Follicular Unit Growth at Four Different Hair Transplant Densities

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Follicular Unit Growth at Four Different Hair Transplant Densities

Michael L. Beehner, M.D.
Saratoga Hair Transplant Center, Saratoga Springs, NY, USA.

SUMMARY of Dr. Beehner’s Abstract from his presentation at the International Society of Hair Restoration Surgery, 2005 – Sidney, Australia

There is a need to find the “threshold” density at which follicular unit (FU) graft recipient sites may be placed and yield excellent survival following a hair transplant. It also needs to be determined whether or not a smaller recipient site makes a difference in graft survival. This study looks at hair survival in two patients 18 months after they were each transplanted with four different densities.

The objective of the study was to determine the optimal density for “dense packing” FU grafts without causing loss of hair from vascular compromise or other factors that can affect graft growth during hair restoration surgery.

In the study, two male patients, both with Norwood Class VI patterns of hair loss, were examined. Two-hair FUs were planted respectively at densities of 20, 30, 40, and 50 FUs per cm². 19g needles were used for the boxes with 20 and 30 grafts per box, and 20g needles were used for the boxes with 40 and 50 grafts/cm². The grafts were placed using a “stick-and-place” method.

% Hair survival

Recipient Site Density	20/cm²	30/cm²	40/cm²	50/cm²
Patient I (18 Months)	95	93	70	67
Patient II (13 Months)	88	92	100	93

The author concluded that both patients had excellent growth of the transplanted hair at densities of 30/cm². However, one patient had decreased density at 40/cm² and 50/cm². Based upon this very limited study, the researcher suggested that there are probably individual factors unique to each patient which affect graft survival of transplanted hairs at high densities.

The author proposes that the patient to patient variation at high densities may be due to variations in 1) scalp thickness, vasculature (atherosclerotic changes or differences in collateral circulation), presence of past transplant work or surgery with resultant “micro-scarring”, amount of epinephrine used in recipient area, or technique and care to grafts by cutters and placers.

Posted by Robert M. Bernstein M.D.

Dr. Bernstein Encourages GQ Readers to ‘Grow Your Own’ Hair

Dr. Bernstein was featured in an article in GQ Magazine on hair transplantation. The article, written by Peter Rubin is entitled, “Grow Your Own.”

Here is a brief synopsis of the article:

GQ: After fifty years of bad plug jobs, we’ve come to regard “hair restoration” as synonymous with “Astroturf head.” Today’s hair transplant procedures are worlds away from the butcherings of old. So forget what you thought you knew.

Two methods of hair restoration are in wide usage: mini-micrografting and follicular unit transplantation. The methods are similar, to an extent, but FUT; co-developed by New York hair transplant surgeon, Robert M. Bernstein, M.D.; is the more advanced of the two procedures, producing cosmetically superior results.

Dr. Bernstein: Anatomically, follicular unit transplantation is the end of the line. The next step would be hair cloning, which is still quite a way off. The way you get the most amount of hair into the smallest wound — and ensure that it’s going to look natural — is by using a follicular unit transplant. We can create swirls, add sideburns… The beauty of follicular transplantation is that the hair will take on the old wave that the original hair had.

GQ: The best part is that FUT regularly achieves an extraordinarily high success rate, meaning nearly every single transplanted graft takes root and grows properly – unheard of fifteen years ago.

Pierce Mattie, a 28-year-old publicist in New York City, had an FUT procedure in May and couldn’t be happier. “I’ve had dental fillings that were more painful,” he says. “I was back in the office two days later, and my hair looks like it did when I was in high school. Everyone keeps saying, ‘You look so great!’—but they have no idea what I had done.”

About GQ Magazine: For nearly half a century, with 854,000 subscribers and 4 million readers, GQ has been a leading voice in men’s magazines, covering men’s style and culture from fashion and politics to travel, entertainment, sports, technology and relationships. GQ has been nominated for 27 National Magazine Awards.

Reference
“Grow Your Own,” GQ Magazine, November 2003, p173-4.

Posted by Robert M. Bernstein M.D.

Dr. Bernstein Featured in Healthology Hair Transplant Video Series

Robert M. Bernstein M.D. was asked to provide expert medical commentary in two hair transplant videos produced by Healthology. The topics included “Hair Transplantation Techniques” and “Using Cloning Techniques in Hair Transplantation”.

Healthology, the leading producer of broadcast and webcast programming that provides consumers with direct access to top medical experts, produced an important series of videos on hair loss. As Associate Clinical Professor of Dermatology, Columbia University College of Physicians and Surgeons, Dr. Bernstein was a vital part of the interview series.

Hair Transplantation Techniques

The first video that Dr. Bernstein was invited to take part in, focused on the various techniques used in surgical hair restoration. As a pioneer of Follicular Unit Transplantation, the filmmakers were eager to hear Dr. Bernstein’s thoughts on FUT:

“A major breakthrough in hair restoration came via identification that hair didn’t grow individually, but actually in small groups called follicular units. And these follicular units are naturally occurring groups of hair from one to four” Dr. Bernstein explained, “in modern hair transplantation, a procedure we call Follicular Unit Transplantation is used; we transplant the hair the way it actually grows in nature.”

This Healthology segment explored how the Follicular Unit Transplantation technique is also helping patients who want to improve the appearance of old transplants or scars.

“What we can do now is remove the old grafts, sew the holes closed where they’re transplanted, place those grafts under a microscope, divide them into individual follicular units and then place them back in the scalp the same day.” said Dr. Bernstein.

In addition to covering surgical hair restoration, the segment touched on the issue of medications for hair loss. Though some patients think getting a hair transplant means they can stop taking hair loss medications, Dr Bernstein illustrated why most physicians recommend using medicine along with surgery:

“Hair transplantation and medications do essentially different things. The main benefit of a transplant is to restore hair that’s been lost. The main benefit of medication is to prevent further hair loss.”

Using Cloning Techniques in Hair Transplantation

In this second Healthology video segment, on hair cloning, they invited Dr. Bernstein to take part in the discussion along with other distinguished guests; including Angela Christiano, PhD an Associate Professor of Dermatology and Genetics & Development at Columbia University.

This interesting segment explored how researchers are trying to find ways to make more follicles for hair transplant surgeons to work with. Research into cloning techniques shows it may be possible to create a virtually limitless supply of new follicles in the not too distant future. Dr. Bernstein provided some insights as to how hair restoration doctors might approach hair cloning in the future:

“The actual role of cloning in hair transplantation will depend upon how the cloning technology actually evolves. Initially, cloning may be used to supplement a regular hair transplant. We would use Follicular Unit Transplantation to give definition to a hairline and frame the face. Cloning would then be used to give the hair transplant bulk, by placing the cloned hair (which may not look as natural as normal hair) behind the transplanted hair.”

Posted by Robert M. Bernstein M.D.

Dr. Bernstein Discusses Hair Transplant Repair In Discovery Channel Interview

The Discovery Channel interviews Dr. Bernstein for a piece on hair transplant repair. View the segment, which includes footage of Dr. Bernstein speaking about hair transplant surgery and performing a procedure, below:

Read the full transcript of the segment:

These days, more and more men who want to compete in the marketplace are seeking cosmetic surgery because they see it as giving them a competitive advantage.

With over 35 million American men affected by hair loss, it’s not surprising that hair restoration ranks high on the list of most popular procedures, generating two billion dollars in revenue each year.

Forty two year-old New York composer Ken Gold started losing his hair 20 years ago.

Ken Gold: In your 20s, you know, everyone is more image-conscious and you don’t want to lose your hair in your 20s.

Ken is not alone. 20% of men in their 20s experience hair loss. In their 30s, the odds jump to 30%, and by the time a man is in his 50s, there is a 50% chance he will be losing some hair.

Ken Gold: Once you’ve lost your hair, you look older. And you don’t want to be 22 and look 35, you know?

Determined to stay youthful, Ken investigated his options and decided to undergo a series of hair transplant procedures beginning in 1981.

Ken Gold: One of the guys I was doing business with, he had a very thick full head of hair. And he said, “Well, I’ve got a hair transplant,” and I was just astonished.

But after five years and four painful, expensive procedures, Ken still didn’t have the full head of hair he wanted.

Ken Gold: My head was a mess. You only had to lift up the hair in the back and you could see what they call the Swiss cheese scalp, just this huge massive scar tissue with little round holes, you know.

Dr. Bernstein: When hair transplants were first started, they thought in order to get enough fullness, you had to move the hair in large clumps, and that’s traditionally known as plugs. And much of our practice is still devoted to hair transplant repair.

Ken despaired of ever finding the solution to his problem until he found the New Hair Institute in Fort Lee, New Jersey.

Dr. Bernstein: When I first saw Ken in 1995. He still had the traditional plugs, and I would say on a scale of one to ten, he was maybe a seven, with ten being the worst. We performed a procedure called follicular unit transplantation where hair is transplanted in exactly the way it grows in nature, which are little tiny groups of one to four hairs.

Ken Gold: After the first surgery I was just ecstatic because I was actually able to look at myself in the mirror.

Almost 20 years and $40,000 later, Ken has finally achieved the natural-looking hair he wanted. But there are alternatives to hair transplant surgery.

Dr. Bernstein: Probably the best thing to do if you’re noticing hair loss is to have a diagnosis of male pattern hair loss to make sure there is not some other treatable condition, and then to use a medication, such as Propecia, which actually can prevent hair loss if it is taken early enough.

But Ken Gold is convinced he’s found the right solution for him.

Ken Gold: I’m very happy now. I wasn’t happy five years ago. When I look in the mirror now, I see someone with hair and I’m able to comb it back and say, yeah, this looks okay.

Watch more videos on hair transplantation and hair transplant repair in our Hair Transplant Videos section

Posted by Robert M. Bernstein M.D.

‘Platinum Follicle Award’ for Outstanding Achievement in Hair Restoration Goes to Dr. Bernstein

The Platinum Follicle Award is given by the International Society of Hair Restoration Surgery (ISHRS) for “Outstanding achievement in basic scientific or clinically-related research in hair pathophysiology or anatomy as it relates to hair restoration.” It was presented to Dr. Bernstein at the 9th Annual Meeting of the ISHRS, October 18-22, 2001; in Puerta Vallarta, Mexico.

The award is the highest honor given by the International Society of Hair Restoration Surgery. At the ceremony, Dr. Marcelo Gandelman, the President of the ISHRS, stated:

“I proudly present the 2001 Platinum Follicle Award to Robert M. Bernstein, MD. Dr. Bernstein has contributed to the field of hair transplantation in dramatic and substantial ways, revolutionizing the advancement of Follicular Unit Hair Transplantation. His published articles have become ‘Bibles’ for this methodology. Dr. Bernstein’s contributions extend beyond the application of Follicular Unit Transplantation, such as studies in examining the power of sorting grafts for density, yield by method of graft production, local anesthetic use, and suture materials. These studies have added to the specialty’s depth and breadth of knowledge applicable to traditional mini-micrografting techniques as well as Follicular Unit Transplantation.”

Posted by Robert M. Bernstein M.D.

HairSite.com Award for Excellence Goes to Dr. Bernstein

Dr. Bernstein received the 2001 HairSite.com award for excellence in hair transplantation. Here is the statement they made in giving Dr. Bernstein the annual award:

Dr. Bernstein is one of the most sought after hair transplant surgeons in the United States. He is one of the very few in the industry who is still involved in scientific and clinically related hair restoration research while engaging in hair transplant practice.

Dr. Bernstein is the author of numerous scientific journals related to hair restoration, currently the most widely published author on the subject of Follicular Unit Transplantation. Since HairSite was founded in 1997, we have no received one single email or correspondence from a dissatisfied patient of Dr. Bernstein.

Dr. Bernstein’s passion in hair restoration research has substantially elevated the standards in hair transplant industry over the years. Dr. Bernstein is also named one of the best hair transplant doctors by New York magazine and is the recipient of the 2001 “Platinum Follicle Award” at the International Society of Hair Restoration Surgery 9th Annual Meeting in Puerta Vallarta Mexico.

Dr. Bernstein performs surgical hair restoration at his offices in New York, NY and Fort Lee, NJ.

Posted by Robert M. Bernstein M.D.

Dr. Bernstein Emphasizes Standardizing Hair Transplant Terminology in ‘Cosmetic Surgery Times’ Article

Dr. Bernstein - Cosmetic Surgery Times - May 1999 “We felt it was necessary to clearly define follicular unit hair transplantation and mini-micrografting cut to size,” explained Dr. Bernstein, Assistant Clinical Professor of Dermatology, College of Physicians and Surgeons, Columbia University, New York. “Follicular unit transplantation has many theoretical advantages… having standardized definitions of these hair transplantation techniques will allow us to make valid comparisons.”

Dr. Bernstein said the elements defining follicular unit hair transplantation include exclusive transplantation of hair in its naturally occurring individual follicular units.

Read the full article

Posted by Robert M. Bernstein M.D.

Microscopic Dissection Article in ‘Skin & Allergy News’ Features Dr. Bernstein

Dr. Bernstein was interviewed by Skin & Allergy News in their article, “Microscopic Dissection Offers Superior Yield” The complete article is below:

Skin & Allergy News
February 1999

Skin & Allergy News - Microscopic Dissection Offers Superior Yield

Microscopic Dissection Offers Superior Yield
Articles by Anna Nidecker
Senior Writer

Washington — The dissecting microscope takes some getting used to, but using it makes more efficient use of donor hair during follicular unit transplantation than magnifying loupes with transillumination, reported Dr. Robert Bernstein of Columbia University Microscopic Dissection of follicular units College of Physicians and Surgeons, New York.

“A limiting factor in all hair restoration surgery is the patient’s finite donor supply. […] Meticulous stereomicroscopic dissection should help preserve the supply and ultimately provide the patient with the most transplantable hair,” he said at the annual meeting of the International Society of Hair Restoration Surgery.

Dr. Bernstein compared the follicular unit graft yields of dissections performed with stereoscopic microscopes and with loupes and backlighting. Initial sectioning of the intact strip was done with loupes, as the staff had not yet mastered the skill of slivering that is needed to section the intact strip under microscopic guidance.

“This method may be useful for a team in transition, a model for staffs in transition to using the microscope,” the hair transplant surgeon suggested.

Tips on Transition to Microscopes

The microscope offers a better yield with follicular transplantation, but some doctors feel that abruptly switching from loupe magnification may send an office into turmoil.

Microscopes will be well received by staff if they clearly understand the benefits and are eased into the transition, Dr. Bernstein said.

Dr. David Seager advised physicians planning the transition to the use of microscopes to let staff observe microscopic dissection at another clinic with an established program, and to send them somewhere to be trained before they start. The Toronto hair transplant surgeon also advised buying a couple of microscopes and letting the staff “play” with them for a while, cutting at their own leisurely rate before entering into a high-pressure transplant session.

Dr. Bernstein also recommended easing slowly into the transition by first training a small portion of staff, which will not affect the overall time of surgery.

Another option is to hire a couple of new technicians and train them from the beginning with microscopic dissection, Dr. Seager suggested.

“You’ll be amazed at the beautiful grafts they will be cutting in a couple of weeks. […] It may be only 40 grafts an hour, but these newcomers will be cutting better grafts than even your 8-year veterans,” he said. “Old staff will look at these new technicians and their grafts, and, if they take pride in their work, they will be quite jealous and will be really eager to catch up.”

Dr. Bernstein agreed: “The value of the microscope may be more significant in the hands of less experienced dissectors. […] There’s some advantage even at the outset.”

Continued resistance from staff should be met with a deadline: ‘Anyone who can’t or won’t fit in, tell them they can do something else in the office, but they won’t be doing transplanting,” Dr. Seager said.

In 41 patients, the donor strip was harvested with a double-bladed knife from the midportion of the permanent zone in the back of the scalp.

The strip was divided into two equal parts along the midline; these were further divided into 2- to 3-mm wide vertical sections using loupes and a straight razor. Sections from one of these donor strip halves were further dissected into follicular units using a 10x power microscope; sections from the other donor strip half were dissected using magnifying loupes.

Follicular units cut using the microscope contained an average of 2.41 hairs; those cut using loupe magnification yielded 2.28 hairs. Use of the microscope also yielded 10% more follicular units and 17% more hair overall, compared with use of loupes.

The grafts were dissected and sorted into follicular units containing one to four hairs, and all hair and hair fragments judged to be potentially viable were counted towards the yield (Dermatol. Surg. 24[8]:875-80, 1998).

Microscopic dissection took from two to four times as long as loupe magnified dissection when technicians first began using the microscopes. After 3 months, the procedure still took twice as long with the microscopes. But by the end of the study 1 year later, it took only 10% longer, a rate they currently maintain, Dr. Bernstein said.

Hand-eye coordination was a factor which automatically improved, and the inefficient movement of grafts in and out of the microscopic field was solved with better organization, he said. Technicians with a tendency to obsessively sculpt grafts under the microscope can be educated to limit this sculpting, which does not affect the quality of the transplant.

Use of the microscope also led to fewer reports of back and neck strain by assistants. They also reported easier dissection when there was donor scarring, and with blond or light-colored hair.

Besides the benefit at the stage of dissecting the sections—as shown in this study—microscopes can improve yield by 5%-10% at the “slivering” stage. Yield can be improved an additional 15%-20% by avoiding use of the multibladed knife at the donor harvesting stage.

Loupe advocates argue that microscopes unduly slow down the procedure and that staff resistance to this new technology may be an insurmountable problem in some practices. They also lament the higher economic cost of purchasing the microscopes, training the staff, and slowing down dissection time with no clear benefits.

Dr. Bernstein said that the benefits of microscopic dissection far outweigh these minor inconveniences and should be incorporated into hair transplant procedures.

Posted by Robert M. Bernstein M.D.

Dr. Bernstein Featured In FUT Editorial By Influential Hair Transplant Surgeon

An Idea Whose Time Has Come - O'tar Norwood The following is a portion of “An Idea Whose Time Has Come,” an editorial written by O’Tar T. Norwood, MD — founder of the Norwood Classification System for Hair Loss — and published in the May/June 1997 issue of “Hair Transplant Forum International”:

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 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.

To read the full article, visit “An Idea Whose Time Has Come” in the Hair Restoration Papers section of our website.

Reference
Norwood O. “An Idea Whose Time Has Come,” Hair Transplant Forum International 1997; 7(3): 10-11.

Posted by Robert M. Bernstein M.D.

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Follicular Unit Growth at Four Different Hair Transplant Densities

Dr. Bernstein Encourages GQ Readers to ‘Grow Your Own’ Hair

Dr. Bernstein Featured in Healthology Hair Transplant Video Series

Dr. Bernstein Discusses Hair Transplant Repair In Discovery Channel Interview

‘Platinum Follicle Award’ for Outstanding Achievement in Hair Restoration Goes to Dr. Bernstein

HairSite.com Award for Excellence Goes to Dr. Bernstein

Dr. Bernstein Emphasizes Standardizing Hair Transplant Terminology in ‘Cosmetic Surgery Times’ Article

Microscopic Dissection Article in ‘Skin & Allergy News’ Features Dr. Bernstein

Dr. Bernstein Featured In FUT Editorial By Influential Hair Transplant Surgeon

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