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Hair Restoration Answers

How Many Hair Transplants Will I Need?

Q: How Many Hair Transplants Will I Need? — E.E., New York, N.Y.

A: The first session of a hair transplant should be designed as a stand-alone procedure with the following three goals:

  1. Establishing a permanent frame to the face by creating, or reinforcing, the frontal hairline.
  2. Providing coverage to the thinning, or bald, areas of the scalp with the hair transplant extending at least to the vertex transition point.
  3. Adding sufficient density so that the result will look natural.

Achieving all of these goals will allow the first procedure to stand on its own.

Because of this, many people feel one hair transplant is sufficient.

Reasons for Second Hair Transplant

While the first session of a hair transplant is designed to stand on its own, there are several reasons why one would want a second hair transplant, such as increasing the density in a previously transplanted area; refining the hairline created in the first transplant; focusing on increased crown coverage, when appropriate; or addressing further hair loss that’s occurred after the first transplant.

Because of this last reason, addressing further hair loss, careful patient evaluation and surgical planning is needed to take into account your donor reserve and the likely extent of any future balding in the planning of your first transplant session.

Wait at least 10 to 12 months Before Getting a Second Hair Transplant

If a second transplant is warranted, patients are advised to wait at least 10 to 12 months after the first transplant before considering a second. This is because over the course of the first year, the first transplanted hairs have grown in and the progressive increase in a hair’s diameter, texture and length can markedly change the look of the hair restoration — this may influence the way a patient wants to groom his/her hair, and only after the hair has reached styling length can the patient and physician make the best aesthetic judgments regarding the placement of additional grafts.

For patients having an FUT (strip) procedure, another reason to delay a second hair transplant session for this time period is that scalp laxity will continue to improve making the donor hair easier to harvest.

You can view our Hair Transplant Photos by the number of sessions each patient has had:

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Will I Need Multiple FUE Hair Transplants Over Time?

Q: I’ve noticed from the chatter on blogs, that it is not uncommon for men to go through multiple FUE procedures over 10+ year time-frame. It seems to be that after the initial FUE procedure to address moderate hair loss, the patient continues their natural balding to where they must undergo another FUE procedure in order to get back to their desired look. I’m almost 33 and while I take Propecia, my hair loss has been very gradual since I was about 26. I still have what many would consider a full head of hair, although very thin and with noticeable loss at my temples and crown. I’d always thought that a hair transplant would be a “1 and done” procedure, and now I’m concerned that if I do an FUE procedure now to replace what’s been already lost, I’ll just have to revisit a subsequent FUE down the line. Are ongoing FUEs simply part of the hair maintenance that a patient needs to accept about hair restoration process? — A.A., New Hyde Park, N.Y.

A: Your concerns are correct and would apply to any hair transplant procedure; FUT or FUE. That is why it is best not to begin hair restoration surgery too early.

Posted by Robert M. Bernstein M.D.
Bernstein Medical In The News

Dr. Bernstein Proposes Improvements to FUE Hair Transplant Procedures

Robotic FUE has improved Follicular Unit Extraction by automating what has been a labor intensive and often inexact manual procedure. It is the latest in a long line of improvements made to hair restoration procedures that lead to better results for hair transplant patients. Dr. Bernstein’s recent publication in Hair Transplant Forum International improves the FUE procedure even further, whether performing follicular unit extraction with the FUE robot or by hand.

In his article, Dr. Bernstein suggests two techniques to enhance the FUE procedure. First, he recommends that surgeons create recipient sites prior to extraction, in order to decrease the time grafts are in their holding solution outside the body. Second, he suggests adding time between site creation and graft harvesting and placement, to allow recipient site healing to progress.

Pre-Making Recipient Sites

As is discussed in the full article (which is available for viewing and download in our Medical Publications section), by making recipient sites first, the time grafts are out of the body will be reduced.FUE procedures lend themselves to easily reversing the normal hair transplant sequence of graft (strip) harvesting followed by dissection and site creation.

These “pre-made” recipient sites will also exhibit less bleeding than newly created sites and will exhibit the stickiness that makes older sites easier to place grafts into with less popping (a common source of graft injury). Besides allowing the placing step to proceed more quickly, pre-making sites will reduce the risk of mechanical injury inherent in repositioning elevated grafts.

After Site Creation, Add Delay between Graft Harvesting and Placement

While Dr. Bernstein acknowledges the expediency for the hair restoration physician, as well as the comfort of the patient in a single-day session, he suggests that, to facilitate growth after a transplant, multiple-day procedures should be considered in large hair transplant sessions that involve the placement of thousands of grafts.

In conclusion, these two modifications -— pre-making recipient sites and adding a delay before graft placement -— to the FUE procedure can potentially contribute to better growth due to easier, less traumatic graft insertion, a shortened time “out of body,” and the creation of a more fertile bed for the implanted grafts.

View the full article to read details about these and other potential advantages of pre-making recipient sites

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Will Multiple Hair Transplant Procedures Improve Hair Density?

Q: I was told that I have low hair density in the donor area. Will multiple hair transplant procedures improve the results of my hair restoration? — J.G., Hoboken, NJ

A: Yes, but subsequent procedures would be smaller and there is a point of diminishing returns where additional procedures would yield so little hair that they would not be practical. There is a finite donor supply and once this is tapped, no more hair transplants are possible, regardless if one uses FUT or FUE.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Can a Hair Transplant at the Temples Cover a Facelift Scar?

Q: I had a facelift about a year ago and the skin on the sides by my temples is really bare. It makes the scar a little obvious too. Can you transplant hair just at the temples to cover the scar? — L.H., Scarsdale, N.Y.

A: Hair loss in the temple area following a facelift is relatively common and can be treated with a hair transplant. If there is scar tissue, the hair restoration will generally require more than one session.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Which Causes Bigger Cosmetic Change: First Hair Transplant or Second Transplant?

Q: In which procedure do you generally see more of a change, the first or the second? — N.N., Flatiron, N.Y.

A: The answer depends upon the patient’s baldness. If they are very bald, the first session will be the most noticeable, since going from no hair to hair is much more dramatic than going from some hair to more hair. In addition, if someone is very bald, the first session is generally the largest, with less hair being transplanted in the second.

The situation is different if someone has had a hair transplant with only a limited amount of hair loss. In this case, the first session may be small (since that is all they need at the time) and the second session, performed after the person has lost additional hair, may be significantly larger.

In addition, while the impact of the first session was lessened by the progression of the person’s hair loss, the second session was superimposed on existing, permanently transplanted hair and may be more dramatic.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

After Hair Transplant, Can Hairline be Lowered Further with Second Procedure?

Q: In my first hair transplantation procedure, I wanted to be as conservative as possible and focus on thickening the thinning hair on top of my head and lowering the hairline minimally. Is it still possible to lower the hairline further in a second hair restoration procedure? Is there an “ideal” time period for a second hair transplant after the first? — B.B., Meatpacking, N.Y.

A: It is possible to lower the hairline with a second hair transplant, but the doctor must be certain that you have enough donor hair so that the transplanted pattern will look natural long-term.

Unless there is some pressing reason that you had to have a second session sooner, I would wait a minimum of 10-12 months between hair restoration procedures so that you can see the full cosmetic impact of the first session.

As a hair transplant matures and thickens, the hairline will look lower as the eye doesn’t see as far into the scalp.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Can Hair Transplantation Correct Hair Loss From a Facelift?

Q: I have had a minor facelift operation and have lost a bit of hair. Have you heard of this before? The areas around the scars are the most effected. What treatments are best for this? — N.D., Westport, C.T.

A: Hair loss after a brow, or face lift, is quite common. If it is cosmetically bothersome, a localized hair transplant can correct the problem.

The hair can be transplanted directly into the scar (if the scar is flat) and into any surrounding areas of thinning. The complete correction may take more than one hair restoration session.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

What is Best Hair Transplant Density and do You Measure Maximum or Overall Hair Density?

Q: Dear Dr. Bernstein, a full head of hair averages ~100 FU/cm2. To achieve the appearance of fullness with a hair transplant 50% is required. In one of your articles you say that you recommend 25 FU / cm2 to your patients. Is that the density per one session or the final one? If that is final density, then it is far below the 50%. Please explain as I am profoundly confused. — W.N., Easton, C.T.

A: If a person is to become a Norwood Class 6, the hair that we have available for us to transplant is only about 12% of what was there originally. This, of course, will vary from patient to patient depending upon one’s donor density and scalp laxity and a host of other factors.

We make the hair restoration look good by restoring 25-50% in the front, and proportionately less in the back. Logically one cannot restore 1/2 of ones original density to an entire bald scalp with only a thin strip of donor hair – there is just not enough hair, even with multiple sessions.

I transplant 25-35 FU/mm2 in one session, but this is the density created in the front, not overall.

Due to follicular unit graft sorting (placing the larger follicular units in the forelock area) this provides even more density than the actual numbers suggest. If someone is relatively certain to have more limited hair loss, then the numbers can be increased, but it is risky if you underestimate the degree of eventual hair loss.

Please carefully read the article on Hair Transplant Aesthetics.

It will answer your excellent question in greater detail. The article is a bit old, but the principles are the same.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Will Multiple FUT Hair Transplants Leave Multiple Donor Scars?

Q: I understand that even if you have multiple hair transplants you will only be left with one scar in the donor area. — T.J., Yonkers, N.Y.

A: If the closure is performed without tension, each procedure should result in the same fine scar.

The best-placed incision is in the mid-portion of the permanent donor area. Since there is only one mid-point, there is one best position for the scar. All incisions should lie on this plane leaving one scar.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Will Hair Transplant Grafts Grow in Scar Tissue on Scalp?

Q: Can hair transplants grow in scars? P.N. – Westbury, N.Y.

A: Grafts will grow in scar tissue as long as the scar is not thickened. However, they cannot be placed as close together as in normal scalp because of decreased blood flow. When performing a hair transplant into scar tissue, it is often necessary to perform the hair restoration in multiple sessions to allow the area to gradually re-vascularize (allow the blood supply to return).

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Can Repair of Old Hair Plugs be Completed in One Session?

Q: When performing a repair on an old, pluggy hair transplant, why can’t all the grafts be removed at once?

A: We always try to do this, but it is not always possible.

If the large grafts (plugs) are spaced too close together, suturing one will put tension on an adjacent graft and make it more difficult to close. This may worsen, rather than improve, the underlying scar.

In addition, it is not always possible to remove all the follicles in a graft on one pass, as the root tends to fan outward deeper in the skin. If you use a large enough punch to remove all the follicles at once than you risk leaving a mark from the excision.

For more details, please see the following hair restoration publications:

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

What is the Effect of Multiple Hair Transplant Procedures on the Scalp?

Q: I have had 4 hair transplants with strips taken out for a total of 2600 grafts over 15 years. The last one was 1,650 grafts. My doc says my donor site is good for a few more but I think it has been probably stretched to its max. Is it believable that the skin can be stretched to such extremes safely? – Murray Hill, N.Y.

A: The scalp is very resilient to stretching, particularly in those with a loose scalp to begin with. After removing a strip, the laxity often returns to normal or very close to it within 6 months to a year.

The problem with multiple hair transplant procedures is not only that scalp laxity may decrease, but that the donor density decreases as well. If too much hair is harvested, the donor area may eventually appear too thin. This may happen with either Follicular Unit Transplantation (FUT) or Follicular Unit Extraction (FUE).

Therefore, it is important the doctor not only assess the scalp laxity, but the residual donor density.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Can a Hair Transplant Restore Original Hair Fullness?

Q: Can you get your original density back with a hair transplant? — C.C. Scarsdale, New York

A: Although the cosmetic benefit can be dramatic, a hair transplant only “moves” rather than creates new hair. In surgical hair restoration, a limited amount of hair from the donor area is transplanted to a much larger area in the front and top of the scalp, so that we can never reach the original density.

Achieving a cosmetically appropriate density in the front part of the scalp (which is around 1/3 to 1/2 of the original) generally takes two sessions and is the goal of most hair restoration surgery. Lower densities are used towards the back of the scalp.

View before and after hair transplant photos of some of our patients.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Can You Perform Hair Transplant into Scar Tissue?

Q: Can you perform a hair transplant into scar tissue? — A.H., Rockland County, New York

A: Yes, hair grows in scar tissue, but not quite as well as in normal tissue. The scar is not as elastic as normal tissue so the grafts are at slightly higher risk of being dislodged; therefore, more care must be taken to protect the grafted area after the hair transplant.

In addition, the blood supply in scar tissue is less than in normal tissue, so that area should not be transplanted as densely and the hair replacement should be performed over multiple sessions.

Finally, grafts do not grow well in thickened scars. If a scar can be thinned using injections of cortisone, it may improve the chance that the transplanted hair will grow.

Read about using hair transplant techniques to fix scar tissue
Read answers to other questions on hair transplants into scar tissue

Posted by Robert M. Bernstein M.D.



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Address

110 E. 55th Street, 11th Floor
Between Park Ave and Lexington
New York, NY 10022

Phone

(212) 826-2400

Clinic Hours

Monday – Friday
8:00 AM – 4:30 PM

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Services

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