Hair transplants have evolved over past half-century

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It all begins with an educated and realistic patient, says to Paul J. McAndrews, M.D., a dermatologist in private practice in Beverly Hills and Pasadena, Calif., and a clinical professor at USC/LAC Medical Center. Dr. McAndrews specializes in hair restoration, including hair transplants and the medical treatment of hair loss.

"A properly trained doctor with foresight can create a hair transplant that looks completely natural today and 20 years from now," Dr. McAndrews tells Dermatology Times.

The patient consult

"Our genes dictate how bad our hair loss is going to be," Dr. McAndrews says.

Looking at earlier generations and their baldness patterns will indicate that individual's future loss, and help the patient understand his or her realistic possibilities and options.

"The consultation is enormously important - it's where they make the informed decision," Dr. McAndrews says.

Patients also need to understand the progressive nature of androgenetic alopecia.

"This knowledge will help them understand the importance of not only creating a hairline that looks good today, but also in the future as their hair loss progresses," Dr. McAndrews says.

The best candidates for hair transplantation are not found in ethnic groups, nor are they the ones with good hair density, good caliber of hair or curly hair.

"A good hair transplant candidate is realistic about what can be accomplished," Dr. McAndrews says. "There are many patients with poor hair characteristics that are excellent hair transplant candidates because their goals are realistic."

Medical therapies

If the patient's goal is to keep what hair they have, then starting the patient on medical therapies is the first step.

"The No. 1 treatment in this case is Propecia (finasteride, Merck). Rogaine (McNeil-PPC) is another option. The combination of the two is what I try to get all my patients to do," Dr. McAndrews says.

"These therapies have a good chance of meeting this patient's goal and there may be no need for a hair transplant," Dr. McAndrews says.

On the other extreme, a patient who has only a rim of hair left may want a full head of hair. "In that situation, the patient's goals are not going to be met by the medical or surgical therapies, and treatment should not be started unless the patient adjusts his goals. The only thing that will accomplish this patient's goal is a hair piece," Dr. McAndrews says.

"A hair transplant is a very valuable tool in accomplishing the goal of a patient who wants a significant increase in density in an area that is bald or thinning.