Designing the Hairline > Page 2
ARE YOU A CANDIDATE FOR HAIR TRANSPLANTS?
The selection of patients for hair transplant surgery is an evolving
area in hair restoration surgery. Everyone who walks in the door requesting
treatment is NOT a surgical candidate. The newer method of selecting appropriate
patients for hair restoration surgery is based on a combination of: 1)
procedural outcome assessment, 2) the age and baldness classification
of the patient, and 3) the patient's goals. Additionally, one must consider
the hair-to-skin color match, the hair shaft caliber and texture, the
donor density, and the amount of hair curl.
THE LEAKY BUCKET SYNDROME
The dominant factor in patient selection is the degree and pattern of
hair loss. In general, the more severe the baldness, the happier the patient
will be in the end. Facial framing will create a beneficial contrast between
the way the patient looked before restoration and the way the patient
looks after restoration. In other words, a positive change in appearance
is greater in patients with well-defined patterns of baldness, as opposed
to patients who are in slow constant evolution from one classification
to the next. Patients with thinning hair patterns often have what we refer
to as "the leaky bucket syndrome" because they are in an active
phase of hair loss. As the surgeon transplants hair into an area, the
patient continues to lose pre-existing hair. In the end there may not
be a positive change in appearance. We make the analogy of attempting
to fill a bucket which is riddled with holes. If you have no baldness
and show only thinning, it's difficult to thicken up your hair.
AGE AND WISDOM
Patient age is the second most important factor to consider and is inherently
linked to the baldness classification pattern. Most young patients (under
30 years of age) have thinning patterns of hair loss and not well defined
areas of baldness. In addition, younger patients tend to be unrealistic
in their expectations and are less accepting of conservative treatment
which will bear positive, proven and predictable long-term results. Older
patients tend to be more accepting of the limitations placed on all of
us by the aging process.
The older patient usually realizes the limitations of the procedure while
the younger patient hangs on to the "dream" of a full head of
hair. So wisdom may not be the only consequence of aging; individuals
are usually better candidates for hair restoration at age 50 than
at age 25.
HAIR COLOR VS. SCALP COLOR
Hair color as it contrasts with scalp color is an important consideration
because the greater the contrast between these two, the more difficult
it is to achieve a natural result. Strong contrast increases the risk
of tufted, pluggy, unnatural appearance of some hair transplants. Jet-black
hair in a lily-white individual is the most difficult situation in which
to achieve a natural appearance. Gray, blond, and red hair tend to provide
more natural results because these colors do not contrast strongly with
the skin color of the scalp. Small follicular grafts need to be used in
patients who do not have a good hair-to-skin color match.
Hair texture and caliber is another factor to consider. The thicker the
caliber, the greater the surface area each hair covers. Small grafts need
to be transplanted with thick caliber and coarse hair. Fine hair on the
other hand provides natural-looking results, but due to the thin hair
shaft, it is difficult if not impossible to achieve a thick, dense look.
Fine hair is easy to style because it has less memory. Fine hair may allow
for the use of larger transplant grafts. In general, fine, soft hair is
easier to transplant than thick, coarse hair, but achieving a dense look
is almost impossible. We like to use the analogy of large, fat, redwood
trees for coarse hair, versus slim pine trees for fine hair. The redwoods
create a dense forest with fewer trees. The pine trees, no matter how
closely planted, can never give the same density of forest. Thus, it is
difficult to achieve a thick look with fine hair.
Hair curl is not as important as the other factors but it is an added
benefit, as curly hair covers more area than straight hair and reveals
less of a tufting, "pluggy" look. The curl adds volume and helps
to hide the exit of the hair shaft from the scalp, giving a very natural
look. Wavy hair also gives a thicker look than straight hair. High-density
medium-fine hair with curl is the most advantageous for restoration.
HUMAN SATISFACTION - A MOVING TARGET
Regardless of the above factors, successful candidate selection hinges
on the patient and surgeon reaching an understanding on an objective goal,
and agreeing on any compromises necessary to achieve the goal. Despite
how well a candidate meets the surgeon's criteria and how well the transplant
is performed, if the patient's goals are not met, he will not be satisfied.
The surgeon must educate the potential patient on the lifelong progression
of male pattern baldness, and therefore on the limitations this never-ending
process places on hair restoration procedures and results. Education for
the patient will help transform ill-defined hopes into concrete expectations.
Most problems with patient satisfaction stem from patient expectation
and not surgical technique.
FACIAL FRAMING - THE KEY ISSUE
A chief goal of surgery should be to restore facial framing by creating
a permanent hairline which will arrest the visual effects of continued
hair loss. This return to facial framing has a tremendous positive impact
on the patient's appearance by restoring familiarity, shortening the face,
and directing the observer's focus to the central face. If facial framing
has not been lost by the patient's balding pattern, then the surgeon needs
to plainly and honestly convey to the patient what is realistically achievable
over time and ask the patient if these goals will satisfy his needs. The
patient must understand what can realistically be achieved and his expectations
must be remolded until both the surgeon and patient are talking the same
language and expecting similar long-term results from hair restoration.
WHY IS THIS FIELD OF MEDICINE SO DIFFERENT?
For many individuals, having a hair transplant is the single most positive
step they may take concerning their appearance. They are thrilled with
the results and receive a very positive change in their appearance. These
individuals cannot imagine why anyone who is distressed over their hair
loss or lack of hair would not consider a transplant procedure. But many
of these "happy campers" represent perfect candidates. There
are many factors, some of which are listed above, that determine whether
or not you are a candidate. Everyone with hair loss is not a candidate
for transplants. Men under 25 generally should be discouraged from transplants.
Exceptions to this rule are made. Those men who are experiencing a rapid
thinning of hair may not receive a positive benefit from transplants.
On the other hand, a 50 year old man with salt and pepper colored hair
and well-defined baldness is a marvelous candidate. When you go to the
dentist and he recommends a root canal, it is generally wise to take his
recommendation and have the procedure. Likewise, you would not determine
if you were in need of cardiac bypass surgery - you would rely on an expert's
opinion. Hair restoration is different. You need to be equipped with
the knowledge of what you can expect from a hair transplant and if this
will meet your goals. Thus, the field is quite different than other areas
of medicine. Education becomes mandatory. If you have read this far, you
are well on your way.
Despite meticulous technique, complications can develop in a small percentage
of all surgical cases involving hair restoration. These include: unexpected
drug reactions, hematoma formation, swelling, persistent pain, raised
scars, wide scars, post transplant cysts, infection and temporary loss
of hair, all are unforeseeable events that are beyond the surgeon's control.
They do happen but are not common. Complications are usually so minor
that they shouldn't scare anyone away from this type of surgery.
Hair Loss information
on this site has been contributed by hair loss specialists
and surgeons who have years of experience in the field of hair