posted by ISHRS on July 1, 2003

The treatment of hair loss, like any other field of medicine and surgery, is constantly evolving in response to new findings from research, new developments in medical and surgical technology, and review of previous experience. Because hair transplants is a form of cosmetic surgery, it also evolves in response to changing expectations of patients regarding the “look” that they hope to achieve from hair transplantation.
Cosmetic surgery is surgery that is performed to enhance the appearance of a patient who is dissatisfied with his or her current appearance. The reasons for dissatisfaction may be largely personal (“I don’t like the way I look”), social (“I think other people don’t like the way I look”), or related to the patient’s occupation or career (“I need to look younger for my clients or my audience.”). In some instances, hair restoration may be one element of the cosmetic treatments a patient may need to accomplish the change in appearance that he or she desires. What can be done and what should be done within the limits of the patient’s age and medical condition, and at what financial cost, are matters that must be pursued frankly and honestly between the patient and the experienced hair restoration specialist. There must be realistic expectations as to what can be accomplished by hair restoration.
Skill and Training and Today’s Hair Restoration Doctor
Surgical hair restoration is a specialty of cosmetic surgery that requires specific training and experience in addition to the general training received by all surgeons. Its body of knowledge has been growing for decades and has been incorporated into formal medical education programs. Its growth into a unique body of knowledge marks the evolution of hair restoration surgery into a unique surgical discipline. Some surgeons who specialize in hair restoration do no other type of cosmetic surgery. In other instances, hair restoration surgery may be performed in an overall practice of dermatologic or plastic surgery. In either case, the surgeon who is qualified to perform surgical hair restoration must have received the requisite training and experience in an approved training program. When choosing a hair restoration surgeon, it is always a good idea to ask specific questions about the surgeon’s training, experience, and areas of surgical specialization.
Evolution of Hair Restoration Surgery
The evolution of hair restoration surgery has been driven by the need to achieve more “naturalness” in appearance. The initial goal for hair restoration surgery was to restore growing hair to the balding patient’s scalp. After surgical hair restoration proved to be a successful procedure, the goal became to achieve hair restoration that looked less like transplanted hair and more like a patient’s original growth. Surgeons recognized that that this goal could only be achieved by a combination of technology and artistry. Instrument technology and magnification was developed that allowed hair restoration surgeons to harvest and isolate small naturally occurring groups of donor hairs, as small as single hairs called follicular units. This is in contrast to the grafts “plugs” of 10, 20 or more follicles that were the standard in thee early days of hair restoration surgery. Surgical artistry was refined as hair restoration surgeons developed the skills required to re-create a natural hairline as well as the temporal area, front region, midscalp and crown.
As hair restoration surgery evolved, it became a unique specialty within the broader specialty of cosmetic surgery. It is important for a prospective patient to understand this. Unless the patient understands this, he or she may not be able to obtain the desired results from hair restoration surgery. For example:
A 40-year-old man with hair loss due to androgenetic alopecia hopes to achieve a “younger” look from hair transplantation. However, also contributing to his appearance of premature aging are deep “frown” lines in his brow and “crow’s feet” at the corners of his eyes. When the prospective patient looks in the mirror, what is his expectation regarding the effects of hair transplantation on his appearance?
A 50-year-old woman has had diffuse hair loss that compromises her preferred hair styles and, she feels, gives her the appearance of “an old woman”. She hopes that some form of hair restoration can restore hair growth and halt the appearance of premature aging. Also contributing to her appearance of premature aging, however, are fine wrinkles around the corners of her mouth, a puffy look around her eyebrows and eyelids, and facial skin roughened by chronic exposure to sunlight over several decades. What is this potential patient’s expectation regarding hair restoration?
In both of these hypothetical cases, the prospective patients may not be ultimately satisfied with the result of hair restoration alone—unless the patient and physician discuss likely outcomes and there are realistic expectations regarding the result of hair restoration. These discussions may include:
the scope and limitation of hair restoration in general, and for this individual patient
looking at hair loss in the total context of the patient’s appearance of premature aging
The evolution of hair restoration surgery has brought it into the mainstream of cosmetic surgery and made it a unique specialty. The prospective patient should consult a physician hair restoration surgeon member of ISHRS with the same confidence as would be the case with a surgeon of any other recognized specialty. The relationship of patient and physician hair restoration specialist should be based upon an understanding of the patient’s needs and wishes in the context of the physician’s assessment of the patient as a whole. Hair restoration surgery is a unique specialty wherein the surgeon always places the patient’s needs and wishes in a medical context.