How Overall Health Dictates Hair Transplant Success
A receding hairline on your scalp or Androgenetic Alopecia (AGA), “male pattern baldness” is a tale as old as time. At some point in their life, most men look for solutions to restore what is lost. After extensive research and consideration, many men find themselves on the operating table, facing the solution of their hair-related problems, a hair transplant.
The road to hair restoration is a long one, and it is paved with obstacles some of which we are aware of and others, like the ones we will discuss in this article, are not. We may be aware that different surgeons have varying levels of expertise, training, and experience that can and will affect the outcome of the procedure and that different methods and equipment also have an impact, but we are not necessarily aware of the medical conditions and characteristics that are necessary for successful hair restoration or that can potentially cause it to fail.
Hair restoration is not only a procedure that takes place on the surface of our scalp, but it involves systemic requirements from the body for the grafts to survive and for the patient to be satisfied with the results.
Unstable Donor Area, Non-Scarring Alopecias, And The Fallacy Of “Permanent Results”
The golden rule of any FUE/FUT transplant is donor dominance. The grafts extracted from the back and sides of the head, from the so-called “safe” zone, are resistant to DHT, the hormone that causes pattern hair loss, and they are, therefore, “permanent”. But not for everybody and not for every scalp.
Diffuse Alopecias
This hair loss pattern, also known as non-scarring alopecias, is an umbrella term that describes hair loss conditions with thinning over the entire scalp. Diffuse Unpatterned Alopecia (DUPA) and Diffuse Patterned Alopecia (DPA) are the two subtypes. In the first case, hair loss is symmetrical and uniform, while the second one, DPA, follows a recognizable pattern.
DUPA is a special type of DPA because, in this case, even the donor area in the occipital region is affected and not suitable for a transplant. Transplanting follicles that have been extracted from a scalp that will also eventually lose hair density is a mistake. As new grafts are established, those that have not survived the shock of transplantation will miniaturize and fall out. The patient is left with a wasted procedure and disappointing, patchy results.
In some instances, this pathology can be distinguished with a simple visual inspection. In others, not so much. The only way to accurately diagnose DUPA and DPA is to evaluate the density and caliber of the hair in the donor area under the microscope.
Scarring Alopecias
Another class of alopecia is cicatricial (scarring) alopecias. This group of disorders also has a broad spectrum of causes and patterns of presentation. Conditions like Frontal Fibrosing Alopecia (FFA), Lichen Planopilaris (LPL), and others are chronic inflammatory diseases that involve the destruction of hair follicles and replacement with scar tissue. In most of these conditions, the inflammation is active, though not visible on the surface, even before hair loss begins.
If you get a transplant on a scalp with active inflammation, the Koebner phenomenon will likely occur. The surgical trauma from incisions made to extract and implant grafts will introduce new lesions along their path that will progress and attack both the transplanted and native hair.
The transplant is off the table in these conditions, except as a last resort and only after the disease has been completely inactive for several years under the dermatologist’s care. However, with time and aging, the inflammation may eventually flare up again in what is called a “recession”, negating all of the work.
Inadequate Microvasculature: Metabolic and Cardiovascular Disease
Hair transplant surgery is a form of controlled trauma. When surgeons cut into the scalp to extract and implant grafts, it results in hundreds of tiny wounds. For a transplant to be successful, they must heal rapidly. But if the body cannot provide a suitable environment for those grafts to get the oxygen and nutrients they need, success rates will decrease significantly.
Diabetes Mellitus
The internal environment is altered in a way that is not conducive to hair growth with uncontrolled Diabetes Mellitus. Excess blood sugar causes microscopic damage to the microvasculature, the network of tiny blood vessels that carry blood and vital nutrients throughout the skin. Without optimal blood flow to these small grafts, their survival rate will be significantly lower. Diabetes also impairs immunity, which raises the risk of bacterial infection at the recipient site, an issue that is complicated further by some of the drugs commonly used to treat autoimmune disorders.
Essential Hypertension
High blood pressure also compromises the healing environment because it can cause excessive bleeding during the procedure. This is a problem for two reasons: first, it blurs the surgeon’s field of view so that they cannot place the grafts accurately, and, second, the bleeding can lead to a post-operative hematoma, a mass of blood clots that creates pressure on the skin.
Autoimmune Disease
Our immune system exists to protect us from foreign invaders like viruses and bacteria, and yet, there are conditions that cause it to attack the body’s own tissues. Lupus, Alopecia Areata, Rheumatoid Arthritis, and others are examples of autoimmune disorders. The immune system is an integral part of the healing process, so if it is hyperactive for whatever reason, it may not only attack the foreign transplanted tissue but also the body’s ability to defend itself from post-operative infections, such as folliculitis.
Abnormal Thyroid Hormone Levels
Hyperthyroidism and hypothyroidism are also known to trigger widespread telogen effluvium, a shedding event in the hair growth cycle. It is not advisable to undergo a transplant while this is happening. To create an even, uniform, and dense result, surgeons must ensure that non-transplanted hairs will not continue to fall out after the procedure, taking with them the scalp of which they are a part. The only way to be sure of that is to stabilize thyroid hormone levels and ensure they remain in the normal range.
Nutritional Deficiencies
Iron and ferritin, Vitamin D, and zinc are common culprits behind many chronic deficiencies, especially in hair that is diffusely thinning. Like performing a transplant in the middle of telogen effluvium, these grafts will not get the oxygen and nutrients they need to enter an extended growth phase, which is the name of the game for optimal results.
Medical Illiteracy, Unrealistic Expectations, And Body Dysmorphic Disorder
Hair restoration is a process, not a one-time event, and the success of this process can be largely dependent on factors not related to the procedure itself.
Body Dysmorphic Disorder (BDD)
Body dysmorphic disorder is a mental health condition in which the person has a preoccupation with a minor or even imaginary defect in their appearance. In this case, the patient with BDD believes that their hair loss is excessive or, in most cases, completely obvious to everyone else.
Patients with BDD are not suitable candidates for a hair transplant because a hair transplant is not a solution to BDD. In fact, a transplant will only reinforce and perpetuate the cycle of an increasing desire for further, non-stop revision procedures.
No Matter How Good You Look, You Can Never Look Good Enough.
Unrealistic Expectations
Having lost hair over the course of several years, the patient has low density in the donor area and will have to settle for less than he expected. The surgeon is the only one who can manage expectations by being clear and upfront about the medical facts.
Hair Transplant Consultation
We cannot overstate the importance of due diligence in selecting a surgeon, and one of the first steps to doing that is to know what to expect during the consultation, which we hope will help you with that process. We’ll also address the most common questions patients have before going on the first visit.
How Can I Be Sure That I Am Not Just Hearing What I Want To Hear?
Finding a surgeon you can trust is a two-way process. A good surgeon will take the time to educate, as you need to do your research before making a decision. That being said, hair transplant clinics usually follow a standard protocol before any procedure is authorized.
Hair loss can affect men of all ages for many different reasons, but you do not have to suffer in silence. Our approach is one that many doctors and surgeons can learn from. We take pride in providing the highest level of care and sharing our knowledge with patients to ensure that everyone can make an informed choice.
