Why do some patients have great hair transplant results, and some have terrible results. Is it the doctor, or the patient? My doctor made it sound like this is a very routine surgery, and would be hard to mess up. If that is the case, do some people’s bodies just not respond well to the grafts?
Hair transplantation is a multi-step process and is only as good as the weakest link in the chain. A great result is due to the whole transplant team and a poor result is the responsibility of the doctor. Simple. Unless a patient goes out of their way to knock out and abuse their grafts, he or she gets no blame.
That said, there are certainly patient factors that can affect how transplanted hair grows.
As an extreme case, if a hair loss doctor decided to do a hair transplant on a patient who had smoked 3 packs per day, had poorly controlled diabetes for 30 years, had vascular disease, and diabetic skin ulcers, impaired scalp circulation could very well lead to poor hair growth. That truly would be a question of bad patient physiology.
More commonly, patients with fine, straight donor hair and small follicular units will not get as dense results as someone with coarser, wavier hair and more hairs per follicular unit, if the same number of grafts are transplanted into the same area. That is more a question of anatomy and math.
Rarely, patients get less than satisfactory results when there is no obvious explanation.
As a doctor, it is my job to try to assess how good a candidate a patient is before offering surgical hair restoration and to offer realistic expectations for each patient. This should be based on their medical status, hair loss, and their hair characteristics etc. By the way, having complete coverage and the hair density of a hair system or a teenager is not a realistic goal for the vast majority of my patients. Sometimes I need to turn away patients who are not good candidates or who have goals that cannot be met.
We do our best but no doctor is perfect. Hair transplantation is a very reliable procedure but it isn’t perfect either. Almost all of my patients achieve or exceed their expected results. For that to happen, the goals have to be realistic, the plan has to be correct, and there has to be good execution of every step of the hair transplant process. If patients don’t achieve the expected results, whether it is because I don’t incorporate patient factors well enough in my plan, our execution of the transplant isn’t perfect enough, or the reason is unclear, it is up to me to make it right. I am the team leader and make all of the decisions and therefore have to accept the responsibility if a hair transplant is not satisfactory. If there is a great result, the credit properly belongs to the whole team.
Fortunately, almost all of the hair transplant procedures “work.” For the rare ones that “don’t”, it is best to first figure out why and then to fix it.
Dr. Cam Simmons