So you have become reacquainted with your scalp (a place on your body that you hoped to remain strangers with), and it looks like you’re about to see a lot more of it if you don’t find a solution soon. You’ve tried a few “cures” already; Rogaine, Propecia, Saw Palmetto oil, and vigorous scalp massage, you are now considering having a hair transplant.

Surprisingly, people generally spend more time researching a new car purchase than they do choosing a surgeon, but researching the right hair transplant doctor is not something you want to rush through. There are a couple of things you will want to be mindful of when seeking a surgeon for a hair replacement operation. Here are a few tips to help you when interviewing a doctor for your hair loss.

Starting Your Research
Hair transplantation has become a fairly large field with many doctors performing these procedures. There are some great surgeons out there and some lousy ones (evidenced by some of the unnatural looking hair transplants that we have all seen). How do you start your quest to find the best physician for you?

In general, the best way to find a physician is through a referral either from your dermatologist, GP, or from another patient. The worst way to choose a doctor, who may be performing surgery on your head, is via infomercials or aggressive marketing campaigns. You should be wary of any medical practice that is spending lots of money on marketing, rather on patient care.

The internet can also be helpful in your research because, unlike infomercials and TV ads, where the doctor can make any kind of claim they want to, online message boards and user forums make it difficult for a doctor to control what is being said about them. But remember that on the internet you have to take any medical advice you might read with a grain of salt.

The Doctor’s Background
The first thing you will want to know is what the doctor’s specialty is. Ideally, he or she is a board certified dermatologist or plastic surgeon. If they do not specialize in these two fields ask them why they have chosen to work in hair restoration. If they are trained as a gynecologist or an internist, why are they doing hair? You are within your rights to know the answer and you should be concerned that they are only in it for the money.

Doctors to consider should be members of the International Society of Hair Restoration Surgery (ISHRS) and be Diplomats of the American Board of Hair Restoration Surgery (ABHRS). The ABHRS is the only board in the United States that certifies hair transplant surgeons.

There are a number of non-physician consumer advocacy groups that help consumers find the best doctors in the field. The most popular are the Coalition of Independent Hair Restoration Physicians and the International Alliance of Hair Restoration Surgeons (IAHRS).

The most coveted awards in the field of hair restoration are the Golden and Platinum Follicle Awards given by The International Society of Hair Restoration Surgery (ISHRS) for outstanding achievements in science or clinical research relating to hair restoration. If the prospective doctor is the recipient of either of these awards, this would certainly show the confidence that their peers have in their skills and abilities as hair restoration surgeons. Each of these is given to only one outstanding physician a year.

Lastly, feel free to inquire if the doctor has helped contribute to the science of hair restoration by performing some research in the field and publishing his or her findings. Publishing medical papers shows that the physician is sharing ideas and experience with other doctors in order to promote patient care. If the publications are in peer reviewed medical journals, the medical community holds them to be of significant value.

Techniques and Approach
You are going to want to ask the Doctor what techniques they use and how long they’ve been performing them. Follicular Unit Transplantation, or FUT for short, is the procedure that has made modern hair transplantation completely natural – if performed correctly that is. If they do perform FUT, ask the doctor where they learned it. It is preferably that they learned the procedure from one of the technique pioneers, like Dr. Robert Bernstein, Dr. William Rassman or Dr. Bobby Limmer. This will give you a sense of whether they really know the nuances of this procedure.

When conducting your interview, ask whether the surgical staff uses microscopes for dissection, loop magnification, or simply the naked eye. Using the naked eye does not allow the optimal harvesting of the follicular units and loop magnification is only a tad better. Stereo-microscopes allow the surgeon and his team to perform the most accurate graft dissection and best preserve donor hair. Take a look at the operating room to make sure it has clean up-to-date equipment, and that there are plenty of microscopes on hand, as each clinical staff member will need one.

Questions to Ask

• What percentage of patients do you recommend surgery for? (People may not be candidates for a hair transplant for a variety of reasons. If the doctor recommends surgery for most patients that he sees, then something is wrong). Many men with early hair loss should be first treated with medication and the majority of women is actually not good candidates for surgery (because of their generalized thinning) and will never be.
• What about shedding? (If the doctor says “my techniques are very good so my patient’s never shed existing hair after surgery” then run out the door because that is simply not a realistic prediction of the surgical outcome of a hair transplant).
• What did my examination show? (The doctor should be able to tell you exactly what he ascertained about your hair loss condition after examining you).
• What age do you start treating patients? (Anyone under 25 has yet to display the traits used to predict their hair loss in say 10 years, for that reason a good surgeon will not perform a hair transplant on anyone too young).

Red Flags
Here are a few red flags to tip you off that a medical practitioner may not have the patient’s best interest at heart:

• Are you being evaluated by a salesman or a doctor? (Though it is fine for a medical assistant to answer general questions, and a salesman to answer financial ones, any examination should be conducted by a doctor and he should be the one making the recommendations. The doctor should not come in as the finisher; he should be the starter and the only one practicing medicine.
• Is your consultation focused on your long-term plan for your hair loss problem or is it just about quickly getting a “hair fix”? (A good doctor will be thinking about where your hair loss is headed many years from now.)
• Is the doctor examining you thoroughly? (He or she should not take a cursory glance at the back of your head and exclaim “oh you’re a great candidate for a hair transplant!” Make sure that you are examined very carefully, having your density checked, with a diagnostic tool called a densitometer, and your scalp assessed for laxity.)
• Is your doctor at the office all the time or does he travel from office to office with some other person doing the follow-up care?
• Are you getting the feeling that you are being rushed? (Hair restoration surgery, or any cosmetic procedure, is not right for everyone. It is important that the doctor not rush you into surgery, but rather discuss all options, emphasizing the importance of medical therapy with, or without, surgery.)

When choosing any kind of health care practitioner a patient should always go with their gut. If you feel uncomfortable with a doctor, it is usually a sign that you are in the wrong place.

What to Focus On
Surgical hair restoration has made some remarkable advances in the past 5-10 years and a hair transplant might be a solution for your hair loss, but only an experienced doctor can determine the likelihood of your benefiting from this option. You should find a health professional specializing in the diagnosis and management of hair loss. Make sure his or her focus is on finding the optimal course of action for treating your future hair loss for the long-term – be it medical or surgical. And resist the dangerous temptation toward self diagnosis and, of course, don’t rush any decisions. Good Luck!

A: It is extremely important to use microscopes when performing hair transplants. It is the only way that follicular units, the naturally occurring groups of hair follicles, can be isolated from the donor tissue without damaging them.

Other techniques, such as magnifying loops and back-lighting are not as precise. Using microscopically dissected follicular units in hair transplants has been the main advance that has allowed doctors to move away from the older mini-micrografting hair restoration techniques to the current procedure that can produce totally natural results.

See the Microscopes page on the Bernstein Medical – Center for Hair Restoration website.

A: One of the causes of having pimples and redness following Follicular Unit Extraction may be buried hair fragments and there are significantly more hair fragments generated with the two-step FUE technique than with the three-step method.

In the three-step procedure, we use blunt dissection which minimizes transection (cutting of hair follicles) and thus reduces the incidence of hair fragments. See the Instrumentation for Three-Step FUE page at the Bernstein Medical – Center for Hair Restoration website.

In our practice, we also place every extracted graft under the microscope. This serves a number of purposes:

1. It gives me immediate feedback on transection rates, so that I can adjust my technique in real-time (using a stereo-microscope is much better than visual inspection for this purpose)
2. It enables us to trim away excess tissue and hair fragments (we use the same judgment as we do with strip harvesting, so that a “viable looking” fragment would be left attached
3. It allows us to accurately count the number of hairs in each follicular unit graft, as it is particularly important to have pure 1-hair grafts for the frontal hairline. This also allows us to better anticipate the end cosmetic result.
4. It allows us to dissect larger follicular units into smaller ones for specific cosmetic purposes, i.e. eyebrows, hairlines, temples etc.

One of the ironies of FUE is that it is more efficient to extract the larger FUEs, since this gives us a greater hairs/hole ratio, but this often leaves us with an inadequate number of 1-hair units, which must be obtained though traditional stereo-microscopic dissection of the larger extracted grafts.

Other causes of folliculitis (manifested by pimples and redness) can result from placing the grafts too deep in the recipient site (where they may get buried) and secondary infection. A mild, transient folliculitis is often seen after a hair transplant without any precipitation factors.

A: Strip harvesting is used in the majority of hair transplant procedures because it allows the surgeon the ability to perform hair transplant sessions using large numbers of grafts while minimizing injury to the patient’s hair follicles.

This is possible because once a strip is removed from the back of the scalp, the tissue can be placed under a stereomicroscope where dissection is accomplished using direct visualization of the follicular units. This allows the grafts to be dissected with minimal trauma.

This degree of accuracy is not possible with other hair restoration techniques, such as FUE, where the separation of follicular unit grafts from the surrounding tissue is accomplished “in vivo” (directly from the scalp).

In their article on FUT, the authors helped the dermatologic community to better understand the best practices of surgical hair restoration. Follicular Unit Transplantation (FUT) focuses on recognizing that the follicular unit is a discrete, anatomic and physiologic entity, and that preserving it through stereomicroscopic dissection is the best way to ensure the natural appearance of the hair restoration. Dr. Bernstein explains why this major step has brought hair transplantation into the twenty-first century.

This chapter also points out that the issues yet to be resolved in hair transplantation include determining the maximum density and number of grafts that can be used safely in a single session, deciding whether it is preferable to pre-make recipient sites or immediately place grafts into sites as they are made, and defining the precise role of Follicular Unit Extraction (FUE).

The authors conclude by stressing that the essence of providing the best care for hair transplant patients rests on proper patient selection, establishing realistic expectations, and using non-surgical management for young persons who are just starting to thin. When surgery is indicated, Follicular Unit Hair Transplantation is the ideal hair restoration procedure.