Category: Hair Transplantation

I just saw a person that had a hair transplant by a man claiming to be a doctor (who actually wasn’t). This fake doc opened up a practice for doing hair transplants, and I decided to write a brief note here to hopefully serve as an important reminder about verifying your doctor’s credentials.

So what does one do to verify if the person who claims to be a doctor is really a doctor? It may sound ridiculous, but you could ask to see his/her state identification (like a driver’s license, for example) to get the correct spelling of the first/last name and then look the physician up at the state medical board database. For California, check here — for other states in the US, I found this Medical Board Directory, and if you can’t find what you’re looking for in there, I’m sure a Google search will turn up results by state/country/region. Try using the keywords “medical board” followed by your state/country/etc. Granted, fake state identification might be relatively easy to get, so maybe then you need to get his/her licenses to practice medicine and their narcotic number, both of which are harder to falsify.

The particular phony doctor that prompted this blog entry had rented another doctor’s office to give himself some credibility and had a line-up of patients for surgery. I won’t get into how wrong it was for the doctor to have rented him the office, but what was particularly significant to me is knowing what would have happened if something went wrong with a surgery. One of the most common complications I see is a fainting spell brought on when the Vagus nerve is stimulated from the excitement of the procedure, slowing the heart down to possible unsafe levels. When the heart slows, there is often a temporary drop in blood pressure, but if this very simple process is not addressed quickly and the patient had atherosclerosis of blood vessels to the brain or heart, a simple drop in blood pressure can lead to or cause a stroke or a heart attack. This complication is easily prevented by lying the patient back with the head down and the feet elevated. In a few minutes of careful observation with the patient in this position, the heart rate usually goes back to normal on its own. If this is not done, what may have been simply practicing medicine without a license might turn into some murder prosecution if the patient died.

Thank you for this illuminating website. I would like to know that when you are doing a hair transplant, what are the things that can go wrong and what can the surgeon do to prevent them?

I can write a book answering this question. Everything seems so simple. When a visitor comes to one of our open house events, they are amazed as to how simple it appears to be (we have a closed-circuit television setup where visitors can see the procedure as it happens). Alas, the beauty of what we do accounts for many of the things that you asked about and it is buried into the process. I will make a list, but the list may not be inclusive of every nuance. I will not discuss anesthesia right now, but will commit another blog entry to address that subject at some future time.

1. For donor area harvesting using the strip method, the issues are (1) damage to the important structures of the scalp (nerves, blood vessels, attaching muscles must be carefully avoided in the incision process) and (2) damage to the hair follicles as the strip is removed which can occur along the blade that is used to incise the scalp. When the wounds are closed, the tension at the time of the closure reflects the size of the donor strip. High tension closures tend to cause a higher degree of scars.
2. The hair follicles are dissected from the donor strip under a microscope and great care must be exercised to avoid damaging them as they are separated into 1, 2, 3, and 4 hair follicular units. The use of a microscope with a skilled staff guarantees the least amount of damage. The grafts must be kept moist at all times, as drying for even less than a minute will kill the delicate follicular units. Graft placement must be timely, for if the grafts are kept out of the body for more than 6 hours the survival decreases with each additional hour. The use of cold solutions can keep grafts alive for longer periods of time.
3. Graft handling is critical, because crush injuries are common if the grafts are not handled very gently. The long term tenure of our staff is what minimizes graft damage during placing the grafts.
4. Graft placement is critical. These grafts must be placed so that the top of the graft is flat to the skin. Placing them too deeply will kill the grafts.
5. Recipient site distribution, direction, and the type of instrument used dictate which direction the hair will grow and if it will be normal in texture. The graft direction and distribution reflect the experience of the surgeon. Improper direction or distribution will produce less-than-ideal aesthetic results. The closeness of the grafts vary between patients. Those with less blood supply should not have close packing of the grafts, while in some patients close packing densities can easily and safely be achieved.
6. Great care must be taken to fill each and every empty site with an appropriate size (# of hairs) graft. Stacking one graft on top of another graft is a common problem (piggybacking) in a less than experienced staff and it is the cause of folliculitis in many practices.

I hope this helps.