posted by ISHRS on August 26, 2012

Hair restoration surgery (hair transplantation, scalp expansion, flap grafting, etc.- See Surgical Hair Restoration) does exactly what its name says it does-it restores hair to areas of hair loss. It is a cosmetic procedure. Its purpose is to improve the esthetic image of the man or woman who has experienced loss of hair and wishes to restore his/her appearance. It is a highly successful procedure that achieves the satisfactory outcome desired by the great majority of patients.
Hair restoration surgery is a procedure that cannot be undone after it has been accomplished. It can be revised over time with additional surgery, but it cannot be undone. Unlike tattooing that may be done, then regretted and removed with expensive, painful laser surgery, permanent hair restoration surgery must be undertaken with careful forethought and consultation with the physician hair restoration specialist.
One of the keys to satisfaction for both patient and physician hair restoration specialist is for both to understand one another thoroughly before hair restoration surgery is undertaken. The physician should ask as many questions as are deemed necessary to achieve understanding of the patient’s wishes. The patient should be fully forthcoming in all answers, and should in turn ask as many questions as necessary to feel fully informed. Some basic questions that need to be addressed include:
Why does the patient want surgical hair restoration?
What does the patient want surgical hair restoration to accomplish? While the answers to these questions would seem to be obvious, the answers can vary greatly from patient to patient.
The question Why does the patient want hair restoration surgery? may in rare cases reveal reasons that are not adequate justification for undergoing surgery. For example:
A chronically depressed prospective patient may want to undergo surgical hair restoration as a “psychological energizer”. The physician hair restoration specialist can usually detect chronic depression in a prospective patient and refer the patient back to psychological counseling and treatment. Surgery is never an appropriate treatment for a psychological condition. Surgical hair restoration can and does appropriately lift the spirits of a person whose appearance has been changed by hair loss. However, chronic depression is an illness that requires appropriate medical treatment and counseling. When the patient’s depression is adequately treated, the patient may be considered for evaluation by the physician hair restoration specialist.
A person who presents himself/herself as a candidate for hair transplantation is revealed during consultation with the physician hair restoration specialist to be a somewhat less-than-enthusiastic candidate. The reason, upon further discussion, often proves to be “pressure” from a spouse, fiancé, or member of the family to have hair transplantation. A person who feels forced into undergoing hair transplantation will have inadequate commitment to the procedure or to its outcome. The person(s) applying “pressure” may be the final arbiters of satisfaction-a situation alien to the doctor-patient relationship.
The physician hair restoration specialist may infrequently encounter a prospective patient who is preoccupied with almost undetectable or imaginary defects in appearance. This is a person who may go from doctor to doctor seeking surgery to “correct” what the patient claims to be serious cosmetic defects, but which the physician identifies as imagined defects or slight cosmetic variations that would not benefit from surgical intervention. Preoccupation with imaginary or almost undetectable cosmetic “defects” is behavior called body dysmorphic disorder; to read more about the diagnosis, go to the See Mayo Clinic website.
The question What does the patient want surgical hair restoration to accomplish? is usually resolved by discussions between patient and physician hair restoration specialist. In the great majority of cases, patient and physician arrive at agreement on realistic expectations for outcome. For example:
The male patient with extensive hair loss does not have enough reserves of donor hair (See Surgical Hair Restoration) to permit restoration of a “full head of hair”. However, carefully selected use of donor hair that is available can overcome the appearance of extensive hair loss and create cosmetically acceptable enhancement. The patient may be pleased with recreation of a hairline that provides a “frame” for his face, and enough hair across the scalp to negate an appearance of total baldness.
The younger man with beginning hair loss may begin with a wish for one-time hair loss correction, but comes to understand that his hair loss is likely to be progressive over decades, requiring a number of hair restoration procedures over the same period of time. In order to serve their patients well, physician hair restoration specialists may ask numerous questions about the patient’s medical history, family medical and hair-loss history, smoking history, current medications, and the patient’s feelings about himself/herself.
All of these questions may have bearing in the overall assessment of the patient as a candidate for surgical hair restoration. They are also useful in discussions with the patient regarding likelihood for successful outcome of surgical hair restoration.
The patient should feel able to ask questions of the physician hair restoration specialist at any time. Well directed questions, honest and full answers, discussion and agreement on all matters relating to the hair restoration procedure are as essential to good outcome as is the surgical procedure itself.