A: Fasting is not necessary for a comprehensive evaluation.

The comprehensive diagnosis may include hair pull tests, hair pluck, hair density measurements, anagen telogen ratios, scalp biopsies and laboratory (blood) tests but no pre-test fasting or other preparation is necessary.

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: Yes. It had been in response to the policy of the larger chains. Patients coming to our practice are evaluated by a board certified dermatologist, trained in diagnosing the causes of your hair loss with expertise in both medical and surgical management. Our consults are not just screens for surgery.

Read more information on becoming a new patient on the Bernstein Medical – Center for Hair Restoration website. If you are ready for a hair loss or hair transplant evaluation, click here to schedule an evaluation with the doctor.

A: I prefer not to do imaging since it tends to oversell the hair restoration procedure.

In addition, the technology is unable to accurately represent what the hair transplant will really look like as there are many hair characteristics that it can’t take into account.

Seeing lots of actual photos of hair transplant patients is much more instructive – and more honest (if the photos are taken correctly). At the time of the consult I design the hairline and photograph it.

A: I perform all the consults myself. I invariably start with a very open ended question as this allows the patient to really express what his/her concerns are and I am often surprised by what I hear.

I agree that the doctor should not have pre-conceived notions about what a patient wants or what he or she is feeling. This doesn’t mean that the doctor can’t advise a patient on what we believe to be the best course of treatment, but we must listen first if we are gong to really help you.

Once the patient has told his story, a thorough history is important to rule out medical conditions – this is essential with women where the diagnosis of androgenetic hair loss is not often clear. A careful exam will enable the physician to see if the patient has sufficient hair resources to match his/her goals.

The specific aesthetic needs of the patient, particularly with respect to hairline design, should be discussed in detail and, most importantly, there should be a long-term plan in the event of further hair loss.

For more extensive information, please read the Follicular Transplantation: Patient Evaluation and Surgical Planning page of the Bernstein Medical – Center for Hair Restoration website.