I am posting this as a review of my experience with Dr. Glenn Charles after I had a FUT transplant with him today (November 2018.) I will be updating my progress throughout the process. In addition, I want to give a brief summary of my hair loss experience and a (kind of) brief review of hair transplants from my perspective as an MD.
1. My history: 28 year old male who started balding in his early twenties. Baldness from both copies of my chromosomes, but my dad's side of the family really have it bad. It really accelerated around age 25 and has been in full force over the past year. I hadn't been on any medications until October, when I started Propecia. I decided a hair transplant was the right decision for me several months ago after over a year of consideration.
2. Hair transplants: I have some experience with the medical field as I finished medical school just over a year ago. Hair transplants weren't a big part of my education, to say the least. Luckily, I have more resources at my disposal than most (peer-reviewed journal articles, chapters from textbooks, etc.) I say this because I am concerned that most people don't have these resources or background to make a truly informed decision. I am by no means an expert, but I believe the following are true for hair transplants and hair transplant surgeons:
a) Hair transplants have varying levels of success from mild improvement to moderate improvement (my opinion). Most people with severe hair loss will require several HTs over their lifetime if they have the wrong genetics (my case). The etiology of this variability is multifactorial and beyond the scope of my post. One factor you can control is your choice of surgeon.
b) Many cases of dramatic hair loss improvement from a single surgery (i.e. nearly completely bald to a full head of hair) are the result of deceptive omission of information. Some pictures will show before and after pictures in different lighting, different angles, or with the use of thickener. Most importantly, I think that many cases of dramatic improvement are the result of the patient starting Propecia. 5% of patients taking propecia develop dramatic increase in hair density. Nearly one third show moderate increase in hair density and another third show mild increase in hair density. For these reasons, I think before and after photos are vital to your choice of surgeon, but not an end-all. Another factor is technique.
c) FUT is an ideal procedure for patients with severe hair loss. Hair transplantation by follicular unit (FUE or FUT) is the gold standard in the industry from many recent journals I have read. FUE seems like a decent option for people who want to have really short haircuts and only have minimal-to-mild hair loss (my opinion). Use of multi-follicular unit grafts was something I had considered. It was the procedure used after "plug grafts," and before the advent of follicular unit transplants in the 90's. Some clinics are using them near the crown, saving single follicular unit grafts for the frontal region. There are sparse reports of this being a better option in a few subsets of patients (blonde haired Caucasians), but nothing that convinced me. Truly there isn't much data on this. My concern, which was shared by Dr. Charles, was that over time these grafts would look "pluggy" and unnatural as the native hair on the crown and frontal region fell out.
d) Hair transplantation is a cosmetic plastic surgery procedure. This is not to say that only a plastic surgeon should perform it. It isn't as simple as a Botox injection, but it doesn't require such extensive training and education as a rhinoplasty, breast reduction, etc. This procedure can be done by a skilled physician from a variety of backgrounds (by law). In my opinion, I would like my physician (whether or not they are trained plastic surgeons) to have plenty of experience performing the procedure, preferably years. In addition, I would prefer that hair transplant be the only major procedure the physician performs. Especially (and certainly not exclusively) in the cases in which the physician is not a plastic surgeon, I would hope the physician shows that he has an interest in staying up to date on the latest research in the field. The surgeon should join societies like ISHRS, the ABHRS, or the AHLA in my opinion.
3. My choice: I chose Dr. Charles in part because he fulfills all of these criteria and then some. The guy was president of the American Board of Hair Restoration Surgery. He publishes research articles (though I haven't read them). His photos are all standardized. He is all over these forums posting results and actively engaging members of this community and others. He responds to patients even when they have a suboptimal result. He takes on complex repair cases and in my opinion has pretty decent results. He is fair and conservative in his promises. I am a physician and can tell you that this guy is a true doctor as the profession was meant to be. He calls patients and keeps them totally informed. It isn't a job to him, it is part of who he is. He must love what he does. He could have made plenty of money being a radiologist (with a better lifestyle), but chose this instead. I don't really care if my provider has a stunning personality (Dr. Charles seems thoughtful, compassionate, kind. I wouldn't be surprised if some might think he has a stunning personality.) I was impressed by his professionalism. My experience with his clinic was great. Pleasant staff, minimal pain, speedy procedure.
As stated multiple times in this post, these opinions are my own. I would hope that they are adequately educated to be of some use to a person considering hair transplants. I encourage any criticism or additions to these opinions. This leads me to my final point:
4. Disclaimer: Not every hair restoration surgeon can be found on these forums. Many are new and many have no interest in participating in this medium. Not every hair restoration surgeon is part of professional societies. Many of those surgeons probably have great results. Some of those who are part of those societies or who participate in these forums do not have a great track record. In the end, many of the successes (or disasters) of a surgeon can be attributed to technical ability. I just believe that keeping up to date and active in the field are key factors that increase success rates and eliminate disasters. I plan on doing the same in my practice. Finally, I suspect that some members of forums and chatrooms are paid representatives for certain physicians. Given the fact that a physician can be smeared unfairly on forums like these, I can't say I blame them for taking this countermeasure. As a precaution, accept no one piece of information in isolation. Do your research as best you can.
I will update the forum with my results.