What are some specific things that are helpful to tell a hair transplant surgeon in terms of your goals?
Doctor Answers 5
It's important to consider hair transplant limitations such as collateral loss during, and continued hair thinning after
I can certainly help you with this. To give you a little bit about my background — I’m a Board-certified cosmetic surgeon and a Fellowship-trained oculofacial plastic and reconstructive surgeon, practicing in Manhattan and Long Island for over 20 years. I have been performing hair transplants for many years, and I’m also the founder of the TrichoStem™ Hair Regeneration Centers, which offer non-surgical alternative solutions to hair loss based on a strategy derived for the improvement of hair transplants.
When patients consult with me regarding hair transplants, I first examine the donor area, or the area at the back of the scalp where hair grafts are harvested from, and see what kind of density the patient has in a given area. The higher the density, the more hairs you can harvest. I then examine the quality of hair — fine versus thick, straight versus curly or wavy, and so on. Determining the optimal area to place the hair is also crucial, and this is where a little projection to what your hair could possibly look like without intervention to stabilize hair loss.
The donor area itself is very limited, and without stabilizing hair loss, you will continue to lose hair. Even with a hair transplant, you will simply be chasing results until your donor area runs out of viable grafts. It is really important to strategize, particularly for men who want their hairline more forward. This is particularly challenging when a patient wants an unrealistic outcome because, as a general rule, the hairline should be about four finger breadths above the eyebrows.
Another limitation involves collateral hair loss. If you still have a significant amount of existing hair around the transplant areas, there is a possibility that the hair transplant procedure itself will traumatize those existing hairs. To illustrate this, if you are having 15,000 hair grafts transplanted, 15,000 tiny holes will need to be made in the scalp. Thus, the odds of damaging existing hair follicles are quite high.
There is, however, an opportunity for improvement even before a hair transplant is done. In our practice, we have a treatment called Hair Regeneration. Hair Regeneration is a non-surgical hair loss solution for both men and women, and it combines Acellular matrix and platelet-rich plasma. The treatment makes use of a wound healing technology to stabilize hair loss and reverse hair thinning, and with a special method of injection, I am able to get more coverage in the right candidate. Based on my own observations as a hair specialist, in many cases the results even exceed the results of two hair transplants.
Before Hair Regeneration, losing existing hair through collateral loss was a reality that we all accepted as part of the procedure. With Hair Regeneration, we are able to improve existing density by making the hairs thicker and reversing the thinning process. Since hair loss is stabilized, a hair transplant becomes a more effective and logical treatment because you are dealing with a more stable canvas. In fact, patients will come to us for a hair transplant to address thinning, and after we treat them with Hair Regeneration, many of them don’t feel the need to pursue a hair transplant anymore because they’re already happy with the results. What we’ve observed is that the earlier we catch someone, the better the results are, and many of our patients are able to avoid a hair transplant altogether.
In addition to doing more research about this treatment and meeting with doctors, I suggest that you also look for a more methodical, realistic, and low pressure approach. Having realistic expectations is what is important here. I would also recommend that you learn more about medical intervention, as well as a regenerative type of treatment like Hair Regeneration.
I hope that was helpful and I wish you the best of luck!
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What things are important to tell my doctor about my goals?
I say this because it is the expectations of the patient and the understanding that develops between patient and surgeon that will have as much to do with long term satisfaction as how the transplant was performed. Two different patients operated on by the same surgeon and who achieve the same results, more or less, but who had different preferences and expectations going into surgery, will have very different degrees of satisfaction with the outcome. This may sound self-evident, but it's disturbing how many doctors either don't listen to their patients (some of whom may have been scheduled for surgery without ever having met the doctor), or try to persuade them that they'll be happy with something that they clearly won't be.
OK, with apologies for my longwinded preamble, here is what I think every patient should communicate to his or her surgeon about goals:
- How much or little density (thickness) would be acceptable to you? One of those two hypothetical patients above might say, "Doc, I just don't want to be able to see through to my scalp", and the other might say "As long as I can get some coverage, I'll be happy. I don't expect to have the hair I had in high school." Make sure to look at plenty of before & after photos with your doctor and let it be known if there are any results you might not be happy with.
- Given the limits on actual and apparent density that can be achieved in a single session, are you prepared to undergo one or more additional procedures (or perhaps scalp micropigmentation) to get closer to the look you want?
- Are you willing to make some compromises with your hairline (e.g., shape, level, amount of recession) in order to cover more of your balding/thinning area further back? Or have less of the top or back of your head transplanted in return for a fuller hairline?
- If you are at an age and stage where future hair loss is likely, are you committed to taking whatever steps possible to slow down the process?
- Do you understand that the law of supply and demand will determine what can ultimately be accomplished by hair restoration surgery? If the total amount of hair lost had exceeded the total amount of usable hair in the donor area, or that scenario is expected to unfold over time, compromises will need to be made. (This is why preventive measures are so important.)
- Do you recognize that the two different donor harvesting techniques, "FUE" and "FUT" (or "strip") each have their advantages and disadvantages, depending on the individual, and that one – or even both – might be recommended in your case?
- If you smoke cigarettes, are you prepared to cut down (if not actually stop) during the critical first 2 weeks after surgery in order to maximize the survival and future growth of your grafts?
These are a few of the things that you need to discuss with your surgeon. Any experienced, sensible, ethical surgeon – *not a commissioned salesperson* – should be able to help guide you through this important conversation. Helping a patient make an informed decision takes time and patience on the part of the doctor, so beware of anyone who tries to rush you through the process.
Thank you for this excellent question.