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Comparing Apples with Apples and Oranges with Oranges in Hair Transplantation: What Benchmarks Should a Patient Rely on to Predict Outcome?

The purpose of hair transplantation is cosmetic improvement, but this has multiple layers of meaning for different people. One may seek hair transplantation to feel better about one’s self, to have more confidence about one’s appearance to others, to be sexually more appealing, to look and feel younger, to compete more effectively in business or profession, and for other reasons unique to the individual.

The reasons a person seeks hair transplantation will be reflected in hopes for transplantation results:

  • How will I look after hair transplantation?
  • How soon will I be able to realize the final result?
  • Will my transplant look like the one my friend had a couple of years ago?
  • Will my transplant last for the rest of my life?

Most, and perhaps all, of the patient’s questions will have been discussed by the patient and physician hair restoration specialist before transplantation was undertaken. An important part of the discussion will be to make sure the patient understands that (1) results will be individual to the patient and cannot be compared to results in another person, and (2) the final result will reflect the patient’s wishes for outcome and the physician’s ability to deliver an optimal result given variables such as the patient’s age, gender, type of hair loss, progression of hair loss, type of hair, color of hair, head and face shape, and anatomic/physiologic features of scalp skin that will receive the transplant grafts.

It is these variables that determine the answers to some of the patient’s questions. For example:

Will my transplant look like the one my friend had a couple of years ago?

Comparison of hair transplants in two different people—even if they are of about the same age and gender—is like comparing apples and oranges with grapefruit and mangos and peaches thrown in to complicate the comparison. Variables such as head shape and degree of hair loss are easily called to attention. Not so easily noted, but just as important in their contribution to the final appearance of a hair transplant, are hair characteristics such as caliber (diameter) of individual hairs, hair straightness or wave or curl, hair color and differential between hair color and scalp color (a large differential can cause scalp to “show through” and limit the appearance of hair density). A characteristic of hair follicle pattern that also influences final appearance of a hair transplant is the hairs/follicle unit ratio (follicular units are the “islands” in which follicles group together on the scalp). A majority of one-hair follicular units versus three-hair follicular units can make a significant difference in final appearance of a transplant.

A physician hair restoration specialist selects a transplantation technique that will best deliver an optimal result. A technique selected for use in one patient may be different from the technique selected for another. Differences in technique can create differences in appearance based upon the result the patient wishes to achieve—for example, one patient may want maximum hair density while another opts for less density.

How soon may I be able to realize a final result?

Every transplantation session produces a result, but the final result may not be realized for several months. Variable factors determine how many sessions may be needed to achieve the optimal outcome the patient desires. A major variable is hair loss progression. Androgenetic alopecia, the most common cause of hair loss, is often progressive and multiple sessions over a period of years may be required to account for progression. View article on Hair Growth & Hair Growth Cycle.

Variables such as these make it difficult to predict with 100% accuracy how a transplant will look a month, three months and six months after a session. The hair follicle, the basic unit of hair transplantation, is a self-contained hair production factory in which hair production is orchestrated by hormonal and other influences unique to each individual.

Will my transplant last the rest of my life?

Hair follicles for transplantation are harvested from an area of the scalp that is not subject to hair loss due to androgenetic alopecia. This is called the “donor area” and the hair taken from it is called “donor hair”. Even after they are moved from donor area to recipient area, donor hair follicles retain their resistance to androgenetic alopecia. The recipient area will not suffer hair loss due to androgenetic alopecia.

Hair loss may continue on other areas of the scalp, however, if the androgenetic alopecia is progressive. Progressive androgenetic alopecia is often predictable, but not always. Reliable predictors of progression include (1) pattern and degree of hair loss in members of the patient’s family, (2) age at which hair loss began, and (3) pattern and degree of the patient’s hair loss.

Hair loss that begins early in life may progress for decades. This is why physician hair restoration specialists often recommend against early hair transplantation in a man who has very early hair loss. Very early transplantation may use donor hair that will be needed in later decades to correct progressive hair loss. A strategy sometimes used for hair loss in young men is to treat the hair loss medically to slow the hair loss for a few years until hair transplantation becomes a viable option.

Apples and oranges

Hair loss is unique to each individual, and the outcome of hair transplantation is unique to each individual. These are the “apples” that can be usefully evaluated. Other comparisons are “oranges” that confuse useful evaluation.

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