News

When Not To Have A Hair Transplant

- Wednesday.December 16. 2020

Hair loss has a big impact on self-esteem and self-confidence. And often, people who are losing their hair will see a hair transplant as their saviour. But it’s important for everyone who’s seeking surgery to be realistic about the results it can achieve.

Yes, hair transplants—if carried out correctly and professionally—can restore a natural-looking head of hair—in most cases. This last point is vital, because hair transplants aren’t suitable for everyone. In this post, we look at instances in which a hair transplant should not or cannot be performed.

Who decides?

The first step the best surgeons will take in assessing the suitability of a person for a hair transplant will entail them asking questions about the patient’s medical history, as well as their mental and physical wellbeing.

Dr Martinick says, “Ultimately, responsibility for assessing whether someone is a suitable candidate for a hair transplant lies with the surgeon planning to carry out the procedure.”

“That’s why it’s important to find a surgeon who will tell you the truth, not what you want to hear,” she says.

Physical reasons for not getting a hair transplant

Certain medical conditions might prevent hair transplants being carried out safely or effectively. These include:

• Skin conditions especially on the scalp e.g. sores and blisters
• Thyroid disease and autoimmune related conditions
• Systemic infections
• History of scar formation

Other factors that will render a transplant a bad idea include a history of hair loss with associated inflammatory symptoms such as fever, itch, scaling, or rash. Also, hair traumas caused by scratching, or too frequent brushing or blow-drying.

The presence of any of the above should get a surgeon’s warning lights flashing and require the patient to remedy any such problems before a hair transplant can be considered.

A physical examination of a patient should be undertaken to assess the cause of the hair loss and whether an infection or inflammation is to blame. The surgeon should be looking for specific conditions such as:

• An unusual or localised hair loss pattern
• Inflammation of the scalp
• Large-scale shedding/Diffused Unpatterned Alopecia
• Inexplicable scarring on the scalp
• A lot of broken hairs
• Any pain in the scalp or skin

The presence of any of these conditions can make a hair transplant inadvisable.

Diagnosing androgenic alopecia has become a fairly simple procedure. Surgeons should look for:

• Hair loss patterns (Ludwig for women and Norwood for men)
• Hair depigmentation
• Hair miniaturisation
• Absence of inflammation

If a patient doesn’t show these symptoms, further tests and examinations may be required before the patient can be cleared for a hair transplant.

Mental health reasons for not getting a hair transplant

A surgeon should also take time to discover the psychiatric history of a patient. Conditions relating to stress, anxiety, and eating disorders can increase the chances of the person having unrealistic expectations of the impact the surgery will have on their lives.

“Many expect the surgery to transform their appearance and the way they feel, which can lead to immense disappointment if the results don’t match their expectations. Such patients must be carefully assessed before treatment can be recommended,” Dr Martinick says.

Other reasons that can rule out getting a hair transplant

Medication

If a patient is taking any medications that could affect hair growth or increase the risk of excessive bleeding during surgery, a hair transplant is not recommended.

The age factor

Another key factor that will determine a patient’s suitability for a hair transplant is their age. Although this isn’t set in stone, Dr Martinick says, “Surgery should not be performed on people under the age of 25. They are the age group likely to have the most unrealistic expectations. And the future pattern of hair loss is less predictable in patients younger than 25.”

Hair type

Hairs with a larger shaft diameter are able to cover more surface area, resulting in denser scalp coverage and hair transplant results that are more aesthetically pleasing. Patients with hair that has a smaller shaft diameter should be made aware that the results of any hair transplant may not be as effective.

Hair density

The best surgeons will know that the best scalp donor sites are the ones with more than 80 FUs per square centimeter. If that level is less than 40 FUs, the candidate is rated as poor and the patient’s expectations for the outcome of the surgery need to be managed accordingly.

The area requiring the transplant

Hair transplants that seek to tackle hair loss at the front of the scalp deliver the most dramatic change to a patient’s appearance. So, surgeons should seek to concentrate grafts in this area as a means to deliver maximum levels of long-term density and the best aesthetic results.

Hair Colour

Light skinned patients with blonde or red hair often generate better hair transplant results due to there being less of a contrast between their hair and skin colour. Proper technique can reduce the impacts on transplanting dark-haired patients.

The importance of preparation

The goal of every hair transplant is to achieve a natural look, safely. This can’t always be achieved in one session. And for some patients, it can’t be achieved at all.

A surgeon has much to discover about each patient before a decision can be made as to whether or not hair transplant surgery can begin. The answers provided by questions the surgeon asks about the physical and mental condition of a prospective patient should shape the actions the surgeon takes.

In many cases, the surgeon will be able to proceed with the hair transplant. But if any of the areas mentioned above are causes for concern, the surgeon may need to refer the patient to a medical specialist for treatment before a hair transplant can be carried out. Or they may have to deliver the news that the procedure cannot be undertaken.

“Should the patient be given the go-ahead to have treatment, the more he is willing to invest properly in himself and the more realistic his expectations, the better.”

“It’s important that the patient is aware that results can vary depending on factors that are often beyond the surgeon’s control,” says Dr Martinick.

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