If you’ve heard about hair transplants that were unsuccessful and have concerns about how it could happen, your questions may make you hesitate to schedule a consultation with a hair restoration surgeon to learn your options. But examining the reasons why some hair transplants fail can help to alleviate your doubts and apprehensions – and better position you to achieve the result you want should you decide to address your hair loss.
Dr. Marco Barusco – founder and Chief Medical Officer of Tempus Hair Restoration – cites 10 of the most common reasons that hair transplants sometimes don’t attain the patient’s aesthetic goal. This article is based on the video – “Why Hair Transplants Fail?” – produced for his YouTube channel, Hair Loss Medical Advice.
Dr. Barusco’s insights are based upon his more than 20 years of experience as an internationally renowned hair restoration surgeon who has developed innovative advances in hair transplant procedures – such as the No-Shave FUE, which completely conceals harvested donor sites immediately, allowing patients to resume their regular activities with very little downtime. During the video, Dr. Barusco shares his experiences working with patients who have come to him after an unsatisfactory procedure.
Dr. Barusco begins by giving his definition of a failed hair transplant. “When I say the word ‘fail,’ it doesn’t mean that nothing grew, although it can be that, too. A failed hair transplant, in my opinion, is anything that didn’t produce the results that you were expecting after the transplant procedure was done.”
Dr. Barusco ranks the 10 main reasons for a failed hair transplant, beginning with the most frequent cause.
Number One: Poor Diagnosis of Hair Loss
“The first cause I see many times is that the hair loss itself was not diagnosed correctly,” says Dr. Barusco. “Not every hair loss is equal; not all hair loss is treatable with a hair transplant procedure.” Dr. Barusco notes that people often have the misconception that hair transplants are a treatment for hair loss when, in fact, they are a restorative measure.
“To prevent and treat hair loss – that is, the androgenetic male or female pattern hair loss – we need to treat with medication. So if you don’t diagnose the hair loss correctly, you may perform a hair transplant [in the wrong area of the scalp] or on a patient who should not have had the procedure. I see this sometimes because in many practices out there, the consultation is done by a consultant or a salesperson, or someone who has had some experience, but is not trained as a doctor to really diagnose hair loss. So a patient can fall through the cracks, and a surgery will be recommended for a patient who did not need to have that surgery.
“I make it a point to see all my patients because I’ve been studying hair loss for many years, as well as talking and teaching about it, so certain things can be subtle – and you need to be looking for them so that you can diagnose correctly. When you do this, of course, the chance of having a successful outcome is better.”
Number Two: Poor Understanding of Hair and Scalp Anatomy
What does that mean, and why is it important? A surgeon operating on any area of the human body must understand anatomy – not only the location of organs and structures in the surgical area, but how they all connect, interact and work together. The same is true of a hair transplant procedure.
“I need an understanding of the landscape of where I’m operating,” Dr. Barusco says. “The scalp has many different layers. It has nerves, veins, arteries and the skull. It has some important structures that I need to avoid. The hair itself has certain structures that need to be protected and transplanted together with the hair so that we can get an outcome that’s favorable.
“Inexperienced surgeons and technicians lack this knowledge, and can cause damage to major blood vessels and nerves, as well as other areas of the scalp. You may end up having numb areas, or areas of tissue that die off – which is known as necrosis of the scalp – and which I have seen. Wherever you go for a consultation, make sure you know who will actually be performing the surgery.”
Our blog post – “Complications in Hair Transplant Procedures” – covers this important topic of unqualified doctors or clinic technicians performing hair transplants in greater detail, with advice on how to protect yourself. Additional valuable information is available on the website of the International Society of Hair Restoration Surgery (ISHRS) – of which Dr. Barusco is a Fellow. Fewer than 10 percent of ISHRS members have achieved this honor.
Number Three: Poor Understanding of
Hair is a very complex organ. Understanding exactly how hair grows and the numerous mechanisms of cellular interactions requires high levels of education, training and experience. “When we transplant a follicle or a hair, it looks very simple, but we have to understand what goes on at a cellular level – how these things are going to play out in the survival of the graft. Grafts need to be treated and handled correctly to keep them viable to the time they’re implanted, as they are deprived of blood flow. You need to understand what goes on during the healing phases of the transplant in order to optimize so that every hair is protected and provided with good blood flow and a good environment for healing.”
Number Four: Poor Emphasis on Education
Dr. Barusco often sees patients who have been seen by other hair loss specialists who were ready to schedule surgery without recommending treatment with such medications as minoxidil (brand name Rogaine) or finasteride (brand name Propecia).
“Treatments were never mentioned to maintain their hair to prevent further loss. I usually recommend a patient first do medical therapy with medication for six months to see if he can comply with post-surgical treatment. Because if not, my transplant will not provide what you want over the long term. If I don’t educate the patient on hair loss, I’m not doing a service. Sometimes, the education involves recommending against the surgery. Not everyone is a candidate for a hair transplant. Education is key, and that’s the reason for the consultation in the first place.”
Number Five: Lack of Recommendation for Medical Treatment
This reason is closely related to the previous, a poor emphasis on education. Treatment with medication – for male and female patients – is essential in helping to prevent or slow further hair loss. Too many clinics and doctors do not prescribe medications or map out a treatment regimen, erroneously leading patients to believe that a hair transplant is a once-and-done solution.
Number Six: Not Listening to Your Concerns and Your Goals
The surgeon may look at you during the consultation and assume you want coverage in a particular area, when you actually want to see growth on a different area of your scalp. You must be sure to communicate your goals to the surgeon during consultation – then make certain the surgeon has heard and understands you.
If you sense the surgeon isn’t listening, or has already decided which areas(s) to focus on despite your description of the desired result, continue asking questions until you are satisfied with the answer. This should not be in the spirit of being difficult. If the surgeon has a vision that differs from yours, there may be a reason – but it is the surgeon’s responsibility to explain their reason so that you understand and can make your decision based upon this information.
“The surgeon needs to explain to you what is and what is not possible,” says Dr. Barusco. “I need to make sure that your goals are aligned with what I can deliver.”
Number Seven: Poor Planning of the Transplant Procedure
If you’ve ever seen men with a hairline that looks “off,” or not natural, you may not have been able to quite figure out why. This unsettling effect can be attributed to poor planning on the part of the surgeon.
“A hairline that’s not correct – such as too aggressive, too rounded and feminine for a man, very young looking on an older man – reflects poor planning. This also includes poor use of the donor zone. For example, using a lot of the donor area hair for a small area of the recipient area is not good planning. You have only so much hair that can be harvested, so I need to use it very wisely. You may need another transplant in the future, so if it’s all used at one time, there will be none left.”
Number Eight: Poor Technical Execution of the Transplant Procedure
Unfortunately, this particular “fail” is often linked to the previous, poor planning of the transplant procedure. A surgeon who lacks the skill to plan the procedure properly to create a natural-looking hairline and growth patterns also is likely to botch the implantation process itself. This includes placing hairs at the incorrect angle or direction, placing the hairline too low, and placing transplanted hairs very close together.
As previously mentioned, proper treatment of the hair grafts to keep them alive so they can take hold in the recipient area and grow is essential to a successful transplant. Grafts that are poorly prepared, allowed to dry out or otherwise mishandled at any point during the procedure will not be viable.
Number Nine: Poor Management of the Limited Number of Donor Hairs
As Dr. Barusco observes, we have only a limited supply of donor hair, although bald areas keep enlarging as hair loss continues over time.
“As hair transplant surgeons, we have to paint a beautiful picture, but we only have so much ink to do it. If we don’t utilize that ink in the best way we can, you’re not going to be happy and I’m not going to be happy. So that involves some compromise. While we can treat an area really well, we can’t treat the whole entire area of hair loss with the donor hair that you have. I need to explain that to you so you understand, and can make your decision. And then we’re going to be successful.”
Number 10: Damage to Existing Hairs by Overly Aggressive Surgery
People who have their first hair transplant too soon after hair loss begins are at risk of a poor eventual result. “In such a case, they still have a good amount of their own native hair, but it’s just starting to thin, and someone goes there very aggressively and puts a lot of transplants in between the existing hair. What then happens is that the transplants traumatize a large amount of those hairs, so they lose a lot of hair from the surgery. The transplants grow, but that trauma caused a good deal of loss of the native hair – so in the end, it’s a wash. They lost as many hairs as probably were placed, so the surgery didn’t produce any visible change.”
For this reason, Dr. Barusco uses a conservative approach, preserving as much native hair as possible. As always, Dr. Barusco emphasizes educating the patient on how hair transplants are planned and performed – including the follow-up medication treatment.
Knowledge is Power – Choose Your Hair Restoration Surgeon Wisely!
As you begin your search for a hair restoration specialist, having the facts at hand can help you avoid being swayed by advertising campaigns that offer a misleading idea of what a hair transplant involves over both the short and long term. Unlike buying a car, most people have no experience in choosing a hair restoration surgeon. This is an important decision that depends upon your knowledge of industry best practices and professional ethics in order to achieve a successful outcome that will allow you to face the world with the self-confidence you deserve.
Ultimately, choose your surgeon based on experience, results and integrity. Dr. Barusco’s long list of accomplishments, his notable artistic ability and his successful surgical team make Tempus Hair Restoration a renowned practice. Contact us to schedule your free virtual consultation. Dr. Barusco conducts every consultation himself, giving you the opportunity to learn your options in the comfort of your home – or any location, on any internet-enabled device.
Dr. Barusco conducts consultations in English, Spanish and Portuguese. For your greater convenience, Tempus Hair Restoration offers a two-night complimentary hotel stay to out-of-town clients who travel 100 miles or more to our Port Orange, Florida, surgical center. No matter how far the distance, we welcome the opportunity to help you on your hair restoration journey!