An Individualized Approach to Each Patient’s Goals

Hair transplantation procedures work very well. In the hands of an experienced hair transplant team, over 95% of the transplanted hair grafts grow strong, healthy hair. There are several factors that affect the growth of transplanted hair.

To start with, the hair transplant physician selects the donor tissue to be removed from the zone of permanent hair. The hair transplant physician must make certain the hair to be transplanted is, in fact, strong, healthy, permanent hair. With men, this is rather simple to assess. Men typically have very identifiable patterns of hair loss. As long as the hair transplant physician removes hair from the horseshoe-shaped area on the sides and back of the head, the hair should be permanent. One caveat is in order here. If the hair transplant patient is young, under 30 years of age, and has loss in the crown (the back of the head), the physician cannot know with great certainly have far down the loss will creep in later years. If the loss continues down the head into the area from which hair was removed, then some of the hair transplants will thin out as well (since they would have thinned out if they had remained in their previous location).

Women present more difficulty. Many women have diffuse thinning all over the head, including in their donor area. If a woman’s donor area is thinning, then any hair relocated from that area will continue to thin in its new location. Women with this type of hair loss are usually not good candidates for hair transplants.

The greatest single factor affecting the growth of hair transplants for men or women is the quality of the medical staff. Almost all hair transplant practices utilize nurses and medical assistants (“techs”) to dissect the hair grafts from the strip the hair transplant physician removes and to place the dissected hair grafts in the recipient sites. During both the hair dissection and placement processes there are ample opportunities to mishandle the hair grafts and thereby impact their survival.

Three Single Hair Grafts

Dissected hair grafts should be placed in a chilled saline solution as quickly as possible to insure their survival. The hair grafts should remain in this saline bath until placed in the recipient sites. The techs might dissect hair grafts and leave them out in the air too long with the result that the tissue heats up and dries out. This can kill the hair graft. The techs might dissect too much surrounding tissue from the graft, making the hair graft too skinny. In this case the essential supporting structures for the hair graft can be lost resulting in the death of the hair graft. Some techs do not possess the dexterity to perform the delicate movements in the dissection and placement process. They repeatedly handle the hair grafts, regripping the delicate tissue with surgical forceps as they attempt to insert it into the recipient site. Too much handling will kill the hair graft.

Some hair transplant practices emphasize speed in completing their procedures. This is common for the high volume hair transplant practices and often done to accommodate the doctor’s desire to leave as soon as possible. Prospective hair transplant patients should be cautious about high volume practices. The transplant practice may be emphasizing speed over quality. Techs who rush the fine work of dissection and placement may end up inadvertently killing grafts. Unfortunately, most patients will never know. They won’t know because the result doesn’t show up until 8 – ­ 12 months later and because the patient won’t know what it should have looked like if all the grafts grew.

Hair transplant procedures work well for all who have an ample supply of permanent hair. Men of all ages and all ethnicities are potentially good candidates for the procedure. As pointed out previously, some women are not good candidates for the procedure because of thinning in their donor areas. For these women, a transplant would mean moving non-permanent hair. What’s the point? However, most men are very good candidates for the procedure.

Hair transplant procedures involve redistributing hair from an area of relative excess to an area of need. No new hair is created with the procedure. The more hair a person loses, the more he needs to recreate his natural look. The task of the transplant surgeon is to give a patient a natural look that will look good after the procedure, and for the rest of the patient’s life. This involves treating the loss today and planning for the possibility of future loss.

Young patients, those in the 20s and early 30s, can have significantly more loss as they age and this possibility must be accounted for in any restoration plan. Once a person reaches his mid-forties, his pattern is well established and the transplant doctor can accurately assess how much donor hair is available for transplantation. A good rule of thumb is that whatever hair loss pattern a person has at age 45, is what will remain. The pattern should not change substantially over the remainder of the patient’s lifetime. This makes it much easier to inform the patient about his restoration plan. For the man in his early 20s with significant hair loss, it is very difficult to know how severe the loss will become. Since the transplants are permanent, the doctor must plan for the possibility of severe loss and be conservative. He must preserve donor grafts in the event that the patient needs further transplants as he ages. Young patients pose a significantly greater challenge.

Another problem with young patients is their expectations. The 24-year-old patient can easily remember what his hair was like at 20. He may want the hair transplant surgeon to recreate that look. This is a classic mistake. Hairlines naturally mature as we age and a 20-year-old’s hairline would look unnatural on a 40, 50, or 60-year-old. Further, the young patient may not have enough donor hair to maintain that look as future loss occurs.

Hair transplantation involves limitations because the supply of donor hair is limited. The Norwood Chart allows for some good general guideline. Generally patients of Class 5 and above on the Norwood Chart can have the appearance of a full head of hair. Their supply is sufficient and their pattern of loss is such that a restoration program can leave them with complete coverage. This will usually involve at least two procedures. Men with loss like those of a Class 6 or 7 may need to be content with more of a thinning look. They will have hair so as not to be bald, but may lack the density of the hair on the sides and back.

In those patients with an inadequate donor supply, it is still possible to give them a natural look. By weighting certain balding areas with more grafts, for example, the central forelock, a patient can achieve a natural hair pattern. It just will not be full in all areas.

As one might expect, the cost of restoration varies widely depending upon the degree of loss and the fullness of the result the patient desires. Again, some general principles are in order. First, despite what some practices say in their advertising, it ALWAYS requires at least two procedures into a balding area to achieve the level of density that will appear to be “normal.” One densely packed transplant session will make a huge difference, but will not appear to be full. It is just not possible to place grafts closely enough together to achieve that look. Therefore, when considering a transplant into a completely bald area, a patient should plan to have at least two procedures into that given area. Many people will be happy with one procedure, but the result will be less than the fullness one typically sees on the sides and back of the head.

If the physician is transplanting into an area that has hair, then the transplants coupled with the existing hair may look like normal density. However, usually, if an area is thinning and yet still contains some hair, then over time that native hair will thin out requiring a second procedure to produce normal-appearing density. Again, the prospective patient should plan on a second procedure sometime in the future. It may be a year, or two, or five, but likely a second procedure will be required to maintain the fullness.

Like most issues in the field of hair transplantation, the degree of pain associated with the procedure is highly variable, depending upon the particular practitioner and technique used. Some patients report “almost zero” pain associated with the procedure and some say it is quite painful. Before discussing the degree of pain and how to make these procedures more comfortable, it is first important to talk about where in the process one might experience pain.

Pain During Anesthesia

Hair transplant procedures are performed under local anesthetic, similar to the anesthetic used when one goes to the dentist. Both the donor area (the area around the back and sides of the head) where the hair is harvested, and the recipient area (the area of thinning or balding) where the hair follicles will be planted, are anesthetized, or numbed, during the procedure. The injections to numb the scalp can be painful if not administered carefully and sensitively.

Most patients should experience no pain once their scalp is numb, but they may have pain during the healing process in the days and weeks following a procedure. Typically, pain in the healing process is confined to the donor area, from where the hair was harvested.

Returning to the degree of pain associated with the anesthesia, it is highly dependent upon the physician’s technique in administering the anesthesia. In other words, it can easily be controlled.

Many physicians give patients a sedative to help them relax before beginning the anesthesia. Then they begin numbing the donor area. If the physician works very slowly, the pain will usually be mild and not an issue. If the physician works quickly, there will certainly be pain.

Pain from anesthesia is caused not so much by the pinch of the needle, but by the rate at which the physician injects the anesthesia into the scalp. The anesthesia causes a burning sensation in the tissue. If the physician waits until the initial injection has caused the area to begin to get numb, then subsequent injections will be less noticeable. The physician can also use anesthesia that contains bicarbonate to lessen the burning sensation.

Sadly, some physicians are simply impatient and insensitive. They rush through the anesthesia to “get to the real work,” and as a result, their patients experience significant pain.

Healing pain is also highly variable and quite controllable. The pain in the donor area as it heals is greatly affected by how the physician removes the donor strip and how much tissue is removed. If the doctor makes a deep incision and takes a lot of tissue out, there will be more pain during healing. Some physicians make deep cuts severing many nerves and blood vessels. This will cause more pain. Other physicians are more careful. They make shallower incisions and take just enough tissue to get the hair out. They cause less disruption and their patients experience far less pain.

If the physician takes a very wide strip to get a large number of grafts, and if the patient’s scalp has limited flexibility, then there may be a lot of tension on the sutured area. More tension equals more pain.

Some tips to consider

A certain amount of pain is unavoidable with hair transplantation procedures, but some physicians do a far better job of making the patient’s experience a pleasant one. It is advisable to talk to patients of that particular physician to get an idea about that physician’s sensitivity to the issue. Ask them about the pain of anesthesia and the pain during healing.

Also, talk to your physician before the procedure. If he or she is dismissive and not comforting, consider finding a new physician. Ask the doctor how long it takes to administer the anesthesia. If he or she says something like, “only a couple of minutes,” be concerned. It is just not necessary to experience great pain to have a great result.

This is one of the most misunderstood areas in the field of hair transplantation. Some doctors advertise the many thousands of procedures they’ve performed. Some highlight the number of grafts transplanted or their years in practice. What does it all mean? What information is relevant and what is just marketing hype? How can you realistically judge a physician? These are all difficult, yet critical, questions.

The first step is evaluating any physician is to ignore all the advertising hype. The number of procedures performed, or grafts transplanted, or years in practice are largely irrelevant. Many of the most experienced physicians have done the most “plug” procedures, procedures that are cosmetically unacceptable. Some of those experienced doctors have evolved with the changing technology in the transplant field and some have not. For example, below is a recent hairline transplanted by one of the most experienced transplant surgeons in the US. This surgeon has a strong reputation in the industry, and superior academic background and excellent training. Yet, the transplanted hairline is obvious, unnatural and unacceptable.

This is not what one would expect from such an esteemed surgeon. However, it is representative of his work. The problem is that this surgeon lacks a strong aesthetic sensitivity. The transplant, while dramatically transformative of the person’s looks, is aesthetically lacking. It is a medical success in the sense that the hair has been successfully moved and is growing in a new location. However, it clearly is an artistic failure because it doesn’t look natural.

There are really three key qualities one should seek in a physician: integrity, artistic sensitivity, and excellent communication skills. It should be the task of the prospective hair transplant patient to assess the physician in each of these areas. If found to be lacking in any area, the physician is probably not someone to do your procedure.

Integrity

Integrity demands that the physician fully informs the patient about the pros and cons of the procedure with no attempt to “sell” the patient on having it. While hair transplant procedures are an excellent treatment for many people suffering with hair loss, they are not for everyone. The physician’s job must be to inform the prospective patient as fully as possible so the patient makes the best decision for him or herself. You should not sense that the doctor is hiding anything in response to any of your questions. You should ask the doctor about the negative aspects of the procedure and get candid answers. You should not feel rushed, or your concerns dismissed.

Artistic Sensitivity

Hair transplant procedures involve far more artistry than medicine. We at Samson Hair Restoration think of these procedures as sculpture with living tissue. As such, it is imperative that the physician has an understanding of, appreciation for, and sensitivity to, aesthetic issues. This is not easy to assess is any person, much less a doctor you are considering. The best starting point is the physician’s before and after photos. Ask the physician about his understanding of the aesthetics of the procedure. Question the doctor generally about what the main aesthetic considerations are for your procedure. Questioning along these lines will give you some insight into the doctor’s artistic sensitivity.

Excellent Communication Skills

Every client has concerns about the procedure. In your consultation with a physician, you should feel free to voice those concerns and have them addressed completely. This type of dialogue ensures the best outcome for all involved. If a physician dismisses your concerns, or doesn’t appear to have time to answer questions thoroughly, or fails to understand your concerns, you should not proceed with the procedure. Remember, there is no hurry.

Additionally, the physician should not necessarily acquiesce to everything a client desires. Oftentimes clients suggest things that are not appropriate in the restoration process. In such a situation, the physician must communicate why they won’t do something the client wishes.