Hair Transplant: Concerned About Long Term Effects?

[Bill - Seemiller]

I recently received an email from someone expressing concerns about "disturbing trends" they've seen during their research related to hair transplantation. I think some he made some keen observations and I've responded with my thoughts on the following article:

 

Hair Transplant Surgery: Concerns about Long Term Effects

 

What advice would you give to this hair loss sufferer?

 

I look forward to your input.

 

Bill

[Bill - Seemiller]

Any opinions on this topic?

[hiflyer]

Hi Bill,

 

I also do feel on what happens 30 years down the line.

 

One fact that this gentleman is not considered is the taking of appropriate medicines to save the existing hair and prolong its life.

 

I feel its better to have a HT done when a good Donor exists rather than have it done when u hit 60 which wouldn't make much sense in terms of style. Thats the age you hit the stop mode and enjoy life to the fullest.

[Dr. Michael Beehner]

I would certainly second everything Bill said above, and had a few comments to add. After 23 years of performing hair transplants and seeing many of my early patients return 15-20 years later, I can honestly say I have only spoken with two or three that wished they hadn't had hair transplants, and each of these were young men in their 20's at the time who did go on to become Norwood VII's. The hundreds of others that have come back to visit me were extremely grateful they had done it. Just this past week, I had three of my old patients from over 15 years ago visit me and each agreed it was "the best money I ever spent." The increase in self-esteem and return of a more youthful look that hair transplantation accomplishes for a balding man is a tremendous thing. The key thing we accomplish is simply framing the face. If this is done in an artistic, natural way - filling in the front half, 90% of our job is accomplished. For those men with lax scalps, extra money to spend, and lots of donor hair who want more than that done, the back half often can be filled in, which is just icing on the cake for the patient.

It is important that you seek out an experienced hair surgeon who makes allowance for where you at your age are likely to end up. I find that after the age of 35 it really is a lot easier to predict where things will end up as a worst-case-scenario for a given patient. For men in this age group, when there is a comfortably medium to large amount of donor hair available, it is almost always possible in 2-3 sessions to give him a "full" look in the front two-thirds of the scalp. Like all surgeons who have been at this for awhile, I am certainly more conservative in transplanting young men in their 20's than I was 15-20 years ago. For a man in his middle 20's who shows some signs that he might progress to a Norwood VII pattern (the definition of the Norwood VII pattern is that the side fringes are down the side of the head and not up at the top), a "forelock" pattern can be done which will always look natural and can be expanded upon later on if the "worst-case" baldness progression actually doesn't come to pass.

It is certainly true that the transplanted hair does thin some over the years, although this varies from one patient to another. 30-40% look as thick as they were 10-15 years before, while the rest are a little thinner than decade or two ago. My own transplants were done around 30 years ago and my wife, who is my barber, tells me that my hair has thinned over that time span. But so has the hair on the sides and back of my head. The other nice thing about getting older is that the hair takes on the multi-hued look of "salt and pepper" with gray hair mixed in, and of course many go on to a totally white head of hair. Simply because a lot of these hairs "disappear" against the backdrop of the light-colored scalp, we sometimes will think the hair isn't even there or has thinned more than it actually in fact did.

I always tell the men who come to me in consultation that they do have to be committed to leaving the hair on the sides and back of their head one-half inch in length to make sure the donor scar doesn't show. I also tell them that, if they want to wear their hair shorter, when the required sessions are done to their satisfaction, there are a few things that can be done to greatly minimize the scar (excision, FUE grafts into the scar, and tattoo dots).

Regarding the fear expressed by the writer of the question to Bill, that donor hair would be depleted by one or two sessions, I would reply that that is extremely rare. Almost everyone has enough donor hair to have three good donor harvests done and with a reasonably thin scar left when it's all done. The stretchability of the scalp is amazing and is the reason we can do what we do in hair transplantation, and, with skill, we can almost always make sure that that "stretching" occurs in the hair-bearing scalp above and below the scar and not in the scar itself. With the addition of FUE later on in the areas above or below the scar, we have even more versatility and capability to obtain even additional hair if needed. In the past five years, I find that two sessions satisfy the majority of our male patients.

The principal areas where hair surgeons and patients get in trouble is in being overly ambitious filling in the crown/vertex in back or over-flattening out the normal recession at the frontal-temporal angles to each side. These errors most commonly occur in the instance of the young man in his 20's or early 30's who wants to look exactly like all of his peers, with no thought of how much he may actually later go on to bald.

A relatively conservative approach, good artistic surgery, and honest communication between the doctor and patient go a long ways to avoiding later regrets and disasters.

Mike Beehner, M.D.

[NEWHAIRPLEASE]

Nice write up Dr Beehner...thanks for sharing your input throughout your career of doing hair transplants....

[mahhong]

Great write-ups by Bill and Dr. Beehner!

 

I think if you go down the hair transplantation route you have to be prepared for the fact that, whether you take drugs or not to slow down hairloss, you are in your lifetime likely going to have to commit to at least 2 hair transplants or at very least be willing to prepare for that likelihood. I understand that every procedure is rightfully planned to look natural and stand up on its own, but hairloss is a progressive thing and the drugs are really designed to slow that progression down to a point that it will not be noticeable over a moderate timespan of say 5-20 years. Accepting that multiple procedures are a distinct possibility is the same as accepting all the other realities about hair transplantation; the density, the coverage, the limitations.

 

As Dr. Beehner points out, the problem (and it's very hard to accept for most of us) is that hair transplantation cannot be about going back but moving forward. There is a tendency to think of a HT as recapturing how you looked years ago, but in reality you are having to design a new plan for your hair that can look as good as possible. Men in their 20s and 30s do want to look like their non-balding peers, but in the majority of cases that is not a good starting point for your restoration journey.

 

I think you have to start the journey knowing it will probably never end. Propecia and minoxidil can work wonders, but over the course of decades they are very unlikely to keep you stable and that will mean using HTs to replace what is going missing. That might mean two or three large procedures of 2000+ grafts in the course of your lifetime, or maybe 4/5+ procedures that have more specific or modest aims.

 

This is something I am having to think about, since my hair is thinning and I found finasteride to give me moderate side effects that I do not believe were psychosomatic or worry related. At nearly 29 I still have some hair on top which, with concealer, can look pretty full, but the time is coming up in the next 2-4 years where I don't think that will be the case. It's tough to know what to do; on the one hand I don't want to lose my hair and want a HT to deal with, but on the other hand I don't want to commit unless I know the results will be acceptable and look good. I'm quite content with the idea of having 2+ procedures over the course of the next 5-10 years and using a lot of my donor to deal with the problem, providing I can be sure it's not a journey I can't finish as I want!

 

It's all about research, preparation and commitment I guess. I think most men have the opportunity to gain a good head of hair again using HTs, as long as you plan and understand. If you're heading for a severe NW6/7, you have to be very frank about it and what you can achieve. If it won't give you the hair you desire, it is a bad choice to make a go of it. I have a feeling I'm heading towards NW5 - so still a pretty advanced balding pattern, but hopefully with the right doctor and the right plan there is a good future on the horizon. I'd rather wait a while longer though and try as best as possible to make sure the possibility of an NW6/7 is unlikely. Without propecia the need for detailed analysis and planning is even more paramount and I really have to think about what can be achieved and how best to go about it.

 

Anyway, yeah, in short the work of HT doctors constantly amazes me. But the real work seems to be at the beginning, when doctor and patient do their utmost to analyse the situation and come up with a crystal clear, realistic, contingency-calculated plan that will provide results everybody is pleased with. I think a lot of patients still hear what they want to hear and regret it. You have to be very frank I guess, but the options and techniques available now are more successful than ever, and I think if you choose the right surgeon and come up with the right plan, the majority of men will find a path that suits them and that transforms them.

[Bill - Seemiller]

Thanks for everyone's valuable input on this topic.

 

Hair restoration is more like a journey than a single procedure. While we live in a world of instant gratification, if often takes multiple hair transplant procedures sometimes in conjunction with medical therapy over many years to achieve the kind of results we all want and deserve. And even then, restoring a "full head of hair" isn't possible for many patients since the demand for hair in balding areas is far greater than the donor supply.

 

That said, many patients who select a quality physician are very happy with their results (including me) and feel that it was well worth the time and money.

 

I look forward to more feedback.

 

Best wishes,

 

Bill

[Bill - Seemiller]

Does anyone else have any thoughts on this important topic?