Designing the Hairline > Page 2

Designing The Hairline

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 transplantation and the way the patient looks after transplantation. 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 transplantation 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.

TEXTURE

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

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 transplantation.

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 transplantation 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.

COMPLICATIONS

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.