Hair of Your Dreams or Surgeon of Your Nightmares?




The adage goes that for most people their house is probably their most important investment. But your house does not sit on top of your head. Nor is it with you at work or when you go on a date or show up at a high school reunion.

Your head is where your hair is — or should be. Similar to when one shops for a home, a prospective hair transplant candidate needs to take time and care to select the right hair transplant surgeon.

Hair transplant surgery is a significant investment; costs in most hair transplant centers range from $10,000 to $35,000. The process is a combination of science and art, given how only board-certified physicians (M.D.s [medical doctors] and D.O.s [doctors of osteopathy]) are licensed to perform the aesthetic procedure.

To start, there are certifications and professional affiliations to look for in a hair transplant surgeon. But it’s an evolving medical specialty, so currency with newer techniques and the use of newly approved medical devices (approved by the U.S. Food and Drug Administration, [FDA]) in all likelihood would improve a patient’s outcome from the procedure. The rapport a patient develops with his or her physician is important, too. But geographical location is less important because hair transplant surgery can be done in one or two sessions; follow-up appointments are sometimes remotely conducted via video hookup (including the use of Skype). corresponded with several hair transplant doctors to get their best thoughts on what a patient should think about prior to undergoing this procedure. The general sense is that new technologies are being introduced, which they consider a good thing. But they collectively warn that robotics do not make the procedure work, that it is the artistry of the doctors and their interaction with their patients that make the hair restoration a success. Hair is one of the most noticeable components of a person’s appearance, after all.

Hair transplant certifications and affiliations

Dr. Robert Leonard, whose Leonard Hair Transplant Associates works out of seven locations in New England (Boston vicinity and Cape Cod, New Hampshire and Rhode Island), strongly advocates that prospective patients first check out a surgeon’s medical board credentials.

Leonard is a diplomate with the American Board of Hair Restoration Surgery — as are most of the physicians we spoke with for this article — meaning he has sat for written and oral exams with the ABHRS. The certification of the emerging medical specialty began in 1996 as a means to “assure the public of the individual’s educational ability to perform safe, aesthetically sensitive hair replacement surgery.” A directory by the state of other diplomates can be found on the ABHRS website.

But it’s about more than membership, says Leonard. “Ask the doctors, or look on their websites, to see if they go to the meetings, where we learn new things. This also helps distinguish between the doctors who make this their full-time practice and those who do not.”

Another HRTS practitioner who works out of the Southeast and Mid-Atlantic region (Atlanta; Chesapeake, Virginia; Columbia, South Carolina; Knoxville (Tennessee); Raleigh (North Carolina); and Tysons Corner, Virginia) believes the practice is not just about the medical doctor. “A hair transplant is very much a team effort,” says Dr. Jonathan Ballon of Hair Club. “A surgeon is only as good as his or her technical staff. How many years of experience do the surgeon’s assistants have, and how long have they been with this particular surgeon?”

Other certifications of note are from the International Society of Hair Restoration Surgery (which recognizes its American counterpart), says Dr. Alan Bauman, who practices out of the Bauman Medical Group in Boca Raton, Fla.

New hair transplant surgery technologies

Bauman himself appears in a YouTube video (archived online) that walked through a transplant procedure done before a web audience in November 2011. In this operation and about 90 percent of the rest of his work, Bauman uses the follicular unit extraction (FUE) technique.

In the past decade, FUE has pretty much replaced the method used previously, linear harvesting. Instead of removing strips of skin and hair follicles from the back of the head, FUE lifts out individual hair follicles. Linear harvest left scars in the back of the head, was more invasive and required a longer period of time to heal. FUE is less invasive, heals more quickly and causes fewer post-op restrictions.

Because it is more labor-intensive, FUE also takes several hours longer and costs more than linear harvesting. But new robotic medical devices that speed up the process, and which can bring down the price, have recently received FDA approval. They are:

  • NeoGraft — this device enables the harvesting (removal from the back of the head) of 1,500 hair follicles in a day, about two to three times as much as could be done by hand.
  • ARTAS — this device also is about easing the follicle-harvesting process. Proponents trumpet how it can be used to transplant smaller areas of hair over multiple sessions, allowing a “patient’s appearance [to] gradually change over time for more natural-looking hair regrowth,” according to the manufacturer, Restoration Robotics, Inc., of Mountain View, Calif.

An early adopter of the ARTAS system — it received FDA approval in April 2011 — is Dr. Craig Ziering, whose Ziering Medical Worldwide offices are in southern California (Beverly Hills and Newport Beach), Chicago, Las Vegas and Salt Lake City. Ziering prefers ARTAS over NeoGraft but says the use of either robotic reduces certain variables in hair transplant surgery, to the advantage of the patient.

The hair transplant surgeon’s artistic and communications skills

Still, says Ziering, the success of any transplant surgery “boils down to the skills of the physician. The doctor’s experience and artistry are what matter most.”

Ziering says that includes reading how the patients may mature and what their expectations are. “The patient has to accept where a realistic hairline on the forehead would be and how thick or thin the hair in front should be,” he says. “And at some point, the patient might decide to shave his head altogether. So it becomes important to know that patient very well before getting started.”

According to Ziering, patients would be smart to identify their transplant surgeon based on the following checklist:

  1. Make sure you and your surgeon have rapport, enough that you can identify what you expect in terms of the end result (and that you both agree on its feasibility).
  2. Have a clear understanding of the procedure itself.
  3. Be clear about the technologies being used.
  4. Study the doctor’s artistic abilities. This includes how the doctor looks at a patient’s bone structure to design the most complementary hairline. Previous patient before-and-after photos are a good means to facilitate this discussion.
  5. Don’t allow geography to limit you. Because most consults and procedures are limited to two or three visits, simply factor in the cost of travel to appointments.

Each of the doctors interviewed for this article indicated that prospective patients should feel comfortable about interviewing more than one physician before making a decision. It is the same thing as getting a second opinion before undergoing any other type of medical procedure. After meeting with them, ask the questions suggested by Dr. Ballon:

  • Did he or she spend sufficient time listening to you and answering questions to your satisfaction?
  • Or, did you feel rushed and pressured?
  • Did you feel he or she was honest and candid?
  • Did you sense self-confidence — but not arrogance?
  • Do you trust this person?

“Your hair transplant should be one of the best investments you ever make,” concludes Ballon. “But don’t select a surgeon on the basis of price. Would you expect the best surgeons to be the cheapest? If you think you’ve found a hair transplant ‘bargain,’ think again. You could be making a mistake you will regret for the rest of your life.”