The following is a letter I sent to a patient I met in the office today. I think that you can see that patient welfare is more important than how much money I can make from doing his FUE surgery. I will call the patient PAUL.
“Paul, it was good to see you today. You were on Propecia for a year which reduced your sex drive which just did not go away with time. I think that today’s visit was s shocker for you. After seeing two other doctors who recommended a hair transplant for you, you came in prepared to get an FUE transplant and we then spoke about this and the Scalp Micropigmentation (SMP) alternative. Your hair density is lower than average (75% of a normal hair density) and your balding pattern is a Class 7 pattern with some hair still left in the top and crown area but what you have is very thin and clearly falling out. You have a very large head so any hair that is moved must cover your very large head. The number of grafts to get reasonable coverage to what you expected are just not there. At 29 years of age, you are almost certainly going to completely develop a Class 7 pattern of balding in the next few years with just a rim of hair around the back and sides of your head. Although your hair appears more coarse than normal (a good quality to have), there is just not enough of it to get the coverage you want. I showed you a series of photos with people having your balding pattern and showed you what the reality of the situation was.
Also, I introduced you to a man who has exactly the same balding pattern that you have and received Scalp Micropigmentation (SMP) today (something you knew nothing about). You can see that these results (which reinforces a shaved look), are very good and similar to your present look but with the ‘appearance’ of hair on your head. The advantages of SMP for you are:
1- The size of your balding pattern is not a factor
2- Your low density of your donor area is not a factor
3- The results are instantaneous while a hair transplant takes 6-8 months to grow out.
4- It is less expensive than a hair transplant ($7,000 vs $20,000 for each 2000 graft Robotic FUE)
You have much to think about. I am not against doing an FUE on you as I am sure that I can make it natural looking, but you will never be able to obtain the coverage you want (front, top and crown) even though you will get natural results like those patients in the photos I showed you. Please come to our next open house here on Saturday February 7th at 11am where you can meet previous hair transplant patients, previous FUE patients and previous SMP patients.”
Comment: I have spoken out many times about the ethics of doing hair transplants in patients like the one discussed above as well as many others. Had PAUL not come to see me, he would certainly have chosen to undergo a follicular unit extraction (FUE) procedure because he was committed to it. No selling was required to go forward with an FUE procedure, the selling on my part, was to dissuade him from going on that course. Such a procedure would have made him unhappy and I know it for certain because I found someone who I did 4780 grafts on (2 sessions) who had good but see-through results. I always inform the patients what to expect and when this man found out what he would have gotten, he was certain that it was not what he was going to do. Although PAUL had better quality hair than the patients whose pictures I showed him, PAUL’s donor density was much poorer. He would have ended up with a thinner frontal area and a bald crown, something he was certain he did not want. Honesty here is a mandated quality, mandated by the medical board that issues doctors their license to practice medicine and mandated by the Hippocratic oath we swear to when we graduate from medical school. Those who violate this oath are immoral people. Being a doctor does not grant ‘God’ status to the doctor. To justify the recommendation to have an FUE hair transplant, if the doctor was ignorant of the facts as I presented them, then his immorality knows no bounds. Think of it, age 29 and at the forefront of his life with a life changing decision to make, just to be led astray by either by an ignorant doctor, or just a dishonest one.