Buyer Beware

Are all balding men transplant candidates?

Just the other day, a 31 year old man came to my office wanting a hair transplant using the Follicular Unit Extraction (FUE) method. He had already seen 3 other doctors and I was 4th on his shopping list. I’m not knocking that — it’s a good idea to meet with more than one doctor before chosing your surgeon , even if you feel comfortable during your first consultation because comparison shopping in this industry is the best way to protect yourself. Whether I was 1st on his list or 4th on his list — I’m just glad he eventually made his way to my office. During the examination I noticed that his balding was more prominent in the front, but there was thinning everywhere, even in the donor area. His hair was light brown and his skin had moderate skin tones and people with this contrast usually show a good fullness in the ‘donor’ area, so I was immediately concerned that something was wrong with this picture. I mapped out his scalp for miniaturization and found that the hair groupings in the front, top, and crown rarely had two hairs per follicular unit, averaging half of the normal healthy hair population. The donor area had a density of 1 hair per mm square (normal for a Caucasian is 2) and there was significant miniaturization throughout the donor area, worse on the sides, but bad enough in the back of the head.

I asked him about the three doctors he had visited and he went on to tell me about their surgical recommendations and how many grafts each had suggested was the appropriate number. I asked him if they mapped out his scalp and he said each had put their hand over his donor area and told him that his donor supply was good. None had used magnification in examining the donor area, certainly not mapping out his scalp. In one pf the doctor’s offices, he only met with a salesman, who recommended the largest number of grafts of all three offices.

This patient had a disease called Diffuse Unpatterned Alopecia (DUPA) and if there is ever a contraindication for hair transplants, this is one of them. I found it more than interesting that all three of the other doctors recommended surgery and I told him that he was not now or ever going to be a hair transplant candidate. Had he undergone surgery, his donor area would have been wrecked and he would’ve had an awful result, losing more hair than any gain he could’ve possible had. The only advantage to having surgery was that the doctors who recommended it could adequately pay for that new house and car they are driving. Let the buyer beware.