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A recently published study ((Bater KL, Ishii M, Joseph A, Su P, Nellis J, Ishii LE. Perception of Hair Transplant for Androgenetic Alopecia. JAMA Facial Plast Surg. 2016 Aug 25. doi: 10.1001/jamafacial.2016.0546.)) is the first to measure the perceived benefit of hair transplantation on a patient’s age, attractiveness, successfulness, and approachability – key factors that play an important role in workplace and social success. The pilot study, published in the Journal of the American Medical Association Facial Plastic Surgery, found that hair transplant recipients were perceived by others to be 3.6 years younger following their hair restoration surgery. The data indicate that the person’s attractiveness, successfulness, and approachability also showed statistically significant positive changes as a result of hair restoration surgery.

Background

Half of men over 40 experience hair loss. This may be associated with significant adverse psychological effects including reduced self-esteem and self-confidence, plus the social consequences that follow. Prior studies have shown that men who are balding are rated poorly when it comes to attractiveness, likability, and personal and career success. ((Wells PA, Willmoth T, Russell RJ. Does fortune favor the bald? psychological correlates of hair loss in males. Br J Psychol. 1995; 86(pt3):337-344.)), ((Cash TF. Losing hair, losing points? the effects of male pattern baldness on social impression formation. J Appl Soc Psychol. 1990;20(2):154-167.)) This perception motivates men to seek hair restoration in order to improve how they are viewed by others. The new study attempted to quantify, for both patients and their surgeons, the actual benefit of hair transplant surgery on these key perceptions.

Methods

The randomized, controlled study involved 122 participants — 47.5% men, 51.6% women — each of whom were shown a series of 13 sets of before and after hair transplant photos. Of the photo sets, seven showed men before and then after a hair transplant of approximately 1,200 follicular unit grafts. The control group were of men who did not have a hair transplant or any facial cosmetic surgery. Each participant was asked to rate how much younger the “after” photograph appeared, on a scale of 1-10 years. For the other metrics — attractiveness, successfulness, and approachability — the participants used a slider bar to indicate a positive or negative change.

Results

On age, the data showed a range of about one year younger to about six years younger for the “after” photos, for an average of 3.6 years younger in people who had a transplant. The “after” photos for the control group were perceived to be an average of 1.1 years younger, confirming that the post-transplant group appeared younger than the control group. On attractiveness, successfulness, and approachability, study participants rated the “after” photos with scores of 58.5, 57.1, and 59.2, respectively. This amounts to a 17% improvement in attractiveness, 14.2% improvement in successfulness, and an 18.4% improvement in approachability.

Summary

Since the first hair transplants in the 1950s we have observed that surgical hair restoration can significantly improve one’s appearance. Now, for the first time, we have concrete data that shows the extent of the change of perception in the person’s age, attractiveness, successfulness, and approachability that is caused by the hair restoration procedure. This pilot study should be encouraging for prospective patients, as the purpose of hair restoration is not only to improve one’s own self-image, but to improve appearance, attractiveness, and successfulness to other people as well. This study shows that this effect exists in a way that is both measurable and statistically significant.

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NYCityWoman.com

Dr. Bernstein was quoted in an article on NYCityWoman.com, where he spoke about the risks associated with popular hair extensions, such as weaves, wefts, and similar clip-in or add-on pieces. Extensions are a stylistic choice that allow women to dramatically change their appearance. However, their frequent use can contribute to a type of hair loss in women called traction alopecia – hair loss around the frontal hairline and temples caused by tight hairstyles pulling on the follicles.

Dr. Bernstein is quoted:

“Hair extensions can create a problem over a long period of time, as constant tugging on the hair follicles compromises their blood supply and may cause permanent thinning,” explains Robert M. Bernstein, M.D., a dermatologist in midtown Manhattan who specializes in hair loss.

Traction alopecia often causes thinning that reverses itself when the hair is worn loose, but if tugging on the hair follicles continues for an extended period of time, the hair loss can be permanent. In patients with permanent hair loss from traction alopecia, a hair transplant can typically restore the hair that is lost from sustained traction. See before and after photos of Patient BOI, Patient NBN, and Patient KAR for examples of women who had their edges restored by hair transplant surgery.

NYCitywoman.com is a website dedicated to lifestyle issues for “women on the right side of 40” — women who are smart, stylish, and eager to embrace new challenges and opportunities.

Read about Traction Alopecia
Read about the Causes of Hair Loss in Women

Before and after photos of women who had surgical hair restoration to repair thin edges:

Patient BOI
Patient NBN
Patient KAR

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Q: Doctor Bernstein, I was looking at your website and saw the photos of medical hair loss treatments only, with Rogaine and Propecia. Doctor, are all those pictures just with medical treatments or is there concealers as well? I don’t mean to sound rude or disrespectful, but are the pics all real and genuine? Those are some impressive responses to medical treatment. — A.D., Scarsdale, NY

A: The photos are un-retouched and without concealers. These are responses to medical treatment alone. Yes, medications (finasteride and minoxidil) can work really well in select patients. Patients with early stages of thinning usually respond the best. Contrary to popular belief, the medications can work in the front part of the scalp, as long as the area is not shiny bald.

Perhaps about 1/3 of patients respond well enough to be put on the site. Most others have a good response, but not necessarily improvement significant enough to be easily noticeable in photos.

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Q: Are the “result” photos from taking Propecia and using Rogaine legitimate? Some of the after photos look too good to be real and a few patients looked like they combed their hair to look like they had more coverage. — T.Y., Darien, Connecticut

A: The before and after photos of patients using Propecia and Rogaine are my patients. All photos on our website are un-retouched. When patients have a good response to medical therapy, they often have more flexibility in how they can groom and style their hair. This is reflected in the photos.

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Losing one’s hair can be an uncomfortable topic of conversation for any adult, but, given the importance many women place on their appearance, hair loss in women is an especially taboo subject of conversation. Whether it is a bald patch, diffuse thinning, balding from a medical condition, or scarring from an accident, hair loss can be upsetting or even traumatic for many women.

The good news is that hair restoration pioneers like Dr. Bernstein are bringing the treatment of women’s hair loss out of the cosmetics bag and into the modern era of hair restoration. What a better way of squashing the taboo once and for all than for Dr. Bernstein to appear on national television and confront the issue head-on. Dr. Mehmet Oz invited Dr. Bernstein to appear on his show, the Dr. Oz Show, to discuss the causes and diagnosis of hair loss in women.

As seen in the image above, Dr. Bernstein used a densitometer to evaluate the hair loss of a female member of the audience. The device enables a physician to determine the amount of miniaturization, or genetic thinning, present in the patient’s scalp. Dr. Bernstein also commented on the treatment of hair loss with low level laser therapy (LaserComb).

Dr. Oz and Dr. Bernstein are colleagues at The New York Presbyterian Hospital of Columbia University. They first appeared together on the Oprah Winfrey Show where Dr. Bernstein explained his new hair transplant techniques to Oprah.

See before and after hair transplant photos of some of our female patients.

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Fox NewsDr. Bernstein discusses the technique of follicular unit hair transplantation in a Fox News segment on hair loss and hair transplantation. In the video, he discusses the use of the Follicular Unit Transplant (FUT) procedure to correct hair loss and camouflage scarring that resulted from the surgical removal of a large skin cancer on the patient’s scalp. You can see this patient’s before and after photos in our Women’s Gallery.

Watch a 1-minute video clip of the program:

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Q: Do you use computer type imaging to create the best way to ensure you (or any hair transplant surgeon) have the same goal or target “picture” of the particular patient’s restoration as that particular patient has as his “picture?” –F.D., Laude, Missouri

A: I prefer not to do imaging since it tends to oversell the hair restoration procedure.

In addition, the technology is unable to accurately represent what the hair transplant will really look like as there are many hair characteristics that it can’t take into account.

Seeing lots of actual photos of hair transplant patients is much more instructive – and more honest (if the photos are taken correctly). At the time of the consult I design the hairline and photograph it.

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Q: I have seen some incredible photos on some websites. In some cases, they seem too good to be true. Are they real? — P.V., Jersey City, N.J.

A: Evaluating results is more complicated than simply looking at photos – even if they are un-retouched and not studio shots.

For example, if 4,000 grafts were used to make a young person’s hair line look very dense, you might say that was a spectacular result. However, if he only has a total of 6,000 follicular units in his donor area (the average), then he is going to have many problems as he continues to bald, since there will be only 2,000 grafts left for the rest of his head.

Not only was too much hair used up in the front, but the high density of the frontal hair line will not look balanced as the person ages, as this density can not be sustained.

Similar problems occur when the frontal hairline is placed too low or is too broad. These look great in photos early on – and are great for marketing purposes – but become real problems as the person ages.

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Q: I was looking at the hair transplant photos on the Bernstein Medical – Center for Hair Restoration website. I noticed that you and the NHI website have some of the same pictures. Did you both perform surgeries on these people? — B.B., Columbus Circle, N.Y.

A: All of the patients that appear on the Bernstein Medical website were operated on by me personally. My own staff assisted me in these procedures.

I worked with Dr. Rassman at NHI from 1995 to 2004. Photos of patients that I operated on during this period may therefore also appear on the NHI website.

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Dr. 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.

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