Today I want to discuss how I as Hair Restoration surgeon manage my patient’s expectations to give them the most realistic idea of what to expect from their hair transplant procedure. Most patient’s today spent time online, from minutes to hundreds of hours, studying hair transplant photo results. This creates varying expectations amongst people.
My role as a Hair Restoration Surgeon is to understand the prospective patient’s expectations and give them feedback as to what they can expect realistically in terms of results from a hair transplant procedure.
The first thing I do is explain the procedure in depth and show them before and after photos of patient’s of mine who have had a similar hair type and balding pattern. This gives an idea of what to expect. I always encourage my prospective patients to spend time on my website looking at the more than 500 before and after patient photos and more than 100 videos of patient’s discussing their experience undergoing the procedure and their results shown on video. I feel that looking at both the photos and the videos give patients a realistic expectation as what to expect and the wide variety of results that are possible. The key factors are hair type, color, skin to hair color contrast, curly versus straight, and most importantly, how much hair will the person eventually lose over time.
Since it takes 6-7 months to see any appreciable results from the hair restoration procedure it is important to stress the growth timeline to the patient so that they understand exactly what to expect and are prepared for the time after the procedure before the new hair grows in. This can be a difficult time for some people and preparing properly is a very important thing to do before undergoing the procedure.
Finally, I tell every prospective patient that they will undergo this procedure more than once. This is for two reasons. Firstly, the transplanted hair will not fall out but the native hair will continue to fall and the person will want to keep up with continuing hair loss by transplanting more follicles. Secondly, almost every patient sees their results and wants to add to them by creating more density. Who wouldn’t want to add more density to their hair if they could?
Today I want to discuss a question I am commonly asked which is “when is the right time to have a hair transplant procedure?” The answer is different for every person. Each time I examine a prospective patient I try and estimate the full extent to which the hair loss will progress over the patient’s lifetime. This is imperative in order to understand how much donor hair the person will have available for the amount of balding area that will present over time. The individual needs to understand and internalize the amount of hair loss they will eventually have and try best as possible to see if they can be happy with a realistic result based on their supply to demand ratio. Young patients may not want to know their eventual hair loss amount or may want to proceed with a treatment plan that does not take this into account. This is not an option, as it is our job as hair restoration surgeons to educate the individual and only do what is right for the patient both in the short term and long term.
In general, I like to wait until the patient is at least 25 before performing the hair restoration procedure unless hair loss is taking a severe toll on the patient’s psychological health and I believe that the eventual loss of hair will not preclude the individual from being a good candidate for the procedure. In addition, that the prospective patient has a good grasp on what is a realistic result both in the short term and long term.
I always tell my patients when they ask me, “do I need to do the hair transplant now?”. No one needs to do this at any point. This is an elective procedure that people undergo in order to make them feel better about themselves. To reclaim a piece of the person that they once had. Something that was once part of their body and their appearance, that was taken away from them. When you get to the point that you don’t like looking in the mirror anymore at what you see on your scalp, then that is the right time to have a hair transplant procedure (assuming you are chosen as a good candidate and you have realistic expectations).
The psychological component of hair restoration surgery is one of the largest factors involved and it is our duty as hair restoration surgeons to educate our patients and allow them to make the best educated decision for themselves both in the short term and long run.
Today I will demonstrate a phenomenon known as “pitting”. This occurs when the transplanted grafts are placed too deeply and it causes the hairs to look like they are growing out of a hole or a pit. This is a completely unnatural look and can easily be avoided by placing the grafts properly with a small amount of tissue protruding above the skin. In the case of this patient, his previous procedure was performed at an unnamed large hair transplant chain operation and 2 different nurses were used to place each side of the hairline. In this case the left side had extensive pitting and the right side did not show the same amount (see the photos below). This is one more reason why quality control is so important in hair transplant procedures. We as physicians are only as good as the nurses placing the grafts and unqualified nurses placing the grafts can lead to results like you see here. My nursing staff have been with me over 10 years each and they have all been working in the field of hair transplant surgery for over 15 years each. Most of my nurses have worked on my scalp personally, and I trust them implicitly, as I am smart enough to know that my results are only as good as they are, and they are great.
All the best,
Marc Dauer, M.D.
This photo shows “pitting” from a previous hair transplant.
This is from the same patient the other side of the frontal scalp that does not show significant pitting.
There are many different variables that come into play when creating a completely natural hairline through hair transplant surgery. The most important is the artistic capability of the hair transplant surgeon. Below is a photos of a patient of mine showing his hairline design immediately post procedure and a close up photo of the transplanted hairline 1 year later. The result is a completely natural hairline that appears natural even when pulled back.
Here is patient of mine describing his experience and showing his results 9 months after his procedure. His results are already impressive and he is very happy. He should get more density over the next 3-6 months as the transplanted hairs continue to thicken.
Today I will discuss the grafts from FUE and how they can differ. Firstly there is the size of the tool used to extract the grafts. Even though many tools claim to be a certain size some are measured from the internal diameter and some from the outside diameter. This may not see like that much difference but an extra .1mm of punch size can leave significantly more pinpoint scarring in the donor region. Many of the automated systems including the ARTAS robotic system tend to use larger punch sizes (1mm and even larger) which can leave significantly more scarring in the donor region. I use a sharp tip that measures .9mm from the outer diameter. For very course curly hair types I also have sizes that go up to 1.05mm when necessary and when extraction body or beard hair I also have tips as small as .8mm. The .9mm is an excellent “work horse” tip that allows for beautiful graft extractions in experienced hands. I have a photo of the grafts from my FUE patient yesterday and as you can see they are all intact and most are multi hair follicular units which is another advantage of FUE in that it allows you to choose the larger follicular units and leave the smaller ones behind.
Not all FUE hair transplant surgeons are created equal and it is of utmost importance that you see good examples of your surgeons FUE results and grafts prior to proceeding with this type of procedure.
Here is a patient of mine 7 months after I completed his hair transplant of approximately 2500 grafts. The harvest was performed via FUT. The patient’s growth is extremely robust for the 7 month mark and he should still see more increased cosmetic density over the next 6-7 months. He is thrilled with the results as they stand and looking forward to more hair growing in.
Today I will address the question of who is a good candidate for hair restoration surgery. To begin with, it should be determined that the loss of hair is due to genetic causes and that the donor area (the sides and back of the scalp) are not affected by hair loss and have robust density of hair present. The next major factor is determining the patient’s eventual total loss of hair (their genetic hair loss pattern) and eventual total donor reserves. This allows us to approximate how much donor hair will be available over the patient’s lifetime and how much donor hair they will require to cover the eventual area of hair loss. This is most important in younger individuals who are usually destined to lose significantly more hair over time. This also allows the patient to have an idea of what they can expect not only in the short term, but in the long run as well. Some patients would opt not to proceed with hair restoration surgery if they know that they cannot cover their entire head with a thick mane of hair, and others would be more comfortable with this. It is our job as hair restoration surgeons to educate the patients as to their realistic expectations in the short term and long term so that they make the proper decision now and one that they will be happy with later on in life. Too often I meet patients who were “sold” an unrealistic bill of goods by an unscrupulous hair restoration surgeon and they subsequently end up regretting their decision to have had the procedure in the first place because they had no idea that their hair loss would progress to such an extent.
In summary, responsible hair restoration surgeon should educate their patient as to all the possibilities and allow them to make the informed decision as to how to proceed with hair restoration surgery, or not to proceed. This is an amazing procedure when performed properly on the proper patient, and having had 3 hair transplants myself, I am a walking testimonial of this fact along with thousands of my patients. But make sure you have all the facts before making the decision for yourself to ensure that it something that you are happy with in the long run.
Here is a a patient of mine who lost the hair in front of her ears after her facelift procedure resulted in the pulling back of the hairline. She also had thinning in the temporal rescissions on both sides which was also probably exacerbated by the facelift procedure. I performed a hair transplant procedure on her and placed grafts in the temporal recessions and recreated a new hairline just in front of the ears on both sides.