Bernstein Medical Center for Hair Restoration

Dr. Bernstein Interviewed by NY Japion Magazine on the Latest in Hair Transplant Surgery

Dr. Bernstein Interviewed in NY Japion Pt 1

Dr. Bernstein Interviewed in NY Japion Pt 2

Dr. Bernstein was featured in a wide-ranging interview published in the New York City-based, Japanese language magazine NY Japion. Among the topics discussed were the differences between FUT and FUE hair transplants, updates on robotic hair transplant technology, the type of procedure most beneficial for Asian patients, criteria that determine candidacy for a hair transplant, and more. Below are some selections from the interview.

On FUT vs FUE:

FUT is more economical than FUE and also more beneficial for patients who wear their hair longer. However, if your plan is to have the option of wearing your hair short, FUT is not for you. That is because with FUT you will have a fine linear scar after the donor area (the area where strip is removed) is sutured, and this may be seen visible with short hair.

On robotic FUE hair transplantation and the ARTAS Robot:

In the case of ARTAS, an advanced camera system and a computer analyzes images of the scalp and calculates angle and direction of individual hairs, hair density and number of hairs in each follicular unit instantly. Then, based on that calculation, the computer controls the punch so that it goes into the skin at the right angle and depth so that it will not damage hair root and/or surrounding tissues. So far, 135 systems of ARTAS have been installed worldwide. About half of them are in the United States and 11 are in Japan. Currently, 5% of hair transplant treatments are performed with ARTAS worldwide.

On which type of hair transplant is more beneficial for Asian people:

FUE is especially good for Asians, including Japanese. With Asians, scars tend to widen. In addition, Asians usually have coarse hair that grows more perpendicular to the skin than in Caucasian scalps, so a linear scar in the donor area (using FUT) may be more visible — especially if the hair is worn short.

On who is a good candidate for a hair transplant:

Some people are candidates for hair transplantation, but some are not. Since a hair transplant uses a patients’ own hairs and relocates them from the permanent zone in the back of the scalp to areas that are thinning or bald, it is necessary that patients have good and sufficient hairs for that.

On the appropriate age to consider hair transplant surgery:

Hair transplants are not for young people since their future balding is so difficult to predict. Young patients should not consider hair transplant as a technique to prevent hair loss. Prevention is best accomplished by medications. The most effective are Propecia (finasteride) and Rogaine (minoxidil). These medications do have some side effects that need to be considered before starting. In general, hair transplant surgery should not be performed for people under 25. There are exceptions, but I prefer for patients to wait until 30 and over.

Dr. Bernstein’s wife Shizuka Bernstein was born in Tokyo, and the two travel to Japan frequently. Shizuka is a master-aesthetician and owns an award-winning day spa by Rockefeller Center in New York City called Shizuka NY. Shizuka developed her own line of skin-care products based on powerful natural anti-aging ingredients and pure Mt. Fuji spring water. She has been seen on CNN, CNBC, Fox News, The Today Show, The Early Show, CBS’s The Doctors, and E!’s red carpet special leading up to the Primetime Emmy Awards.

Posted by Robert M. Bernstein M.D.

Study is the First to Measure Perceived Benefits of Hair Transplant Surgery

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.

Posted by Robert M. Bernstein M.D.

Can A Hair Transplant Damage Existing Hair Follicles In A Thinning Area?

Q: My hair is thinning, but I’ve been told I have too much existing hair to warrant a hair transplant. I heard that transplanting new hair into my thinned areas will lead to a loss of existing hair follicles. I was told to delay a hair transplant procedure until my density has further decreased. Is this true? — M.S., Maple Glen, P.A.

A: A hair transplant does not cause loss of hair follicles in the recipient area. The procedure may cause a temporary “shock” loss of the hair. Shock hair loss is a physiologic response to the trauma to the scalp which is caused by a hair transplant. Hair that is healthy is going to come back after some period of time – generally 6 months. Hair that may be near the end of its lifespan may not return. When a hair transplant is performed at the proper time, in the proper candidate, shock hair loss should just be an incidental issue.

It is possible that you simply don’t need a hair transplant at this time. If you have early thinning, it may be best treated with medication, or not at all. As you age, we will have a better idea of your thinning pattern and, at that time, a hair transplant may be more appropriate.

Posted by Robert M. Bernstein M.D.

When To Assess One’s Donor Supply?

Q: I am 24 years old and just starting to thin. I was told by another doctor that it was too early to have a hair transplant, but the hair on the back and sides of my scalp seems really thick. Shouldn’t I have a hair transplant now, just in case I am not a candidate in the future? — A.S., Cherry Hill, NJ

A: The most important criteria in determining who will be a candidate for a hair transplant is the presence of sufficient permanent donor hair. When hair loss is early, it is often hard for the doctor to determine this, since early on the donor area can appear very stable. It is not until the front and/or top of the scalp has significant thinning that the donor area may also show thinning. Therefore, it is only at this time that the stability of the donor area can adequately be assessed.

It has been argued, that one should have a hair transplant early, before the donor area can thin. This is not a reasonable argument, since doing a hair transplant early, does not make the donor hair more permanent. If the donor area is not stable, the transplanted hair will continue to thin after it has been moved to the new location. This will cause the hair transplant to gradually disappear and also risk the donor scar from becoming visible as the hair covering it continues to thin. This problem can affect patients undergoing both FUT and FUE procedures.

Age itself is another factor to consider. The donor area in young people almost always appears adequate. However, the older a person is, the more likely he/she will show donor changes. Therefore, the older a person is, the more confident we are of donor area measurements being accurate. In very general terms, it is very difficult to assess the permanency of one’s donor area in patients under 25 year of age.

Posted by Robert M. Bernstein M.D.

Can a Hair Transplant Treat Hair Loss that begins in the Early 20s?

Q: I am in my early 20’s and I was told my hair loss pattern is a Norwood Class 6, on its way to becoming a Class 7. My hair is brown in color and medium to coarse and I was told I have high density in my donor area. Although I was told I could have hair transplants, do you think that I should based upon what I have told you? — D.W., Pleasantville, N.Y.

A: The main concern I would have is that when someone is already a Class 6 by their early 20’s, he may eventually be left with only a very thin see-through fringe as he ages. A high donor density now does not ensure that this will not occur – and coarse donor hair at age 22 does not ensure that it will not become fine over time. In fact, there is a significant chance that it will.

Since the hair restoration would require one or more large sessions, there is a risk that the donor scar(s) will not be hidden over time. If you had a widened linear donor scar from an FUE-strip procedure, you would need to grow your hair longer on the back and sides to cover it (if that is even possible). And this look of longer hair on the back and sides would not be a good one for a young person, especially if there was not enough donor hair to fill in the crown.

On the other hand, large FUE sessions leave a very wide band of small round scars in the back and sides of the scalp that can become visible if the anticipated permanent donor zone was not truly permanent and narrowed over time.

When we are younger, our decisions are often more emotion-based and impulsive. When one is older, and our tastes change, we may change our mind about having had surgical hair restoration, but the hair transplant, once performed, is not reversible.

Read about the Candidacy for a Hair Transplant

Posted by Robert M. Bernstein M.D.

Can Hair Transplant Restore Hairline in 21 Year Old With Early Hair Loss?

Q: I am a 21 year old male experiencing the first signs of hair loss as of late. I looked at your before and after pictures of hair transplant patients and honestly right now I have a lot more hair than the patients, even in the after photos. By no means do I intend to criticize your work at all, but I noticed that they still had a receding hairline. I myself am an artist and pay close attention to detail. What I want out of a hair transplantation procedure is to basically have the full head of hair that I had even before puberty. Is it possible for this to be done? — P.N., New York, NY

A: Your concerns and goals, although understandable, are impossible to achieve through hair transplantation and is exactly the reason why we don’t perform hair transplants in young persons.

Surgical hair restoration can never give you your original density back since we are just redistributing a smaller amount of hair.

In addition, your original hairline should not be restored since a transplanted hairline is permanent and will not evolve naturally as you age. A mature hairline must be built into the design of the first hair restoration procedure, regardless of a patient’s age.

Read about the Candidacy for a Hair Transplant

Posted by Robert M. Bernstein M.D.

Is Success of Hair Transplant Affected by Age or Scalp Fibrosis?

Q: It is my understanding that as a person loses his or her hair, the skin of the scalp undergoes a number of changes, namely there is a loss of fat, an increase in cellular atrophy, and of course the dreaded perifollicular fibrosis (now that’s a mouthful). It seems to me that these changes, in particular the fibrotic scarring, are the main obstacles in the way of regrowth, and the reason Propecia does not work for extensively bald men. What can be done about this demon we call fibrosis? Can it be slowed, stopped, prevented, reversed? If we could somehow counteract collagen formation, wouldn’t our baldness problems be solved for good? If a bald scalp is atrophic, how does it have the capacity to hold a whole new head of transplanted hair? Is there a limitation to the number of hairs we can transplant (outside of donor limitations)? — R.L., Rivington, C.T.

A: The findings that you are describing are well documented; however, it is not clear if these changes are the cause of the hair loss or are the result of having lost one’s hair. Most likely, the DHT causes the hair follicles to miniaturize and eventually disappear. This, in turn, causes the scalp to thin and lose its abundant blood supply (whose purpose is to nourish the follicles). The changes in the scalp are also affected by normal aging, which causes alterations in connective tissue including the breakdown of collagen and other components of the skin. The changes seen with aging are greatly accelerated by chronic sun exposure.

Fortunately, even with long-standing baldness there is still enough blood supply to support a hair transplant, although there are some limitations. One should perform a hair transplant with a lower density of grafts when patients have thin, bald fibrotic scalps since the blood supply is diminished.

The most important factor, however, is photo change. The sun dramatically alters the connective tissue making the grafts less secure in their sites and alters the vasculature, (blood vessels) decreasing tissue perfusion (blood flow to the tissues). When there is bald atrophic, sun damaged scalp, I generally perform two hair transplant sessions of lower density (in place of one) spaced at least a year apart to give time for the scalp to heal and blood flow to increase in the area.

I often have the patient treated with topical 5-flurouracil before the surgery to improve the quality of the skin and to treat or prevent pre-cancerous growths from the sun.

Posted by Robert M. Bernstein M.D.

Am I Too Old for Hair Transplant Surgery?

Q: Is there ever an age where you are too old for a hair transplant? — L.K., Norwalk, C.T.

A: One can be too young for surgical hair restoration, but not too old (as long as one is in good health medically).

Older people generally make excellent candidates for hair transplantation since their expectations are generally more realistic and the future extent of their hair loss more predictable than in those who are younger.

We have successfully treated a number of people in their 80s. In spite of the fact that their spouses and friends asked them, “What do you need a hair transplant for at your age,” the patients were uniformly happy that they did the surgery.

Posted by Robert M. Bernstein M.D.

Does the Donor Area Decrease in Size Over Time?

Q: I am 22 and want to go for hair transplantation. I want hair restoration surgery now because I have a concern about my donor area that it might diminish if I postponed my transplantation. Could this be the case? — T.J., Westchester County, N.Y.

A: The logic is not correct. Having a hair transplant at an early age does not protect the donor supply.

If your donor area diminishes over time, then the transplanted grafts will fall out as well. Hair does not become permanent just because it’s moved in a hair transplant. It is never any better than the hair in the area where it came from.

The longer you wait – i.e. the older you are when a hair transplant is performed – the more information we will have about the stability of your donor area and this will allow for optimal planning of the hair restoration.

Posted by Robert M. Bernstein M.D.

Should I Have Hair Transplant and Use Hairpiece?

Q: What is your opinion on having a hair transplant to restore the hairline and then wearing a hair system behind it to regain the appearance of a full head of hair? K.Y. – Hackensack, New Jersey

A: It is my personal feeling that one should not use a hair transplant to supplement a hair system, especially at a young age. We have occasionally performed this procedure in older men and women.

In my view, a main purpose of a hair transplant is for it to be low maintenance. The combination of a hair transplant and a hairpiece is extremely fussy.

In addition, hair systems cause traction alopecia (hair loss from constant tugging) and the hair loss will become permanent over time, limiting the ability to have a hair transplant in the future. If one needs to have the high density of a system — i.e. for a career — then just use the system. It will give you more long-term options.

Posted by Robert M. Bernstein M.D.

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Hair Transplant Age

Dr. Bernstein Interviewed by NY Japion Magazine on the Latest in Hair Transplant Surgery

Study is the First to Measure Perceived Benefits of Hair Transplant Surgery

Background

Methods

Results

Summary

Can A Hair Transplant Damage Existing Hair Follicles In A Thinning Area?

When To Assess One’s Donor Supply?

Can a Hair Transplant Treat Hair Loss that begins in the Early 20s?

Can Hair Transplant Restore Hairline in 21 Year Old With Early Hair Loss?

Is Success of Hair Transplant Affected by Age or Scalp Fibrosis?

Am I Too Old for Hair Transplant Surgery?

Does the Donor Area Decrease in Size Over Time?

Should I Have Hair Transplant and Use Hairpiece?

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