Why Plan Long Term?
"Well, after all, I want to look as good as possible
right now. I’ll deal with tomorrow when it comes".
"Doc, I just want my hair back now, while I’m
young enough to enjoy it. Do whatever you’ve got
to do". "Make me look like (fill in the blank
with celebrity/actor/musician of choice)".
These statements and requests are understandable when
one is dealing with hair loss, especially in the younger
man. We have great empathy for the feelings behind them;
some of us have been hair loss patients, too. However,
such communications are also indicative of an attitude
that can lead to future frustration and heartbreak, and
to antipathy toward the surgeon who was foolish or greedy
enough to indulge these fantasies.
Remember that with hair transplantation, it is mathematically
impossible to recreate the density of youth in the bald
and potentially bald areas, given the current limits of
the permanent zone, or donor area. Nor is it cosmetically
necessary. We work with creating the illusion of density
in the balding regions, by the artful placement of grafts
in a way that maximally blocks light penetration to the
scalp. Indeed, hair restoration surgery does not "cure"
baldness. We simply move hair around in order to ameliorate
the appearance of thinness or balding.
The technical aspects of these procedures require intense
training, good hand-eye coordination, excellent surgical
skills, a steady hand and a sharp eye and the ability
to concentrate and endure tedium. The artistic and aesthetic
aspects, on the other hand, require an integration of
both cerebral hemispheres (right brain/left brain coordination).
This cannot be "book-learned"; it is either
part of a physician’s basic constitution, or it
is not. It may be honed and improved upon, but it is not
created by taking courses or by sheer force of will. Poor
performance can lead to less than desired outcomes.
Sadly enough, cosmetic disasters can also be the consequence
of poor planning. Even with the use of follicular unit
transplantation and associated state of the art techniques,
lack of artistic foresight and proper patient selection
and education can eventually lead to an unnatural appearance,
premature depletion of donor reserves, visible scarring,
unequal distribution of hair, unnecessary surgeries, patient
dissatisfaction and frustration for all involved. It is
better to risk initially disappointing the patient who
has an overambitious or unrealistic plan, than to rush
into surgery without a mutually agreeable, long term plan
in mind. Postponing or even refusing surgery with such
an individual is the ethical and moral course of action.
What to Look for in Your Hair Transplant Surgeon
First of all, you should have a consult with him, and
not just a non-physician consultant. Since we’ve
brought this issue up here, let’s talk briefly about
the role of the non-physician consultant. These are individuals
who may know a great deal about the process and results
of hair restoration surgery. They may be former patients
themselves, and they can play a valuable role in helping
educate and reassure prospective hair transplant recipients,
and assist them through the process.
Some patients have done a fair amount of reading (often
on the internet) about hair transplantation. Some of the
information they have received is valid, and some of it
not. The consultant can help separate the hype from the
truth in these cases. On the other hand, some patients
are essentially without any semblance of a knowledge base
regarding their options, and require much more in the
way of education. In either case, the consultant is paid
to educate patients, facilitate the process, allay their
fears, and often, to act as a primary contact person.
What the consultant is not paid for is to profit personally
by the patient’s decision to have surgery. Unfortunately,
in some organizations, the role of the consultant is just
that: to make a commission on each procedure and on every
graft that the potential patient receives. The conflict
of interest is obvious, and we do not believe in the use
of commissioned consultants. The physician, the consultant,
and the other members of the team are integral to helping
the patient make an informed and rational decision as
to if, when, and to what extent any surgical procedure
will take place. Coercion, manipulation, and financial
incentives have no place in an ethical hair restoration
practice.
So, in addition to any other staff members the patient
sees and works with, the role of the hair transplant surgeon
is primary. This is indeed "where the rubber meets
the road". The surgeon must, above all others, gain
the trust of the patient, help him with the often difficult
decisions that must be made, and also counsel him against
making possibly irrational and fear-driven choices.
Your surgeon should check your hair carefully himself.
Some form of magnification is necessary to evaluate the
degree of density, and also of miniaturization. Beware
if he just ruffles your hair, briefly rubs your scalp,
and says that his experience allows him to "just
eyeball it" and make a judgment regarding these factors.
This cavalier approach does not honor you or the complexity
of modern hair transplantation. Surgeons now have the
information, the techniques and the tools to carry out
the appropriate pre-operative planning and counseling,
and they should do so!
He can tell you about your particular pattern of balding,
your likely progression, the amount of donor reserves
he estimates you have, what your hair characteristics
are, and how all of these factors will play into the decision-making
process and your likely outcome. Will multiple sessions
probably be required? How many grafts might you need for
an initial session? What areas of the scalp are most important
for you cosmetically? All these questions and more must
be answered to your satisfaction.
Remember that medical treatments like Propecia and Rogaine
are adjunctive; in the context of long term planning,
we must assume that they will not work, or that their
action will be less than optimal, or will decrease in
effectiveness over time. This does not imply that they
should not be used, but it is foolhardy to make surgical
planning decisions for the present or the future based
on "Propecia maintaining the crown" or "Rogaine
filling in the density on top". Similarly, to count
on new advancements such as more powerful medication or
hair cloning in making these decisions if irrational.
Properly planned and performed follicular unit transplantation
should be seen as a lifelong investment that will stand
on its own and stand the test of time.
If you are very young, and anxious, and you are not sure
you are the best candidate for hair restoration surgery,
how eager is your surgeon to operate? Is he willing to
postpone and reevaluate in a year after medical treatment,
or is he still pushing you to "sign up?" Sometimes
the most ethical and caring physician is the one who tells
you what you don’t necessarily want to hear. This
is born out of an overriding concern for what is in your
best interests. Honesty is of paramount importance in
dealing with someone as vulnerable as a young person experiencing
rapid hair loss.
Your Role as the Patient
It is said that patience is a virtue. This can be very
true for the hair loss patient, and also very difficult
to achieve. Remember, only a trained hair restoration
surgeon can properly evaluate and counsel you as to your
options, or lack thereof. Educate yourself. Communicate
with your doctor, and let him know your fears; we deal
with these issues day in and day out, and you are not
alone in your concerns. We have heard the same questions
and misgivings from other patients. Many of us have had
these procedures ourselves, and have sat in the "patient’s
chair".
Don’t fall into the trap of being too compliant
("Whatever you say, doc, you’re the expert!").
This attitude may seem to make things easier and faster
for you and the doctor, but it is less than ideal. The
more you are in true agreement, the happier both parties
will be in the end. On the other hand, a resigned or downright
hostile attitude ("Go ahead, doc, you’re gonna
do what you’re gonna do. I’m the next victim!")
is just counterproductive at the least, disastrous at
worst. Again, there must be a real consensus of opinion
and plan before you take your seat in the surgical chair.
In the rush to "get hair growing", don’t
forget to be realistic. Adolescent density is not probable,
nor is it necessary. An adolescent hairline is inappropriate
and odd-looking in someone middle-aged (and, someday,
young people do become middle-aged. Take our word for
it!) Moreover, despite your feelings at twenty-five or
thirty-five, you will care about your appearance at forty-five
and fifty-five, and for life. A balanced, symmetrical,
natural hair transplant, done at any age, will serve you
well for the duration.
