What makes a good candidate for Hair Transplant surgery?

Hair transplantation involves moving follicles from a high density permanent (donor) area at the back of the head to a low-density balding (recipient) area on the hairline or in the crown area. But not everyone is a good candidate for HT. There are a number of considerations that come into the mix. Here are thoughts from our hair loss expert Spencer Stevenson of spexhair.com and his experience…

Realistic expectations and a good understanding of the process are also critical. You need to understand that your hair loss might continue to progress even if you are taking prescription medication to stop the progression. You also need to understand exactly what will be happening to your head during the HT procedure and the types of surgery that are available (as well as those you should positively avoid!)

Expectations

You need to remember that there is a finite amount of donor hair that can be moved to the thinning areas of the scalp. If that hair isn’t used in an efficient manner the outcome of the procedure might not meet your expectations.

If you thinking that having small surgeries to keep up with your hair loss is a practical way to address your hair loss issue you need to think again. Patients with a significant amount of hair on their scalps run the risk of ‘shock loss’ of some or much of their existing hair caused by the trauma of the surgical procedure. In some cases this lost hair will not return and you could be left with thinner hair than before the procedure.

Poor candidates for HTs are:

• Men with ‘diffuse unpatterned alopecia’ (DUPA). These men have an unhealthy donor supply, making them poor candidates for a hair transplant.
• People with diseased donor supply for any reason. This is more common in women than in men and typical for some forms of genetic androgenetic alopecia in women.
• Those with low hair densities.
• Those with a lack of adequate funds to continue surgical hair restoration over time.

Hair transplantation is a long term solution to a long term problem. Several surgeries might be needed to achieve the result you are looking for. You need to ensure that the funds are available for the whole programme, because it is just isn’t something you can pull out of once started, nor can you sporadically have a surgery when you’ve got some spare cash.

Hair and scalp characteristics- why these affect your suitability for transplant surgery.

The characteristics that are most cosmetically important are: hair colour (especially relative to the underlying skin colour), hair curl (or lack thereof), and hair caliber, or cross-sectional area (in other words, is the hair shaft fine or coarse?). The best hair restoration surgeons will take all these factors into consideration when planning a procedure, in order to give the greatest aesthetic benefit to the patient, with the minimal use of the limited donor hair.

Characteristics

Hair caliber, or cross-sectional area is actually more significant than density in its ability to cover bald scalp. The appearance of baldness, particularly where the hair is thinning but still evident, is due to light penetrating past sparse or absent hair, and then being reflected off the scalp. The more hair that is in place to block the light, the less the appearance of baldness will be. Increasing the caliber/thickness of hair would do more to block light than doubling the density (hence the use of hair thickeners). However, there are other important factors.

One of these is the degree of curl. Generally speaking, the more curl or wave the hair possesses, the more coverage it will grant the scalp. An excellent example of this is Afro-caribbean hair. This hair tends to be tightly wound or kinky, which may be an evolutionary adaptation to protect the scalp in hot climates. Although African follicular unit density tends to be lower than that of Caucasians or Asians, (0.6 FU/mm2 vs. 1 FU/mm2), the curl characteristics lend this type of hair wonderful coverage properties, as it tends to stand thick and mat-like above the scalp, thus blocking much light.

Hair colour, especially as it relates to underlying skin colour, is also of great importance. The less contrast there is between hair and scalp colour, the better the potential for coverage. A blond person with light skin, e.g. of Scandinavian origin, appears bald only after significant hair loss has occurred. This is because their skin and hair colour appears to blend together. The eye sees a high contrast as standing out and areas of low contrast blending together. This low contrast makes for a good transplantation candidate.

On the other hand many Asians have good density and excellent hair caliber (coarseness), but they may be more challenging hair transplant candidates. Dark, straight, coarse Asian hair is high contrast against relatively light scalp skin; the eye notes the contrast and follows the straight hair shaft right down to the scalp, which appears balder than in someone with more favourable hair characteristics.

We can see then that a combination of many factors play a part in determining who will be a poor, good or excellent candidate for hair transplant surgery. High density is great, but unfavourable hair characteristics may offset some of the benefits of this density. On the other hand, someone with curly, coarse, salt-and-pepper hair (very good characteristics), but with poor donor density, may also not be the ideal candidate.

Scalp flexibility also has a part to play, known as scalp laxity – i.e. how tight or loose your scalp is. A tight scalp (low laxity) is more difficult to remove follicles from and transplant into than a loose scalp (high laxity).

So it isn’t just as simple as deciding you want to have a transplant to deal with your hair loss. There are many factors which will dictate whether it is a suitable route for you. This is where the experienced, artistic, knowledgeable and honest hair restoration surgeon really shines: he knows whether it will work for you, he won’t take your money and then leave you scarred physically and mentally, and he will work with the positive resources you do have, to ensure the best possible outcome for the present and for the future. I’ll go into more detail about how to choose the right surgeon for you in chapter eight.

What should I be asking myself?

There’s another bit of research that is critical to your decision process when considering hair transplantation and that is the questions you need to ask of yourself.

It’s all too easy in your panic and desperation to rush off to the nearest or cheapest HT clinic. Just don’t do it! A reputable and good surgeon won’t in any case just pop you in a chair and start moving your hair around your head – but there are those that will! HT should be the last method you resort to in managing your hair loss and you need to ask yourself some probing questions before you even make contact with an HT clinic.

Questions such as these:

1. What level of baldness do I actually have?
2. Do I, to the best of my knowledge, have a healthy area of donor hair.
3. Do I understand the realities of what a hair transplant can and cannot do?
4. Have I exhausted other alternatives? (Even if you have male pattern baldness, which could eventually be helped by transplant, hair loss at its earliest stage is best treated with medication. The use of medication may forestall a transplant for years.)
5. Have I researched this thoroughly and given the matter considerable thought from every angle?
6. Do I know what I am going to lose by going down this route and what I am going to gain?
7. Do I understand all the consequences of doing this including things like time off work, all the financial costs, the cost to my relationships, etc.?

Particularly if you are under 25 years you should ask yourself the following questions:

1. Have I looked into other options?
2. Does my hair loss really bother me that much?
3. Have I given medication a try and waited long enough to see the results?
4. Have I thought through the financial implications of multiple surgeries over my lifetime?
5. What will happen if I continue to lose hair after the surgery is done?
6. What balding pattern does the doctor think I’m heading for?

And the big question you need to consider at any age is: What is my aim in going down the HT route?

Now, the answer might seem obvious, I want my hair back! However, there are deeper questions you need to explore.

Here’s a little exercise to help you:

Imagine yourself with the head of hair that you really want. Imagine what your life is like with that head of hair – what do you see, hear and most importantly, feel now that you have it? Now focusing on those feelings write down three words that describe how you feel – use simple words e.g. confident, energised, focused, light, motivated etc. rather than complicated phrases.

Now focus on those three words. What do you already do or have in your life right now that gives you those feelings? What else would give you those feelings now or in the future? Survey your life for anything (I mean anything) that can be described with any of those three words.

Putting your attention on those aspects of your life where you already have those feelings, or that could give you those feelings, will help you feel happier right now and help you put your potential HT into perspective. Because having an HT is not a panacea for making your life better. It won’t solve all your problems nor will it automatically make you happy. It certainly might help and it certainly will make you feel better about your image. But it isn’t the only way.

Be certain that your motivation for having that HT is a realistic one and that you aren’t just pinning all your hopes for more happiness in your life on that one thing.

Your Expectations

When you are venturing into HT’s it’s vital, in my opinion and experience, to have a very good understanding of YOUR expectations. It’s important that you understand that your hair’s characteristic, donor supply, donor density, laxity, physiology play the most vital role in the short/long term success of your HT. A competent doctor should work with you to plan the best surgery to get the results you want to achieve, but it needs to be an achievable result. The best doctors are good, and some can even perform miracles, but you need to help them with realistic expectations. You need to understand that Patient X’s hair characteristic may provide them with a completely different cosmetic result compared to yours – even though they had similar graft counts.

Obviously we all try to compare our own situations to various posters or pictures of other guys with similar loss patterns and we all obviously hope for amazing results. BUT although you might feel you are very similar to patient X it doesn’t necessarily mean you are going to end up with the same result – especially not first time round – and this is where your expectations need to be kept realistic.

Everyone wants to have their situations resolved first time round via HT’s but this is very rare. No one gets just one HT – even guys with minimal loss will obtain hair greed and want even more. It’s the nature of the beast: hair and money – we always want more.

The point I am trying to get across here is have a realistic expectation of what you are setting out to achieve – and be aware that YOU the patient need to be aware of the variables that you bring to the table ( your hair characteristics, donor supply, loss pattern, personal goal, donor density, laxity, physiology, previous surgery etc).

The experience of the surgeon is applied to you as an individual in order to enable YOU to reach the maximum potential from YOUR session. Male Pattern Baldness might be a common affliction, but your hair, your density, your thinning areas are all unique to you.

When you are considering the transplantation route you should always meet with the surgeon in person before the day if possible. Once the surgeon can see you in person then the exact and most appropriate plan can be established combining your personal goal and their experience for the best way to go.

Even if you have not met with the surgeon before the day, you should discuss your personal goal in great detail and go through the design and hairline position, plus all the personal factors mentioned above before letting him go near your scalp with a knife! This discussion is also going to determine which method of harvesting is going to be most appropriate for you, and we’ll look at the options in the next chapter.

So now you’ve got an idea of the things you should consider and the research you need to do BEFORE you book a HT appointment. Remember surgery is the LAST resort.