Wait as long as you can before you take the plunge.
1) Surgical hair transplant is irreversible and unless you are absolutely sure, WAIT !
2) People who are too young may not be a good candidate for surgical procedures. Most
surgeons recommend that surgical procedures are more appropriate for older patients, eg:
25 years old and up because the pattern of future hair loss will be more predictable by
then. Surgical procedures will be more likely to yield satisfactory results when the
surgeons can anticipate the patient's future pattern of baldness.
2) It is also wise to wait because there are new techniques
being introduced all the time. The longer you can wait, the more
likely you will benefit from the latest techniques in surgical
hair transplant. For example, recently, comapnies such as
Intercytex, Aderans and many others around the world are
experimenting with cell based hair restoration procedures commonly
referred to as Hair Multiplication. However, it will probably be
years before this technique becomes commercially available in
the market. So if you can wait, you may be able to benefit from
the latest in technology. More info about Hair Multiplication
research can be found in our
- Make a will
Don't laugh ! If you can't wait any longer and decide to have the surgery done, I
think it would be a prudent move to make a will first. After all, it is a surgery and
there are risks involved just like any other kinds of surgical procedures. So make sure
you have a will prepared before you go under the knife. But then to the best of my
knowledge, I have never heard of someone who died because of a hair transplant. (However,
I have heard of people died from other minor cosmetic surgeries)
- Background investigation - Surgeon
Get all the dirt on the surgeon who is going to perfom the procedure on you. Check
with independent local medical authority to find out if there
are any existing or previous lawsuits, complaints or litigations against the surgeon. You
do not have to pull your hair trying to locate all these records. Simply ask the surgeon
directly as to where you can do a background check regarding lawsuits and complaints etc.
As a surgeon, he should have the answer right away as to where you can find those records
in your city. If he or she dances around the subject and tell you something like he
doesn't remember which governmental or medical authority in the city maintains those
records, MOVE ON to another surgeon. This is a good indication that the surgeon probably
doesn't want you to check up on him, and we all know why.
Board certified (for U.S only)
Is the doctor certified ? The American Board of Plastic Surgery
requires a five-year surgical residency. This should be the first thing or the minimum
requirement that you look for in a surgeon.
Surgical privileges with a
hospital (for U.S
Has the doctor applied to a hospital's review board for surgical
privileges ? Usually, this is only possible for the more accomplished doctors.
Since most hair transplant procedures are done in the doctor's
clinic and not in hospitals, some essential equipments (eg: crash cart) and personnel
guidelines may not be in place at the doctor's clinic. Be sure that your doctor only uses
local anesthetic for the procedure. In 1997, a flight attendant decided to get rid of a
few wrinkles on her face by a very simple and routine laser skin resurfacing procedure.
The procedure was done in the doctor's office in Atlanta, Georgia and the patient was
sedated during the process. But when the patient went under, something went wrong.
Georgia's composite State Board of Medical Examiners concluded that the patient and the
clinic were not prepared to handle the emergency. With neither an anesthesiologist nor
monitoring equipment at the doctor's office, nobody in the office noticed that the
patient's pulse rate and blood pressure dropped dangerously low. The patient's breathing
had almost completely stopped before anyone realized that she was in trouble. The clinic
staff called 911 but the patient was dead by the time she reached the hospital.
The surgeon only performs a small portion of the
Don't think the surgeon will perform the entire procedure. In most
instances, the surgeon will only perform the most critical steps, eg: cutting the donor
strip, designing the recipient site, and closing the donor area with suture. All these may
only account for perhaps 30% - 50% of the time. The rest of the work, eg: cutting the
donor strip into micro grafts and planting the grafts will be done by technicians in the
clinic. Most technicians are not doctors. However, please do not be alarmed by this. This
is standard practice and the technicians are usually closely supervisied by the surgeon.
Also, most of the work performed by the technicians are pretty straight-forward.
No New Breakthrough Yet
As of now, we are not aware of any new breakthroughs in surgical
procedures that are truly revolutionary in nature. The latest and the most popular
technology is still the use of micrografts. Although lately there are some new techniques
or patents in the market (eg: Dr. Hitzig's punch grafting technique, NHI's Hair Implanter
Carousel and laser techniques etc.) that may slightly expedite the procedure or enhance
the results to some extent, they are not revolutionary by any means and do not produce a
cosmetically significant improvement over other techniques. There are new research
currently underway that are truly revolutionary in nature, eg: Dr. Gho's follicle
multiplication procedures, but they are not commercially available at this point. So if
you hear some surgeons telling you he has a breakthrough technique that is definitely
superior to the rest in the industry, be skeptical !!
About laser-assisted hair transplant
I have spoken to a lot of surgeons in New York and elsewhere and it appears that
most surgeons do not favor laser hair transplant. Most say that if laser can really
improve the results, many surgeons would have turned to that already. The machine is
relatively inexpensive and easy to use. Most agree that laser can minimize the
bleeding and thus a patient will heal much faster. However, the other side of the coin is
that blood is require for the new transplanted grafts to grow. Laser tends to clog the
blood almost instantly and there is less of a chance for fresh living blood in the
transplanted site to nourish the grafts. In some cases, this may affect the number of
grafts that will eventually grow. Please note that this is just a theory against the use
of laser for hair transplant.
On the other hand, there is a small group of surgeons who insist that laser is the
preferred technique for hair transplant. In fact, they have conducted some small scale
research and studies to substantiate their positions. However, for some reasons, although
laser technique has been around for a fairly long time already, it has never gained
popularity as the preferred technique for hair transplant.
Also, please note that many surgeons tend to shy away from discussing a very common
side effects of surgical procedures - post-surgical shedding. Quite a number of patients
actually lost a lot of their existing hair soon after the surgery. Some surgeons say that
the shedding is related to a surgical shock and the hair will grow back. Other surgeons
say that the shedding result only in hair follicles that are destined to be short-lived
anyway. The post-surgical shock simply expedite the process and bring you to your destiny
sooner. Honestly, I think they are all lying. They are just trying to come up with some
theories to justify the situation. The fact is that nobody knows why post-surgical
shedding occurrs. So bear in mind that you may end up with less hair than before you go
for the surgery.
Vomit During or After the Procedure
It happens perhaps 2% of the time. Nobody knows exactly why but
there are patients who vomitted during or after the procedure. I have spoken to a lot of
surgeons about that and there are a number of possible explanations: 1) patients allergic
to the anesthesia, 2) patients went into surgery without any food in their stomach at all,
Almost at least half the patients experience swelling in their
forehead and part of the face soon after the surgery. The swelling will last about three
days to a week at most. Nobody knows exactly why. Some surgeons say it is because of the
anesthesia. The swelling can get quite noticeable and it would be awkward for someone to
go to work in that condition. There is no effective way to get rid of or stop the
swelling. You simply have to wait till it diminishes. Most doctors will advise patients
using ice on the swelling. I have heard some surgeons mentioned about using cortisone
injection after the surgery to minimize the chance of swelling. Not sure how effective
that is. Also, some doctors advise their patients to sleep on a tilted pillow to minimize
Meeting the Doctor
It is ridiculous that some people will make an appointment for a
surgery without even meeting the doctor. Some clinics are encouraging this practice but I
would never recommend that. In fact, Dr. Bernstein from NHI condemns such practice as
unethical in the medical profession. I had encountered that twice in New York, once at
NuHart and the other time at MHR. In both instances, the consultations were handled only
by consultants. I did not get to meet the doctor who will perform the surgery. I was
even pressured into making an appointment for a surgery by the consultant at NuHart. When
I asked to speak to the doctor who perfoms the surgery, I was told that the doctor was
very busy and I have to make another appointment. However, most clinics in New York
are pretty good when it comes to involving the doctor during a consultation, for example,
the clinics run by Dr. True, Dr. Hitzing, Dr. Bernstein (NHI), and Bosley etc.
This is by no means scientific. However, "judge of personality" can
sometimes be the most reliable method in determining which surgeon you should use. In
fact, this screening criteria is getting more and more important these days. The reason is
that nowadays, all hair transplant clinics have the same sales pitch, it is almost certain
that you will hear the following:
- promise of a natural hairline
- use of micrografts that consist of one to three hairs
- suture closure of the donor area with a small or invisible scar
- promise that you can go back to work in just a few days
- a photo album full of past patients with great results
- that the procedure will be painless
- board certified surgeons with years of experience
Of course, we are looking for someone with integrity and who is
honest, sincere and reliable. You probably do not want someone who resembles a slick used
car salesman to operate on you. Basically, you should ask yourself the question: DO I TRUST THIS SURGEON ? I have seen a lot of surgeons in
the New York area and I must say Dr. True (from Elliott & True) really stands out from
the rest. Not because Dr. True offers any superior techniques that are not used elsewhere,
but simply that he comes across as the most honest. Dr. True will definitely be my choice.
Megasessions are procedures in which a large number of grafts are
transplanted in one session. It may involve anywhere from 1,000 - 3,000 grafts in one
session. Normally, only about 500 - 800 grafts are transplanted in one session. NHI is the
most prominent advocate of megasessions. Doctors who encourage megasessions say that
patients can accomplish a more dramatic result in one session. Also, patients can actually
preserve more of the precious donor hairs because megasessions result in less cutting of
the donor strips at the back of the head. Smaller sessions will involve more cutting, more
suturing and result in more scars at the back of the head which ultimately affect the
integrity, quantity and quality of the ultimate donor hair supply.
However, some doctors do not encourage megasessions. Some say that the procedure is too
involved and there is no guarantee that all the transplanted grafts will grow. Also, there
are concerns that the blood supply of the scalp cannot supply a large session and many of
the precious grafts will ended up being wasted.
Dr. Bernstein from NHI responded to the above comment about insufficient blood supply with
this: "The issue is one of oxygenation, not blood supply. By their very size, large
grafts over 2mm, will result in oxygen deprication to the hair located in their center.
This has been proven over and over again by observing the phenomenon called donuting (the
loss of hair follicles in the center of larger grafts). In contrast, oxygen diffuses
easily into grafts 1mm or less in size. The blood supply of the scalp is among the richest
in the entire body, enabling it to support the growth of large number of grafts, provided
that they are kep very small. "
Guarantee for Failed Grafts
I simply can't understand how they offer this kind of money back
guarantee. Many doctors tell their patients that if any transplanted grafts failed to
grow, they will replace the failed grafts with new ones at no cost to the patient. Yeah
right !! First of all, how can a patient identify a graft that fails to grow ? The grafts
are so miniscule that it is virtually undetectable to the human eye. Second, assuming I
have the expertise to identify a graft that fails to grow, does it mena that the doctor
will perform a full blown surgery on me just to replace that one graft ?
- Brief synopsis of hair transplant events in
Contributed by Dr. Hitzig, leading hair transplant surgeon
- February 1998 - American Society of Hair Restoration Surgery
annual meeting; New Orleans. Dr. Schwinning presents "Why Linear Grafts Create
March 1998 - Dr. Hitzig demonstrates the advantages of the Linear Punch vs. multiple laser
techniques at the WAHRS surgical workshop
March-April 98 - International Hair Transplant Forum; "Linear Slot Grafting
April 1998 - Dr. Hitzig elected Medical Director to the American Hair Loss Council.
May 1998 - Dr. Schwinning heads surgical workshop on Hair Restoration Surgery at IV
International Symposium of Aesthetic Surgery; Cali, Columbia
June 1998 - International Journal of Cosmetic Surgery, Vol 6, No. 1; Linear Slot Grafting
3 Year Retrospective; A how to, instructional paper for surgeons utilizing this new
September 1998 - International Society for Hair Restoration Surgery; Washington, DC. Dr.
Hitzig presents "Enhanced Healing & Growth in Hair Transplantation Using Copper
Peptides" & "Linear Slot Grafting Retrospective". Staff members Louis
Amico, Ronald Kirk and Wilfredo Martinez spoke to the Medical Assistants and led a hands
on technical workshop.
October 1998 - Dr. Schwinning instructs Linear Grafting technique to Physicians in Padova
Hospital, Italy and is featured in Il Mattino Newspaper.
November 1998 - Laser Aesthetic Surgery and Complimentary Techniques, Cambrils, Spain. Dr.
Schwinning presents "Slot Grafting Utilizing the Linear Punch vs. Laser Slot
January 1999 - Good Day New York; FOX-TV. Dr.'s Hitzig and Schwinning discuss the latest
surgical and medicinal treatments available for woman experiencing hair loss.
April 1999- Debra Duncan Show; Channel 13 - Houston,TX. Dr. Hitzig represents the American
Hair Loss Council on panel discussion of female hair loss and it's treatment.
Consumer Education: Dr. Hitzig explains:
Schedule of Open Houses and Seminars
Complete listing from leading surgical hair
transplant clinics. Totally free of charge. Highly recommended for people considering
their first hair transpalnt.
If you want to add to the above checklist, please send your