Dr. Bernstein’s Key Contributions to Hair Restoration Outlined in Historical Review of Dermatologic Surgery

Dr. Bernstein’s Key Contributions to Hair Restoration Outlined in Historical Review of Dermatologic Surgery

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 Dr. Bernstein’s landmark medical publications

Download and read ‘Current status of surgery in dermatology’ (pdf)

Posted by Robert M. Bernstein M.D.

Study: Latanoprost Might Be A Viable Hair Loss Medication

A double-blind scientific study published in the May 2012 issue of the Journal of the American Academy of Dermatology has found that latanoprost, a drug that mimics naturally-derived compound molecules called prostaglandins, significantly increases hair density on the scalp after 24 weeks of treatment in young men with mild hair loss.

Latanoprost, like the eyelash restoration drug bimatoprost (better-known by its brand name Latisse), has been used to treat glaucoma. And like bimatoprost, latanoprost has been used to treat eyelash alopecia. The scientists who conducted the study sought to determine if latanoprost could stimulate hair growth when applied topically on the scalp.

While the sample size of the study was small (only 16 subjects), the researchers found that 50% of the subjects had statistically significant differences in hair density associated with increased hair pigmentation and thickness. Overall, at 24 weeks into the study, hair density had increased 22% in the entire study population. Another interesting finding is that the proportion of hairs in the anagen phase versus the telogen phase — referred to as the anagen/telogen ratio — remained stable. The authors of the study describe the significance of this finding:

“The stabile anagen/telogen ratio might indicate that latanoprost does not modify the length of anagen and telogen phases of individual hair follicles. However, as the absolute number of both anagen and telogen hair increased, it seems latanoprost recruits new hairs into the growth phase.”

In conclusion, the authors suggest that the study shows the possibilities of using prostaglandin analogues, like latanoprost, to treat androgenetic alopecia, or common hair loss on the scalp. More research is needed on latanoprost, or other prostaglandin analogues, to determine the ideal dosage and duration of treatment for hair loss.

Latisse, the brand owned by American pharmaceutical company Allergan, is currently being studied as a topical hair loss medication. The study will conclude in September 2012.

View the section on Hair Loss Medications

Posted by Robert M. Bernstein M.D.

Latisse Improves Eyelash Growth in Controlled Study

Latisse, which is the brand name for the drug bimatoprost, has been found to effectively and safely grow eyelashes in a double-blinded scientific study published in the May 2012 issue of the Journal of the American Academy of Dermatology.

The study found that the drug starts showing improved eyelash growth at week 4 of using the medication. The growth is notable by week 8 and even more substantial by week 12. The majority of subjects using bimatoprost, 78.1% of the group, found improvements in eyelash prominence, length, fullness, and darkness by week 16. Only 18.4% of subjects using the placebo found such improvements at 16 weeks.

In the safety component of the study, adverse events were tallied and subjects were given ophthalmic examinations. Bimatoprost was found to have a “very good” safety profile. The only adverse event that occurred in a statistically significant greater proportion among those who used bimatoprost was conjunctival hyperemia, also known as “red eye”. This adverse event happened in only 3.6% of subjects — five out of 137 — and none of the subjects discontinued participation in the study. Ophthalmic examination of subjects during the study revealed that there is no statistically significant change in iris pigmentation due to bimatoprost. There was also no statistically significant change in visual acuity.

Bimatoprost, which mimics a type of “messenger molecule” called a prostaglandin, was initially designed to treat glaucoma. It was known for several years that the drug’s side effect was eyelash growth, and it was approved by the Food & Drug Administration in 2008 under the brand name of Latisse. The physiological mechanism by which bimatoprost affects eyelash growth is unknown and requires further scientific study.

Latisse — which is owned by the California-based pharmaceutical company Allergan, Inc. — is also being studied as a treatment for hair loss. That study is underway, and is on-going as of the most recent update in January 2012. The study should be complete by September 2012.

Read about Latisse/Bimatoprost

Posted by Robert M. Bernstein M.D.