Non-Doctors Doing Hair Transplants?

/by William Rassman, M.D./0 /,

Can a Non-doctor Do a Hair Transplant?

In some countries (more so in third world countries, but some non third world countries may be included here), non-physicians can legally do a hair transplant. In Western Europe, Australia, Canada, Mexico and the United States, I believe only licensed medical doctors can legally perform hair transplant surgery.

What is legal and proper, however, is not always what happens. I was an expert for the State of California in an action against a non-licensed physician passing himself off as a hair transplant surgeon. He was prosecuted along with the doctor who promoted him.

In 1992, a doctor in Cook County was charged by the State of Illinois, stating “…the business has allowed non-doctors to perform surgery on clients, including one non-physician who claims expertise as a muskrat skinner and who was first employed by Dr. [name removed] planting trees on his farm.” Illinois Assistant State’s Atty. Robert Lyons, supervisor of the consumer fraud division, said “We’re not saying the guy can’t stand there and hold gauze, but we are saying he can’t stitch a wound”. (from Chicago Tribune, July 26, 1992)

In another situation, I was a aware of a doctor in New York that was charged by the State for allowing garbage collectors to perform surgery at his clinic. Their training was apparently done after they finished collecting garbage as extra-help for the doctor. It appeared that they were coming in after hours as well, performing surgery themselves without the doctor present. It was not clear if the doctor knew of this activity but it was done in his office. I doubt that the patients were aware that these men were not physicians. I know of one business that was set up in Virginia where the technician opened their own business and hired ad-hoc doctors to cut along the dotted line and the doctors did not know anything about the field of hair transplants. I was told that sometimes the doctor did not show up so the technicians went ahead anyway. In one clinic located in Pittsburg: they hired residents from one of the universities and told them where to cut and what to do, paying them a nice hourly wage for their service. A class action suit was instituted against the poor doctors for mal-practice (I believe that they became poor). I was an expert for the plaintiff on that case and agreed to participate because the results were hideous and many, many people were deformed permanently. This Pittsburg clinic was owned by the sleazist salesman you can imagine, who must have convinced the doctors that they were doing a real service for these patient. The clinic gave the names of over 500 patient references. That was impressive, but when I got that list from one of their victims, I started down the list to call the patients and went through about 20-30 of those on the top of the list. I found that not one person on that list had anything nice to say about the clinic, the experience or the results. In fact, most people complained about their deformities and the emotionally angry conversations I had over the phone with them is what I remember most.

Non-physician clinics are opening everywhere, even if the various state laws were intended to restrict non-physicians from profiting from the practice of medicine. There is a legal work-around that has not yet been challenged in any state. Hair Club for Men (which is owned by Regis International, a $5 billion company) and Bosley (which is owned by Aderans, a Japanese hair piece manufacturer) have medical groups which are owned and run by a competent doctor who commands the hair transplant elements of the practice while the complex process of running the ‘sales driven business‘ is managed by businessmen from the non-physician entity. I am not saying that a physician-owned hair transplant business is any guarantee of quality, as there are some sleazy licensed doctors out there who are as bad as the Pittsburg clinic I referenced. I have seen many results of bad non-physician and physician-owned clinics over the years and know that the victims have little recourse against the non-physician owned clinics because the state license authorities have little contol over the business entities (only the doctors who work for these clinics are controlled by medical practice agencies and laws).

Some States can not enforce the laws against non-physician owned medical clinics fast enough as entities change their names and identities as soon as the States get ready to put them away. I was hired by one State prosecutor as an expert witness against such a business entity, but the owners of the company closed down one corporation just before trial and opened a new corporate entity with an almost identical name with the exact same service. The prosecutor had to start from square one all over again. The doctor who ran that particular clinic was over 80 (he was a figure head leader with a valid medical license) and he lost his license to practice medicine because he could not change his name or protect his license. He was easily replaced with another figure head physician. Over the past few years, I have been told many times of ‘doctors’ who turned out not to be doctors doing surgery on them. It is happening all of the time (most recently a month or two ago in Los Angeles not far from my office). What is the difference between sleaze (like the Pittsburg entity) and the class act hair transplant entities? How do you know what to do, who is good and bad, how to pick a doctor and what to spend for a hair transplant? Is the bargain you are getting really a bargain? The good news is that today’s hair transplants can be absolutely first class and undetectable. The bad news is that they can be disastrous and deforming. You have to do your research to protect yourself in order to find your way through this complex maze.

One might ask, why not let a non-doctor operate on you after they’ve learned how to perform a hair transplant? Perhaps it could save you money? I won’t argue that the technical issues of the surgery are not difficult and everything goes well. The person doing the surgery would have to train a good team and teach the nuances of the surgery. But I would then ask where is the proper diagnosis, planning, and treatments that require knowledge of surgical planning, medications and how to treat a side effect of a medication or a complication if that should occur. When Xylocaine is given, can it precipitate a heart attack or a seizure? Absolutely, yes! A simple fainting episode in the operating room which slows down the heart rate to dangerous levels, can bring on a stroke or a heart attack (usually in older susceptible people with heart disease). What do non-physicians know about the treatment of such events? How do non-doctors treat run-away high blood pressure that occurs during a hair transplant (not-uncommon) in a hypertensive prone person? Or bleeding? If an inexperienced physician does a hair transplant, can he/she produce permanent nerve damage if they are not intimately familiar with the anatomy? Absolutely, yes! I can go on and on, but I hope that my readers get the message. Surgery can be safe, if it is done by a skilled, experienced and competent physician lead team, or it can kill you without such expertise. I have said many times that hair transplants are permanent and maybe I should add that death in the hands of a ‘would be surgeon’ is permanent as well. It is a buyer beware situation, as always.

Tags: doctors, hair transplants, legal

Barry Bonds, Batting Averages, and Hair Transplants

/by William Rassman, M.D./0 /, ,

Hi Doctor. Thank you for this blog and your honest responses. The fee that you charge to perform a procedure yourself is nearly double the fee to have one of your other doctors perform the procedure. I am sure that you are in high demand and as the laws of supply and demand go you are able to command double. What I really want to know is if the QUALITY of the results of a procedure performed by you would be noticibly better than that of a procedure performed by one of your doctors? I also see that there is only one other doctor and if I’m correct he is new to your practice. Bottom line is that when it comes to something such as a hair transplant, Quality and not Price would be a deciding factor as to who I went with. To use a baseball analogy, If you and John were baseball players would you both be batting .350 or would you be batting .400 and John .250 :)

Thanks again!

BaseballGreat question! Like any good baseball team, you need to have the team work together to get a winning result. What I have consistently said is that a great hair transplant doctor can not produce great work without a great team. In 1991, the quality of the work performed by the hair transplant industry was not acceptable to me, so I had to redesign the surgical techniques to make them acceptable. I have published a massive amount of work defining the standards in hair transplantation techniques (see: Medical Publications).

If you took me out of the team today and moved me to a 2nd class team, I might produce 2nd class work if I would allow myself to do just that. Back in the late 1980s and early 1990s, the quality of the work done by all hair transplant doctors was poor because the techniques were crude. The pluggy ‘dolls’ head appearance was the standard of care. So, on the first day I started to do hair transplants, I changed the technique I offered to one that allowed for delicacy of the transplants with a larger and larger number of smaller grafts, but this took manual techniques that had yet to be invented and lots of labor to produce and place these smaller grafts. Since I have never allowed myself to produce 2nd class work in anything I do, I had to build a 1st class team that understood all of the nuances that made for great hair transplants so that I could increase the number of small grafts in a single session so my patients would not have to have a surgery many times to get their hair back. You can not imagine the number of things that are controlled by the processes we developed and implemented at NHI. If I had to start all over again, I am one of the few physicians worldwide capable of doing every single part of the transplant process and I have been teaching process and techniques (one on one) to dozens of doctors and many, many medical assistants over the years. I have personally trained and retained the best people with me over the years. I pay them well and create a festive and positive work environment for the team and they return to me a diligent focus on quality and an attitude that most patients feel is imparted to them when they experience a hair transplant from this team. When I have ‘terminated’ a staff member, they always find work with other hair transplant doctors (many doctors want a medical assistant trained by me), but as I would never ‘fire’ someone great, these doctors get medical assistants that could not meet or sustain my first class standards.

In my practice, there is no such thing as a batting average of less than 1000 (400 just does not cut it, because it means that the doctor and team get great results only 40% of the time). Barry Bonds does not bat 1000 when he is at the plate, but I can bat consistently at 1000 with the NHI team and a batting average in a hair transplant reflects great results consistently. Without the team, particularly in these larger session transplants, I doubt that I would bat 1000, unless I reduced the size of the sessions to meet what I could do alone in a single day, as I did in 1992 as I evolved the megasession.

Simply put, my fees are higher because of supply and demand issues competing for my time (as you discussed).

Tags: rassman, hair transplant, fees, costs, hairloss, hair loss

Where Do Doctors Get Hair Transplant Training?

/by William Rassman, M.D./15 /

Where do doctor’s get hair transplant training? What credentials should I look for?

Since I wrote this extensive answer to a similar question in the past, the International Society for Hair Transplant Surgeons have attempted to address the problem with little success. Although standards are now known, training is still an unsolved problem.

Please see my post from April 2005, Hair Transplant Doctor Training for the previous response.

Buyer Beware

/by William Rassman, M.D./0 /

Are all balding men transplant candidates?

BaldJust 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.

Avoiding Hair Salesmen

/by William Rassman, M.D./0 /,

SalesmanI just saw a 23 year old man come back to see me after he had a hair transplant with another medical group known for ‘overselling’ hair transplants using pressure tactics with an aggressive sales force. He had seen me just a few months earlier and I told him that I felt that he was not a good candidate for a hair transplant at this time, because he was too early in the hair loss process. I further told him that if he had a surgery without a course of Propecia, he might accelerate the hair loss. I thought we had agreed that he would go on Propecia in an attempt to slow down the hair loss he was experiencing and then return in 8 months for further evaluation.

He went to another doctor for another opinion and then, under pressure by their salesman, he had a hair transplant. On his visit with me yesterday, it is now 5 months after his surgery and he looked fairly bald now, with a reactive hair loss. Prior to his surgery he was a Class 3 pattern balding and now he showed a full Norwood Class 6 pattern. The 1000 grafts he received at the surgery were insignificant in view of the hair loss he had. The patient never took the Propecia (which might have protected him from the loss he experienced).

Some clinics still exist today who ‘sell’ hair transplants like a used car. This young man is now hooked on the hair transplant process, like it or not. Will he ever be normal? Will his supply of donor hair meet the demands of his progressive balding? Will he have enough money to follow the course he is now on? Did he ever really have Informed Consent offered to him? What are his options?

I am not going to answer these questions, because by posing them I have in a way brought the purpose of this blog entry to your attention. For those shopping for a hair transplant today, it is still appropriate to warn: Let the buyer beware!

Analytical Questions From a 21 Year Old Balding Man

/by William Rassman, M.D./1 /,

Respected Sir,
I am very happy to see the service you are providing. My name is nabeel hussain .My age is 21.5 years. I have started getting bald when I was of eighteen. Now on THE NORWOOD/HAMILTON SCALE I am at 3V position. I have met a dermatologist he recommended me genesis and minoxil2%. I was told that initially I will lose hair + I have to use these medicines for whole of my life. Sir please answers my following questions I will be highly thankful to you.

  1. I don’t want to do this hectic and frustrating job of using medicines. As it is temporary and as I will stop using them my hair will lose more rapidly. Apart from that they have side effects also. Am I right? Will medicines have some negative effect on my donor area?
  2. I want to go for hair transplantation. but one doctor told me that doing so at an early age of 21.5 is not a good option because I will continue losing my hair and I will be again bald at a age of 30.and the previous transplantation will become fruitless. Is it right?
  3. I want to transplant hair because I have a concern about my donor area that it might not diminish if I postponed my transplantation. Is it could be the case?
  4. Can we take hair from the side of our head as donor hairs?
  5. What is period of complete bed rest after transplantation?
  6. At what age should I go for transplantation?

I have asked you a lot of questions but I hope and am certain that you will answer them all as you are very co operative.

Kindly recommend a better solution for me.

  1. If you are balding from genetic causes, then there is a good reason to be using finasteride 1mg (marketed as Propecia), which you must take for the rest of your life ( that is, until a cure for balding is discovered).
  2. The doctor who told you that you are too early for transplants is probably correct, but I have not seen you so I am drawing this conclusion based upon no objective findings, just the average 21 year old who is in the early stages of the balding process.
  3. Hair transplantation may not be the answer for you because you do not know how bald you will become and if the supply of your donor hair will meet the demands of your eventual balding pattern. You could end up depleting your donor hair for the short term gain at the expense of your long term look without a Master Plan for hair loss in your hands.
  4. The donor area is on the side and back of the head as you indicated.
  5. Hair transplantation does not require any bed rest after the surgery. You can walk around and within 5 days, even run a marathon.
  6. Generally, balding patterns are clearly evident by the age of 25-26. The later you can delay the decision, the more mature the hair loss pattern will be.

You are asking good questions. Take the advice of the good doctor you have already seen.

Dishonest Doctors and FUE

/by William Rassman, M.D./0 /,

I have published an article recently in the Hair Transplant Forum International (an industry newsletter, see below) that warns of doctors who perform Follicular Unit Extraction and produce a Follicular Holocaust, killing off many of the hair follicles and then charging the patient as if all of the follicles were actually transplanted. This process is unfortunately more the rule rather than the exception, because doctors just do not count what they actually deliver. This is a double ‘insult’ to the patient who pays for 100% of what the doctor says he is transferring and actually receiving something in the order of 25-50% of that quantity. The second part of the insult is the loss of the hair which may be irretrievably lost from the patient’s limited donor supply for life. So, the surgeons who engage in this process are cheating the patient and at the same time destroying valuable donor hair.

I have just participated in a Regional Workshop for the International Society for Hair Restoration Surgeons where I was one of the faculty, teaching the FUE technique on patient volunteers to some 25 doctors from around the world. A few of the better known self promoted doctors were invited to attend, but they did not take up the invitation. Most of the doctors who attended the course came with an open mind to learn state of the art FUE technology from more experienced physicians who have been doing FUE successfully for years. I learned that the reports of dishonesty that I reported in the article I wrote continue to be a real problem. I received confirmation of what I discussed in the article, which appears to be widespread, over much of the world. I applaud doctors who take formal approved courses to learn or enhance their skills for new technologies by spending the time and the money to come from Korea, Japan, Western and Eastern Europe, North America and the Middle East, but I continue to be disgusted by physicians who would rather develop experience by experimenting on patients and damaging/cheating fellow human beings. I admire the courageous balding people who want to get the benefits of new technologies, but when dishonest doctors promote their expertise with no real basis, they behave like hucksters, only distinguishing themselves from other crooks selling products or services by having an M.D. after their name and a ‘doctor’ for a title. Clearly, for the FUE buyer, the buyer must beware!

Here is the editorial I wrote addressing problems of ethics in hair transplantation surgery, which was published a few months ago in the Hair Transplant Forum International, January/February 2006, Volume 16, Number 1:

How Does a Doctor Get FUE Training?

/by William Rassman, M.D./0 /,

I see that many HT docs are offering FUEs and claiming how great they are. Where did they learn this and how can the consumer know what we’re getting is really quality work and not just a publicity scam?

It is best to ask to see the doctor’s patients and meet them directly. Do not accept photographs alone, for they may not be what they appear to be. FUE is becoming the ‘hip’ thing to offer patients to start to build a practice. It takes about 8 months from the time of the surgery until the results are known. For the dishonest doctor, that could become the ‘funding’ for a new venture and claims of expertise are easily made throughout newspaper ads and internet websites. Training is almost impossible to obtain unless you have a large hair transplant practice and are willing to practice on a dozen or so FUE grafts on every patient you perform a strip surgery upon. That is how I learned how to do them, 1-2 at a time per patient over 9 years. The main difference between me and others is that today’s self proclaimed expert can reference the standard I set and published. For me it was more complex than that, because I never knew it was really possible to obtain consistency until I had been doing it for years. The question you did not ask is about claims of success are measured. Self-proclaimed success in harvesting is clearly dependent upon ‘self reporting’ without audits. Trust is everything and integrity is at the core of the surgeons being. I can not advise upon this point for the buyer has responsibilities to research it heavily (please see The Truth About Cheap Hair Transplants for more info). As I always end these types of comments, let the buyer beware.

What Questions Should I Ask My Doctor?

/by William Rassman, M.D./1 /,

I’m african american, cherokee, and chickasaw indian and i’ve been natural since 2001. The last perm I had before that wasn’t rinsed well and left on my scalp. I went home and washed it. I thought everything was fine until 2003 when I noticed hair loss and gradual thinning from ends to root but growing length hasn’t been a problem. I’ve taken blood tests and found everything to be normal though the hemoglobin was 11.3 and b-12 374pg. Now the hair near my scalp looks as though it will disappear any minute now. I’ll be seeing a different dermatologist soon. How will i know what questions to ask to be aware that the doctor is being thorough? Please help.

It would be unlikely that anything left on your hair from two years earlier would be responsible for your present hair loss. A good doctor will lead the questions and get responses from you. The doctor will know what to ask of you, what tests to perform on you, and what to examine. That is your doctor’s job, not yours. Reading what is on this blog (see Female Hair Loss category) will give you insights into what you may experience with your doctor and what other women’s questions were. See what makes sense to you and then you can ask these questions of your doctor if you feel that he/she may need more guidance.

A Good Dermatologist?

/by William Rassman, M.D./0 /,

My daughter is 27 had a child 3yrs. ago. she is still having hair loss and is getting very thin,use to have beautiful thick her…do you do test strands of the hair ? I understand through a test the hair can tell alot. She commented to me that the hair on her legs does not grow either. could this be a inbalance of hormones? her OB decided to give her something that would stop her periods thinking it would help her margine, which it has.. BUT has this also messed her system all up ?

Please help her…how do you know if you have a good dermatologist? would it be helpful if you took pictures of the way it was once for the doctor to see ?

-A concerned Mom

The best way to find a good dermatologist is to ask your doctor or friends for recommendations. If that does not work, you can go to the American Academy of Dermatology website and look up a dermatologist in your area. I can’t be more specific without first examining you, as there are many things that I would need to know (such as health history) and see in person.

Price Quotes for Hair Transplants

/by William Rassman, M.D./0 /,

I was researching your ste and I was wondering about pricing. I have male-pattern baldness and have reached a 3V or 4 on the Norwood Scale. Roughly, how much would the procedure be?? Thanks.

If I had photos it would help a great deal. The differences in 3V and 4 classification vary so widely in different people that it is difficult to estimate without at the least a photo. Our records are confidential so that sending good photos will be instrumental to estimation. I generally like to speak with the person by phone (telephone consultation) when I receive the photos to fill in the needed information and then I can quote you. Things like your age, use of Propecia and its effectiveness, color and contrast of hair color, weight of the hair and its characteristics, scalp laxity, family history of balding and who you might take after, are all things that will tell me what I need to know to put real value on numbers and costs. Your goals are also critical as well.

What Do You Think of This Doctor?

/by William Rassman, M.D./0 /

Dr. Rassman. Are you familiar with Dr. [name removed]? He seems to do incredible work artistically, but he seems awful aggressive in transplanting and his marketing techniques seem a little shady. What is his reputation in the hair transplantation indusrty? Is he trustworthy? I am considering him because he has a local office.

Thanks!

I make a point not to react to questions like this on a specific basis, but you list many of the elements of a doctor that are critical in the doctor selection process. Aggressive and shady are two negative descriptions. I generally recommend that you stay away from any doctor who you do not trust. Having a local office is the worst way to gamble on your looks for the rest of your life. I use the words confidence, trust, integrity, reputation, artistic, etc.

I do offer a travel reimbursement program if you qualify, so even Los Angeles is not that far away.

Also, please read more about doctor ethics in past blog entries:

Is Miniaturization at The Crown Considered Maturing?

/by William Rassman, M.D./0 /

If I have some miniturization at the crown and diffusely all over, this would not be considered a mature hairline would it?

Miniaturization of hair (greater than 20% small or thin shafts) is considered balding, irrespect of its location. A mature hairline begins roughly around 1 finger breath above the tip of your frontalis muscle at the frontal area and about 1 1/2 or 2 fingers breath at both corners. If you have diffuse miniaturization all over your head, consider checking your permanent zone for miniaturized hairs. A condition called Diffuse Unpatterned Alopecia (DUPA) means that you have miniaturization all over your head including the permanent zone in the occipital area. In the classic male pattern baldness, there is less than 20% miniaturization in the permanent zone in men.

Loupe Magnification for Diagnosing Miniaturization

/by William Rassman, M.D./0 /

Dr. This is a quote from an e-mail I recived back from another doctor when asking about testing for minaturization. He said, “I use what is called ‘loupe’ magnification which can easily detect hairs which are ‘miniaturizing’.”

Is this the same as what you do or is this something different?

I use a densitometer apparatus or a magnifying video camera to map my patient’s head with magnification at 20-50 times normal. I believe this is important and easier to use with reasonable accuracy. However, if the hair doc which you mentioned used magnifying “loupe” to map his patient’s with accuracy and quantifies the degree of miniaturization by the location in the various areas of the scalp, then I will not argue the point. There are many correct roads to take.

Hair Mapping for Miniaturization

/by William Rassman, M.D./0 /,

Dr.Rassman, What is hair mapping? I have a derm doctor. He did a biopsy that showed AGA. I am 59, female. I started taking Prempro again, with hope of keeping what hair I have. Who do you think I should see in the Orland Park IL. area? I have lost more than half of my beautiful hair! I am at the moment using steroid gel on the bald spots every day, I really value your opinion.Where do I go from here? I will travel any where…

P.S. My doctor loves your site/ He said he would follow your instructions!

Hair mapping means that a physician is using a densitometer or video magnifying camera to look for miniaturized hairs at multiple sites on your head. The percentage of miniaturized hairs and the thickness change in those miniaturized hairs will determine:

  1. if a balding process is going on
  2. the pattern of the balding process
  3. over time and advancement or regression of the balding process

Based upon the many different published patterns of hair loss, the doctor can determine:

  1. what pattern of hair loss you are demonstrating or probably evolving into
  2. a look into your future hair loss based upon his/her experience with that particular pattern of hair loss as it conforms to the published patterns (e.g. Norwood Chart)
  3. the overall health of the hair in different parts of the scalp

For example, if a man has extensive miniaturization of hair in the Norwood Class 6 pattern (under microscopic examination), he may advance to a fully bald Class 6 pattern (even if it is not evident to the naked eye). Miniaturization is looked at in two ways; first, the total number of normal vs miniaturized (narrow shafted) hair, and second, the degree of overall miniaturization on a per hair basis (e.g. 80% of the hairs are miniaturized with an average hair loss 50% of its original diameter). If, over time, the percentage of miniaturized hairs stay the same, but the diameter of the hair shafts increase to, let’s say, 80% of their original diameter with a person on Propecia, the change can be documented as benefiting from the Propecia, or reduced to 20% of its original diameter, indicating a progression of the miniaturization and a failure to respond to the Propecia.

For women with genetic hair loss, miniaturized hair follows very different patterns than for most men. For the transplant surgeon, it is critical to know the miniaturization that is going on in the proposed ‘donor area’, for if the hair in that area shows significant miniaturization (diameter reductions and the percentage of hair involved in the process), then most of the hair that is used for donor hair will fail to survive a transplant, because the miniaturized hair will not have value in the new location. As an example, if a woman needs hair in the frontal hairline but has 80% miniaturized hair in the sides and back of the head, then one would assume that 80% of the hairs that are transplanted will fail when moved from this donor area.

For the male patient who is going on Propecia, getting baseline measurements will tell something about the changes in the hair after a reasonable treatment period. An example of this would be: a young man who had 90% miniaturized hairs in the hair population from a balding area measuring a 3 inch circle in the back of the head. Let’s say he was started on Propecia and then 8 months later, the miniaturization came down to 50% of the hair in the circle. That means the drug is working nicely and some reversal of the impact of genetic balding on the 3 inch circle in the back of the head had responded to treatment.

So you can see that the value of measurements here are both for diagnosis (what is causing the hair loss and how bad it is) and prognosis (predicting the future with and without treatment). If measurements are not made, then there is no sense of control for the doctor or the patient and the cause of the hair loss can not be followed intelligently. Measurements are the foundation for clinical science. A patient with compromised kidney function gets a blood test to see the progress of the disease and the value of any treatments given. The electrocardiogram (ECG) measures the damage of the heart after a heart attack or predicts a pending heart attack. I can go on and on here, but basically, hair should not be treated any differently than other sick organ systems. There must be an end of the days when a doctor runs his fingers through your thin hair and says (somewhat magically) that he knows what is wrong and how to fix it, he knows that the density is good or you are not going bald.

Blood work will help rule out other causes of hair loss such as hypothyroidism, anemia, hormone imbalance, and malnutrition.