By Dr. Cole, FUE Hair Transplant Pioneer

Patient Expectations, Education and Physicians Responsibility

Hair transplant patient
Patient Expectations, Education and Physicians Responsibility, Forhair

We place a great deal of emphasis on patient satisfaction. We never like to hear about a patient who did not meet their expectations. We do everything possible to meet these expectations and stand behind our work. We have not heard from this patient, and we have not seen him back in our office. I will say that it is tough to make any recommendations or give any advice to our patients in a chat room forum.

We are driven by customer satisfaction. We leave no stone unturned in ensuring that our services meet and surpass our customer’s expectations. However, it is very difficult to make recommendations to expectant customers or give them any other kind of advice based on what we hear in the chat room forum.

I have never come across a case in a patient where there has been no hair growth with a virgin scalp. However, I have seen many cases where there has been poor hair growth and scarring from previous surgeries. In the case of ridging, poor growth is often the case. In my hands though, it will never occur in virgin scalps. When you use an implanter, there may be poor growth in virgin scalps, but we never use them. I do remember the case, and there was no reason to worry as the grafts were done very well.

For this particular case, I reviewed all the threads. I made a point to note what the advise given was, it was 2500 grafts and o examination I found that there were only 1000 grafts. I also noted that the fist fulls of hair were coming out about 3 – 4 months after the procedure. He had also mentioned that he has hair characteristics that were favorable. Well, he did have medium-coarse hair, but the density was below average.

When individuals do not understand the hair loss process properly, they are bound to be disappointed with the procedures. This is the reason why I make it a point to educate my patients by having all the information on my website as well as on the printed literature. Informed customers are less prone to getting disappointed as they are well versed in the problem, solution, and treatments. However, consulting the patient is also very important.

Duckman, my patient has not consulted me since the procedure, so I can only put down what I know in theory. In all likeliness, Duckman has progressive Alopecia. The reason for fists full of hair loss just 3 – 4 months after the procedure can only be attributed to androgenic alopecia. It is definitely not due to shock loss, as this starts about 3 – 4 weeks after the surgery and stops almost immediately after a few weeks. While progressive alopecia could also be the reason of hair loss within 3 – 4 weeks, but shock loss has to be considered as well. Shock loss is definitely not the cause when fists full of hair start coming out after 3 – 4 months.

If you have been advised to get 2500 follicular units to get your hair density raised by 25 – 40 %, but are only given 1000 units, you will not achieve the results that were promised. In fact, 1000 follicular units will only provide you with 10 – 16% of your original density.

When you start losing the hair that you started the procedure with, your condition will only become much worse. Let’s try and make understanding the numbers simpler, if you start with just 10 hairs and add 2 hairs, you will look about 20% better. But, if you lose all the hair that you had started the procedure with, your chances of looking bad will increase by 80%. This will lead you to blame the surgery as opposed to the actual reasons for hair loss. However, it is important to note that if you had not added the two hairs, you would look 100% worse, which means you are looking relatively better.

It is important to understand that hair loss cannot be stopped by hair restoration surgery. It is a life long and progressive condition. The donor supply is limited, and hair can often not be restored to the coverage that is desired, especially in cases where hair loss is extreme.

Certain people who truly believe in follicular extraction will urge people to go in for surgery even before they have the chance to understand all the facts related to hair restoration surgery. Certain physicians are admired in chat rooms as they will provide patients hope that does not exist. Let’s try and dig a little deeper, A single hair is like a cylinder. The coverage of hair can be defined as a reflection of light waves through pigmented cylinders. It takes thousands of cylinders to cover a balding scalp. Hair transplant surgeons are not Gods, and we cannot place just two cylinders and make it look like there are five cylinders. Hair does not grow like grass; in fact, they do not even in some cases grow back in the donor area. Hair loss cannot be ceased with hair restoration surgery.

I have not seen Duckman personally, but he is the only patient that I have treated in all probability who did not show any evidence of hair re-growth. In my many years as a surgeon, I have treated more than 7000 patients, and have never come across a case where hair regrowth was an issue. There might have been a few patients, who said that there was no re-growth, simply because they could not see the grafts, because the process was carried out so well and they simply could not make out the difference between the grafts and their natural hair.6 months time is too early to bet on hair restoration surgeries, it takes at least 8 months to a year to see full hair growth results.

We stand behind our promise, and if there has been no hair growth, we will replace the procedure, at no cost. We work extremely hard to make all our customers happy. I know that customers expect too much out of these procedures, which are not always possible to meet because of the natural progression of hair loss, and sometimes patients do not understand it completely. If I am wrong in this case, I will definitely fix it.

The degree of hair loss may have become excessive and in this case, it is best to conduct a follicular extraction, which can be quit at any time and no scars will be left behind as well.

Class 5 or 6 individuals would require at least 7000 – 10000 grafts to get the level of coverage that they desire. While sometime more grafts may be needed, in other cases, there may be lesser grafts needed. Patients, however, should be prepared to face the costs, which may be in terms of money, time, patience, and discomfort. Hair loss can happen at ant time, you can continue losing hair till the day you die. If you start losing hair near the date of your restoration surgery, in all likeliness you will blame the surgery rather than blame your genes. Your genes will continue to cause hair loss six weeks after your procedure. When you start losing hair, 1000 grafts are hardly enough to provide adequate coverage. Six months after a procedure, the coverage will be much less than it will be after a year, simply because only 60% of the hair is in a growing phase and are only about a few millimeters long.

I would like to examine Duckman and make a note of any growth. However, if there is no evidence of growth then I would be more than happy to refund most of his money, as I have sincerely never seen a case of no hair regrowth in a virgin scalp, in a procedure done by me. Patients need compassion, help, and understanding during this time. Medicine is not just a business, it involves treating people to heal them. People who come to my office, are looking for help with hair loss. They wish to find surgical or medical solutions that are permanent, natural-looking, affordable, and risk-free. However, not all of them will be perfect candidates for hair restoration surgery and it is our job to make them see that.

Patients in the twenties who already belong to class 5, have below-average density are not the best candidates. These people will never achieve complete restoration. These patients will require about 7000 grafts to treat both the front and the back of their scalp. If the front is made full and thick, and then the lower rim is lost, the front look will look awkward, with excessive loss at the back. We have not met any expectations in this case. However, we do whatever we can to help. Sometimes no treatment in this area is the best idea. Looking at this individual with a reduced fee structure may be the ideal idea, though an unfortunate one. Duckman is our customer and we always want to make our customers happy, we succeed in most cases, in some cases, we have little luck. It is our goal to make our patients feel better and we will never stop trying.

In this case, we failed to meet Duckman’s expectations. It is disappointing as we were unable to make him understand the potential for additional hair loss. We did not tell him what to expect from 1000 grafts and when he could expect it. It is a common situation that can happen in hair restoration surgery, and we must be ready to deal with it in the most human way possible.


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