Think “hair replacement” you’ll probably picture a bunch of large, round “plugs” that look worse than any balding head. Unfortunately, until now, hair restoration has left a lot to be desired, says Gregory Pistone, M.D., F.A.A.D., a dermatologist with Advanced Dermatology PC and 20 years experience specializing in hair restoration. But new techniques mean patients with hair loss—even those who have undergone earlier transplantation surgeries—can have truly natural-looking results.
Roughly 80 million Americans suffer from hair loss. Worldwide, more than 800 million people are seeking professional treatment for the problem, and there are close to 300 million restoration surgeries performed every year. But while the numbers are high, the quality of treatment and its results can be poor. Surgical hair restoration is essentially unregulated, and any licensed physician can perform it without specialized training or accreditation, Dr. Pistone says. What’s more, there are still plenty of snake oil salesmen out there, eager to sell products and procedures whose outcomes are iffy, at best.
“Hair loss can be traumatic,” Dr. Pistone says, “and people will try almost anything to remedy it.” Many patients can get good results with FDA-approved drugs—Minoxidil (Rogaine) and Finasteride (Propecia)—but these meds don’t work for everyone. And until recently, those patients had two choices: live with the loss or take a big risk on surgery.
Happily, today’s procedures are light-years ahead of the disastrous “plugs” of old. Surgeons now take grafts of individual follicular units—naturally occurring groups of one to four hairs from areas where hair is healthy and move them to areas where it’s sparse. Earlier grafts contained as many as 15 follicles, which created that tufted, ‘doll’s head’ look, Dr. Pistone says. “But we know now that hair naturally grows in groups of only one to four follicles and that it grows in different directions in different parts of the scalp, so we replicate those patterns to achieve a truly natural look.”
Picking the practitioner
One of the most critical steps in a successful surgery is choosing the best hair transplant surgeon. “This is a specialized field of practice that depends heavily on expertise and experience,” Dr. Pistone says. Here are the questions to ask:
Am I a good candidate for this surgery?
“Run, don’t walk, away from anyone who tells you that hair replacement surgery is right for everyone,” Dr. Pistone cautions. The best candidates are men with androgenic alopecia (a.k.a. hereditary thinning or male pattern baldness), and people who have lost their hair due to trauma or burns. Women with certain types of hair loss also can benefit. “Your surgeon should carefully evaluate your situation and tell you what’s behind the problem and how to address it,” he says.
How many procedures will I need?
“That depends,” Dr.Pistone says. “Hair with greater density (more follicles per square centimeter) requires fewer grafts than thinner hair. Likewise, coarse hair covers more than than fine (the diameter of each hair is bigger) and wavy and curly hair covers more than straight. The closer your hair color is to your skin color, the better. For example, people with dark hair and fair skin need more grafts because they have greater contrast between hair and scalp. The rate and pattern of your future hair loss and the shape and density of your natural hairline also play a role. It may take a few sessions (spaced months or even years apart), but most patients can get the results they want in one or two.”
How should I pick my surgeon?
Avoid large chain operations that contract physicians to perform hair transplantation under a common umbrella. “You want an experienced, dedicated hair transplant surgeon, not someone who dabbles in it,” he says.
You should ask to see several sets of “before and after” photos, and ask to speak with former patients (ideally people with hair and skin similar to yours). “Make sure your surgeon is an expert in hair restoration who has had success with patients like you,” Dr. Pistone says.
Gregory A. Pistone, M.D., F.A.A.D. Dr. Pistone is a pioneer in cosmetic dermatology and hair restoration and was recognized as one of the “Top Plastic Surgeons” by Philadelphia magazine. Dr. Pistone is one of only a few surgeons in the world who are double board-certified in both surgical hair restoration and dermatology and are qualified to perform Follicular Unit Transplantation (FUT) and Stereo-Microscopic Hair Transplantation surgery. He’s also recognized and recommended by both the International Alliance of Hair Restoration Surgeons and the American Hair Loss Association. He has performed over 8,000 hair restoration procedures. Visit http://www.advanceddermatologypc.com for more information.
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