Month: January 2006

Is hair transplantation an art form? Does one doctor really get better results than another? If it is only technicians putting grafts into holes in a head, how is it worth the money that you doctors charge?

Hair transplantation is a discipline that includes a sense of artistic balance, a sense of meticulous organizational skills, good judgments, and lots of experience. I know this because I see too many hair transplants that reflect failures of these elements. For example:

1. Artistry: I can tell that a person had a hair transplant just by the location of the hairline. There is a range of normal locations, yet many doctors tend to place the hairline too high, in order to conserve hair, when the location is clearly not ‘right’. The eye catches something is not normal, and even when, on close inspection, the grafts meet the follicular unit golden standard for today, you know that something is wrong.
2. Teamwork: Poor growth may reflect poor organizational skills and less than experienced staff. Many doctors use itinerant staff, brought in and paid by the hour. They were trained in different offices with different standards and learned habits and techniques that may not conform with the same standards as other team members. Many of the technicians who were terminated from NHI, now work as itinerant technicians who move from office to office. They bring with them the same bad habits that caused them to lose their job with me. Unless a doctor’s team has been working with that doctor for years and are self disciplined with a common focus using strict quality control processes, the team’s work will often reflect the weakest person working on the case. It is critical to recognize that today’s modern hair transplant standards are a team effort, not the output of a single individual, doctor or nurse.
3. Judgment: The problem with balding people is that hair loss is a moving target, progressive over time. For the hair transplant surgeon it is also a matter of balancing supply of donor hair and the ‘moving’ demand of balding. A surgeon must work in the present time using what hair is reasonable to move today, while preserving hair for future hair loss so that the patients always looks normal. I have seen people who have had grafts placed in a 2 inch bald spot in the crown, which then advances to a 5 inch bald spot in the crown. They had an island of hair like an oasis in a bald desert. The same is true for frontal balding in the young man who has corner recession and gets them transplanted only to find that the corner recession advanced to full frontal balding. He comes to my office with ‘wings’ protruding out at the corners and a bald area around it. Both of these men looked freakish, so that any short term benefit they received was offset as their balding progressed. The unfortunate fact is that too many young men do not recognize that their bodies (and balding patterns) will change over time.
4. Experience: I can not say that experience is king here, but I can say that experience means that mistakes should be minimized and #1, 2 and 3 above, have been incorporated into the routine of the transplant surgeon. I am fortunate to have become the doctor’s doctor in the Beverly Hills plastic surgeon community. These surgeons have had their transplants done by me or they have sent their patients to me and have seen the results we get. I have focused much of my professional career to publish the lessons I have learned over the years in the most prestigious medical journals and text books. Often I have had patients come to me saying that Dr. X told them that he invented ‘blah, blah and blah.’ I always tell the patient to have the doctor prove that they are the inventor and most of the time what they can’t get the information they are asking for. Falsely claiming authority or inventor status should not be taken lightly, as it is a measure of the fabric of the surgeon. Look up his/her credentials and experience and only believe what you can verify.

I can go on an on here, but to see what I am talking about, visit my website. There are over 200 patients with before and after photographs on the site and copies of much of what I have written and published is in the medical literature. Yes, hair transplantation is expensive, but would you want people to immediately say, “Nice hair transplant”? No one should even know.