Hair restoration surgeon Dr. Michael Beehner is recommended by the Hair Transplant Network. To view this discussion and other hair loss topics, visit our Hair Loss Social Community and Discussion Forums.
Dr. Beehner’s comments are in response to the article: Hair Transplant Surgery: Concerns about Long Term Effects
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 transplant surgery and each of these were young men in their 20’s at the time who went on to become VII’s on the Norwood Scale for Hair Loss. 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 restoration surgeon who makes allowance for where you, at your age, are likely to end up. I find that, after the age of 35, it 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 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 a while, 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, 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 a decade or two ago. My own transplants were done around 30 years ago and my wife, who is also 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 a “salt and pepper” look with gray hair mixed in and 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 has.
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, follicular unit extration or FUE grafts into the scar, and scalp micro-pigmentation).
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. 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 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 later go on to bald.
A relatively conservative approach, good artistic surgery, and honest communication between the doctor and patient go a long way to avoiding later regrets and disasters.
Mike Beehner, M.D.
Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q & A Blog.
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