Goals and Expectations > Styles and Costs > Repair Work

Realistic expectations are essential to the success of hair transplantation; setting them is the responsibility of both doctor and patient. The doctor must provide each patient with enough information to make an informed decision. This is the doctor's legal obligation. Every hair follicle lost because of genetic balding (androgenic alopecia) is lost forever. If you compare a head of hair to an apple, as the balding process progresses, parts of the apple are being lost. In cases of advanced baldness (a person with a Norwood Class 7 baldness pattern), such a person has lost up to 75% of the apple and as such, he should not reasonably expect to get a full head of hair back.

It would be impossible for anyone to make 25% of an apple look like 100% of an apple. However, if 20% of the apple was lost, a skilled person could reconstruct the apple so that the missing 20% could be disguised. The goal of a hair restoration procedure is to make a patient appear to have more hair than he actually has. This is where the art form must be balanced against the technical skills of the surgeon. The combination of art and technique cannot overcome limitations in the quality or quantity of the supply of hair. Generally, the more hair lost, the less full the appearance of the restored hair. All hair restoration procedures, including hair transplantation, actually move hair from one place on the head to another.

New hair is not created, but redistributed from the back and sides of the head (where there is an abundant supply) to areas where there is little or none. No surgical procedures create new hair. Scalp reductions do not preserve hair for use in transplants, as some physicians claim, for the same wreath of permanent hair is stretched to cover a wider area in the crown, thereby thinning it. Flaps move large areas of hair from the wreath of permanent hair, leaving significant scarring and distortion of scalp anatomy in the process. Traditional large 4 mm hair transplant grafts, transfer plugs of hair into bald areas, creating patches of hairy skin and thus create the doll's head look, so commonly associated with hair transplants.

In modern hair transplantation, very small naturally growing groups of hair follicles are moved. These follicular grafts are less noticeable than larger grafts and are often indistinguishable from the natural groups of hair growing in adjacent areas of the scalp. The grafts are placed into a pinhole that may leave no discernible scar. The density of the transplanted hair in its new location cannot equal the density of the hair that was originally in that location. In thinning areas, transplanted hair can significantly increase the apparent density by adding hair follicles or groups of hairs and mixing these with existing hair. The key is to add density inconspicuously. The hair in the new location must appear as full and natural as possible.

Unless a very bald man has a high hair density and a loose scalp, there is not enough hair to cover the entire head. A very thin head of hair, a very conservative, high hairline, and/or deliberately leaving the crown area un-grafted or very thin, may be the only available options; this must be understood when a patient makes the decision to have surgery. This is particularly true if the patient's hair density is below average. In patients with extensive hair loss and low-density of donor hair, there is no way that transplantation can achieve a full head of hair. Special artistic techniques, however, can exploit what hair remains. Many of these individuals will be satisfied with a high hairline that does not have a distinct edge. This produces a natural but well-framed thin look. High contrast hair-to-skin color combinations make more advanced hair loss harder to restore.

Both the patient and the doctor bring their own expectations to the process. For the patient, there is no substitute for doing proper research into the subject. Patients must accept the responsibility for their actions and choices if they fail to do the necessary research prior to having surgery. Anyone contemplating such services can only protect himself by educating himself.

A patient's education should include reading general material on the subject that has been produced by the doctor being considered for the transplant service. A review of this material can reveal a great deal about the particular medical group; it will also tell you whether the doctor wants educated patients.

An educated consumer should learn to recognize marketing gimmicks and how such gimmicks can be used to set false expectations in selling hair transplants. Beware of a one-sided, very positive interview. Educating prospective patients and giving them the information necessary, including negative information, to make these very important decisions with confidence is the purpose of the interview with the doctor.

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