Hair Loss Advice


Hair Transplantation for Men - Is it Right For You

Hair Transplantation for Men: Is it Right For You

Medically Reviewed On: October 16, 2000

Webcast Transcript:

DAVID R. MARKS, MD: Hi, and welcome to our webcast. I'm Dr. David Marks. What you're about to see on this video is someone regaining a head of hair. Hair transplantation has come a long way in the last few years. But not everyone with hair loss is a candidate. Here to help us figure out who is a candidate for hair transplantation are two doctors.

Dr. Michael Reed. He's Assistant Professor of Clinical Dermatology at NYU Medical Center and he directs their hair transplant program. Thanks for being with us.

MICHAEL L. REED, MD: Thank you.

DAVID R. MARKS, MD: Next to him is Dr. Robert Cattani. He's one of the founders of the American Board of Hair Restoration Surgery and he practices in New York. Welcome.

Let's talk about men. Hair loss is obviously very common in men. But not everyone's a candidate. Who is a good candidate for hair transplantation?

MICHAEL L. REED, MD: Any person who has lost enough hair, they don't have to be bald, enough hair so that on casual observation you can see scalp and not hair, and who has a condition where the hair that is transplanted will live and survive and behave in a proper way at that new site, a condition called donor dominance is a potential candidate for transplantation. Most of these patients are men with male pattern hair loss, hereditary hair loss.

DAVID R. MARKS, MD: What does donor dominance mean?

MICHAEL L. REED, MD: Donor dominance refers to the phenomenon that if genetically blessed hair is going to live forever in the back of the head, or for a lifetime, it will decide it's own fate at the new site. That's the case in male pattern baldness, that's why we can transplant it. You could not transplant a hair into an area where, say, there was infection because the infection would destroy the hair. So the phenomenon of donor dominance must prevail. Since most men who get transplants have male pattern hair loss, that is a donor dominant condition and therefore they can be transplanted with long-term success.

DAVID R. MARKS, MD: Dr. Cattani, just describe what male pattern baldness is.

ROBERT V. CATTANI, MD: If I may just add to what Dr. Reed said first. Dr. Reed so wonderfully outlined the objective criteria of those who would be candidates. Let me add the subjective criteria which I think the audience would like to know. I think it is essential that someone be very bothered by their hair loss to make themselves a good candidate. If they're not bothered, if someone else in their family is bothered, or someone else induces them to secret consultation then they are not a good candidate.

But if they are severely bothered by hair loss and their expectations are realistic, then and only then can they become very good candidates for this. Those are very important factors, David.

DAVID R. MARKS, MD: So in other words, you're talking about someone doing it to please someone else.

ROBERT V. CATTANI, MD: Absolutely. That is without question the number one taboo. A question I ask initially in consultation, "Are you here because your hair loss bothers you or did someone suggest to you, 'Hey, you know something, maybe you ought to get your hair looked at.'" That's very important. Dr. Reed will also, I'm sure, agree with that.

DAVID R. MARKS, MD: Tell me about male pattern baldness. What does that actually mean?

ROBERT V. CATTANI, MD: Male pattern baldness is a condition which is hormone related and gender related where, due to lack of certain hormones there is a hair loss that begins at various times and at various rates in individuals.

I can only tell you that as varying as it is, the one constant seems to be that it is usually viewed the earlier the loss becomes, the more devastating it is to the patient. Most young men view it as a very unwanted thing, very unacceptable to them and often seek medical correction of it.

DAVID R. MARKS, MD: You have some picture I understand to show that. Is that right?

MICHAEL L. REED, MD: Yes. I have several pictures. I was just going to say that I absolutely agree with the subjective part that Dr. Cattani mentioned, namely that this is a procedure for people who suffer from baldness. Not everyone who has baldness, suffers from it. What suffers is their self esteem and their self image and this is a way to more or less permanently correct that hair loss as a way of improving the way they feel about themselves when they look in the mirror. Improving their self confidence and their self esteem. Otherwise there's no reason to do it.

In terms of hair loss, here's a typical young man with frontal recession of his hairline. It used to be down to here and now it's gone way back. Remember that when you look at a person, when you first make eye contact with that person and then your eye subconsciously runs up the forehead until it stops, then you have a perception.

If your eye can run off the top of somebody's head into outer space, then the mind perceives baldness. So what we do when we transplant people, we create a new hairline. It stops the eye and it tricks the mind and the mind no longer perceives that a person is bald. They may perceive of them as having thin hair or a receded hairline, but the perception of baldness is greatly ameliorated if not eliminated.

DAVID R. MARKS, MD: Dr. Cattani, you had mentioned getting it early. But if a young man is just starting to lose his hair, shouldn't he wait to see how the hair loss is actually going to progress? What's the reason for getting it so early if he's still going to continue to lose hair?

ROBERT V. CATTANI, MD: What I was trying to say is this, that the earlier the loss, usually the greater the loss as time goes by. Ideally I would like to begin treatment of patients no younger than the age of 25.

If it's a very dynamic loss, in other words if I know, or if I can somewhat predict through different parameters that that patient is going to rapidly lose his hair, we have to make an assessment.

Think of it this way, David, the more you need, the less you have. I have to, and Dr. Reed has to predict as best as we can how much donor site we're going to have to work with. So if I can ask a patient to come to my office every three to six months and follow him and nurture him and advise him and console him, when the longer I wait to age 25 to age 30, I feel the better service I will do for the patient.

DAVID R. MARKS, MD: What are the downsides of having a hair transplant for people who are considering it?

MICHAEL L. REED, MD: Probably the biggest problem the patients run into is the self consciousness factor. They wonder about the post-op period. Once the procedure is explained, they're happy and they want to do it but they're very self-conscious.

They say, "How long? Am I going to have little scabs? Is there going to be much pain? What's the downtime?" Then probably the most disturbing thing is that when the hairs are transplanted they're shocked and even though they survive the trip to their new home, they sleep for a while. They rest and they don't restart their growth process until two or three months have passed.

So there's a period where people can have a little bit less hair before they have a lot more hair and they have to get through that period.

DAVID R. MARKS, MD: Do you mean the donor hairs fall out?

MICHAEL L. REED, MD: The living hair follicles rest, stop making the hair shaft. Hair shafts are not alive, they're dead. They grow for maybe a week, like a little stubble, and then they rest. Then they come out after a while and then a new hair has to grow to replace them. When it starts to grow at eight to 12 weeks it grows a half inch a month.

So if we want to take postoperative photos to show the results we usually can get them in six to seven months. So during that time period they have a little bit less hair than before they have more. So they have to get through that.

DAVID R. MARKS, MD: You were going to show a picture.

MICHAEL L. REED, MD: I was going to say that in the long term, Dr. Cattani alluded to this, somebody starts young, they're going to lose more hair, they're going to maybe cue ball out at an earlier age. For early onset it's best to try to delay it if possible.

As we said in other webcasts, that medical treatment is available, that dermatologists and plastic surgeons know about that they can recommend, that sometimes will arrest the process, sometimes reverse it in certain areas.

So medical treatment should always be considered early on for a young person starting to lose their hair. No one should rush to get a hair transplant. They have to have lost enough that they really get a benefit by having it done and remember also, we have to plan that a person will always look natural from the work we do.

No one should end up chasing their baldness, or should put a few here, a few there, and then if they don't complete it, some day they look like the guy from planet Z, not from planet earth. So we have to do long-term pattern planning and this little diagram shows the natural things that we see in the world besides a full head of hair. We see people with bald heads and then we see people who have see through hair. These are usually women with female pattern hair loss, and then we see variations on the theme of male pattern hair loss where there's a receded hairline in front, perhaps some thinning in the back.

So when somebody makes their plan, when they want to do something for the long-run, we have to say, "How do you want your hair to look? Do you want it to be in this pattern, or this pattern?" Most people, if they do eventually lose all their hair, have to have a hair pattern up there that can stand the test of time. That's really carefully planned. We call it long-term pattern planning. Always plan ahead. No pun intended.

DAVID R. MARKS, MD: Briefly, what are the surgical risks? The risks associated with this procedure?

ROBERT V. CATTANI, MD: As with any procedure you have to inform the patients of bleeding, infection, scaring, things of that nature. Poor take and so forth. I think that all of the intricacies of the procedure are probably beyond the scope of the time allotted here. But Dr. Reed said something that's very profound.

No one should rush to have a hair transplant. No one should because that's when the true disasters come. I think you have impart to patients the following, and I try to relate this message. I will tell them, "Look, your hair loss bothers you this much. It bothers every one else this much. If you think as a male you're losing your virility or your allure, it bothers women this much if at all, and that's a very true statement.

So what we want to do, if you rush into a hair transplantation after 25 years of performing this procedure I think what suffers is naturalness and detectability, and you never want to do that. So I think Dr. Reed will agree with that.

DAVID R. MARKS, MD: Last question, in people deciding whether they want this procedure, cost. What's the cost in general?

ROBERT V. CATTANI, MD: There's a range depending on how much tissue is moved from the back to the front, how large an area needs to be done.

So the cost can range anywhere from $2,000-10,000 depending on the size of scalp moved, the number of hair follicles that are moved in that area of scalp, the number of grafts that are put into the top of the head and how large an area is covered.

MICHAEL L. REED, MD: I could probably add to that a little bit, too, because I think that $2,000 or $10,000, either one of those sums is a lot of money looked at alone. But look at it this way, what we do it permanent.

How many things in life are permanent. If we buy a car and we spend $10,000 for it, in three years it's worth significantly less. So the work that we do is permanent. So in that regard, yes, it's expensive but it prevails. I think that's a good thing to tell the patients.

DAVID R. MARKS, MD: As opposed to some of the medicines for hair loss which are $600-700 a year for the rest of your life.

MICHAEL L. REED, MD: Those things mount up.

DAVID R. MARKS, MD: Thank you very much. Thank you both for being here and thank you for joining our webcast. I'm Dr. David Marks. Goodbye.