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,