So you’re thinking of having hair surgery, but trying to find a specialist can leave you pulling (the rest of) your hair out. There’s no need to panic; there are hundreds of physicians around who can get the job done effectively, safely, and with minimal discomfort, leaving you looking and feeling great.
“Hair transplant surgery can be performed by many types of doctors across the board from family medical practitioners, general plastic surgeons, heart surgeons, vascular surgeons, facial plastic surgeons, dermatologists, and others,” explains Mark Glasgold, M.D., a facial and plastic surgeon, based in Highland Park, New Jersey, and in Manhattan. “Some of them may have naturally expanded into these areas, others may have decided they didn’t like their original specialty and pursued a specialty in hair transplant surgery. There are no qualifications in basic training that makes one person better than another. In fact, one of best transplant surgeons in the country used to be a psychiatrist.”
“Choosing the right specialist is extremely important,” says Robert Guida, M.D., director of facial and plastic surgery at New York Hospital Cornell Medical Center. “A doctor can be board certified as an emergency medical physician or a podiatrist, but that doesn’t mean he/she can do hair transplants. There are even OB/GYNs who do liposuction as well as hair transplants. It’s very important to find someone who has done a good number of hair surgeries and keeps up to date on the latest techniques.” Dr. Guida adds that you shouldn’t feel restricted to looking for a physician in your own area. “If you live in a big city, you’ll find a handful of very good hair surgeons, but if you live in a rural area, you may have limited options and it might be worth traveling a bit to find someone more qualified. For example, if you live in central Illinois, it might be worth traveling to Chicago to have your surgery done. It will be worth the trip.”
Just because you arrange a consultation with a hair surgeon doesn’t mean you are going to need surgery. The right surgeon will examine you and try to treat your hair loss with medications first. “The advantage to coming in early,” says Tom Rosanelli, M.D., chairman of the American Society of Hair Restoration Surgery, a subgroup of the American Academy of Cosmetic Surgery, “is that there are several drugs currently available on the market to prevent hair loss making it possible to stop hair loss prior to surgery. This can allow a patient to go several more years before undergoing a surgical procedure.”
If you have experienced a minimal amount of hair loss or thinning but are okay with that and just don’t want to experience further hair loss, you can be treated medically for the rest of your life. The doctor should be able to listen to a patient’s expectations and desires and treat him/her accordingly.
“There are surgeons from different specialties that perform hair replacement surgery,” says Dr. Rosanelli, “but the only board that can specifically certify a doctor in hair replacement surgery is the American Board of Hair Restoration Surgery. If a physician is not a member of this board, it’s important to find out what experience he/she has in hair restoration.” There are two organizations that teach procedures and offer conferences in hair restoration surgery: The International Society of Hair Restoration Surgery and the American Society of Hair Restoration Surgery. Says Dr. Rosanelli, “If a doctor isn’t certified by the American Board of Hair Restoration Surgery or isn’t a member of either of these organizations, it’s not the best sign. On the other hand, just because a doctor is a member of either of these societies, doesn’t necessarily mean he/she’s qualified.”
“These organizations are legitimate bodies and the people who run them are focused on producing good results, avoiding confrontation, and taking good care of patients,” explains Dr. Mark Glasgold, M.D. “There are also a number of great websites available that list surgeons in your area. Keep in mind, however, that a lot of people are able to travel successfully before and after hair transplant surgery since there is little post-op care. The procedure is done and then you leave.” Apparently, there is no certification for hair surgery within the certification for dermatology or plastic surgery. So while these practitioners may have experience practicing hair restoration surgery, they won’t be specifically certified for it.
Dr. Rosanelli advises potential hair surgery candidates to find out the number of years a physician has been doing surgery, look at before-and-after photos of previous patients and, if possible, speak to a former patient about his/her experience with the doctor and the procedure. “The amount of experience a doctor has is critical in this particular field, no matter how much experience he/she has as a surgeon. If a doctor hasn’t practiced hair surgery, a number of things can go wrong.”
According to Dr. Rosanelli, one or two hair surgeries a year aren’t enough to give a surgeon enough experience. In fact, doctors who specialize in hair surgery procedures often do somewhere between twenty to forty cases a year. “A surgeon should be doing five cases a month to stay current. The American Board of Hair Restoration Surgery requires fifty cases a year to qualify to take the board.”
“I think you have to use your common sense and get several consults before you decide to do the procedure,” says Thomas Romo III, M.D., F.A.C.S., director of facial, plastic, and reconstructive surgery at Lenox Hill Hospital and Manhattan Eye, Ear and Throat in New York City. “It’s also important for a person to know what’s going on with new technology. You don’t want to go to the first person who’s doing a new procedure, but you don’t want to go to the last person, either.”
There are so many questions to ask, so much research to be done. Thus before you sign on the dotted line, check out this list of do’s and don’ts for choosing a hair surgeon.
Do
Don’t
First and foremost, you need to feel comfortable with this surgeon. “Make sure you meet the surgeon and feel comfortable with him/her so that if something goes wrong, you know you can go back for help,” says Dr. Glasgold. “You want to find someone who looks at you like a patient, not a customer, and cares about your medical issues.” While the doctor needs to interview you to find out if you are a good candidate, you also need to interview the doctor to find out if he is qualified at what he does and if he understands your expectations. “It’s important for patients to interview their physicians,” says Dr. Romo. “There are a lot of doctors out there and you need to make sure they have the training in what you want them to do. I have no problem with patients asking me to tell them about the results, complications, progress of my last hundred surgeries.”
“It’s helpful to go to someone who specializes in hair surgery but, if not, you want to at least use someone who has performed a good number of surgeries,” says Dr. Guida. “You don’t want to use someone who only does this once a month or a few times a year, since they won’t have as much experience as other doctors who have done it more often.”
Do you have your own team of technicians? Find out how much the technicians actually do. You don’t want to use someone who lets techs do all the work but, at the same time, you want to ensure there is a qualified team of assistants to help with the procedure.
Am I a good candidate for hair surgery? “Ask the doctor whether or not you are an easy transplant,” suggests Dr. Glasgold. “Are there areas where it may take more than one procedure to meet your expectations? Will he do one procedure to move 15,000 hairs over the course of eight hours or will he do three two-hour sessions?”
What techniques do you use? If you look at the pictures and see big plugs that look unnatural, that’s what you will get. But if the surgeon is using the right combination of mini- and micrografts or follicular transplants, the results will look extremely natural. “Follicular transplant is state-of-the-art,” says Dr. Glasgold. “Not every transplant has to be done using this procedure, but a surgeon who uses it shows a sign of someone who is maintaining a current level of technique and technology and is always working to improve his skills.”
What specific procedure will you use for me? It doesn’t matter whether the doctor knows how to perform all of the general hair surgery procedures. Each treatment plan should be individualized for each patient, and the doctor should be able to explain what he plans to do for you. For example, will the doctor do follicular transplants all around or will he mix follicular transplants in the frontal region with some micrografts in other areas? You should also be able to look at pictures of someone with hair similar to yours to give you as much of an idea of what to expect.
How qualified are you to perform hair surgery? “When I do surgery, I like to get good results, but hair surgery is not my specialty,” says Dr. Glasgold. “So while I tend to operate on more favorable patients—those with lighter or curly hair—and I have done quite a few transplants, I will send patients who require more detailed procedures to someone who is devoted to doing hair.”
What other medications can I take simultaneously, or what hormones can I be on? Your doctor should be able to advise you on medications and hormones that you may take during the pre- and post-op period.
Can the doctor offer nutritional and endocrinological advice to help you deal with the procedure? The doctor should also focus on hair physiology as well as hair surgery. He/she should be able to provide nutritional counseling and should give you a complete physical analysis beforehand to check for thyroid gland problems as well as autoimmune disease. If the doctor doesn’t feel comfortable discussing these issues, he/she should be able to refer you to a nutritionist or endocrinologist who can offer expert advice.
How much will this cost? “Price is based on how much hair needs to be moved,” says Dr. Glasgold, “so there is a huge range of prices around the market. You can find tremendous bargains out there, so it’s worth shopping around. Just keep in mind that quality isn’t synonymous with price.”
The last thing you want to do is go in for a face lift, rhinoplasty, eyelid blepharoplasty, or any other facial surgery and find that in order to do the procedure, the doctor has cut away critical masses of hair-bearing skin. Lucky for us, surgeons like Dr. Romo are sure to take this into consideration before embarking on creating your new look.
“As a surgeon, the last thing I want to do is cut out hair-bearing skin, even when doing a face lift. So I developed a way to do face lifts, eyelid blepharoplasties, and other surgical procedures by making an incision at the hair line instead of going back into the hair where extra skin can be cut away.”
Dr. Romo explains that the upper part of the face, including the eyelids, brows, and forehead, ages a decade before the lower part does. “People used to come in for consults in their 50s and 60s,” says Dr. Romo. “Now, they show up in their late 30s and 40s.” He explains that the previous procedure for people who came in with redundant upper eyelid skin was to cut away the excess or to pull the eyebrows up toward the hairline when they begin to droop down.
The technique used involved making an incision from ear to ear across the top of the head 6 centimeters from the frontal hairline, which is called a coronal brow lift. Through this process, an incision is made in the hair-bearing skin and the skin is pulled back, then one inch of hair-bearing skin is cut out and thrown away. In an endoscopic brow/forehead lift, which Dr. Romo now performs, a small incision is made in the hairline, and the brows are pulled into place and secured via sutures into the bone. The skin then shrink-wraps down to the skull and no hair-bearing skin is removed. “This is a more conservative technique which gets the job done and helps maintain hair growth,” says Dr. Romo.
Armed with this information in mind, you are set to seek out a professional who can help you look and feel your best by restoring your hair to a close-to-natural state. The bottom line: Do your homework and you’ll reap the rewards.