Additional photos of patient from August 2008

[Dr. Michael Beehner]

A reader had asked for additional photos of this patient's crown area and they are attached. For details of the case and explanation for why certain areas were emphasized more than others, please read my note in this section following the orginal posting.

Mike Beehner, M.D.

[TC17]

Dr. Beehner,

 

Thank you for updating this patient. Considering where this patient was, I think this is an outstanding result. Would you consider this average for what a man of this balding pattern could achieve?

[hdude46]

but but i thought all patients who go this bald will have donor thinning with see thru scars. what about future loss? this patient has 20-30 more yrs of his life left.

 

obviously im being sarcastic but you get the point.

[TC17]

Never once have I said that all patients will experience donor thinning. All I have ever said, is that young patients who are advanced on the NW scale, are at a greater risk of evolving into older men with EXTREME baldness. And, with that extreme baldness, comes far less donor availability, a greater chance of donor thinning, and far more bald area to cover.

 

So, I don't really get your point. The fact of the matter is that this patient presented to Dr. Beehner when he was already relatively old, and Dr. Beehner gave him a very nice frontal forelock pattern. If this same patient had presented at age 25 or so, I highly doubt that same pattern would have been used. And yet, when we see young patients on this forum that will turn into a patient of this style, we never see this pattern being used. It's something that should be discussed more often than it is.

 

Attempting to imply that my concerns about future loss and donor thinning are without merit, shows that you have yet to grasp the gravity of transplanting a young patient inappropriately.

 

At the end of the day, it doesn't matter whether 90% of men never experience donor thinning, because it will matter a great deal to those 10% that do. People coming to this site should be informed as to all potential risks, and plan accordingly. Nobody ever thinks bad things will happen to them, but rest assured that some people who are presently loving their transplant, will live to regret it because of poor planning.

[hdude46]

Attempting to imply that my concerns about future loss and donor thinning are without merit, shows that you have yet to grasp the gravity of transplanting a young patient inappropriately.

 

No, I just think the licensed physicians know more than either you or I. There is not a one size fits all. Thats my point. Patients who are given different hairlines likely have some combo of a great donor supply, great response to meds, and a good family history.

 

I think your concerns are definitely valid and I see your point.

[TC17]

The last thing I will say is that I agree, and disagree with you hdude46. I agree that physicians know far more about hair transplantation than you and I do, I agree that a one size fits all approach is not appropriate, and I agree that various factors should be considered by the physician when performing a transplant.

 

The one thing I disagree with you on, is that I don't believe that any physician knows more than you, me, or anyone else about what a patient's future holds with regards to his hair loss. Ultimately, the best any doctor can do is take a detailed family history, examine the scalp under magnification, and guess as to the final pattern.

 

My concerns are that patients place far too much trust in the physician - specifically, that the patients confuses the physicians knowledge about hair transplantation, with ability to predict the future. (This is why under the Federal Rules of Evidence we limit expert testimony, because the jury has a tendency to give it greater weight because it is coming from an "expert.") I worry that the patients who are not given a pattern similar to this man that will eventually turn into this man, will look silly.

 

I totally understand that not every man will reach this level of baldness, and I am not questioning the ethics of any doctor. I truly believe that each physician recommended on this site wants nothing but good things for his/her patients. However, having good intentions is not the issue, the issue is whether younger patients who are transplanted at anything more than this patient, will continue to look good 20, 30, 40, 50 years down the road.

 

At this point, nobody knows the answer to that question.