Psychological Screening

[pkipling]

I'm curious as to what a lot of you think about the extent surgeons should go to in order to accurately determine if someone is psychologically suited for a HT or not. Are there any doctors that have some sort of protocol in place to reach such a conclusion? Or is it based on a gut feeling?

 

Way too frequently, I see guys coming on the forums in a state of panic/distress/depression following a procedure, and it seems that more often than not, their concerns aren't valid. They panic if they don't have a full head of hair within the first 2-6 months, and can't understand why they look worse than they did before, they think they made the worst decision of their lives, they feel like all hope is lost, etc.

 

I see two things going on here that seem problematic to me:

 

1) It often seems as if they had absolutely no explanation of what to expect after the procedure and what they were in store for. When I had my consultation, it was explained to me clear as day what to expect and when to expect it, and also what not to expect. I believe this to be standard practice - especially with the top surgeons - but either many of these guys are not being educated by their surgeons when scheduling their HT, or they simply don't listen to a word the doctor says.

 

2) The only other alternative I can think of is that some people just aren't emotionally/psychologically ready for a hair transplant. With these people, no matter what the surgeon does, no matter how great the experience is, no matter how fantastic the results - the final outcome could be deemed disastrous: a very distraught, unhappy, unsatisfied individual who's left feeling more insecure the months/years following the procedure than he was before.

 

I bring this up because I suffered for years from an anxiety disorder of my own. I read some of these posts from guys following a procedure who think the world has ended because they don't have results at 2-3 months, and I know all to well that feeling of panic and distress (not with my hair transplant, but with other situations years prior). I went through quite a bit of counseling and therapy to help straighten my brain out when it starts to get funky, and I have an entire arsenal of tools I can use when my anxiety starts to get the best of me. It's clear to me that some of these guys don't have that, and they find themselves in a seemingly hopeless situation with no tools on how to get themselves out of it. (Except for coming here, of course - where we can sometimes talk them off the ledge). I'd rather not see them reach that state to begin with though....

 

So what do we think is the issue in these cases, and what, if anything, can be done to prevent this from happening? Are there some doctors that simply need to do a better job of making sure the patient is fully aware of what to expect and what not to expect after the procedure? And/or does their need to be some sort of screening process to determine if someone is mentally and emotionally ready for a hair transplant and everything that comes with it?

 

I know these cases aren't the norm, but they seem to happen much more frequently than I think should be normal. The hair loss journey is tough enough as it is without having to go through such unnecessary mental anguish during what should be a very exciting time.

Edited December 1, 2015 by pkipling

[Dr Tejinder Bhatti]

Mr. Pkipling,

 

This is a very good subject but one that is very difficult to answer easily. I believe that, as medical professionals, we have a responsibility to do no harm (which is one reason I ceased performing FUSS). One of the ways we can "do no harm" is to deny cosmetic surgery to those that may not be able to handle the emotional toll it can inflict because in the long term the procedure may cause more problems than it solves by putting the patient into a state of despair that is not easily resolved. FUSS can create this issue by the mere presence of the donor scar regardless of how excellent the result is. Bad growth only compounds the issue and in the case of FUE, even without the linear scar, bad growth can decimate one's emotional and psychological well being. Patients get a hair transplant to look better and when they believe this is not going to be the end result, or worse, they believe they are having a negative result, everyone loses.

 

During consultations we have to use our very limited amount of time with the patient to spot any issue that may indicate something is amiss. In my clinic, however, I choose to use this time to get to know the patient as well as I can for the general well being of the patient and the success of their procedure. By establishing a positive rapport we can influence the overall tone of the post-operative process. This is one reason why I do all of my own consultations as well as pre-operative and post-operative interactions. I try to have a relationship with the patient and with thorough education before, during and after the procedure we can greatly reduce the incidence of despair even in those that may have originally had misconceptions about the timeline for growth. These issues arise when patients are left alone after surgery and have no one to reach out to so they rely on photos of other patients to judge their own success, for better or for worse. I feel this is wrong and is why we see some patients panicking well before it is necessary to do so.

[JON86]

This is a great topic and not discussed nearly enough. I believe where you are mentally is just as important as your donor tbh. Realistic expectations is the key to doing this. I can only speak for myself but in the beginning I had no idea what I was looking for or what I was doing. I would have chosen terribly been in a bad situation now. I had no idea of what to look for in a doctor and my first choice was an awful one. The doctor is banned from this site and not allowed to be spoken of. All I will say is he is in South Florida and claims double density so that might give you an idea. I had no clue as to how this industry worked. Luckily things happened that prevented me from going through with it. I am much more educated now and that is the key really just as the great Dr Bhattia has said. A patient needs to be educated and realistic. It's really sad to see that there are lots of clinics that spend so little time with patients. I have been on so many consultations now and it is ridiculous that in some I was not even evaluated by a doctor but by a sales person. I am not naming names but there is a doctor on here that is recommended and he didn't even look at my donor hair. If you have a surgery with this clinic you have to schedule a phone call or skype if there are any problems. It can take weeks or months to get a response. Sorry not what I am looking for in a surgeon. This is a lot of money especially in the states and we deserve better treatment in my opinion. There is a patient on here that said the same doctor didn't even look at him after his procedure and that is ridiculous and terrible bed side manor in my opinion. After care is non existent at that clinic. In my opinion after care is just as important as the surgery itself. Being left alone on an island to deal with this seem like a scary thing. Everything Dr Bhatti said in his statement is what should be the norm . Doctor should be with you before during and after. He is very ethical but there are clearly lots of clinics out there that are not. Luckily I know what to look for now and was patient in making a choice. Everyone has their own choice as who to choose if they get something done. Personally I choose ethics over price. Yes emotionally health is very important. Two years ago I was a mess but now not so bad because I am educated. In reality I am a 3v pattern so not so bad but two years ago I was bald in my mind. But to answer your question two years ago my emotions would have screwed me. I look at things differently now and am inspired by people that are class five and six and deal with it and still find a way to look great.

[esrec]

Responsibility goes in both directions. For every patient that remains uninformed or proceeds with unrealistic or misguided expectations, there's a doctor who doesn't take the time to properly educate, or worse, makes false promises to the patient.

 

A candidate who thinks he should have significant growth in month 3 is just as irresponsible as a doctor attempting to predict hair loss patterns 10 years from now. Communication is key, both pre and post op. Ultimately, the recommendation process needs to be updated to help mitigate some of these more avoidable issues.

[Bill - Seemiller]

I really appreciate you creating this topic because I think it's a very important one. That said, I disagree with Dr. Bhatti about FUSS and now fear that this topic will turn into a strip versus FUE debate, which I do not want to see happen. So please, I ask that people do not use this topic as a venue to debate strip versus FUE as this is done on many other topics. That said, I think the key is education. Too many patients go into surgery on educated not knowing what to expect. Many patients do not understand that it takes up to a year or even 18 months for the results to grow in. I've seen patients post on this forum way too depressed and distraught blaming their physician at three months for a lack of results and are in complete shock that their transplanted hair is how falling out between 4 to 6 weeks.

 

I think there is a joint responsibility for both the patient and the physician. The physician and the clinic should do everything they can to educate the patient about the procedure and what to expect. This includes whether or not the patient will most likely need multiple procedures to meet their goals and discussing the reality that they will most likely never achieve a "full head of hair" again. Sure an adequate illusion of density can be re-created and their hair make up here full, but original density may never be met especially for those with extensive baldness.

 

Then there are the risks of complications, which is true for both FUSS and FUE. Patients need to be willing to take those risks before undergoing surgery and understand that some things happen that are beyond the physicians control. On the other hand, I believe that quality physicians should stand behind their patients and do the best they can to help them in the event that something goes wrong. After all, many patients spend their life savings on restoring their hair and if things go wrong, not only have they lost their life savings but they may even look worse after surgery. This includes sparse growth, excessive scarring, infection or ongoing redness in the recipient or donor areas, and more.

 

While physicians and clinics should do their best to educate patients, I also feel strongly that patients should go beyond the clinic and research the procedure and all doctors they are considering. This forum is a great place for that. We also have websites found in my signature below that fully explains the procedure and what to expect. In my opinion however, nothing beats speaking to other patients who have been through the procedure. That's what makes this community so great, there are so many willing patients who are excited to give back and help others. A special thanks to those committed members who giveback each and every day and help other members get the information they need.

 

But what about those patients who never find this forum? Sure a simple search on the web will lead people here, but patients must be willing to do the research. Too many people blindly trust doctors and clinics and then later wonder if they made the right choice. I think it's important for patients to be confident in their decisions before they move forward.

 

As for their mental state, I do you think it's wise that clinics perform some type of test if possible to determine their mental state. Regrettably however, I've spoken to a number of doctors after-the-fact telling me that the patient was not quite right but they took them on his patients anyway. The number one thing I say to them is, "then why did you take them on his patients?" The typical response is that the physician felt bad for the patient and wanted to help him or her, which is admirable however, if a patient is not in the right state of mind, they will most likely never be satisfied and loss, will be in a worse state after surgery then before surgery. I think physicians need to turn down patients who they feel don't have an adequate understanding of the procedure and/or aren't mentally prepared for it. That's of course, just my opinion.

 

Best wishes,

 

Bill

[home1212]

I know before my HT, Dr. Rahal's office required my general practitioner to complete a medical assessment form and to perform bloodwork. In reading the form before my doctor signed it, it not only asked if I was physically suited to undergo a HT procedure, but if I was taking any sort of medication or therapy for psychological or depression issues. If the answer was "yes" - there were additional questions to follow. So besides this type of routine medical screening, that's all I'm aware of - but totally agree, there are many people recently who've come on the forums who seem to exhibit signs of mental instability or at least are not prepared for the healing stages that follow a HT. Patience and a good state of mind is definitely required before and after the HT procedure. This issue should defintely be discussed further...

[Hairsearch21]

Guys...

Common.

 

Whats the problem with a little bit of crying after the procedure?

3-4 months post op is the toughest part of the hole HT journey.

Thats what most people say and as im exactly between the 3 and 4 month mark i defenitely agree with that.

 

But hey... Time will pass anyhow.

If someone is crying or smiling. Time will went by... No matter what youre doing .

And thats the good news.

But i think its totally understandable that this time when things start to happen and you cant wait for it is a tough one.

 

So there is nothing wrong to come to this place and tell all those guys here your worries.

I think this side is important before you undergo a surgery.

But its also important AFTER the surgery.

 

And day for day the time flies by and around the 6 month mark all this "superbig problems" just vanish.

And hopefully youre superhappy with your "result" from there on .

 

All the best.

[Melvin- Admin]

Fantastic topic, I've seen pretty recently some individuals discuss their "disastrous" situation, but when looking at pictures it's hard to gauge what they're actually talking about, it's absolutely vital to screen patients and educate them properly on how or what thins may look like for the next several months. Far too often you'll see surgeons say you can return to work with no hat after a few days. Whattt are you kidding, scabs don't start coming off until 2 weeks, and if you have sensitive skin it may be reddish for upwards to 6 months, physicians and patients need to really sit down prior to having surgery and go over everything, including why they want to have the surgery, if it's a guy having a midlife crisis or young really bald guy wanting that bieber hairline, these guys may not be suitable candidates due to expectation and or state of mind.

 

What happens is that these guys now have the procedure and regret having it because they were either in a bad state of mind or did not have realistic expectations. They were not properly assessed and unfortunately, they are not educated until after its too late, now they're left with regret, and mentally perhaps they are not fixable, even if you were to give them the most natural looking result, perhaps it's either not enough for the young guy, or too unnatural and weird looking for the older guy.

 

When doing something cosmetic that will alter yourself, there's a certain degree of normality that goes along with it, much like we felt when we started going bald, we felt like our identity was being taken, now it's the same except opposite, now these guys feel like they can't recognize themselves. It's a bad situation to be in, and I feel for those guys, this could've been avoided with proper research and assessment.

[esrec]

Well said HT.

 

You touch on a number of topics that don't get enough press. We speak alot about pre-op education as we should, but there's such variability in post-op by patient it becomes difficult for doctors to give honest and accurate timelines. Creates a pretty sticky situation.

 

I'm 8 weeks post-op as of yesterday. If I hadn't planned a few months of travel I'd be f**ked. I still look pretty avg and that's with a pretty decent amount of hair and modest 2450 grafts with Dr. Shapiro. The staff has been nothing short of outstanding, but not even they could predict how long my native hair would take to grow back, or how much I would shed and how quickly, or what hairstyle or concealer would best mask me in the meantime.

 

Point is, these scenarios all need to be discussed ad nauseum. The patient needs to really push their own education on the front end, but there's factors post surgery they dont know to ask. And how could they?

[newbie33]

I... now fear that this topic will turn into a strip versus FUE debate

 

I wonder, has anyone ever thought about creating a strip v fue thread? ;-)

 

 

This is an interesting topic. I think a lot of point one would be covered in any discussion around 'informed consent' in most countries with a developed medico-legal system. Or at least it should be.

 

Point two is a bit more difficult. People's expectations can be wildly optimistic, no matter what they are told and seemingly understand about a possible 'good' outcome. I would think most ethical doctors would be weary of operating on a patient who displayed those kind of unrealistic expectations. But realistically, how much time would there be to discuss and pick up on this in a pre-surgery consultation?

[Hairsearch21]

How should anyone (maybe god) know how the result will look like at 3-6-9-12 months?

Thats simply not possible guys..

 

You can get an idea from others who underwent the surgery already but thats it.

Noone not even the doc can imagine how exactly the final product will look like..

 

And when the patient is at 3-4 months, the hairs start to sproud out the skin and the density is low (as it is totally normal at this stage and most patients know that) its a human reaction to disbelief in the work of the doc or to just think maybe i want have the result im hopeing for.

So all this guys (me included) at this stage will worry and its normal..

Let us cry when we wanna cry

And in just another 3 months most of us will stop crying and post updates with very nice progression and we all will be thankful to the guys who helped us in the past hard months .

[matt3480]

Let's be honest....do most patients really read the pre-op paperwork (with the exception of what medications to take and when)? Probably not.

 

Hair transplant surgery is very unique. It's not like getting a nose job or boobs....where the result is instantaneous. It's very unique in that the hair falls out for months that was there after surgery and then maybe it grows back...maybe it doesn't.

 

I do believe that people who come on here who don't know the very basic principle that your hair will shed after the transplant almost have no business getting a HT. If you don't even know that....how can you even have the knowledge to pick a good surgeon...which is the NUMBER 1 factor in a successful or failed HT.

[pkipling]

Good thoughts on all of this. I was quite spoiled by the amount of one on one time I got with Dr. Mohebi at my consultation. Not only that, but there was an open door policy with the entire staff that allowed me to call the office anytime leading up to my surgery with any questions I had about the procedure, what to do before, what to expect after, etc. They were always extremely patient and willing to help - and I suspect this is the case with the majority of surgeons, especially the really credible ones.

 

The point is that Dr. Mohebi (and other doctors like him) left very little room for me to even justify in my head freaking out at week 4 or week 8 or week 12. And any questions I did have the weeks following the procedure were answered immediately with a phone call to his office.

 

Unfortunately, this isn't always the case. Add to that that some of these guys are prone to anxiety in the first place, and when they're uninformed and don't have access to their surgeon and his/her staff, things can go south quickly. There's obviously no way to cover every possible scenario or question that could arise post-op - but there are some pretty standard guidelines that a lot of guys seem to miss.

 

@Newbie23 - Now I'm curious if there's a correlation between the guys that seem to have been the most ill-prepared for surgery and the country they're from. The consent form in the States, for example, may be a lot more detailed than in other countries. It'd be interesting to see if certain countries have a higher percentage than others of patients coming online in a state of panic over something that's standard and routine. Maybe I'll do some research....

 

@HTSoon - Very well said. The regret and panic and overwhelming state of anxiety is what I would love to see some of these guys avoid - especially when what they're experiencing is more than normal.

[newbie33]

[quote

@Newbie23 - Now I'm curious if there's a correlation between the guys that seem to have been the most ill-prepared for surgery and the country they're from. The consent form in the States, for example, may be a lot more detailed than in other countries. It'd be interesting to see if certain countries have a higher percentage than others of patients coming online in a state of panic over something that's standard and routine. Maybe I'll do some research

 

"Newbie23", you flatterer, you!

 

It's not the country the patient comes from, it's the one they get the operation done in that's important. In the UK, of which I know best, there are well developed laws about 'capacity' and what 'informed consent' means - with emphasis on the 'informed', which doesn't just mean you have signed a form.

 

A patient can sue if they did not believe they were sufficiently informed to give full consent. And this tends to concentrate medical professionals' minds on having a process that makes sure the patient is in a position to understand the risks of their operation (or minimise their chances of being sued, which might not necessarily be the same thing). So it's normal for them to explain the complications and risks which might arise from the surgery and that the patient understand they may suffer these, along with the routine aspects of what they can expect after surgery.

 

In the more litigious US, I'd imagine it's pretty similar. As I'd expect (but don't know) for most of Western Europe. But elsewhere, I have no idea.

[pkipling]

"Newbie23", you flatterer, you!

 

Haha. You're not a day over 25, I'm sure.... :cool:

[biolizard]

Fantastic topic, I've seen pretty recently some individuals discuss their "disastrous" situation, but when looking at pictures it's hard to gauge what they're actually talking about, it's absolutely vital to screen patients and educate them properly on how or what thins may look like for the next several months. Far too often you'll see surgeons say you can return to work with no hat after a few days. Whattt are you kidding, scabs don't start coming off until 2 weeks, and if you have sensitive skin it may be reddish for upwards to 6 months, physicians and patients need to really sit down prior to having surgery and go over everything, including why they want to have the surgery, if it's a guy having a midlife crisis or young really bald guy wanting that bieber hairline, these guys may not be suitable candidates due to expectation and or state of mind.

 

What happens is that these guys now have the procedure and regret having it because they were either in a bad state of mind or did not have realistic expectations. They were not properly assessed and unfortunately, they are not educated until after its too late, now they're left with regret, and mentally perhaps they are not fixable, even if you were to give them the most natural looking result, perhaps it's either not enough for the young guy, or too unnatural and weird looking for the older guy.

 

When doing something cosmetic that will alter yourself, there's a certain degree of normality that goes along with it, much like we felt when we started going bald, we felt like our identity was being taken, now it's the same except opposite, now these guys feel like they can't recognize themselves. It's a bad situation to be in, and I feel for those guys, this could've been avoided with proper research and assessment.

 

Very well stated HT. I love reading your post, you're so incisive and write so eloquently. Thank you for your post.

 

I'm not going to rehash my whole story here on this thread (some are familiar my grievances from previous post and threads) , only to say that the of psychological evaluation needs to be seriously addressed within the hair transplant industry.

[Sam23]

i m one of those people that make a lot of noise and nagging after HT cuz i was not educated

 

I became like this gradually, i will take the chance to make a new noisy reply

 

- After I saw many people around me had HT and have good results, i said to myself why not, it seems it is something so easy these days and everyone doing it

- I checked quickly on youtube and some pices on the net and this increase my believe this will work, this is the right move, so i decide to do it

- I went to famous clinic in my area after some recommendations, and they convinced me that this surgery is super easy without pain and even so small scars unoticable, they convienced me that they apply a new technique nobody use it so far called (stem cell fue) which use so small tools 0.5 to 0.7 maximum and there are 30 to 40% regrowth in donor area ( they showed me a lot of succesful cases and really they were amazing

- I choose the doctore myself after saw his results and read his CV doctor he is (ishrs & eshrs) 15 years only Fue (doing only one opestion per day and everything by his hands woth team of 5 technicians)

- they told me you have to wait 1 year at least to see the results ( so i did not give a lot of weigh to this factor)

- i did the procedure

- Start reading during recovery time, reach to this site and then i saw the truth (a lot of information i did not think about it before) start feeling worry and think what i did to myself, this is not simple procedure this a life changer, this should be planned carefully

- each time i read something, i asked if the doctor did this ( like forehead measurement or hairs directions, grafts number) to all details and a lot of doubtness about the procedure

 

- Just one thought destroyed everything and make me freaking out ( there is nothing called Stem cell FUE, it is commercial scam, baldness will continue if you did not take Fin and later on you will end up with isolated hairs and you cannot shave because there will be scars no matter what the skills of the surgent)

 

- A huge depression i stop doing anything, i do not care about anything anymore in mylife i hate myself, i feel i m fake, i ve became so obssessed about HT and gave up hope and start love being bald, i wish to be be bald with clean shiny scalp

- After while i stop recognize myself, and just wander who was that guy with full energy (before HT never sleep more than 6 hours so active, now i sleep all days and i wish never wake up)

 

At least maybe i was lucky and blessed that i end up with surgent hand not a technician but i m not optimistic as i did not find the surgent name here also

 

I m still following up with my Doc and the clinic each 15 days or month and to be honest they always happy to answer all my questions, even they called me to check on me if i did not go to see them

 

One last thing, as i like this site and all the supporting that people give here, but when you r reading, it exaggerates the things in your mind, in reality you say to yourself it is just damn hair who cares, but when you read here you feel no this is more than hair and it is not alright at all

 

So sometime i think it was better if i did not come here and being enlighted after surgery maybe it was more easy to myself

Edited December 6, 2015 by Sam23

[Sam23]

Biolizard you and me are the most nagging people here

[biolizard]

Biolizard you and me are the most nagging people here

 

True. I have a lot of excess emotion and energy over this. I have to find some place to vent it.

 

Also, I really want others to not repeat my mistakes. The way I went about this HT was totally wrong. It's funny, but after the fact, I now know everything I wish I would've done. I feel victimized by the slick FUE marketing out there. An FUE is not something that should be entered into lightly.

 

It is MAJOR life altering SURGERY! And that's often NOT how it's portrayed by the hair transplant marketing machine. The reality is FAR different than what was advertised!

 

At best I was GROSSLY underinformed, uneducated, and ignorant to exactly the immensity of the journey i was about to embark on. I was in a midlife crisis depression. I made an impetuous decision. I wanted to believe that things were as easy as the advertising made it seem, so I unsuspectingly went through with the HT.

I'm sorry but, signing a sheet the day of surgery, full of fine print and medical-legal mumbo jumbo jargon does NOT count as me being properly 'informed'! I can see all the red flags NOW. At the time I was not able to see them. I do regret this HT and I would hate for someone else to replicate my mistakes.

 

I've listed on other sites what I wish I would've done: (only learned this after it was too late for me) now I'm stuck just trying to make the best of this bad situation.

 

And my hair misery will not end soon. It will just change form. Certainly I'll have MANY more problems to contend with soon in the near future as my native hair loss continues to progress. I am unable to take propecia. My HT surgeon NEVER once discussed ANY post op hair regimen. Again I had to do all that research on my own. Research that I should've been required to do PRIOR to a doctor permenantly altering my image. I am really disappointed to find out just how little even many of these 'recommended' docs do to ensure that what the patient wants, is also in the patients best interest. As patients we are frequently ignorant, self conscious, and freaked out about losing our identity and our hair. We are not in a solid state of mind many times. We foolishly trust that some of these 'doctors' will always do what's best for us. That is however, not often the reality of some of the HT industry docs I've experienced and read about.

 

Here is a list of what I wish I would've done done prior to jumping into this major hair transplant surgery:

- initial HT consultation with at least 2 coalition doctors

- try the big 3 meds first for at least 6 months; pay attention to side effects

- continue researching HT procedures, techniques, results and doctors for 12-18 months

- understand location and cost should not be constraints

- measure donor & recipient density/hair bulk, loss pattern

- consult with dermatologist for any possible reactions

- understand the procedure end to end including surgical process, expectations, common side effects in the skin, healing and care

- consult with psychologist (no joke) to understand if I would be able to handle the change

- consult with coalition HT doctor again and draft a master plan

- see a HT result in person, performed by different doctors; all pictures can lie; lighting and angles deceive

- Look for pictures and posts of good AND bad HTs

- Know your options for HT repair

- shave head and keep it that way for at least 1-2 months, see if you like it

- read bald guys forums for support and tips to maintain a buzzed dome

- After 12-18 months, if ready, try HT and be as conservative as possible

[Sam23]

My friend, we cannot do anything now, i m in the same situation like you, you know that

 

Consider yourself now in jail for one year, you need to live in this prison now and stop denying what you did, and later after one year we will see what are our options at that time

 

Try to find something make you away from mirror, for me it was video games and movies and novels really help me a lot now i do not look to the mirror only few times per day, when i go out i put a cap and forget it, i think i start get used to it or because the skin has improved so it does not bother me so much like before, i hope it will be better in few months

 

Best of luck