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Q: I had a hair restoration procedure and the hair grew, but after one year the hair was kinky and dry. It has remained like this ever since.

From what I have read Dr Bernstein says this is uncommon but can happen. I understand there is no definitive explanation for this but I would like Dr Bernstein’s opinion on why this happens. My theory is that DHT is more prominent on the top of the head and is changing the structure of the transplanted hair. The hair is so dry and unmanageable it looks like I am wearing a wig. I await his response. — P.O., Greenwich, CT

A: Some dryness and texture changes can occur after a hair transplant and this usually self-corrects over 1-2 years during which time the transplanted hair gradually regains its original luster and texture. These changes are most likely due to the unavoidable trauma that takes place as follicles are removed from the scalp and placed into recipient sites. Excessive dryness can occur if the sebaceous glands had been stripped away from the graft. In FUT, this can be due to over dissection (i.e., grafts that are trimmed too much). In FUE, this can be due to loss or damage to the sebaceous glands in the extraction process. Persistent kinkiness may represent either damage to grafts from the procedure (improper handling, crush injury) or effects of scarring in the recipient area (usually from older procedures which used larger recipient sites) that distort the growth of follicles.

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Dr. Eric S. Schweiger - Associate at Bernstein Medical - Center for Hair RestorationDr. Eric S. Schweiger, board-certified dermatologist, is quoted in a few recent articles on the effects of chemotherapy on hair, genetic testing for hair loss, and protecting a balding scalp from the sun.

“Coping with Chemo-Induced Hair Loss” was published in a recent issue of Energy Times, a publication focused on wellness and nutrition. Dr. Schweiger commented on the way hair follicles can react to chemotherapy treatment for cancer patients:

Expect changes like “chemo curl.” Eric Schweiger, MD, explains that chemo shocks rapidly dividing cells like hair follicles in the scalp, causing the hair loss. “When the follicles grow again, the shock sometimes changes how they grow, temporarily resulting in a different hair texture and color, which eventually normalizes,” explains Schweiger.

In the article, “Genetic Testing to Predict Hair Loss,” published on HairLoss.com, Dr. Schweiger and Dr. Bernstein discussed the efficacy of genetic tests for hair loss:

[Dr. Schweiger] explains, “I think the test has probably identified a predictor of hair loss but not the only predictor. There is science behind the test and some published research studies; however, the longitudinal, larger studies have not been done, because this testing procedure is just too new.” Dr. Robert Bernstein, M.D., director at Bernstein Medical Center, agrees and adds, “These tests focus on one particular dominant gene, but what is becoming apparent is that hair loss is a complex genetic condition most likely involving several different genes.” He further notes that age, stress, hormone levels, disease and many other factors also are at play in determining factors for hair loss. “Just because a person has the genes for baldness, it doesn’t mean the trait will manifest itself. The truth is the cause and effect have not been proven and differ from person to person, and the association is not anywhere near 100 percent.”

[…]

“Right now, we predict future hair loss based on follicle miniaturization, using advanced microscopic equipment,” says Dr. Schweiger, “and I advise a man to do this at around age 25. If someone presents with more than 25 percent miniaturization, then it’s time to start a hair loss prevention regimen.”

Lastly, Dr. Schweiger contributed featured commentary to an article on HairLoss.com on a topic of importance to those suffering from hair loss, namely, protecting your scalp from the dangerous radiation given off by the sun. In “When You Lose Your Hair, Protect Your Scalp,” Dr. Schweiger encourages bald or balding individuals to take important steps to protect their scalps:

…if you notice your hair thinning or you have baldness of any kind for any reason, it’s important to protect your scalp from sun damage, precancer and skin cancer,” says Dr. Eric Schweiger, M.D., a board-certified dermatologist and hair transplant surgeon at Bernstein Medical — Center for Hair Restoration in New York City. That’s because 100 percent of the surface area on top of your head directly faces the sun’s burning rays when the sun is strongest, between 10 a.m. and 2 p.m. “In general, a mild sunburn on your scalp won’t harm your hair follicles. But any exposure that causes blistering can cause scarring and pre-cancer cells, which will harm hair follicles permanently, so you need to take special care of your scalp when exposed to the sun, even for only a few minutes,” explains Schweiger.

Set up a hair loss consultation with one of our board certified physicians.

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Q: I have hair loss due to a treatment of Accutane. I have been off this medication for about a year and a half now, yet my hair has not recovered. The texture of my hair has completely changed. Given the fact that there is no family history linking me to male pattern baldness, I attribute my hair loss exclusively to Accutane. What should I do? — H.F., Eastchester, NY

A: If the texture alone has changed there is nothing you can do except to wait. The texture should improve over time even though it has already been 18 months.

If there are signs of genetic hair loss (i.e. male pattern alopecia), then finasteride should be considered.

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Hair transplant surgeon Robert M. Bernstein M.D. was recently interviewed on the National Public Radio program The People’s Pharmacy. Invited to speak about hair loss, Dr. Bernstein offered insights about the causes of hereditary baldness and it’s solutions, including hair transplantation.

The show was entitled “Dealing with Hair Loss” and addressed issues such as the importance of hair to our sense of well being.

The full hour radio interview was filled with informative facts about male pattern baldness, cultural attitudes toward hair loss and surgical hair restoration. For example, Dr. Bernstein was asked about his pioneering work in follicular unit hair transplantation and host of other questions ranging from the causes of hair loss to the psychological effects of balding. Here is one exchange from the interview:

Moderator: How one can tell the difference between hair loss from hormonal imbalances and common baldness?

Dr. Bernstein: Measuring hormone levels alone, although important for medical management, does not necessarily reveal whether the cause of the hair loss is actually hormone related or is genetic. The diagnosis is made by examining the scalp and looking at the hair under close magnification using an instrument called a “Densitometer.” If the hair shafts are of different calibers, this is relatively diagnostic of female patterned genetic hair loss and in this case hormone levels are often normal. Hormonal changes or imbalances, on the other hand, may cause alterations in hair texture (such as in thyroid disease) or a generalized shedding that can occur after childbirth (called telogen effluvium). In telogen effluvium, the hair can l actually fall out in clumps – you can literally get handfuls of hair, but the hair often returns over time. In genetic hair loss, however, it is not a question of the hair falling out any faster, but the hair being replaced with thinner, finer hair in each hair cycle, until the hair gradually disappears.

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Hair loss has a variety of causes. Diagnosis and treatment is best determined by a board-certified dermatologist. We offer both in-person and online photo consults.

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