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10 Reasons NOT to get a Hair Transplant

Often when talking about hair transplants, we focus on the plusses. Today we’re dedicating the blog to unpacking some of the reasons you shouldn’t. 
When someone is considering a hair transplant (or any plastic surgery), part of our job is to make sure they have all the information they need to make the right choice for them. But it’s a two-way street. Part of understanding whether a procedure is right for you is understanding both the expected benefits along with the potential pitfalls and risks. 
Read on for my take on some commonly cited reasons not to get a hair transplant. Some of them are obvious, but others? Like a lot of things in cosmetic plastic surgery (and medicine), there’s important nuances that I really think are worth taking the time to discuss. 
1. If you’re concerned about scarring or restrictive hairstyles, is a hair transplant for you?
We never lie, so yes, with any hair transplant there’s a mild to moderate concern over scarring, but it’s important to understand how dependent the level of concern should be based on the type of hair loss you have, and the hair transplant method used.
FUT and FUE both leave scars, but FUE performed on the right candidate with the proper tools is difficult to detect. Many FUE patients choose to wear their hair short to show off the transplanted hair. In contrast, FUT, due to the nature of harvesting a strip of the scalp, can leave a noticeable scar. 
No matter the type of transplant, there will be a scar. But, some are much less detectable than others… 
Remember that the right hair transplant for the hair loss you’re experiencing is the one that will give you the best result. 
2. If your donor hair (or the hair near the recipient site) is fine, thin, or weak are you a hair transplant candidate?
Pairing a hair transplant with medical therapy is something we always encourage. One of the reasons is that I like to see the hair you have in the best shape possible before we follow through with a transplant.
 Minoxidil, finasteride, PRP, microneedling, and low-level laser light therapy – when used in the right scenarios – can all improve the density, diameter, and strength of the hair you have at both the recipient and the donor sites. Medical therapy can really improve your foundation, giving you results that are that much better. 
And speaking of candidacy, make sure to ask your surgeon whether you’re a good candidate and ask them how often they say no. People can get greedy, and surgeons are no different. 
3. If I’m in my 20s and I already have hair loss (plus a family history of hair loss), is FUE still an option? 
Often the advice floating online is that if you’re young and already experiencing hair loss, FUE is a problematic road to go down – you’ve got years of hair loss ahead and the results might not last. The consensus seems to be to wait until you’re older. 
But there’s nuance there. If someone’s hair loss began in their teens, by 20 they could be Norwood 6 or 7. Well, what are you telling them to wait for? Their hair loss has already significantly progressed. 
Age alone shouldn’t be the defining factor. If someone in their 20s has stabilized their hair with medical therapy and their expectations are in check, they should be offered surgery. 
4. If I have dark hair and light skin, is it possible to get the results I want in one procedure? 
Regardless of hair color, there will always be some patients who seek out a 2nd or even 3rd transplant later-on. That doesn’t mean that the first surgery failed. It might be that they simply want to improve on those results later on. Results are individual and more dependent on density and thickness. Typically, someone with denser, thicker hair will have a better result than someone with a finer caliber of hair, and that’s regardless of the number of transplants. Again, it’s why medical therapy is so important. 
Results are less dependent on starting hair color as they are on density and caliber. Denser thicker hair types tend to see better results. It’s one of the reasons we like medical therapy so much. 
5. Don’t rely on consults from surgeons who only perform one type of hair transplant This is actually a great piece of advice. There’s a tendency with clinics (and surgeons) who specialize in a single procedure to view every problem as a nail that can be solved with the same hammer. 
If there’s a procedure I don’t offer but I think could benefit a patient, I refer them to someone who can. For me it’s a question of ethics and making sure the patient has all their options, not about losing business.
Another issue is that with the popularity of FUE (easier to wear short hair, etc) many doctors are no longer being trained on FUT. That’s a real shame, because there are definitely instances where the harvesting power of FUT makes it a better transplant choice. 
A surgeon who can do both FUE and FUT can direct you to the right transplant for you, not the right one for their balance sheet. 
Not every problem is a nail. If a consulting surgeon only performs one type of transplant, you’re wise to be skeptical and seek out an opinion from a surgeon who performs both FUE and FUT. 
6. Stay away from hair transplant machines
Great advice. And it opens up a much bigger conversation. A lot of doctors are now offering a slew of cosmetic procedures – Botox, fillers, lasers, hair transplants – regardless of training.
It’s not so much what board a doctor is certified by, but who they’ve trained and mentored with. It takes a while to learn how to do a hair transplant well – both artistically and on the surgical front. Obviously, a surgeon (such as a head and neck specialist) is going to have better surgical training. Does that mean a dermatologist can’t do a hair transplant well? Of course not! Artistry is very important, and dermatologists tend to have a strong artistic background. But there’s a nuance – where did they get their surgical training? A machine is not a substitute for a hair transplant surgeon. Seek out a real professional. 
 A machine is not a substitute for a surgeon. Seek out a professional. 
7. The surgeon should be the one doing the extractions, especially when it comes to FUE 
This is another one where there’s nuance. Your transplant surgeon absolutely needs to know how to do extractions, but it’s not always the best use of their surgical stamina. 
I know how to extract, and I sometimes jump in during that part of surgey to help. But I have a hair PA (along with a highly trained, personally chosen surgical team) under my supervision who does much of the extraction for me. It’s a better use of my stamina and makes me more efficient (and fresh) when it comes to making the sites. In my opinion, site making is the artistic portion of the procedure, and where I make sure to be very active. 
But that's worlds different from a surgeon who leaves everything up to the technical staff and might not even be there for your surgery. I think that’s a scenario where wariness is very warranted. 
Vitamins – Malnutrition can play a role in hair loss – B12, Viviscal, Nutrafol, and other biotin rich supplements – can be used to potentially help the overall state of your hair. The degree of improvement is small – you can’t rely on vitamins to regrow hair, but it’s also very low risk. There’s no harm in adding these as an adjunct to your routine. 
Low level laser light therapy – This treatment can increase blood flow to the scalp, helping support hair growth. The problem is that we still don’t know the optimal frequency, power, diode count, and duration of use. It should go without saying that these devices are relatively new and, like with all new technologies, we also don’t know the long-term effects (though they’re considered quite safe). They’re best used as a support to other hair loss therapies. If you want to learn more about low level laser treatments for hair loss (benefits, side effects, recommended devices) I have a dedicated video
Steroids – Steroids are useful to bring down inflammation in scarring alopecia or active telogen effluveum, especially if there is a lot of active hair loss. The tricky thing with steroid creams is that they’re really not a great long-term solution. Depending on them for too long use can be very problematic, given the systemic

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8. A surgeon without a plan is a red flag 
A treatment plan for surgery is huge, and a lack of one is a warning sign. 
If a person has many areas of hair loss, then you need to have a treatment plan in place for where to harvest and treat to maximize results. That goes for whether a single surgery is the goal or subsequent treatments in the future. A plan helps your surgeon maximize your donor hair (so none is wasted) and determine the best spot to place it. Are you planning on medical therapy? How does that factor in? 
9. If the promise is too good to be true, it probably is
Doctors MIA, stolen before and afters, heavy discounts, lofty mega session graft counts promised on the cheap… There’s some fraud out there, and for something as emotionally charged as hair, you need to be on your guard. It’s easier to become a victim than you think. 
Be skeptical. If it sounds too good to be true, it probably is. There’s fraud out there and it’s easier to become a victim than you think. 
10. Should my hair transplant come with a guarantee? 
This one is tricky. A hair transplant is surgery. It’s not like buying a chair where you expect it’ll be free from a defect. 
There are so many things involved in surgery and a lot of unknowns. There’s a patient’s healing, how they respond to surgery, and then all the things that can surprise everyone – like a condition you couldn’t possibly have known about. 
Patients need to understand what kind of result they’ll get – if they need two surgeries for the results they want, they need to know that. But you can’t guarantee a surgical result and – if someone is – that’s a reason to run.
Now, most plastic surgeons do have policies in place for revisions, but that’s not a guarantee of the work, that’s to address problems that might come up that are statistically expected and completely unpredictable. There’s no crystal ball that can predict the future, you’re signing up for the risks when you proceed with any cosmetic procedure. The scars might be bigger than you’d like and require you to change your hairstyle, or you could develop a condition afterwards (like alopecia areata). It’s important that a patient knows that if there is a true complication, you’re there for them – you’ll make the finances work, you won’t abandon them – that’s fair, but it’s a very different situation than a guarantee. 
Not unlike a lip lift (another surgery I perform) if concern over the potential scar is giving you obsessive anxiety, or you’re expecting absolute perfection, then you might not be a great surgical candidate.
 
Final thought
Deciding on a hair transplant is tricky, as is deciding where to go. Be informed, take a look at the surgeon’s work, and seek out multiple consultations. Understand both the power of cosmetic procedure and the inherent risks. 
Remember to be confident out there no matter where your hair story takes you! If you are considering medical hair therapy and/or a hair transplant, visit us at City Facial Plastics to schedule a consultation and find out what your options are! 

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Written by
Kristi Charish
Edited by
Dr. Gary Linkov
The content of this newsletter is for entertainment and educational purposes only. This content is not meant to provide any medical advice or treat any medical conditions. Patients must be evaluated by an appropriate healthcare provider on an individual basis and treatment must be tailored to meet that patient’s needs. Results and particular outcomes are not guaranteed.

 

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