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Q: Should I cut my hair prior to the hair transplant? — R.R., Poughkeepsie, N.Y.

A: It is easier for the hair transplant surgeon and his team to work when the existing hair in the area to be transplanted is cut short, but a skilled surgeon can work well in either situation. Most experienced surgeons are used to working without cutting the hair in the recipient area, since so few patients want their hair to be cut – particularly in New York.

The main advantage of having a closely clipped scalp is that one has better visibility and therefore the procedure moves along faster. This has little bearing in moderately sized sessions, but becomes very important in sessions over 2,400 grafts, when working through existing hair can make the duration of the procedure excessively long. Of course, the disadvantage of clipping the hair is that it is more difficult to “hide” the procedure.

I prefer for the patient to arrive the morning of the scheduled hair restoration with his/her hair having some length so that I can better see the demarcation of the area of thinning. Once the area is marked, the hair can be clipped to the appropriate length in the operating room. Although the hair transplant will be more visible post-op if the hair is clipped short, it is much easier for the scalp to be kept free of crusts.

It is important to differentiate between a closely clipped scalp, which is an advantage, and a shaved head, which makes performing the hair transplant more difficult. When there is some existing hair, the distribution and angle of the original hair is easy to discern and this allows the new grafts to be placed in a direction that follows the existing hair and in a distribution that complements that hair.

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Follicular Unit Transplant - Surgery of the Skin - Dr. BernsteinSurgery of the Skin: Procedural Dermatology; published in 2005 by Elsevier-Mosby and Edited by Robinson, Hanke, Sengelmann and Siegel; is monumental work that covers the entire spectrum of dermatologic surgical procedures. In the editor’s words, the goal of this 872 page textbook is:

“To capture the art and practice of dermatologic surgery at the beginning of this century.”

It is to be used as the core surgical textbook for dermatologic training programs. The book is divided into four parts: Part I – Basic Surgical Concepts, Part II – Essential Surgical Skills, III – Aesthetic Surgical Procedures, and IV – Special Procedures.

The text covers a wide range of subjects on aesthetic surgery, including liposuction, chemical peels, Botox, soft tissue augmentation, laser hair removal, laser skin resurfacing, leg vein treatment, blepharoplasty, face lifts and, of course, hair transplantation.

Dr. Bernstein was honored to write the section on hair transplantation that covers the historical aspects of the field, patient evaluation and surgical planning, operating room set-up, surgical techniques and how to maximize the cosmetic outcome of the hair transplant.

The focus of Dr. Bernstein’s chapter is on Follicular Unit Transplantation, the technique that has changed the face of surgical hair restoration over the past decade. The chapter discusses strip harvesting, follicular unit extraction, the use of anesthetics, ways to optimize density and ensure the naturalness of the procedure, as well as a host of other important topics. The textbook may be purchased at Amazon.com.

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