Is Repairing Possible?

I’ve had surgery 14 times on my hair (5 scalp reductions and 9 hair transplant procedures) since I started the process 20 years ago at the age of 19. I don’t look normal and that is hard to say, even in an email. I went to a number of doctors over the past 20 years and each one told me confidently that they could make me normal. I want to believe that I can be made normal, but I am not sure if I can trust anymore. Do you have any advice for me?

This is a question that I could write a book to adequately address. It involves many things including (1) ethics and earlier surgical solutions that were sub-standard solutions for hair loss, (2) what was/is informed consent for the surgical process of hair loss, (3) After 14 surgeries, what can he expect from the more modern procedures available today, if anything, (4) how does anyone get faith back, when they have experienced hopelessness, etc..

1. Ethics and the Earlier Solutions for Hair Loss: There was a time when surgeons and patients alike were naive and thought that they solved the hair loss problem with creative surgical solutions. Patients want to believe that doctor could produce miracles, and doctors want to view themselves as miracle workers. No field was more fertile that the balding young man who desperately felt that solving his hair loss was more important than almost anything ‘on his plate’. Unfortunately, desperation mixed with over exuberant doctors (some of whom had the ethics of a viper) was drawn together with an inferior surgical procedure that was (unfortunately) the only procedures available at that time. As more and more men came in ‘hordes’ to the doctors doing the surgery, doctors convinced themselves that what they were doing must be the right thing, for why would the patients come in droves if they were not pleased. For the pluggy or deformed patients that were produced, denial was a quality that played tricks on the mind, like the Emperor’s New Clothes, everyone saw what they wanted to see rather than what was there, or did they?

   In the 70s and 80s, many celebrities were drawn into the stampede. When Frank Sinatra had hair transplants, everyone found out about it. Even the doctor who did it promoted the Sinatra name as if it was an endorsement for either his services or the procedures themselves. A patient of mine and friend of Sinatra (1993) told me how angry Sinatra was when he discussed his hair transplant experience. The rumors of despair and depression that followed Elton John’s transplant experience are legendary and echo the questions posed by this 39 year old’s questions to me. If the rich and famous were sucked into a substandard standard, how could the ordinary working class man avoid the trap? The answers here are many. There were ethical doctors around in the 1970s, 80s and 90s, so the axiom buyer beware still prevailed then as the ultimate fail-safe control for our welfare in our capitalistic society. Even today, finding an ethical doctor is as important as finding a competent one, for the vipers are still out there and buyer beware paradigm is still an important guide in selecting a doctor. Unfortunately, in the 1970s and 80s, the procedures that were available were still (in my opinion) substandard which is the dilemma that our questioner implied from his early experience and it unfortunately still goes without an adequate answer.

2. What was/is informed consent for the surgical process of hair loss? This is a critical focus for our questioner to command. In the buyer beware paradigm, I would always want to collect the following information before making a decision on selecting a doctor:

   a. Does the doctor have experience repairing the misadventures of the older techniques? Here the patient should depend upon his skills in interviewing a doctor, just like interviewing an employee for an important job. Does the doctor appear honest, sincere, and competent? Does the doctor present himself with command of the subject material? The patient should ask for proof that the doctor can deliver what he promises to deliver. He should request to see patients who have had the repairs done by that doctor and ask these patients what they thought of the promises after the work was complete. Meeting some former repair patients will be very helpful in establishing a good base line for comparison, as no two repair jobs are going to be the same.

   b. Listen carefully to what the doctor is telling you and ask yourself: Does this make sense? If the doctor makes unrealistic promises, they should be compared with other opinions that the patient should elect to get with visits to other doctor’s offices. Comparative shopping is critical in the hunt for a good, ethical hair restoration doctor in every situation.

   c. What is the experience of the doctor in the mal-practice arena, medical board activities with the state licensing board, better business bureau, membership in professional organizations such as the International Society of Hair Restoration Surgeons.

3. After 14 surgeries, what can he expect from the more modern procedures available today, if anything? This is a huge variable. This patient will most likely never be full hairy and “normal” so the answer to this question is to find out just what the patient believes is wrong and what makes the patient feel that he is “not normal”. The doctor must find just what the extent of the problem is from the patient’s perspective and what he has to work with from the patients remaining hair supply. The doctor should ask the patient to prioritize his concerns. There must be some point of intersection here, between the patient’s needs and his supply of remaining donor supply. The good news is that with the addition of the new Follicular Unit Extraction procedures, hair can be moved around, even from areas where they were moved before. A realistic assessment must be made prior to judging what can be done.
4. How does anyone get faith back, when they have experienced hopelessness, etc.? This is a particularly difficult question to answer. It is highly personal and depends upon the unique characteristics of the relationship between the doctor and the patient. Great care needs to be taken in search for another doctor, but there are many doctors today offering experimental techniques that involve body hair transplants, hair cloning and the like, that are no different than the huckstering of this questioners past experience. The good news is that there are good doctors out there today with wonderful judgments and skills. Only the patient can make the final decision and it will be a costly and geographically wide search for the finding the right doctor.