I was a Norwood Class 6, with straight, dark brown, medium weight hair with a donor density of 2.1. I had three hair transplant sessions totaling 5,300 follicular unit grafts with very little done to the crown area. It has been 7 1/2 months since the third transplant, and I feel as if I still have to do a comb-over to conceal the right parting area of my hair ( I part my hair on my left side). I conveyed my concern over this area prior to the third surgery and the surgeon suggested that I not tell him how to do his job. And, I don’t believe that many grafts–if any–were placed in this area of concern. I do recall the surgeon stating that he’d favor the left side part since this is where I part my hair. I am generally happy with the surgeons work. Based on my profile, is it realistic for me to expect that I would not have to do a comb-over to conceal my hair loss. In other words, am I expecting too much from three transplants of 5,300 grafts? Any help would be greatly appreciated. Thank you.

The keys to patient satisfaction are: good communication, setting expectations with reality, and proper patient education to show where that reality is. I was disturbed by your doctors comment, to “not tell him how to do his job,” for that implies that he may have fallen short of the three critical issues I just mentioned.

Think about the math of the transplant process. In a typical person with a Norwood Class 6 pattern, the person would have lost about 50,000 hairs. If you had 5,300 grafts, then you would have received (assuming that they are follicular units) 10,600 hairs. That is 20% of your original density. There is an art form that will make 20% look like far more hair than it should, but it can not be equal to the original hair population, either in fact or in appearance. I always tell my patients that the surgeon creates an illusion (the surgeon controls the distribution of the grafts) assisted by various patient factors not always in his/her control (e.g hair and skin color, hair shaft thickness, hair character or the degree of waviness, and the densities that are achieved). This is very difficult for the average patient to understand before hand, so I take the unusual step of having the open house events monthly at my offices (done for over 13 years). For these events, I invite between 5-15 patients who’ve had various degrees of balding with different hair characteristics to allow people like you to meet patients first hand, so that the art and the illusion is appreciated. That (without taking an “I know it all because I am a doctor/surgeon” type of attitude) produces a very high patient satisfaction rate. The answer to your question is that you probably did not have the type of realistic expectations that you should have had and no matter how good your surgeon may be, your surgeon did not package all of the important elements into your Master Plan to give you what you needed to know.