Reality versus Expectation?

Realistic goals are a mutual obligation of both doctor and client – and only by discussing expectations, an individualized treatment plan, and sharing historical experiences of what other clients have experienced, can realistic goals be established.

This is the doctor’s legal obligation. Every hair follicle lost because of genetic balding (androgenic alopecia) is lost forever. 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. 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 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.

While a doctor is responsible for sharing historical experiences and preparing the client for procedures, clients too, have a responsibility to educate themselves and do their own research. We expect clients to review material presented and ask questions for clarification. An educated client is a satisfied client because it eliminates the possibility of “surprise” or “I didn’t know” or “how come you didn’t tell me.“ We appreciate educated clients because these are the kind of clients that can distinguish between gimmick and truth in advertising and separate wishful hoping from actual possibility. In this way, both the client can leave satisfied, and the doctor too, feels as if his/her services were used to facilitate someone’s goals and increase a client’s sense of wellness.