Simply put, a hair transplant involves taking permanently growing hair from the back and/or sides of the head (“donor area”) and moving it to a balding or thinning area (“recipient area”). These carefully selected follicles are resistant to the effects of the hormone dihydrotestosterone, or “DHT,” so they will continue to grow even though the original follicles they are replacing have stopped growing. Though the effects of DHT are responsible for about 90% of both male and female hair loss, there are many other causes. Hair transplantation would be appropriate in some of these cases, but not in others. This is a decision that should be made by an experienced hair transplant surgeon, occasionally in consultation with a dermatologist.
Hair transplant technique has evolved considerably over the past several decades. A modern-day hair transplant performed by an experienced and skilled surgeon should be undetectable to your family, friends, and coworkers. Improved techniques have also made it possible to transplant larger amounts of hair in a single session and, therefore, to cover larger areas.
Choosing a Hair Transplant Surgeon
Probably most important is to choose a surgeon whose entire practice is devoted to hair restoration and who performs at least several hair transplants a month, not one or two every six months. It may come as a surprise that a doctor is not required to have a surgical background to be a hair transplant surgeon, but prior surgical experience is obviously a plus; indeed, the only requirements one must have to perform hair transplants are an M.D. or D.O. degree and a license to practice medicine in that state. Some hair transplant surgeons have had no specialized training in hair restoration at all. Caveat emptor: check your surgeon’s credentials! Membership in the International Society of Hair Restoration Surgery (ISHRS)*, preferably with “Fellow” status (FISHRS) and certification by the American Board of Hair Restoration Surgery (ABHRS)* are indications that your surgeon holds himself to a high standard, is committed to associating with his peers, and is involved in continuing medical education. (See below.) When choosing a surgeon, ask if he has contributed to ISHRS-sponsored scientific meetings by presenting papers, teaching courses, or serving on panels.
Your surgeon should openly take pride in his work, and offer you an opportunity to see “before” and “after” pictures as well as speak to several patients. When looking at patient photos, it is very important to know that you are looking at the work of the surgeon who would actually be performing your transplant.
If you must choose among several surgeons you feel are equally qualified, pick the one with whom you feel most comfortable. Did the doctor spend sufficient time listening to you and answering questions to your satisfaction? Or did you feel rushed and pressured? Did the doctor seem to take the long view of hair loss, keeping your best interests in mind not just for now, but for the future? Were non-surgical approaches discussed? Did you feel the doctor was honest and candid? Did you sense confidence, but not arrogance? Were you discouraged from getting another opinion? Go with your gut: do you trust this person?
Of course, this assumes that the person you see for your consultation is the person who would actually be performing your surgery. It is fine to get general information about hair loss and hair transplants from a non-physician “consultant” or “counselor,” but you should not make a decision to have surgery based solely on the advice of this individual, who very often is working on commission. If you cannot meet face-to-face with the surgeon, be sure to arrange time for a videoteleconference, or at least a phone call after the surgeon has had an opportunity to review photos and/or a video of your head.
*From the ISHRS website (www.ISHRS.org):
“The ISHRS is the leading authority on hair loss treatment and restoration with more than 1,200 members throughout 60 countries worldwide. We are dedicated to promoting the highest standards of medical practice and medical ethics. The ISHRS also provides continuing education to hair transplant doctors specializing in hair restoration surgery and is committed to providing the latest information on medical and surgical treatments for hair loss to the general public. The ISHRS was founded in 1993 as the first international society to promote continuing quality improvement and education for professionals in the field of medical hair restoration surgery. The mission of the International Society of Hair Restoration Surgery is to achieve excellence in medical and surgical outcomes by promoting member education, international collegiality, research, ethics, and public awareness. The vision is to establish the ISHRS as a leading unbiased authority in medical and surgical hair restoration.
In 2012, the designation of Fellow was established in order to recognize members who met its exceptional educational criteria. In order to be considered, the hair restoration surgeon must achieve a specific level of points in a system of various educational parameters such as serving in leadership positions, American Board of Hair Restoration (ABHRS) certification, writing of scientific papers, teaching at scientific programs, among others. It is a great honor for a member to achieve the Fellow designation of the International Society of Hair Restoration Surgery (FISHRS). This recognizes the surgeon who strives for excellence in this specialized field. To maintain this status, the surgeon must continue to meet established educational criteria over time.”
**From the ABHRS website (www.abhrs.com):
The mission of the ABHRS to “establish specialty standards and to examine surgeons’ skill, knowledge and aesthetic judgment in the field of hair restoration.” The ABHRS grants certification “to candidates who meet the highest standards of the medical profession in the field of hair restoration surgery.”
Supply vs. Demand
One of the most important concepts for a prospective patient to understand is that of supply vs. demand. There is only so much hair that can be removed from the donor area (supply) before it becomes noticeable. In many cases, depending upon the amount of present and potential future hair loss (demand), this simply is not an issue; however, if you have lost more hair than your donor area allows you to replace, or you are on track to do so, it is very important to have an experienced and artistically skilled surgeon who can help you achieve the most aesthetically pleasing look possible.
Surgery can replace some of the hair you’ve already lost, but it does not stop the process from continuing if it is genetically programmed to do so; conversely, medical treatment can help you keep the hair you still have, but won’t bring back what is already gone. Thus, the two approaches work hand in hand: a hair transplant to help replace the hair you’ve already lost, and medication/laser therapy to help you keep the hair you’ve still got.
Density and Coverage
A single hair transplant can make a huge difference in your appearance and self-confidence; at the same time, it is important to have realistic expectations regarding the thickness (“density”) that can be achieved and the size of the area that can be addressed with a particular number of grafts. There is an inverse relationship between density and coverage. For example, a given number of grafts could be used to provide less density to a larger area of the scalp, or more density to a smaller area of the scalp. Many patients are very pleased with the results of a single procedure; but a good result from a first hair transplant can almost always be made even better by another. Dr. Ballon will discuss various options with you at the time of your consultation to help you achieve the result that will be most pleasing to you.
During your consultation, it is essential that you speak with the surgeon who would be the one to perform your hair transplant. At this time, it will be determined if you are a suitable candidate for surgery. Specific recommendations will be made after taking into consideration the cause of your hair loss, your particular goals and expectations, your age, the rapidity of your hair loss, present and possible future hair loss, hair color and texture, response to medication, the quantity and quality of your donor hair, family history, etc. As with any doctor’s visit, be sure to ask questions about anything you don’t understand. Remember, just as the doctor is evaluating you as a potential surgical patient, you should be evaluating him or her as your potential surgeon. (See “Choosing a Hair Transplant Surgeon” above.)
A hair transplant is a simple, safe, outpatient procedure; there are very few health issues serious enough to pose a problem. Your day begins with a good breakfast at home. After meeting to review your immediate and long-term goals, the plan for the day will be finalized. You will then be given a customized amount of medication to relax you. (Some patients prefer to be wide awake, others just mildly sedated, and others “completely out.”) The donor area to be used is then shaved and local anesthesia is administered to allow completely painless removal of the donor follicles that become the “grafts” to be used for the transplant. Either two parallel linear incisions (FUT) or hundreds to thousands of circular incisions (FUE) will be made painlessly. Once this has been done, a predetermined number of tiny slits or holes (“recipient sites”) will be made in the area(s) to be transplanted; again, this is completely painless once the scalp is anesthetized. The grafts are then inserted one at a time into the recipient sites; it is customary throughout the United States and much of the rest of the world for this to be done by highly skilled assistants. Depending on a number of factors which vary from individual to individual, a hair transplant may take anywhere from 3-4 hours to all day.
At Aesthetics Hair Restoration, we take our work very seriously, but we like to have fun—and we want to make your experience as pleasant, relaxing and enjoyable as possible. Every effort is made to assure your comfort and to make the time go by quickly. Most people doze off for the better part of the morning; if you would prefer to be more awake, you can watch TV or a movie, listen to music, or chat with our friendly staff. A tasty lunch will be provided for you. We will be attentive to your every need and provide opportunities for you to use the restroom or simply get up, stretch, and walk around. A ride home is helpful but not essential; the effects of the medication given earlier are gone by the end of the day and the vast majority of patients are able to drive themselves home fully alert and with little or no discomfort. In the rare event that a patient is unable to drive home, transportation or lodging will be arranged.
Healing and Growth
Following the procedure, you will have some redness and crusting over the recipient area that gradually will resolve during the first 7-10 days. How noticeable this is will depend on how much surrounding hair you have, where on your head the grafts were placed, your hair and skin color, etc. It’s OK to wear a hat immediately after the procedure if you’d like. Some patients will develop swelling in the forehead, and occasionally around the eyes, about 3 days after surgery, though steps will be taken to minimize this. As mentioned above, the donor incision in FUT surgery is often undetectable through the overlying hair immediately after surgery; however, it may take weeks to regrow enough hair to cover the shaved area following an FUE procedure. In either case, the short, stubby hair taken from the shaved donor area typically falls out after 2-3 weeks and the follicles beneath the surface begin to grow new hairs in 3-4 months. By 6-8 months, most people have enough growth to make a significant difference, but new hairs will continue to emerge through the scalp for another 6-8 months and provide the final result.
No medical procedure comes with a 100% guarantee of success. That said, a hair transplant performed by an experienced and skilled surgeon who performs hair transplants exclusively, who carefully selects good candidates for surgery, who is driven by a desire for excellence, and who works with a team of outstanding and dedicated assistants, should be able to provide a very high level of satisfaction in nearly all cases.
Will I Need To Do This Again?
As mentioned previously, many people are satisfied with the results of a single procedure, though you should be prepared for the possibility that you might require two or more procedures to achieve the optimal result. This will depend on the area to be addressed, the type of hair you have, hair and skin color, the thickness (density) desired, and whether or not you continue losing hair.