Expectations and Decision-Making in Hair Restoration Surgery

Patient Expectations

When a prospective patient consults a physician hair restoration specialist, he comes with a set of reasons for seeking hair restoration. The patient may be a man or woman; most often, the patient is a man whose hair loss is due to hereditary androgenetic alopecia (See About Hair Loss).

For both patient and physician, the patient's expectations for hair restoration must be clarified. After expectations are fully explored and understood, patient and physician can begin to discuss surgical and/or nonsurgical approaches to satisfying the patient's wishes.

A patient's reasons for seeking hair restoration contribute to shaping his expectations. Among the most common reasons for a man to seek hair restoration are:

  • To avoid an appearance and feeling of premature aging due to hair loss, and
  • To restore self-confidence that waned as his hair thinned.

Hair loss can be a significant event in a man's life, influencing how he sees himself in social and business environments, and how he believes others perceive him. For some men, an appearance of premature aging may be the most disturbing effect of hair loss. Other men may come to believe that hair loss overshadows their personality and character-that what others see when they look at him is a "balding man" rather than a distinct and interesting person.

Thus, a man's stated or unstated reasons for seeking hair restoration can profoundly influence his expectations for hair restoration. The patient and physician hair restoration specialist must work together to plan hair restoration that is appropriate, surgically and/or nonsurgically achievable, within reasonable time constraints, and at a cost acceptable to the patient.

If a patient's reasons for seeking hair restoration give rise to unrealistic expectations (for example, to restore a 35-year-old man's appearance to his appearance at age 20), the expectation for outcome must be placed in a realistic context. When a patient's reasons for seeking hair restoration, and his expectations for outcome, are placed in context with other information about the patient, the basis for realistic approach to hair restoration begins to emerge.

Information that strongly influences hair restoration planning, and eventual outcome, includes:

Age

Androgenetic alopecia (in men, often called male-pattern hair loss) is usually progressive. When a man is in his 20s or early 30s, it can be difficult to predict accurately how much hair he will lose, and in what pattern, over the course of the next 10 to 30 years. Planning for hair restoration in a young man must take account of the likelihood of future hair loss. A "one-time" hair transplantation procedure in a young man can result in increasingly poor result if hair loss continues, and virtually assures the need for future surgery to correct the poor result.

Pattern of Hair Loss to Date

An important aspect of hair loss to date is an estimate of the amount of hair that is likely to be available for transplantation (if transplantation is the procedure of choice), and the amount of bald scalp that will need to be covered.

History of Hair Loss in the Patient's Family

While it is not entirely predictive of a patient's eventual hair loss, a history of hair loss in the patient's nearest male relatives provides some guidance as to the type and extent of hair loss to expect in the patient over his lifetime.

Hair Characteristics

Hair caliber (diameter of the hair shaft), hair color, hair color in the context of scalp color, and hair curliness/frizziness are all important characteristics to consider in planning hair restoration surgery. They can be essential esthetic considerations in planning for an appearance of "fullness" in transplanted areas of the scalp (See Surgical Hair Restoration).

Patient's Health

Surgical hair restoration is an invasive procedure that requires the administration of anesthetic medication. While hair restoration surgery can be considered "minor" in comparison to procedures involving the removal or repair of an internal organ, the patient must be able tolerate the procedure. The physician will require a full medical history and physical examination of the patient before surgery is undertaken.

Psychological Status

The physician may rarely encounter a patient who appears psychologically unfit for surgical hair restoration-for example, a patient whose hair loss is due to compulsive hair plucking (the condition called trichotillomania) would be considered unfit for hair restoration until the psychological problem is successfully treated.

History of Previous Attempts at Hair Restoration

Many men with hair loss will have tried self-administered hair restoration medications. The physician should be given a list of these, which could be useful in planning nonsurgical approaches to hair restoration. If the patient has undergone a previous surgical hair restoration procedure, this should be discussed with the current physician hair restoration specialist in terms of (1) the patient's feeling about outcome, and (2) what needs to be done to repair an unsuccessful outcome, or to incorporate the previous transplanted area in current planning.

Cost Considerations

Both patient and physician must be willing to engage in full and open discussions regarding the cost of hair restoration. Some patients may consider cost to be secondary to the achievement of the best possible outcome. Other patients will wish to seek the best possible outcome within given cost constraints. Both patient and physician should be willing to explore all cost-benefit options.

In summary, every patient has reasons for seeking hair restoration, and the reasons give rise to expectations as to what hair restoration can accomplish. The patient and physician hair restoration specialist begin at this point to find how "expectations" can become "possibilities" for achieving the best result.

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