Reflecting upon 2020

And 2020 is now coming to an end. In these last days of the year I always like to take some time to reflect upon the last 12 months. 

First of all, I hope everyone had a safe and Merry Christmas, within what was possible. If not physically together with your loved ones, at least in spirit and making use of technology to make things just a bit easier.

As I look to 2021, I go back to this past year to decide our direction moving forward. It’s no secret that I always want us to do better, to be better, to achieve even better results, to give more to our patients and to improve in all aspects. Evolution and progress is a big part of my enjoyment of this  field. 

Of course, it’s hard to not address the elephant in the room: COVID-19. That really threw a spanner into our gears and caused us to stop all clinic activity for a few months. Of course we still kept working from home. We kept moving, studying, offering online consultations to patients, better understanding how we can reach and help more patients. It did help me catch my breath for a bit, but then when lockdowns were lifted came an avalanche of requests. Consultations, online consultations, surgeries, etc, etc. I am so so grateful for how much our patients and prospective patients enjoy our results, our work, our philosophy (and our hospitality for that matter :)). It’s really nice to feel not only their unequivocal preference to have me as their doctor, but to see how hard they work to simply get to our clinic in a time when traveling is not as straightforward as it was even only 12 months ago.

This time we spent in lockdown, combined with the sheer number of patient requests we receive, did make our waiting lists (for consultations and for surgery) longer than what I’d like. I now have an overwhelming backlog of online consultation requests. I do answer each and every patient personally in a very detailed manner. The current situation and how much our waiting times slipped makes me believe that I have to rethink our online consultation model. I don’t want to sacrifice quality, so I am actively brainstorming ideas (together with Alexandra, our patient manager) to improve waiting time. We may for instance, introduce a paid “fast track” system for patients who need to have a quicker answer and don’t wish to spend sometimes months waiting for an answer. 

Online consultations as you know are with no cost to the patient. So we do get some requests from people who are either just curious or not in a rush to get surgery. They may be thinking about it, but only in a year or so. Which is totally fine. I’m happy to help those patients the same way that I’m happy to help patients who want surgery “yesterday". But for each of those patients for whom I spend (quite some time) writing up an analysis, there is another who really wants to get an answer ASAP. So the goal is to give those patients a chance to get a quicker turnaround. The ones who are not in a rush still get they analysis, but in a wider timeframe.

This is just an idea of course. I may also temporarily give a shorter format consultation analysis (still answering to all important details) in order to make back some ground and not have such a long waiting list. I’d like to get some feedback from the readers on this. We’re always looking for ways to improve.

As for what happens inside the OR, we’re continuously upgrading it. Bringing in new equipment or upgrading the current one. I’m always testing out all sorts of weird ideas or gadgets I come up with [and the nurses keep accidentally destroying my instruments, which breaks my heart! (just kidding though. They’re all incredible! :)] 

The team has been doing a great job and I’ve watched them evolve over these months. We did encounter some challenges, some COVID related. But I’d like to congratulate the nurses Catarina, Liliana, Neuza and Ricardo as well as Alexandra, our patient manager on their evolution and progress. I’d also like to thank them for their hard work, dedication and for how they wear the BF jersey. It makes me proud to see what we’ve achieved and to see them caring so selflessly for our patients. They’re all so ethical, professional and well intentioned that I really have to pat myself on the back for bringing together such a great group of people. :)

We’ve also been receiving a steady stream of excellent results photos, so expect to seem some new case results soon. ;)

So, for 2021, my biggest goal is to improve our efficiency in terms of online consultations and to be even closer to our patients who are post-op. It’s really important for me that patients feel that we’re with them throughout the whole process. From first contact to their end-result consultation.

We’re also working on improving our website and making it more useful for patients. More results, more FAQs, more information. I also intend to make a big investment in our YouTube presence. So expect to see more of me on camera in the near future. I also have been receiving requests from patients to write more frequently in the blog and to post in forums. I only have so much time, but I promise to try.

So, once again. Thank you very much to everyone! You are the reason we exist. I wish you all an amazing 2021 and may we all be able to again do the things we love, together with the ones we love.

I wish you all the best,

No Two Hair Transplants Are The Same

Why is it important to do a personalized, bespoke and detailed approach to a hair transplant and why a one-size-fits-all approach doesn’t work.

A hair transplant is a very personal thing. No two heads are alike. There are many, many variables to take in account when performing a hair transplant. One variable can change everything. And that’s just for planning. When you actually go to work, everything can change once more. 

I keep saying this, but it’s worth mentioning because it’s true: there are tens of different parameters I evaluate in a single patient before I even decide if he’s a candidate for surgery. Some I assess in a more conscious way than others, but they all are accounted for. All those variables are computed (in my head) to establish a diagnosis, a strategy, a plan, a timeline and a prognosis.

Things like the patient’s age, the level of agressiveness and activity of his alopecia, the patient’s family history of hair loss, medications or other environmental factors he could be exposed to. The patient’s wishes and expectations as well as his/her psychological ability to be subject to a surgery or multiple surgeries. The patient’s hair characteristics, donor surface area, caliber, coverage value, etc, etc, etc. The list goes on and on...

Of course there are similar cases. But whenever I show a patient a case from another patient, it’s always just a reference of what’s possible. Consistency in results is very important for me. It’s very important to give a patient a prognosis that I feel comfortable in achieving. I do err on the side of underpromising, as I think that evens out the patient’s expectations. So It’s always super nice to see the patient’s reaction when we overdeliver. ;)

But the way of getting those consistent results is totally different from one patient to another. That’s why it’s sometimes difficult to explain to a patient that I’m taking a different strategy or using a different process or instrument to achieve his/her result. In the patient’s mind, he/she is thinking “but you used x process to get that great result I saw. I’d like to use the same to get the same result.”

It doesn’t work like that.

I’ll go as far as to say that if you use the same exact process for all patients, you’ll start to get below average results. Complacency will start to show and you may get a few good results, but also a lot of sub-par results. 

Patients need different processes/strategies/instruments/etc according to their specific case. And I’m not even talking about when complications arise and you have to get creative. 

So yes, no two transplants are alike. And a very detailed, bespoke, personalized approach is not only much more pleasant for the patient. It’s needed! ...at least if you want to get high quality results.

I also think it would make my job super boring to just do the same thing over and over. Rinse and repeat. We’re not EA. :P

So, I change things up. I try new things. I get creative and by doing that I develop more skills for my “bag of tricks”. Always remembering habit #7: 

“Sharpen the Saw” ;)

Until next time,

Does Hair Length Matter for a Consultation?

As we’ve previously discussed in Why Consultations Are So Important, the initial approach to a case is simply crucial in obtaining the best possible outcome for a patient. Therefore, it is in both doctor and patient’s best interest that the at least strive for optimal conditions for the consultation to happen.

When we have good conditions for a consultation, the whole evaluation is just better. I have a better view and a better idea of the issues we have. I have a more comprehensive look at the parameters I need to evaluate in a patient and therefore I’m much abler to provide more accurate measurements and estimates for the case at hand. Communication with the patient is also improved as by making information more precise, we remove biases, assumptions and noise that affect the quality of our doctor-patient relationship.The patient can be more clear of what he/she is bothered about, his/her goals and concerns. And I’m more able to provide the patient with both a precise diagnosis and prognosis.

One of the most crucial parameters in this initial evaluation is hair length. It may be a surprise to some of you, as we mostly deal with the absence of hair in a determined area and the length of hair would not be a parameter since patients should simply wear it as long or short as they prefer. And that’s true. However, hair simply behaves differently depending on it’s length and this not only happens within an individual’s hair, but also from person to person.

So, when we do a hair transplant, we’re usually after coverage. Coverage is different than density. Density is a very objective measurement of hairs per a predetermined surface area. Coverage is the ability of hair to cover the scalp in a determined area. The way hair transplants are usually performed, we’re not trying to match the exact density the patient had before he lost his hair, since that would simply be a waste of hair/grafts. Since we only start to notice loss of coverage when around 40-50% of the hair in an area is gone, we would not need to restore 100% of the density in that area to achieve coverage. The donor area is also a finite resource and it’s very important to manage it correctly. When we transplant more hair than we need to achieve coverage, we’re essentially wasting donor area.

So, why did I take the time to explain the difference between density and coverage?

Because I can always measure density, no matter how long your hair is. But coverage? Coverage is something I need to observe. And since coverage is very different from patient to patient, the only way to properly assess it, is to actually see it. 

Therefore, I sometimes have to request that patients return at a later date to a consultation with longer hair or that they send new photos in a month or so with longer hair. And this is the reason. The only way for me to know how much hair we must transplant to achieve a desired effect, is to have a correct understanding of our baseline.

Pep Guardiola. It's hard to predict just how much coverage he would have were he to grow out his hair.

And there have been quite a few times where I was surprised but by hair that has low density but excellent coverage, and hair that is super dense and has poor coverage. You hair density and caliber are just two characteristics. There are more things that affect coverage. 

For example, your crown may look like it has some miniaturization when I see your hair short, but when it grows out, It’s still fully covered. Or you can have good density in an area with short hair and when it grows it, it’s still see-through.

So, please bear in mind that when you request a consultation, you should either come to the consultation or send photos with at least 15-30mm of hair length.

And we’ll be a step closer to getting your hair to where you want it. ;)

‘Till next time,