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Q: I have read that a lot of doctors today administer Midazolam (Versed) to sedate the patient. I have two questions in reference to this drug: 1) How does the doctor determine how much of a dose to administer to the patient and 2) is the drug administered all at once, or intermittently throughout the procedure? — D.D., Bronxville, NY

A: Each doctor has a different protocol, so it is hard to generalize. At Bernstein Medical we usually use Versed 2 to 4 mg IM one time 10 minutes prior to giving the local anesthesia. The dose is not repeated.

We also use Valium 5-15mg by mouth. I determine the dose of each based on body weight and history of sensitivity to sedatives.

Read more about the Hair Transplant Procedure.

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Q: Is it necessary to take medications before, during, or after the hair transplant? Will these medications affect pregnancy? — V.M., Fairfield, C.T.

A: It is not necessary to take any medication for a hair transplant other than the local anesthesia used during the procedure.

Although I would not have a hair transplant during pregnancy, the procedure will have no effect on future ones.

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Q: Dr. Bernstein, is a follicular unit hair transplant, the way you perform it, very painful? — M.C., Laguna Niguel, C.A.

A: We perform our hair transplant procedures using long-acting, local anesthesia, so after the initial injections, the patient doesn’t experience any pain or discomfort.

The local anesthesia (a combination of Lidocaine and Marcaine) lasts about 4-5 hours. For long sessions, we give additional anesthesia before the first wears off.

Before we start the local anesthesia, we give most patients IM Versed (also known as midazolam). This medication is a very fast acting sedative that is very relaxing. Some patients even doze off at the beginning of the procedure. This is very different, however from the deep sleep produced by general anesthesia.

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Q: Will I be unconscious during the hair transplant procedure and do you use general anesthesia? – C.L., Boston, Massachusetts

A: All of the surgical hair restoration procedures at Bernstein Medical are performed under local anesthesia. The fact that general anesthesia is not needed is what makes hair transplant procedures – even though they are long – very safe.

Patients are given a sedative to help them relax, but they are not put to sleep. Most patients watch TV, see movies or just chat during the procedure.

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Dr. Bernstein — and a Bernstein Medical – Center for Hair Restoration hair transplant patient — were featured on NBC television’s “Today” program with Matt Lauer. The segment, which mostly covered hair transplant repair procedures and hair restoration, was one of a three-part series on hair loss.

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Read below for a portion of the transcript:

What men will do for a few more strands of hair

Recent changes in transplant surgery have led to more natural-looking results and a boost of self confidence for some balding men

Hair transplants are one of the top five cosmetic procedures for men in the U.S., with more than 19,000 performed last year, according to the American Society for Aesthetic Plastic Surgery. But is it worth it? As part of a three-part series on hair loss, “Today” spoke with two men who underwent the procedure.

Allen Appleblatt has made a big change in his life. He works out, spends time with family and stays busy with work. And when it comes to his appearance, he’s feeling good about his new head of hair.

“I kind of felt like I was an idiot looking at myself in the mirror,” said Appleblatt. “Whenever I took a shower, at the end of the shower I found a clump of hair at the bottom of the drain. And there was no way of stopping it.”

So Appleblatt had two hair transplants. His partner, Shirley Garofano, likes what she sees.

“I liked him both ways. But I like him better now. He looks great, he’s very positive, he’s happier,” she said.

Happier, but he still wants thicker hair. “Today” followed him while he underwent his third hair transplant, taking advantage of the latest techniques.

“Over the past 10 years we’ve developed a new procedure called follicular unit transplantation, where hair is transplanted exactly the way it grows,” said Dr. Robert Bernstein, an associate clinical professor of dermatology at New York’s Columbia University.

This new technique replaces the plugs — groups of hairs inserted into round holes in the scalp — used in the early days of hair transplant procedures. It is now known that hair grows in groups of one to four hairs.

“So follicular unit transplantation is a transplantation of hair in its naturally occurring groups,” said Bernstein. “We’re really just transplanting the root.”

Appleblatt is given valium and local anesthesia, and then a donor strip is removed from the back of the head where hair is not genetically programmed to fall out.

“We have a team of people dissecting the grafts. They divide it into individual follicular units,” said Bernstein.

The units are then transplanted into the balding area. And 10 to 12 months later, the new hair will be in place.

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