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Because of the many different techniques used for hair replacement,
it is critical that the patient educate himself so that he is comfortable
with the technique his surgeon uses. As detailed in earlier sections,
I am an extremely ardent supporter of follicular unit transplantation,
and I would very strongly suggest that someone’s first step
in finding a surgeon would be to locate a list of physicians who
utilize follicular units with microscopic dissection for the entire
procedure. The only three such lists that I am aware of include
the International Alliance of Hair Restoration Surgeons at IAHRS.org,
the Hair Transplant Network at hairtransplantnetwork.com, and in
Spencer Kobren’s book The Bald Truth. I would also emphasize
that these lists are not all inclusive. Just because a surgeon is
not listed does not mean he does not perform follicular unit transplantation.
Otherwise, the search can become very confusing. There is no clear
way to find who will do the best work. Relying on advertising to
make the decision is foolish. The best advertising tends to comes
from several of the large hair transplant clinics with franchise
locations in most of the major cities. They typically employ numerous
physicians who perform the transplants in their individual cities.
On occasion, the surgeons fly back and forth between cities. This
is truly big business. They have multi-million dollar advertising
budgets. They utilize large advertising firms and Hollywood producers.
Not surprisingly, their commercials, videos, and brochures are extremely
well done. Slick advertising does not make these clinics bad, but
I would stress that it also does not make them good. Most of the
nationwide clinics currently are not performing follicular unit
transplantation. Whether someone goes to a nationwide franchise,
or a small local clinic, the surgeon, his preferred technique, and
the team performing it will largely determine the quality of his
transplant. Potential patients should be forewarned that some clinics
are advertising follicular unit transplantation, but are either
using that technique for only a small portion of the transplant
(i.e. the hairline), or are not using microscopic dissection.
Again, finding the right surgeon can be difficult. Obviously, the
best way to pick one is to talk to friends or family who have been
treated by different surgeons. It is sometimes possible to obtain
information on various surgeons on chat rooms or message boards
on the internet, but this information should be viewed as suspect.
Surgeons should have patients that they use as references but, obviously,
these patients will not be relating negative experiences.
As I have mentioned multiple times, if someone does not already
know who to go to, he must first educate himself about hair transplants.
After that, he should begin reviewing various clinics’ brochures,
websites, and videos. If he can develop a working knowledge of the
field, he can begin to weed out any clinics that seem to be all
hype and no substance. Do their materials make scientific sense?
Does the surgeon perform the type of transplant you want? Is there
information on the surgeon who will be working on you? If the advertising
stresses special deals that someone must act upon immediately or
showcases beautiful women, I would recommend being cautious. A local
hair replacement clinic featured a man, walking on the beach, with
a gorgeous model, busting out of her bikini, riding on his shoulders
in its advertisement. A friend called me and said, “If you
can get that to grow on my head, I’m coming in”. Sex
sells, but potential patients should be very careful what it is
selling.
After someone has narrowed his search, it is time for him to meet
with the doctor—and that is exactly what he should do. Unfortunately,
some large clinics use non-physicians to counsel and consult. They
may be “customer representatives”, “consultant
specialists”, “patient advocates”, or just “Tom”,
but they are not surgeons. If the potential patient does not meet
with the surgeon, then he will be meeting with an employee who is
either paid a commission to talk him into a transplant, or an employee
whose job review will depend on how smooth he is with potential
patients. He will be consulting with a salesman. It is perfectly
acceptable for him to meet with someone whose job it is to answer
basic questions before he meets with the surgeon, just as long as
he does meet with the surgeon at some point.
When someone does consult with the surgeon, he should ask himself
these questions. Does he seem honest or evasive? Does he discuss
the cons as well as the pros? Is he friendly or intimidating? Does
he want to answer questions or is he patronizing? Do you feel like
you are being sold to or pressured? I feel it is always helpful
for someone to go to the consultation with a member of the opposite
sex. If he is married, he should bring his wife. If not, he should
bring a girl friend he can trust. I am a firm believer in intuition.
By bringing someone of the opposite sex, if something is not right,
I believe that one of the two will feel it intuitively, if not outright.
If someone has educated himself as recommend, I would advise him
to ask the surgeon some additional questions. What is his opinion
of medicines used to help stop hair loss such as Propecia and Rogaine?
Would he be willing to write you a prescription for Propecia? He
does not have to agree with my views on the medicines, but he should
he be able to talk about them intelligently. If the consulting patient
is a Norwood type V to VII on the balding scale, he should ask the
surgeon if he will be able to have all the balding area filled in
so that he will have full thickness throughout. Although individual
variables will be present with each case, in general, a full head
of hair with advanced balding is not a realistic expectation. In
fact, it is probably foolish of the surgeon to try for full coverage
in the back (vertex) of young men. Going back to the Dr. Norwood’s
baldness scale, he should ask him if he could get a Norwood type
I hairline. If the surgeon says “yes”, the consulting
patient probably does not need a transplant anyway, and/or the surgeon
is not concerned about how the patient will look in the future.
He should ask him his opinions of follicular units, minigrafts,
scalp flaps, and scalp reductions. Just as with the medicines, he
does not have to agree with my opinions, but he should be able to
converse intelligently about each of these.
Figure 8-1. In advanced balding (Norwood
types V-VII)
a full head of hair with a transplant is usually not a realistic
expectation. |
Here is another telling question. The potential patient should
ask him if he would recommend several other surgeons who do good
work. If the surgeon hesitates or says that locally there is no
one whom he could recommend (which, by the way, could be very true),
the consulting patient should tell him that he is willing to fly
anywhere in the United States. If he still refuses to recommend
other potential surgeons, either he is scared to have patients compare,
he does not know much about the field, or he really believes he
is the very best in the entire nation. I would recommend finding
another surgeon.
If the consulting patient feels the surgeon might be telling him
only what he wants to hear, he should send a friend who is either
a Norwood type I or VII in to see that surgeon. If it is a Norwood
type I, the surgeon should tell him he does not need transplants.
If it is the type VII, the surgeon should either tell him he is
too bald or he should devise an extremely conservative plan. If
after thoroughly educating himself and meeting with several surgeons,
he is still unsure, then he still has a good option. He should do
nothing. As I explained in an earlier section, there is absolutely
no hurry in getting a transplant. He should wait and ponder, but
he should not
hurry into something he is not comfortable with.
Figure 8-2. If a man is a Norwood type I,
he certainly
does not need a transplant. If he is a Norwood type VII
he either should not have a transplant or should have
an extremely conservative transplant. |
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Choosing
a Hair Transplant Surgeon 