serotonin, kinins, prostaglandins, etc.) that increase blood vessel permeability and stimulate cell migration. Allowing these processes to begin before implantation of the grafts should be beneficial to their healing and subsequent growth. ((Bernstein RM, Rassman WR. Pre-making recipient sites to increase graft survival in manual and robotic FUE procedures. Hair Transplant Forum Intl. 2012; 22(4): 128-130.))
By making recipient sites in advance of harvesting the grafts, three important things are achieved by the surgeon:
Dr. Bernstein proposed “pre-making” recipient sites in 2012 as a way to improve the Follicular Unit Extraction (FUE) procedure, and robotic-assisted FUE (Robotic FUE) in particular. This is due to the fact that the positioning of the patient makes it problematic to create recipient sites and place grafts while follicular units are being extracted from the donor area. This is not the case in Follicular Unit Transplant (FUT) procedures, in which a donor strip is removed from the patient then dissected on a dissecting table. In FUT, recipient sites can be created and grafts can be placed concurrently with the dissection process.
“Pre-making” recipient sites is a protocol that should be followed during all FUE hair transplant procedures. It is also applicable in hair multiplication and hair regeneration techniques that are being studied as a way to provide an unlimited amount of donor hair for hair restoration purposes.
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Dr. Bernstein was interviewed for an article in NYCityWoman.com that ran the gamut of available treatments for hair loss in women. Read below for some select quotes on a wide range of topics related to hair loss in women and treatments for female patients with androgenetic alopecia (common genetic hair loss).
On the fading stigma of hair loss in women:
“Women today are more comfortable talking about their hair loss.”
On indicators of hormone-driven female hair loss:
“It is typical to have a positive family history of hair loss and the presence of miniaturization (short, fine hairs) in the thinning areas.”
On minoxidil for regrowth of thinning hair:
“Rogaine (minoxidil) can increase the quality (length and diameter) of hair that is just starting to thin.”
On the different strengths of Rogaine (minoxidil):
“I generally recommend the 5 percent for women and men. Although it’s sold in separate packages for men and women, the basic ingredients are essentially the same.”
On Rogaine Foam:
“It is an elegant mixture, made for compliance,” says Dr. Bernstein. “It is an aerosolized foam, so it is less irritating than liquid Rogaine, but can be more difficult to get directly on the scalp.”
On LaserComb vs. cap-based Low Level Laser Therapy (LLLT) devices:
“The cap is both easier to use and more effective for very thin hair, due to the greater number of lasers. But for higher-density hair, a laser comb or the LaserBand82 may be more effective, as it’s probably better at getting the laser therapy beam to the scalp.”
On Follicular Unit Transplant (FUT) surgery:
“FUT hair transplants allow many women to have a completely natural hair restoration, producing a dramatic change in their appearance.”
On Robotic FUE hair transplants:
“Robotic FUE allows for unparalleled precision, without any line scars in the donor area and no post-operative limitations on physical activity.”
See before and after photos of some of our female hair transplant patients
Read about the causes, classification, diagnosis and treatment of hair loss in women
The 2015 hair restoration practice census, published by the International Society of Hair Restoration Surgery (ISHRS), showed that hair transplantation is an increasingly popular treatment for hair loss. The biennial survey found that 397,048 procedures were performed in 2014, an estimated increase of 28% over the previous survey, published in 2012. Three prior surveys found increases of up to 12%, so the rate of surgical hair restoration seems to be accelerating.
Since 2006, the number of procedures worldwide has increased 76%, with the estimated global hair restoration market now valued at approximately $2.5 billion annually.
Age
Over half of all men and women treated were younger than 50. Men aged 30-39 made up the biggest percentile at 31.7%, followed by those aged 40-49 (26.9%). It was the inverse for women, however, with those aged 40-49 making up the biggest percentile at 27.7%, followed by women in the 30-39 year old bracket (27.0%).
Gender
In 2014, 84.7% of surgical patients were men and the rest (15.3%) were women. The number of women receiving a hair transplant increased by 12% since 2012. There was also a 21% increase in non-surgical female patients.
Procedure
While Follicular Unit Transplant (FUT) procedures accounted for over half of all hair transplants, Follicular Unit Extraction (FUE) is gaining rapidly, with a 51% increase over the 2012 results (from 32.2% in 2012 to 48.5% in 2014). See the chart:
Dr. Robert M. Bernstein, pioneer of modern hair transplant procedures and a Clinical Professor of Dermatology at Columbia University in New York, was included in New York Magazine’s ‘Best Doctors’ issue for the 16th consecutive year.
New York, NY — Robert M. Bernstein, MD, MBA, FAAD, a Clinical Professor of Dermatology at Columbia University in New York and renowned pioneer of Follicular Unit Transplantation (FUT) and Robotic Follicular Unit Extraction (Robotic FUE) hair transplant procedures, was included in New York Magazine’s annual ‘Best Doctors’ issue for the sixteenth consecutive year.
On being chosen for his sixteenth consecutive ‘Best Doctors’ issue, Dr. Bernstein said: “I am honored to be considered among the best doctors in New York and it is a credit to the hardworking staff at Bernstein Medical that, after two decades of incredible progress, we are still making significant advances in the surgical treatment of hair loss.”
Recognition of Dr. Bernstein and his contributions to the field of surgical hair restoration comes as he continues to push the envelope with advances in Robotic FUE hair transplants, improving more traditional hair restoration techniques and exploring adjuvant treatments.
Among the improvements Dr. Bernstein has made to the robotic hair transplant procedure include: automated selection of follicular unit grafts, robotic creation of recipient sites, reducing wound size, and a “long-hair” FUE technique that allows a patient to have an FUE hair transplant without the donor area being visible in the post-op period. Collectively these improvements make the robot more efficient, reduce scarring from the procedure, and improve the outcome for patients. Dr. Bernstein’s internationally renowned hair restoration facility, Bernstein Medical – Center for Hair Restoration, is a beta-testing site for Restoration Robotics, Inc., the company that produces the ARTAS® robot. Dr. Bernstein is a medical advisor to the company.
New York Magazine’s ‘Best Doctors’ issue is a special annual edition of the acclaimed magazine which contains a directory of the New York City area’s best physicians. The directory is created by Castle Connolly, Ltd., through a survey of doctors in the New York Tri-State area. To be included, doctors in New York, New Jersey and Connecticut are nominated by their peers and then must pass a rigorous physician-led review of their qualifications, reputation, and skill in diagnosis and treating patients. Castle Connolly also publishes America’s Top Doctors, which has included Dr. Bernstein in all fourteen editions.
About Robert M. Bernstein, M.D., F.A.A.D.
Dr. Robert M. Bernstein is a Clinical Professor of Dermatology at Columbia University in New York, founder and lead surgeon at Bernstein Medical – Center for Hair Restoration, and renowned pioneer of Follicular Unit Transplantation (FUT) and Robotic Follicular Unit Extraction (Robotic FUE) hair transplant procedures. Dr. Bernstein was the first to describe Follicular Unit Transplantation and Follicular Unit Extraction in the medical literature, and his more than 60 medical publications have fundamentally transformed surgical hair restoration. Dr. Bernstein has received the Platinum Follicle Award, the highest honor in the field given by the International Society of Hair Restoration Surgery (ISHRS), and has appeared as a hair restoration expert on many notable television programs and news and lifestyle publications over the years. Examples include: The Oprah Winfrey Show, The Dr. Oz Show, The Today Show, Good Morning America, ABC News, CBS News, New York Times, Wall Street Journal, Men’s Health Magazine, and more. He is co-author of Hair Loss & Replacement for Dummies. Dr. Bernstein graduated with honors from Tulane University, received the degree of Doctor of Medicine at the University of Medicine and Dentistry of NJ, and did his training in Dermatology at the Albert Einstein College of Medicine. Dr. Bernstein also holds an M.B.A. from Columbia University.
About Bernstein Medical – Center for Hair Restoration
Bernstein Medical – Center for Hair Restoration, founded by Dr. Bernstein in 2005, is dedicated to the diagnosis and treatment of hair loss in men and women using the most advanced technologies. The state-of-the-art facility is located in midtown Manhattan, New York City and treats patients who visit from 58 countries and all 50 states. The board-certified physicians and highly-trained clinical assistants at Bernstein Medical take pride in providing the highest level of treatment and care for all patients. In 2011, Bernstein Medical became one of the first practices in the world to offer Robotic FUE hair transplant procedures using the image-guided, computer-driven technology of the ARTAS Robotic System. Bernstein Medical is a beta-testing site for this technology.
Posted byQ: How Many Hair Transplants Will I Need? — E.E., New York, N.Y.
A: The first session of a hair transplant should be designed as a stand-alone procedure with the following three goals:
Achieving all of these goals will allow the first procedure to stand on its own.
Because of this, many people feel one hair transplant is sufficient.
Reasons for Second Hair Transplant
While the first session of a hair transplant is designed to stand on its own, there are several reasons why one would want a second hair transplant, such as increasing the density in a previously transplanted area; refining the hairline created in the first transplant; focusing on increased crown coverage, when appropriate; or addressing further hair loss that’s occurred after the first transplant.
Because of this last reason, addressing further hair loss, careful patient evaluation and surgical planning is needed to take into account your donor reserve and the likely extent of any future balding in the planning of your first transplant session.
Wait at least 10 to 12 months Before Getting a Second Hair Transplant
If a second transplant is warranted, patients are advised to wait at least 10 to 12 months after the first transplant before considering a second. This is because over the course of the first year, the first transplanted hairs have grown in and the progressive increase in a hair’s diameter, texture and length can markedly change the look of the hair restoration — this may influence the way a patient wants to groom his/her hair, and only after the hair has reached styling length can the patient and physician make the best aesthetic judgments regarding the placement of additional grafts.
For patients having an FUT (strip) procedure, another reason to delay a second hair transplant session for this time period is that scalp laxity will continue to improve making the donor hair easier to harvest.
You can view our Hair Transplant Photos by the number of sessions each patient has had:
Posted byDr. Bernstein was interviewed by Spencer Kobren on The Bald Truth, the critically acclaimed broadcast on hair loss and hair restoration. They discussed the latest in robotic hair transplant surgery, the ARTAS® Robotic System, FUE and FUT hair transplant procedures, and the future of hair restoration.
Spencer Kobren: It’s great to have you back. And I know you only have about a half an hour – actually about 20 minutes now… Let’s get straight to the point. You heard my opening, you kind of know how I feel about the way that the industry is moving, the direction the industry is moving in, and also my concern about now that these devices are really starting to become a bigger part of the market, I believe that these devices are getting into the wrong hands. Now let’s just start with why you’ve embraced it and then we can go into how the industry is evolving.
Dr. Bernstein: Follicular Unit Transplantation via strip was a pretty straight-forward procedure, and once we figured out how to use microscopes to dissect out the follicular units and train the staff on microscopic dissection, it was pretty much a slam dunk. It was just a question of other doctors embracing it and patients understanding what it is and demanding the procedure. With Follicular Unit Extraction it’s really a much different animal. The technique is very, very tricky. And the reason why it’s tricky is because the dissection is done essentially blind. The hair follicle changes direction as it goes deeper in the skin, and also the hairs that comprise a follicular unit splay outward — they fan outwards — so it’s very tricky to get a very small punch around an intact follicular unit. When you do this by hand thousands of times, it’s really, really hard for a physician to concentrate and be consistent and not get bored out of his mind. Also, you don’t have all the visual cues that you have under a microscope. So this repetitive procedure lends itself to robotics. For years we worked on the technique, first with a sharp punch, then a dull punch, then a two-step technique where we used a sharp punch to score the skin and then a deeper [duller] punch under it. Each got better and better, but it never was really consistent, and it certainly was very, very dependent on the user, the patient, and how you’re feeling that day. So this procedure lends itself to robotics. I first learned about the robotic procedure very early in 2011 and when I first saw the robot it made total sense to me.
The Bald Truth is America’s longest running self help radio show for men’s hair loss. Kobren is the Founder and President of the American Hair Loss Association and a founder of the International Alliance of Hair Restoration Surgeons (IAHRS).
Posted byQ: I’ve heard that healing after a hair transplant requires stitches. How long will they stay in? — S.R., Cresskill, N.J.
A: In a Follicular Unit Transplant (FUT), the surgeon removes a thin strip of scalp from the patient’s donor area that supplies the follicular unit grafts for the hair transplant. After the strip is removed we use either sutures (stitches) or staples to close the wound.
We now close most wounds in the donor area with staples, rather than sutures, because we have found that staples cause less injury to the remaining hair follicles compared to sutures; therefore, more hair will be available for future hair restoration sessions. For more about sutures vs. staples, see Why We Changed from Sutures to Staples in FUT Hair Transplants.
Posted byQ: At one time, I was told my donor area was not sufficient for an FUT hair transplant procedure. Does this also mean I’m not qualified for a FUE procedure either? — K.K., Houston, T.X.
A: Great question. You are not giving me quite enough information to answer your question specifically, so I will answer in more general terms. If your donor hair supply was not good enough to do FUT (i.e. you have too little donor hair and too much bald area to cover) then most likely you will not be a candidate for FUE either, since both procedures require, and use up, donor hair. That said, if don’t need that much donor hair, but the nature of your donor area is such that a linear FUT scar might be visible then FUE might be useful.
An example would be the case in which a person has limited hair loss in the front of his scalp, has relatively low donor density, and wants to keep his hair on the short sides. In this case, FUT would not be appropriate as you might see the line scar, but we might be able to harvest enough hair through FUE to make the procedure cosmetically worthwhile. Remember, with low density neither procedure will yield that much hair to be used in the recipient area.
Another example is an Asian whose hair emerges perpendicular from the scalp so that a line incision is difficult to hide, i.e. the hair will not lie naturally over it. A third example is where the patient’s scalp is very tight. In this case, the donor density might be adequate, but it would just be hard to access it using a strip FUT procedure. In this case, FUE would also be appropriate.
From these situations, one can see that the decision to perform FUE vs FUT, or even a hair transplant at all, can be quite nuanced and requires a careful evaluation by a hair restoration surgeon with expertise in both procedures.
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ARTAS Robotic System display monitor showing parameters for the creation of recipient sitesNew York, NY (PRWEB) — Robert M. Bernstein, M.D., F.A.A.D., A.B.H.R.S., founder of Bernstein Medical – Center for Hair Restoration, introduced new technology that allows the ARTAS Robotic System to accomplish a critical step in hair transplant surgery, the creation of recipient sites. Presenting at the 2nd ARTAS User Group Meeting, Dr. Bernstein previewed the recipient site creation technology that brings the robotic system one step closer to performing critical aspects of the labor-intensive, hair transplant procedure.
The ARTAS System is currently able to harvest intact follicular unit grafts from the permanent area in back of one’s scalp using precise robotic technology. This is the most difficult aspect of a follicular unit extraction hair transplant – the newer type of hair restoration procedure that avoids a linear scar in the back of the scalp. Now that site creation can also be done robotically, only one step remains – graft placement.
The ARTAS Robotic System maps the surgeon’s hairline design onto a 3-D model of the patient’s headFor the recipient site creation, the doctor first draws a hairline and other markings directly onto the patient’s scalp to delineate the surgical plan. Next, multiple photographs are taken and fed into software, called the ARTAS™ Hair Studio, which converts the images into a 3-D model of the actual patient. This computer model can be manipulated and saved for the patient’s procedure. Using the ARTAS™ Hair Studio software, the physician then specifies the angle, direction, density, and randomness of the recipient site incisions to create the most natural look. During the procedure, the robot uses image-guided technology to avoid existing hairs while it creates up to 1,500 recipient sites per hour. In performing recipient site creation, the robot automates a process that can be physically demanding and prone to human error.
On the advancement, Dr. Bernstein said:
“This development is a crucial step towards a robotic system that can perform every aspect of a hair transplant. A great deal of credit goes to the engineers of Restoration Robotics who have worked to make automated recipient site creation a reality. I am proud that this work not only improves hair transplants for patients, but adds to the increasingly important trend of using robotic technology in medicine.”
The site creation technology that Dr. Bernstein debuted at the ARTAS User Group Meeting; which was held in California (Laguna Niguel, CA) on February 7th and 8th, 2014; will be available to hair restoration physicians in the fall of 2014. Gabe Zingeratti Ph.D, head of R&D at Restoration Robotics, Inc., presented details of the technology, which was beta-tested at Bernstein Medical – Center for Hair Restoration. With the next generation ARTAS® Robotic System rolling out in the coming months, the focus of research will then be on the final phase of robotic hair transplantation, the robotic insertion of follicular unit grafts into recipient sites. This last step will take several more years to develop.
The ARTAS Robotic System, developed by Restoration Robotics, is currently in use by hair restoration physicians around the world to automate the extraction of grafts of skin and hair called follicular units.. Follicular units, which are natural groupings of one to four hair follicles, form the biological basis of the modern hair transplant procedure. Once extracted from the back of the patient’s scalp, the follicular unit grafts are then inserted into recipient sites in the balding area of the scalp where they grow hairs that are immune to the effects of common hair loss.
No stranger to innovative advances in hair transplant surgery, Dr. Bernstein introduced Follicular Unit Transplantation (FUT) to medical literature in a 1995 publication. FUT transformed hair transplants from the use of large grafts of skin and hair, known colloquially as “hair plugs,” to a more medically-oriented procedure that produces completely natural-appearing results. Dr. Bernstein with his colleague Dr. Bill Rassman again broke new ground with his 2002 publication that introduced the concept of Follicular Unit Extraction (FUE) to scientific literature. Dr. Bernstein was the first physician on the East Coast of the United Sates, and one of the first in the world, to use the ARTAS System to perform FUE using the new robotic technology.
About Robert M. Bernstein, M.D., F.A.A.D.
Dr. Robert M. Bernstein is a Clinical Professor of Dermatology at Columbia University and founder of Bernstein Medical – Center for Hair Restoration. His landmark scientific papers are considered seminal works in the field of hair transplant surgery. Other publications include textbook chapters on dermatologic surgery and books, like Hair Loss and Replacement for Dummies, aimed at the consumer audience. He has been selected as one of New York Magazine’s “Best Doctors” for fourteen consecutive years and has appeared as a hair loss and hair transplantation expert on The Oprah Winfrey Show, The Dr. Oz Show, Good Morning America, The Today Show, CBS News, Fox News, and The Discovery Channel. Dr. Bernstein has been interviewed or featured in articles in the New York Times, GQ Magazine, Men’s Health, Interview Magazine, Vogue, and others.
About Bernstein Medical – Center for Hair Restoration
Bernstein Medical – Center for Hair Restoration, founded in 2005, is a state-of-the-art facility and international referral center for the treatment of hair loss that is located in midtown Manhattan, New York City. Hair transplant surgery, hair repair surgery, and eyebrow restoration are performed using Dr. Bernstein’s pioneering techniques of Follicular Unit Transplantation (FUT) and Follicular Unit Extraction (FUE).
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Dr. Bernstein is featured in Columbia Business, the alumni magazine of the Columbia Business School, for having “revolutionized the field of hair restoration.” Dr. Bernstein, who received an MBA from the renowned university in 2004, is quoted as having seen an opportunity in 1995 to transform hair transplantation from a procedure using “hair plugs” to one with significantly more natural results. In collaboration with Dr. William Rassman he introduced Follicular Unit Transplantation (FUT) which, the article notes, is now the “gold standard” for modern surgical hair restoration.
Also mentioned in the article, which is titled “Hair Hero,” are his pioneering work in robotic hair transplant procedures, his receiving the Platinum Follicle Award, and his appearances in the popular media including a feature on Good Morning America.
Dr. Bernstein is a Clinical Professor of Dermatology at the College of Physicians & Surgeons of Columbia University, where he instructs residents in general dermatology and the specialized art of hair restoration surgery.
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Dr. Bernstein is credited with introducing the “follicular unit” to surgical hair restoration, the innovation that allowed for a “completely natural-looking hair transplant” to be achieved. The commentary on Dr. Bernstein’s contributions to the field of hair transplantation are outlined in an historical review of dermatologic surgery that appeared in the Journal of the American Academy of Dermatology.
Dr. Bernstein is noted as being responsible for moving the field of hair restoration surgery away from large graft “plugs” and mini-micrografts to follicular units:
The following year, dermatologists Bernstein et al laid down the conceptual framework for follicular unit transplantation in their 1995 article, “Follicular transplantation.” In 1997, they detailed its clinical application in the paired articles, “Follicular transplantation: patient evaluation and surgical planning” and “The aesthetics of follicular transplantation.”
The 2 advances, the application of the stereomicroscope to follicular dissection and the use of follicular units as the basic element of hair transplantation, arose from a background in dermatology. They moved the field of hair restoration surgery from plugs and mini-micrografting, where this basic anatomical feature of the hair follicle was ignored, to follicular unit transplantation, where the follicular unit became sacrosanct. These 2 ideas, when put to clinical use, allowed the once elusive goal of a completely natural-looking hair transplant to finally be achieved.
Dr. Bernstein’s pioneering of the Follicular Unit Transplant (FUT) procedure still resonates, almost two decades later, as the follicular unit continues to be the anatomical structure that is transplanted in hair transplant surgeries worldwide.
The article then describes how Dr. Bernstein, along with his colleague Dr. Rassman, laid the foundation for the next major developments in hair restoration; first with his description of the Follicular Unit Extraction (FUE) technique and more recently with innovation in robotic hair restoration technology.
With the publication of the article, “Follicular unit extraction,” in 2002, the follicular unit extraction procedure gained popular appeal and was rapidly adopted by doctors worldwide. The authors cautioned on the limitations of this harvesting technique and the risk of follicular damage. Dermatologists Berman, Zering, and Bernstein, along with their colleagues in other specialties, continue to work on the problem of harvesting in follicular unit extraction, with the application of robotic technology showing particular promise.”
Taken together, these passages underscore how Dr. Bernstein’s research and medical publications have fundamentally transformed the field of hair restoration to the benefit of patients and physicians alike. While many other very talented physicians have had a substantial impact on hair restoration procedures ever since the hair transplant concept was first proposed by Dr. Norman Orentreich in the 1950s, Dr. Bernstein has contributed the key innovations that have made modern, natural-looking hair transplant surgery a medical and aesthetic possibility.
The article is titled, “Current status of surgery in dermatology.” The Journal of the American Academy of Dermatology is the official journal of The American Academy of Dermatology (AAD), the largest, most influential and most representative dermatology group in the United States.
Reference
C. William Hanke, Ronald L. Moy, Randall K. Roenigk, Henry H. Roenigk Jr., James M. Spencer, Emily P. Tierney, Cynthia L. Bartus, Robert M. Bernstein, Marc D. Brown, Mariano Busso, Alastair Carruthers, Jean Carruthers, Omar A. Ibrahimi, Arielle N.B. Kauvar, Kathryn M. Kent, Nils Krueger, Marina Landau, Aimee L. Leonard, Stephen H. Mandy, Thomas E. Rohrer, Neil S. Sadick, Luitgard G. Wiest, Current status of surgery in dermatology, Journal of the American Academy of Dermatology, Volume 69, Issue 6, December 2013, Pages 972-1001, ISSN 0190-9622, http://dx.doi.org/10.1016/j.jaad.2013.04.067.
Read more about Dr. Bernstein’s history of innovation in hair transplant surgery
Read Dr. Bernstein’s landmark medical publications
Download and read ‘Current status of surgery in dermatology’ (pdf)
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The 21st Annual Scientific Meeting of the International Society of Hair Restoration Surgery was held in San Francisco from October 13 through 26, 2013. The meeting covers the most important scientific and clinical advances in the field of surgical hair restoration.
As a member of the panel on “Difficult Cases,” that explored challenging and atypical medical conditions and their treatment, Dr. Bernstein presented the “Management of Frontal Fibrosing Alopecia.” This condition is a form of primary scarring hair loss. Dr. Bernstein chose to discuss this disease because it can be mistaken for common baldness; however, since the transplanted hair will be destroyed by the disease process, it is a contra-indication for hair transplantation. Since missing this diagnosis can lead to unnecessary and ineffectual surgery, an awareness of its signs and symptoms are important for every physician managing patients with hair loss.
On the panel on “Post Finasteride Syndrome,” Dr. Bernstein was part of a group that reviewed the latest studies on the efficacy and safety of finasteride in the treatment of androgenetic alopecia. They discussed possible adverse events including claims of persistent sexual dysfunction (Post Finasteride Syndrome) and concerns relating to prostate cancer. They also discussed the challenges that arise in caring for patients when scientific research and the mass media give conflicting information.
In the Symposium “Question the Expert,” Dr. Bernstein presented a case of Diffuse Un-patterned alopeica (DUPA). This condition was first detailed by Dr. Bernstein in his landmark paper “Follicular Transplantation: Patient Evaluation and Surgical Planning,” that was published in Dermatologic Surgery in 1997. DUPA is a form of androgenetic alopecia that presents as rapid generalized hair loss in young adults. Besides being a significant psychological burden for young men and women, its identification is extremely important since medical intervention can have a significant positive impact when instituted early. On the other hand, a misdiagnosis that leads to surgery can result in a failed hair transplant and donor scarring that may become visible over time.
Dr. Bernstein was also the Keynote Speaker for the ARTAS International Users Forum. His presentation, titled “Follicular Unit Extraction: Then and Now,” discussed the evolution of FUT, FUE and Robotic-FUE and how it relates to today’s hair restoration practice. Of particular significance was the natural progression of FUE instrumentation from hand-held manual tools to robotic assisted hair transplantation. Dr. Bernstein explained that in the future, robotic capabilities will not be limited to graft extraction, but eventually will perform each aspect of the transplant including recipient site creation, and graft placement. See “Dr. Bernstein Gives Keynote Presentation On Robotic Hair Transplantation” for more details on the presentation and some photographs of the event.
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Dr. Bernstein was honored to deliver the keynote address at the ARTAS International Users Forum in San Francisco, California. Dr. Bernstein’s presentation, “Follicular Unit Extraction: Then and Now,” was a review of the evolution of surgical hair restoration from Follicular Unit Transplantation (FUT) through Follicular Unit Extraction (FUE) to the cutting edge technique of Robotic-FUE.
The presentation described the steps that resulted in the use, and growth in popularity, of the state-of-the-art ARTAS Robotic System for FUE. Dr. Bernstein pointed out that with the introduction of each procedure — FUT, FUE, and Robotic-FUE — there was initially a rocky reception with physicians. In each instance, however, the surgeons’ concerns were overcome first by strong, patient interest and then by clinical studies that confirmed the procedures’ usefulness.
Dr. Bernstein discussed how FUE procedures progressed from the use of hand-held instruments to the computer-assisted, image-guided ARTAS Robot. One of the initial hurdles of FUE procedures using hand-held devices was a high rate of follicular unit transection (cutting of the follicles). Restoration Robotics, Inc., the company that developed the ARTAS system, used a “sharp/blunt” punch technique that was introduced by Jim Harris in his 2004 publication on the SAFE System for FUE. The sharp/blunt technique, that was validated in 2006 by Dr. Bernstein’s research publication, “New Instrumentation for Three-Step Follicular Unit Extraction,” reduced transection of follicles when compared to older instrumentation. Dr. Bernstein then detailed modifications to the system that he proposed in order to improve the ARTAS robot. These improvements include: a smaller tip for the sharp/blunt punch, selection of larger over smaller follicular units, tensioner placement, ‘feathering’ the ends of the tensioner, and pre-making recipient sites before extracting the follicular unit grafts.
Looking to the future, Dr. Bernstein mapped out the further evolution of the Robotic FUE procedure and the tasks it will be required to perform. In future procedures, the physician will not only guide the robot on extracting follicular units, but also in creating recipient sites and, further down the road, placing grafts into the recipient sites. Graft placement will represent the most significant challenge to the robotic system as this step is the most sensitive to patient to patient variability. Once this last step is accomplished, a fully automated hair transplant should be possible, eliminating much of the human error in the mechanical aspects of the hair restoration process.
More photos from the event:
New York Magazine’s 2013 ‘Best Doctors’ issue includes Dr. Robert M. Bernstein, a pioneer of modern hair transplant procedures, making this the 14th consecutive year Dr. Bernstein has appeared in the special annual issue.
New York, NY — Robert M. Bernstein, M.D., F.A.A.D., Clinical Professor of Dermatology at Columbia University in New York and a pioneer of modern hair transplant procedures, was included in the ‘Best Doctors’ issue of New York Magazine for the fourteenth consecutive year.
Dr. Bernstein earned his placement in the Best Doctors issue, and his reputation as world-renowned hair restoration physician, through a 20 year career of developing surgical techniques and adopting and guiding technological advances in the industry. His more than 60 medical publications on Follicular Unit Transplantation (FUT), Follicular Unit Extraction (FUE), and Robotic FUE (R-FUE) have revolutionized the field of hair restoration and provide the foundation for hair transplant surgeons worldwide.
The New York Magazine ‘Best Doctors’ issue is an annual issue of the magazine that contains a directory of the New York area’s best physicians. The directory is based on the results of a peer-reviewed survey that is conducted by Castle Connolly, Ltd. The company also publishes the guidebook “Top Doctors: New York Metro Area,” based on the same survey of doctors. As part of the survey, physicians are nominated from across the New York metropolitan area including Manhattan, Brooklyn, Queens, The Bronx, Staten Island, Westchester County, Long Island, and counties in New Jersey and Connecticut. The recommendations are based on the nominated doctor’s qualifications, reputation, skill in diagnosis, skill in treating patients, and other criteria. A physician-led research team at Castle Connolly tabulates and vets the nominations and compiles the final list.
Bernstein Medical – Center for Hair Restoration, the facility Dr. Bernstein founded in 2005, is a state-of-the-art hair loss treatment facility in New York City that serves men and women from around the world. The center specializes in FUT, FUE and R-FUE hair transplants, and also performs corrective hair transplants and offers medical treatments for hair loss patients who are not indicated for a transplant. In 2011, Bernstein Medical became the first hair restoration facility on the East Coast to offer Robotic FUE procedures using the ARTAS Robotic System. Dr. Bernstein has worked closely with Restoration Robotics, Inc. to improve both the robotic technology and the R-FUE procedure protocol.
Dr. Bernstein has appeared on many notable media programs and publications over the years. Some of these include: The Oprah Winfrey Show, The Dr. Oz Show, The Today Show, Good Morning America, ABC News, CBS News, The Early Show, Fox News, National Public Radio, NY1, New York Times, Wall Street Journal, Men’s Health Magazine, GQ Magazine, Telemundo, “O” the Oprah Magazine, and more. He is co-author of Hair Loss & Replacement for Dummies and has received the Platinum Follicle Award, Surgeon of the Month, and Pioneer of the Month honors from the International Society of Hair Restoration Surgery (ISHRS).
Posted byQ: I have seen through forums that a hair transplant gives severe shock loss in the donor zone (especially behind ears) after the surgery. Doctors say it is temporary and can last about six months or more. Frankly, do you believe in this? Will the donor shocked hair recover? — M.D., Darien, C.T.
A: It depends if you are speaking about follicular unit hair transplantation using strip harvesting (FUT) or Follicular Unit Extraction (FUE). With FUT, it is extremely uncommon to have any shock hair loss in the donor area. This could occur if the hair transplant procedure was done improperly, i.e. the donor area was closed too tightly. In this case, some hair loss may be permanent. This is one of the reasons that very large hair transplant sessions are unwise. Shock hair loss in FUE is more common, but is generally not significant and should eventually recover completely.
That said, some shock hair loss in the recipient area is quite common with either hair restoration procedure (FUT or FUE). This is particularly the case if there is a lot of existing miniaturized hair (hair that is starting to thin) in the transplanted area.
Posted byQ: If I have no linear scar and I can exercise right away, why would you ever recommend FUT instead of FUE? — H.T., Dover, M.A.
A: I advise FUT because the grafts are of better quality (less transaction and more support tissue surrounding the follicle) and because more hair can be obtained from the mid-portion of the permanent zone –- which is where the hair is the best quality and most permanent. For the majority of patients a linear scar buried in the donor hair is not an issue. Each patient has to weigh the pros and cons of each procedure when making a decision.
Posted byQ: A while ago I saw you and you recommended FUT hair transplantation, but my friend came in and you recommended FUE. How come? — C.T., Hackensack, N.J.
A: I think that both procedures are excellent, which is why I do them both. My recommendations are determined by the individual patient. His or her age, desire to wear hair cut very short, athletic activities, donor density and miniaturization, extent of hair loss, and potential future balding are all important aspects in the decision process.
Posted byQ: Is the recovery time a lot longer with FUT compared to FUE? — C.W., Chicago, I.L.
A: Cosmetically, the recovery for FUT is actually shorter, since the back and sides do not need to be shaved and the longer hair can completely cover the donor incision immediately after the Follicular Unit Transplant procedure. In large Follicular Unit Extraction procedures, the entire back and sides of the scalp need to be clipped very close to the scalp. It can take up to 2 or 3 weeks for the hair to grow long enough to completely camouflage the harvested area. Once the healing is complete and any redness has subsided, the hair can be cut shorter.
For strenuous physical activity, however, the recovery is longer with FUT due to the linear incision. This is a major reason why professional athletes or very physically active people prefer FUE. However, many business professionals prefer FUT hair transplantation as there is significantly less down time from work (for the cosmetic reasons discussed above).
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Dr. Bernstein and Bernstein Medical – Center for Hair Restoration were featured in New You magazine’s article “My Hair Lady.” The main topic of the article is hair transplantation in women, however it also touches on hair loss in women, Follicular Unit Transplantation (FUT), medication and other products.
On Bernstein Medical – Center for Hair Restoration:
The Manhattan office of Bob Bernstein, just steps from Park Avenue, is the kind of space that makes successful men feel at home — a good thing for one of the country’s foremost specialists in hair restoration (and the co-author of Hair Loss for Dummies). The layout is part design statement, part science lab, slick with granite, slate, and glass and full of microscopes and high tech gizmos. Among the space’s most noteworthy gadgets is one of only twelve robots in the world programmed to help perform hair transplants, which has a home in Dr. Bernstein’s office.
A female patient of ours discussing the “taboo” of hair transplantation in women:
Sara Lyles, 62, whose hair loss was caused by a styling technique, said that when Dr. Bernstein performed her hair transplant 12 years ago, the subject was taboo. “Women never talked about it, and I was so embarrassed that I avoided all social functions,” she recalls. “I’m African American and I slept in large tight rollers to keep frizzing under control. The traction destroyed my frontal hairline.”
At the time, she would have been mortified if someone found out she had undergone a transplant. “Even my hairdresser had no clue,” she says. “Dr. Bernstein not only gave me my hair back, he gave me my life back.”
Dr. Bernstein on the amazing progress of the hair restoration industry:
Posted byAs Dr. Bernstein emerges from his operating room, sporting green scrubs and green Nikes that match the room’s tiles, he shakes his head and sighs. “When I went into practice back in the eighties, transplantation was almost barbaric and Rogaine was the only alternative,” he remembers. He marvels at the advances and choices he and others now have to over. “I never would have thought I would be working with robots, lasers, and cloning.”
Q: How long are FUT and FUE visible after the procedures? — S.V., Weston, C.T.
A: The recipient area is visible after both procedures for up to 10 days. The donor area in FUT is generally not visible immediately after the procedure. In FUE, the donor area must be shaved, so that will be visible for up to two weeks (the time it takes for the hair to grow in).
Q: I am currently 8 days post op. I started to massage my hair in the shower to get rid of the scabs. When I was done I looked in the mirror and saw two of my transplanted hairs were slightly bleeding but still intact. What does that mean? Did I lose the grafts? — B.G., Stamford, C.T.
A: If they bleed, but were not dislodged (i.e. did not come out), they should grow fine. Just be gentle for the next week. Generally, when follicular unit transplantation is performed with tiny sites (19-21 gauge needles) the grafts are permanent at 10 days. Since I did not perform your procedure and am not familiar with the technique your doctor actually used, I would give it the extra few days.
Posted byNew York, NY (PRWEB) — Robert M. Bernstein, M.D., F.A.A.D., A.B.H.R.S., a world-renowned hair transplant surgeon, presented a series of improvements to hair transplant procedures which use the ARTAS Robotic System for Follicular Unit Extraction (FUE). These updates include revisions to the FUE surgical protocol and technical adjustments to the robotic extraction system. He presented his refinements at the first user meeting held by the developers of the system; Restoration Robotics, Inc.; on September 14 – 16 in Denver, Colorado.
Dr. Bernstein receives recognition from Restoration RoboticsDr. Bernstein described his series of improvements in a lecture to an elite group of physicians who are among the first adopters in the industry of the image-guided, robotic-assisted system. The updates are designed to improve the results of FUE hair transplantation by enhancing both the surgical protocols of the procedure as well as the functionality of the robotic system. In FUE, small groups of one to four hairs, called follicular units, are extracted individually from the back and sides of the scalp and are then implanted into recipient sites, which are tiny holes that the surgeon creates in a balding area of the scalp.
Dr. Bernstein discussing robotic-assisted FUE at Restoration Robotics’ first user meetingThe most important update to the FUE procedure that Dr. Bernstein proposed is for surgeons to create recipient sites before they extract the grafts, rather than create the sites after grafts are extracted. Drawing on his decades of experience in hair transplantation, Dr. Bernstein developed this technique of “pre-making” recipient sites in order to maximize survival of the grafts during the hair transplant. Using this technique, extracted grafts are outside the body for a shorter duration of time. It also minimizes instances of “popping,” in which grafts are exposed to desiccation (drying) and hypoxia (low oxygen) before they are inserted back into the scalp. By “pre-making” the recipient sites, these harmful factors are mitigated and a greater number of the grafts grow into viable, hair-producing follicular units. Dr. Bernstein encourages surgeons to use this technique on all FUE procedures, whether using manual methods or robotic instrumentation.
When asked to comment on his improvements to the robotic FUE procedure, Dr. Bernstein said:
“It was fortuitous timing that the ARTAS Robot became available just as I was developing my refinements to the FUE procedure. The combination of the automated robot for graft extraction with the technique of pre-making recipient sites has led to a significant improvement in hair transplant surgery.”
Dr. Bernstein is the founder of Bernstein Medical – Center for Hair Restoration, and he is recognized world-wide for his innovative work in the treatment of hair loss. He is among the first hair transplant surgeons in North America to utilize the ARTAS Robot for FUE in his practice.
Being an early adopter of the advanced follicular unit extraction system has enabled him to work with Restoration Robotics to refine it to his exacting standards. Dr. Bernstein has, again, put his fingerprints on a revolutionary upgrade to the hair transplantation industry. He was the first to describe FUT and FUE procedures in the medical literature, in 1995 and 2002 respectively. In contrast to FUE, where follicular units are extracted individually, in FUT procedures a strip of skin is removed from the back of the scalp, it is then dissected into follicular units, and those follicular unit grafts are then implanted into recipient sites in the patient’s scalp.
About Dr. Bernstein
Robert M. Bernstein, M.D., F.A.A.D., A.B.H.R.S. is a Clinical Professor of Dermatology at Columbia University and a pioneer in the field of hair restoration. His landmark scientific papers are considered seminal works in the field of hair transplant surgery, and he is the most widely published author on the topic having published more than sixty articles, editorial reviews, books, and textbook chapters.
Dr. Bernstein has been selected as one of New York Magazine’s “Best Doctor’s” for thirteen consecutive years and he has appeared as a hair loss and hair transplantation expert on The Oprah Winfrey Show, The Dr. Oz Show, Good Morning America, The Today Show, The Discovery Channel, CBS News, Fox News, and National Public Radio. Dr. Bernstein has been interviewed or featured in articles in GQ Magazine, Men’s Health, Interview Magazine, Vogue, the New York Times, and others.
About Bernstein Medical – Center for Hair Restoration
Bernstein Medical – Center for Hair Restoration is a state-of-the-art hair restoration facility and international referral center, located in midtown Manhattan, New York City. The center is dedicated to the diagnosis and treatment of hair loss in men and women. Hair transplant surgery, hair repair surgery, and eyebrow restoration are performed using Dr. Bernstein’s pioneering techniques of Follicular Unit Transplantation (FUT) and robotic Follicular Unit Extraction (R-FUE).
Posted byQ: While I was lying awake last night your approach of making sites the day before implantation came to mind. It takes guts to have spearheaded that! I am not aware that that precedent has been set in hair transplant surgery. I would have been timid about infection; it’s a lot like closing a wound with a foreign body in it the next day. As with most things, I am a little slow to jump on board something new so I’m glad you’ve paved the way. Do you have any hesitance about this or do you have enough experience that you no longer hesitate? I would be concerned that variations of the local flora might make a difference and that, accordingly, a large sample size would be necessary to get comfortable. Glad for all of us that you are still blazing trails. — S.S., Shanghai, China
A: Thanks for your kind words. No hesitancy whatsoever. We find no increased risk. Think of it as if you did a hair transplant and ran out of grafts. The remaining sites don’t get infected, they just close up. In the process, all those chemotactic factors involved in the healing process move toward the wounds, so if a graft is placed into them, they would be less likely to get infected than a graft placed into a fresh (non-primed) wound, not more. It is like applying the surgical dressing Duoderm to a wound that helps it auto-sterilize. Putting the speculative science aside, we have not seen one single issue with it. Give it a try with an FUE or FUT procedure. Make the sites, have the patient takes his normal shower that night and you will be pleasantly surprised how little bleeding there is the next day and how easy it is to place the grafts.
Read a summary of the article on pre-making recipient sites
Read the full article as it was published in the Hair Transplant Forum International
Posted byQ: I was told that I have low hair density in the donor area. Will multiple hair transplant procedures improve the results of my hair restoration? — J.G., Hoboken, NJ
A: Yes, but subsequent procedures would be smaller and there is a point of diminishing returns where additional procedures would yield so little hair that they would not be practical. There is a finite donor supply and once this is tapped, no more hair transplants are possible, regardless if one uses FUT or FUE.
Posted byQ: What are the chances of the donor scarring being visible long-term in FUT compared to FUE? — M.M., Altherton, C.A.
A: Both FUT and FUE produce donor scarring; FUT, in the form of a line and FUE in the shape of small, round dots. With FUT hair transplantation, the line is placed in the mid-portion of the permanent zone, whereas in FUE the dots are scattered all over the donor area.
If a patient becomes extensively bald (i.e. the donor fringe becomes very narrow), the line of FUT will generally still remain hidden, whereas the dots of FUE will be seen above the fringe of hair. In the less likely scenario of the donor hair actually thinning significantly, both the line (of FUT) and the dots (of FUE) may become visible.
Posted byDr. Robert M. Bernstein — pioneer of the follicular unit transplantation (FUT), follicular unit extraction (FUE), and Robotic FUE hair transplant procedures — was selected for the 13th consecutive year to be included in New York Magazine’s ‘Best Doctors’ issue.
New York, NY — Robert M. Bernstein, M.D., F.A.A.D., the world-renowned hair transplant physician, pioneer of the Follicular Unit Transplantation (FUT) and Follicular Unit Extraction (FUE) and founder of Bernstein Medical – Center for Hair Restoration, was included in New York Magazine’s ‘Best Doctors‘ issue for the thirteenth consecutive year.
When asked of his inclusion in this annual peer-reviewed list, Dr. Bernstein, a Clinical Professor of Dermatology at Columbia University in New York City, said:
“It is such an honor to be recognized by New York Magazine. Our passion for providing the best hair loss treatments has served as the impetus for pushing the envelope in utilizing new state-of-the-art hair restoration techniques such as Robotic assisted hair transplants.”
New York Magazine’s Best Doctors issue is a directory of physicians that is compiled through a peer-review survey conducted by Castle Connolly Medical Ltd. The company also publishes “Top Doctors: New York Metro Area,” a guidebook based on the results of the same survey of doctors. Each year, physicians in the New York metropolitan area — including Manhattan, Brooklyn, Queens, The Bronx, Staten Island, Westchester County, Long Island, and counties in New Jersey and Connecticut — nominate their choice of the best doctors in a specific field. The physicians make their recommendations based on criteria including: qualifications, reputation, skill in diagnosis, and skill in treating patients.
Dr. Bernstein, a native New Yorker, has spent two decades developing new hair transplant techniques. His medical publications on FUT and FUE hair transplantation have revolutionized the field of hair restoration surgery and provide the basis for modern techniques used by hair transplant surgeons worldwide. Bernstein Medical – Center for Hair Restoration is a state-of-the-art hair restoration facility in New York City. Located in midtown Manhattan since 2005, the center is dedicated to the diagnosis and treatment of hair loss in men and women and specializes in both corrective hair transplants as well as the traditional restorative FUT and FUE techniques. Dr. Bernstein is the first hair transplant doctor on the East Coast to offer Robotic FUE hair transplantation to hair loss patients.
Dr. Bernstein has regularly appeared in notable media programs and publications over the years. Some highlights include: The Oprah Winfrey Show, The Dr. Oz Show, The Today Show, Good Morning America, CBS News, The Early Show, Fox News, National Public Radio, NY1, New York Times, Men’s Health Magazine, GQ Magazine, Telemundo, “O” the Oprah Magazine, and more. He is co-author of Hair Loss & Replacement for Dummies.
Posted byQ: I am so confused reading about FUT and FUE on all the blogs. Can you please tell me which is better, FUT or FUE? — M.T., East Brunswick, NJ
A: FUT (via strip) will give the best cosmetic results (more volume) since the grafts are of better quality (when using microscopic dissection, there is less transection and more surrounding tissue to protect the grafts) and better graft selection (the grafts can all be harvested from the mid-portion of the permanent zone).
In contrast, in FUE you need approximately 5 times the area. Because of this large donor area requirement, some of the hair must be harvested from fringe areas and thus the hair will be less stable genetically.
With subsequent FUT procedures we remove the first scar, so the patient only has one scar (albeit long). With subsequent FUE sessions we are adding additional scars, so over the long-term the cumulative scarring over large areas can present its own problems of visibility.
The main advantage of FUE is to have the option of wearing your hair very short (but not shaved). FUE is also appropriate for patients who are at risk for a widened donor scar (i.e., very athletic and muscular or with thin, tight scalps, etc.).
In my experience, Robotic Hair Transplantation is superior to other FUE methods in that it is much more accurate and more consistent. It enables the doctor to extract grafts with less damage than with hand-held instruments or other automated devices.
Posted by
Dr. Bernstein not only pioneers hair transplant procedures, but hair restoration technology as well. The NY1 television station, based in New York City, visited Bernstein Medical to see a demonstration and talk about the newest tool in the hair restoration toolkit, the ARTAS Robot for Hair Restoration.
The NY1 piece shows the robotic FUE system in action at Bernstein Medical, with views of the robotic arm, the image-guided system, the punch tool, and the user interface.
The segment also reports that Dr. Bernstein is among the first hair transplant physicians to use the technology:
Removing those units has always proved to be the toughest part of this method, but the robot changes that, which is why even Dr. Robert Bernstein — the man who’s widely credited with developing follicular unit transplantation and follicular unit extraction — jumped to be among the first in the U.S. to use the device.
Dr. Bernstein speaks to one of the main benefits of the robot, the increased efficiency in extracting follicular unit grafts.
NY1 serves 2.1 million people in the tri-state area, including all five boroughs — Manhattan, Brooklyn, Queens, Staten Island, and The Bronx –– parts of Westchester and Hudson Valley, as well as cities and towns in Bergen County and Hudson County in New Jersey.
Read more about Robotic Hair Transplantation
Posted byDr. Robert M. Bernstein, pioneer of the follicular unit transplantation and follicular unit extraction hair transplant procedures, was selected as one of New York metropolitan area’s top physicians.
New York, NY — Robert M. Bernstein, M.D., F.A.A.D., world-renowned pioneer of the Follicular Unit Transplantation and Follicular Unit Extraction hair transplant techniques and founder of Bernstein Medical – Center for Hair Restoration, was included in New York Magazine’s Best Doctors issue for the twelfth consecutive year.
Dr. Bernstein, a Clinical Professor of Dermatology at Columbia University in New York, said that he is honored to be recognized again for the Best Doctors issue. He said, “My inclusion in the Best Doctors issue for the twelfth year in a row is a testament to the hard work and dedication of my staff, our consistently high quality of care, and our passion for treating patients who are struggling with hair loss.”
The New York Magazine Best Doctors issue is an annual compilation of physicians that is based on a peer-review survey conducted by Castle Connolly Medical Ltd., a research company that publishes Top Doctors: New York Metro Area. Each year, medical professionals in the New York metropolitan area nominate their choice of the best doctors in a field. The physicians make their recommendations based on several criteria including: professional qualifications, reputation, skill in diagnosis, and skill in providing treatment for patients.
Dr. Bernstein, a New York native, is a true innovator in the field of hair restoration. His medical publications on follicular unit transplantation (FUT) and follicular unit extraction (FUE) have revolutionized hair transplantation and provide the foundation for techniques in use by hair transplant surgeons across five continents. His medical practice has been solely devoted to the treatment of hair loss since 1995 and he has provided hair loss treatments and hair restoration surgery at his state-of-the-art hair restoration facility in New York City since 2005. The Bernstein Medical – Center for Hair Restoration, located in midtown Manhattan, is dedicated to the diagnosis and treatment of hair loss in men and women and specializes in both restorative and corrective hair transplants.
Dr. Bernstein has appeared on a wide variety of notable media programs and publications. Some of these include: The Oprah Winfrey Show, The Dr. Oz Show, The Today Show, Good Morning America, ABC News, CBS News, Fox News, National Public Radio, New York Times, Men’s Health Magazine, GQ Magazine, Univision, Telemundo, “O” the Oprah Magazine, and more. He is co-author of Hair Loss & Replacement for Dummies and The Patient’s Guide to Hair Restoration.
Posted byQ: I am considering having a hair transplant. Does my hair need to be cut? — I.S., New York, NY
A: In all hair transplant procedures, we are able to transplant into areas of existing hair without it having to be cut. The question of whether hair needs to be cut in the donor area depends upon the way the donor hair is obtained (harvested).
With a Follicular Unit Hair Transplant procedure using single strip harvesting method (FUT), only the strip of hair that is removed needs to be cut. When the procedure is finished, the hair above the incision lays down over the sutured area and it becomes undetectable.
In Follicular Unit Extraction (FUE), particularly in sessions over 600 grafts, large areas of the donor area must be clipped short (to about 1-2mm in length) in order to obtain enough donor hair.
View our page on the Pros & Cons of FUE hair transplantation
Posted byQ: I heard that there have been some new advances in hair cloning and that it may be available sooner than we thought. I was planning on doing a hair transplant soon. Considering that hair cloning may be available at some point in the future, should I do FUE or FUT, or wait for cloning? — K.R., Fort Lee, NJ
A: Although there has been a major development in hair cloning with the use of ACell, an extracellular matrix to simulate hair growth, the model, at this point, is still in its earliest stages of development. It is hard to know when the technology will reach a state where it can be useful in hair restoration.
With respect to which you should do FUE or FUT if, theoretically, cloning is around the corner, the answer would be FUT, since FUT will give you the fuller look.
If the goal is to eliminate any trace of the traditional hair transplant, again FUT will most likely be the best choice, since the single linear scar would be easy to camouflage with cloned hair. With FUE, this would be much more difficult, since there are literally thousands of tiny scars. However, neither FUE nor FUT will preclude a patient from fully benefiting from cloning if, and when, it becomes available.
Read more:
Posted byDr. 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 below to see images of surgical tools, illustrations of surgical techniques, and before and after patient photos. Running commentary by one of the eminent authorities on the subject makes it easy to grasp, even for newbies.
Dr. Bernstein has conducted presentations on his innovative hair transplant techniques at medical conferences around the world including Barcelona, Spain; Vancouver, Canada; Sydney, Australia; and Washington D.C. Many have learned about the nuances of hair transplant surgery from one of the pioneers of surgical hair restoration.
Q: What is Follicular Unit Transplantation and how is it different from Follicular Unit Extraction? — H.L., White Plains, NY
A: Follicular Unit Hair Transplantation, called FUT for short, is a procedure where hair is transplanted in the naturally occurring groups of one to four hair follicles. These individual groups of hair, or units, are dissected from a single donor strip using a stereo-microscope. The area where the donor strip was removed is sutured closed, generally leaving a thin, fine, line scar.
In Follicular Unit Extraction, or FUE, the individual units are removed directly from the back or sides of the scalp through a small round instrument called a punch. There is no linear scar. There is, however, scarring from the removal of each follicle. Although the scars of FUE are tiny and round, the total amount of scarring is actually more than in FUT.
In addition, since in FUE the bald skin around each follicular unit is not removed, the total amount of hair that can be removed in FUE is substantially less than in FUT. This is because if one were to remove all the hair in an area, it would be bald. In FUT, the intervening bald tissue is removed along with the follicles in the strip.
Posted byRobert S. Haber, M.D.
CASE School of Medicine, Cleveland, Ohio, USA
SUMMARY of Dr. Haber’s Abstract from his presentation at the International Society of Hair Restoration Surgery, 2005 – Sidney, Australia
Harvesting high quality donor strips with minimal transaction remains an elusive goal for many hair transplant surgeons, particularly beginners. Hair restoration techniques that involve the use of scalpel blades demand the greatest skill and may cause significant transection. The Sandoval Score and Spread technique showed that non-traumatic dissection during hair transplantation is possible using a blunt instrument, but this technique is limited by poor ergonomics and the potential to cause tissue damage.
A new instrument for blunt dissection had been developed that is easy to use and is able to separate tissue along the natural planes of cleavage that causes minimal damage to hair follicles. This device has four sharp, staggered prongs aligned centrally and long handles developed for hair transplant procedures. This design utilizes the strong forearm muscles, as opposed to the weaker hand muscles, and distributes the spreading force over a larger area, minimizing trauma. A minimum depth scoring incision is made with a double-bladed scalpel to a depth of 1.5 mm. The device is inserted and expanded at intervals along the incision.
Fifty consecutive patients whose donor strip was harvested utilizing the device for the hair transplant were studied. It was found that the device works well for hair transplantation, producing virtually transaction free strips in approximately 90% of cases. The instrument was ineffective when the patient has very rigid tissue that did not yield to the force of the device. Standard scalpel blade excision was used in these cases.
When performing a hair transplant, there exists a natural dissection plane within the donor scalp that can be used to obtain high-quality strips with blunt dissection. This newly developed instrument is ergonomic and easily used by both experienced and beginner hair restoration surgeons.
Posted byby O’Tar T. Norwood, MD, Oklahoma City, Oklahoma, USA
Hair Transplant Forum International (July/August 1997 issue)
NOTES FROM THE EDITOR EMERITUS
The evolution of “follicular transplantation” can be attributed to three people. Dr. Robert Bernstein coined the phrase and advanced the concept. Dr. Bob Limmer ((Limmer B: Forum, Vol. 2, #2, 1991.)), ((Limmer B: J Dermatol Surg Oncol, 1994; 20:789-793.)) introduced the use of the binocular microscope, providing the technology, and Dr. David Seager showed by direct hair counts, comparing the growth of grafts cut with and without the microscope, how the hair growth was improved when the follicular unit was kept intact. ((4th Annual Meeting of the International Society of Hair Restoration Surgery September 19, 1996, “Does the size of the graft matter?”)), ((Seager, DJ: Micrograft size and subsequent survival — accepted for publication — Journal of Dermatologic Surgery.))
“What then is follicular transplantation?” I quote Dr. Robert Bernstein because he states it so completely and succinctly in his 1995 article “Follicular Transplantation:”
“Follicular Transplantation is the logical end point of over thirty years of evolution in hair restoration surgery beginning with the traditional large plugs and culminating in the movement of one, two and three hair units, which mirror the way hair grows in nature. The key to follicular transplantation is to identify the patient’s natural hair groupings, dissect the follicular units from the surrounding skin and place these units in the recipient site in a density and distribution appropriate for a mature individual. The critical elements of follicular transplantation are an accurate estimation of the donor supply of hair, meticulous dissection of the follicular units, and careful design of the recipient area to maximize the cosmetic impact of the transplant, use of large numbers of implants in fewer rather than more sessions, a long-term master plan that accounts for the progression of male pattern alopecia, and realistic expectations on the part of the patient.” ((Bernstein, RM: Follicular Transplantation. Int J of Aesthetic and Restoration Surg. 1994 Vol.3 #2 pp 119-132.))
By combining the concept of follicular transplantation with the use of the binocular microscope, hair transplant surgery has reached a new level of excellence.
Note, however, the grafts at the top of photo done several years earlier. They contain 4-5 hairs but more importantly they don’t look nearly as natural as the ones where follicular units were specifically kept intact.
Follow-Up
I am beginning to see my first patients back since I began follicular transplantation using the binocular microscope. Growth is better, particularly in single hair grafts which is exactly what I was told would happen. I have seen about ten patients, and every one of them is growing earlier and better.
X-factor
I refer to Dr. Jose Greco’s article in the last Forum about X-factor. I have had patients similar to his that grew only about 10% of the hair and I had repeated it usually at no charge and was very careful and still got poor growth. I have one of those patients now that wants some more grafts and I am going to do follicular transplantation and maybe in another four months we will know the answer.
Postoperative Ointment
Also in the last Forum, an article by Dr. Bernstein on ointment following hair transplants. Over the years I have gotten to where I did not use any ointment but there is a lot of evidence in the dermatology literature encouraging the use of post-op ointment. Ointments appear to speed up the healing process. I asked Dr, Blaine Lehr, my associate, to comment on this and he gave me the following statement “Postoperative ointment maintains moist wounds and increased surface humidity, which greatly increases the rate of re-epithelization. By decreasing crust formation, migrating epithelial cells do not face a barrier to their movement. With improved healing there is less potential for scarring and residual pigmentary abnormalities.”
Since I have been using ointment, patients look much better sooner. Sometimes there are hardly any crusts.
Why does it take so long?
Also in the last issue, Dr. Shiell commented on how it is interesting to read old Forums and specifically mentioned Bob Limmer’s use of the dissection microscope. Since I had not read the last issue of the Forum, I called Bob Limmer to get the first reference on the binocular microscope, and he said it was probably the one mentioned in the last Forum by Richard Shiell in his Editor’s Notes. What a coincidence!
I wonder why it took us so long to recognize how important that work was. I also wonder why it took us so long to recognize follicular bundles as the most logical unit for hair transplanting.
Posted byby O’Tar T. Norwood, MD, Oklahoma City, Oklahoma, USA
Hair Transplant Forum International (May/June 1997 issue)
I just returned from visiting Dr. Bob Bernstein in New York, and was impressed with his operation and even more impressed with his thoughts, observations, and insights into hair transplant surgery. He applies scientific methods to his work, is academically honest, and has an almost eerie instinctive knowledge of hair transplant surgery. Of course he has Dr. Bill Rassman to work with, but it is still remarkable. Dr. Bernstein is best known for introducing follicular transplantation ((R. Bernstein and W. Rassman Follicular Transplantation, International Journal of Aesthetic and Restoration Surgery. Vol. 3: No 2,1995, 119-132.)) to hair transplant surgery, an idea Bob Limmer has been pushing for ten years with the use of the binocular microscope, but no one would listen to him. Dr. Limmer, however, never used the term follicular transplantation. Using the microscope, you automatically dissect the follicular units. It can’t be avoided if done properly.
The follicular transplantation concept is based on the observation that hair naturally grows in follicular units of one to four hairs, so probably the best way to transplant them is to keep them in this natural anatomical and physiological state. Dr. David Seager ((DJ Seager, Micrograft Size and Subsequent Survival, accepted for publication, Dermatologic Surgery.)) has recently shown that when the integrity of the follicular unit is maintained up to 20%, better growth occurs, making this concept of truly major importance.
We discussed many other topics, and it is interesting how he has a fresh, new look at the fundamentals of hair transplant surgery, hair growth, and anatomy and physiology of the hair follicle. Many of these ideas and concepts will appear in the upcoming special issue of Dermatologic Surgery. ((R. Bernstein and W. Rassman, The Art of Follicular Transplantation, accepted for publication, Dermatologic Surgery.))
His views on the following special subjects I find interesting:
1. Donor density: He emphasizes the importance of density, describes how to measure it, and explains how precious donor hair is. He shows that in the average patient, we can safely transplant about 50% of the available “permanent” donor hair. He does this mathematically. Dr. Bernstein and Dr. Rassman have brought measurement of density to a scientific level by using the densitometer and counting numbers of hairs in each square centimeter. I have started using this and it really works. I believe the importance of density cannot be over-emphasized. It is actually as important as the classification in patient selection and design.
2. Caliber of hair: Coarse vs. fine diameter. He believes coarse hair covers much better than fine hair. He considers not only the number of hairs but the total value of hair mass that is available for transfer. He believes that coarse hair creates the illusion of fuller coverage than fine hair can achieve.
3. Scalp – thin vs. thick: He emphasizes the importance of thickness of scalp. I have preferred thick scalps to thin scalps for years, but never was quite sure why.
4. Delayed growth: His analysis of the natural hair cycle and its relation to hair transplant surgery, I think, is brilliant. It explains what we see on a daily basis. ((R. Bernstein and W. Rassman, Delayed Hair Growth, Hair Transplant Forum International. Vol. 7: No 3, 1997.))
5. Diffuse patterned alopecia (DPA) and diffused unpatterned alopecia (DUPA):
Although I first described these years ago, I failed to recognize their importance. They are quite common in men and women. Although they have received some recognition in women, their study in men has been completely ignored. It is important to distinguish DUPA and DPA because hair transplants should probably never be done on a patient with DUPA.
6. Aging alopecia: This occurs in everyone and occasionally occurs extremely early in life, so that is important to recognize. I have watched my own hair thin over the years, and I have watched my patients’ donor hair and their transplanted hair thin over the years. Sometimes you can see through the remaining donor fringe. Dr. Bernstein describes the differences of senile alopecia, androgenic alopecia, and diffuse alopecia and their importance.
I really haven’t had time to “digest” all the new ideas I obtained from Dr. Bernstein. I haven’t had time to try all of the techniques I saw, but I am sure his influence on hair transplant surgery is going to be considerable.
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