OCT 2017

MedEsthetics—business education for medical practitioners—provides the latest noninvasive cosmetic procedures, treatment trends, product and equipment reviews, legal issues and medical aesthetics industry news.

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HIGH DENSITY 28 OCTOBER 2017 | Med Esthetics hair loss over the next 20 years, he's going to have a gap behind the hairline." In this situation, unless the patient is able to understand the long-term concerns and commit to utilizing adjunct therapies to slow his hair loss, both Dr. Reese and Dr. Niedbalski discourage surgery. "If it's a young man and he is willing to try things like minoxidil or fi nasteride and LLLT or platelet-rich plasma (PRP)-based injections to keep the loss from progressing over the next year or two, then we can have a conversation about hair restoration surgery," says Dr. Niedbalski. "But most guys that age are not willing to do that. They're coming in because they want to 'fi x' the prob- lem. I tell these guys that I'm not going to do any surgery until we determine that these other treatments are going to be effective for them—of course, I'm assessing their com- pliance along with the effectiveness of the treatment." After roughly one year of adjunct therapies, Dr. Nied- balski determines whether to move forward with the hair transplant surgery. If the patient is compliant and ready to proceed with surgery, "we can put some hair up there to improve the contour of the hairline and make him feel more comfortable," he says. For these patients, Dr. Reese anchors genetically perma- nent transplanted follicles from the desired hairline into the temporal or "fringe" hair to create a natural look that will last a lifetime. "Typically, you re-establish a new hairline at the level of the frontal hairline where it meets the temporal hairline and extend it left and right," he says. "But if you do only this, as the temporal hairline continues to pull down, it will leave a channel defect. Then the patient may be forced into having another hair transplant to fi ll in that gap. So you want to establish a hairline that is anchored into the tempo- ral hairline with permanent follicles." Communicating Realistic Expectations When explaining likely outcomes, Dr. Reese utilizes his library of before-and-after images. "I can make any patient look completely natural and not transplanted with one surgical procedure, but 100% of my patients want more density," he says. "This is why simulation devices that plastic surgeons use to show patients what they will look like after a procedure are not considered good tools in hair restora- tion. You can dial it up so that the hair looks ultra full, but you can't always achieve that in one procedure." The before-and-after images clearly show patients what can be achieved in only one transplant. "I tell my patients that I can take them from point A to point B with one good transplant. But if they determine, after looking at these before-and-after pictures, that one pass is not good enough, they're going to need a second hair transplant," says Dr. Reese. Women and Surgery Traditionally, women have not been considered good can- didates for hair transplant surgery because of their typically diffuse pattern of hair loss. But there are some exceptions. "Women are fantastic candidates for surgical hair restora- tion in two primary categories—scalp and eyebrows," says Dr. Reese. Wigs and hairpieces are a good option for patients who are poor candidates for surgery. In some cases, they can be combined with surgery. © GETTY IMAGES

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