A New Look at Transgender Hair Transplants

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A New Look at Transgender Hair Transplants

Transgender females and males now have a wide range of resources to help complete the process of aligning their physical appearance with their gender identity. Hair transplantation to create the correct feminine hairline for transgender women and facial hair transplants to further masculinize the appearance of transgender men have gone mainstream, and are heavily promoted – making the caution to choose your surgeon wisely more relevant than ever.

Dr. Marco Barusco – Founder and Chief Medical Officer of Tempus Hair Restoration – has been honored to help our transgender patients fulfill their challenging journey. As one of the first hair restoration surgeons in the United States to welcome transgender patients with respect and support, Dr. Barusco continues to serve members of this diverse community through his experience, skill and strong sense of aesthetics.

“We have many patients who come to us for help during their transition period,” says Dr. Barusco. “Of course, that involves a lot of medical therapy, hormone replacement and commitment on the patient’s part. I greatly admire the courage of people who are going through these transitions, as they are not easy from a psychological or social standpoint.”

If you’re ready to take this next step in your transition, you may already be knowledgeable about your hair transplantation options. However, there is always something new to learn. Because you want to achieve the best possible result, we will look at the many factors involved, and the elements that can affect the process.

We also invite you to watch Dr. Barusco’s video – “Hair Restoration Surgery for Transgenders” – on his YouTube channel, Hair Loss Medical Advice. In this informative video, Dr. Barusco discusses the process in greater detail, and describes the procedure he performed for Ronie, a transgender woman who wanted a feminine hairline and correction of balding scalp areas so she could feel complete as a female and confident going out in public without a wig.

The Art and Technique of Creating a Feminine Hairline for Transgender Females

For those transitioning from male to female, the male hairline presents an aesthetic obstacle, as the hairline and growth patterns for males and females are noticeably different. As our blog post – “Transgender Hair Transplants – Becoming Your True Self, Beautifully” – notes, the male hairline has the following characteristics:

  • A lower overall position.
  • M-shape – temporal corners are further back.
  • Forward flow pattern frontal hairs – angles project straight forward.

Conversely, the female hairline is characterized by the following:

  • A higher overall position.
  • Inverted U-shape – creates an oval effect.
  • Frontal hairs in a backward-facing whorl flow pattern – also known as a “cowlick” growth pattern.

For this reason, we introduce our first note of caution. If the hair restoration surgeon you consult recommends a hairline lowering procedure, know that this technique won’t produce a good result, as it was designed to address issues with a cis female hairline. The objective here is to create a female hairline, rather than to correct one. Lowering the hairline alone does nothing to fill in the outer temple areas, which are critical to crafting the new feminine hairline.

Here is where the skill and artistry of the hair transplant surgeon is of particular importance. There is more to creating a feminine hairline than simply making an oval shape around the face. Just as a cosmetic surgeon specializing in rhinoplasty carefully considers the unique facial characteristics of each patient to reshape the nose in perfect, attractive proportion to the face itself, so does an advanced hair restoration surgeon in performing hairline feminization. There is no one-shape-fits-all approach. The surgeon must be able to correctly place each hair graft so that the hair grows and falls around the face in a natural, pleasing manner. The ideal outcome is the achievement of feminine beauty, not just an appropriate hairline.

Addressing Male Pattern Baldness in Transgender Females and Males

Depending upon when you began your journey transitioning to female, you may have been experiencing hair loss as the result of androgenetic alopecia. This is popularly known as male pattern hair loss (although it also occurs in women), and is genetically predetermined. Undergoing hormone therapy will help to slow or stop further loss as estrogen levels increase, but it can’t reverse existing hair loss. Only a hair transplant procedure can address bald areas of the scalp.

In the case of balding at the crown (vortex), a transplant can be successful and achieve the look of natural growth. Our blog post – “Crowning Glory – The Art of Hair Transplantation to the Crown Area” – covers the challenges involved, as well as the cross-hatching technique developed by Dr. Barusco, which he has written about for medical textbooks and reference publications.

Those transitioning from female to male may begin experiencing androgenetic alopecia as testosterone therapy replaces estrogen. For either situation, the same types of hair transplantation procedures apply:

Follicular Unit Excision (FUE) – In this procedure developed by Dr. Barusco, follicular units in groupings of one, two or three hairs are individually extracted from the back of the head using small circular punch blades instead of a scalpel. The grafts are then transplanted to the thinning or balding areas of the scalp. Once the desired number of grafts are obtained, the donor sites are left to heal without suturing. The resulting scars are not readily visible and are easily concealed even by very short hair.

No-Shave FUE – Also developed by Dr. Barusco, the no-shave FUE completely conceals harvested donor sites immediately, allowing you to resume your regular activities with virtually no evidence of the procedure.

Follicular Unit Transplantation (FUT) – Also known as the “strip” method, the FUT procedure has undergone refinements over the years so that the only evidence is a pencil-line linear scar easily concealed by hair – even at a shorter length.

Combination FUE and FUT – This technique covers large areas of baldness in a single surgery. Patients with advanced hair loss are typically required to undergo multiple hair transplant procedures to obtain coverage – having to wait one year or more between procedures. This allows patients to achieve their ultimate goal sooner, with one procedure versus many. The combination FUE and FUT could be an appropriate procedure for those who began their male-to-female transition later in life, when hair loss from androgenetic alopecia was already well under way.

Facial Hair Transplants for Transgender Males

Facial hair transplant surgery is popular among transgender men to further masculinize their appearance so they can confidently be at ease in the world. Hormone therapy promotes facial hair growth, yet is often not dense enough to grow a full beard, mustache or sideburns. An eyebrow transplant may also be needed to provide the fullness typical of male eyebrows.

Techniques used for facial hair transplants differ from those used for the scalp, because the length, texture, characteristics and growth patterns of the hair differ. An experienced surgeon such as Dr. Barusco knows how hairs from different areas of the body behave, and has the skill and artistry to harvest those that are the best match, thereby ensuring the hair follicles are angled correctly when transplanted. Be aware that not all hair restoration surgeons are equal in their ability to create the appearance of natural facial hair growth.

Choose Your Surgeon Wisely, and Live Your Best Life as Your True Self!

You already have valuable experience in choosing the team of physicians and surgeons who have brought you this far. Knowing who to trust to make your new life a reality is important, and making the right hair restoration surgeon part of your team to provide the finishing touches is vital.

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 live your authentic best life!

Why Do Some Hair Transplants Fail?

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 Physiology

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!

We’re All Famous Now! Why You Deserve to Be Your Best!

If you’re of a certain age, you probably never expected to be in front of a video camera unless you were in show business or a TV news anchorperson. Today, of course, most of us are on camera on a regular basis – from Zoom meetings to dating apps. While it may not seem fair, appearances really do count! We at Tempus Hair Restoration are seeing the trend toward hair restoration procedures driven by social media and virtual meeting apps.

If you think that your hair loss may be holding you back in your career and other areas of life, you could be right – and you are definitely not alone! Our blog post – “Does Hair Loss Hurt Your Career?” – shares compelling evidence of a “yes” answer. The post cites a study in JAMA Facial Plastic Surgery, which found that a few more hair follicles can make all the difference between people seeing you as a success or a lost cause. In this study, Johns Hopkins University researchers recruited participants to compare photos of men before and after they got a hair transplant. Although they were looking at the same men, participants rated men after they got their hair transplants as more attractive, approachable and successful.

Thomas Cash – emeritus professor of psychology and author of The Body Image Workbook – conducted a study looking at bias against bald men. His study found that when people were shown photographs of bald men and asked to estimate their age, they added an average of three years and nine months to the men’s actual age. Men with a full head of hair had an average of two years and five months taken off.

Going from Self-awareness to Selfie-awareness

The term “selfie-awareness” was coined by the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS). The organization recently released results of its 2020 members’ survey, which revealed that many patients were seeking a “real-life filtered look,” with 75 percent of surgeons detailing patients seeking cosmetic procedures to look better in selfies – representing a 33-percent overall increase since the AAFPRS first identified this trend in 2016. The trend, of course, isn’t limited to cosmetic surgery. The booming demand for Botox and injectable fillers indicates a desire to banish wrinkles and an overall tired appearance through minimally invasive, non-surgical procedures. In addition, estheticians now offer a high-tech array of specialized facial treatments designed to turn back the clock by firming facial muscles and minimizing lines.

Actually, this is a continuation of “The Brand Called You” phenomenon. Coined by Tom Peters and featured in a Fast Company article in 1997 (long before the first selfie was snapped), this concept holds that each individual is their own brand – just as much as Starbucks or Nike – and so we need to market ourselves accordingly to stand out in an increasingly competitive society. The idea that we are the star of our own story has been around for quite a while. Social media has upped the ante, placing increasing emphasis on presenting a youthful, vital image as it gives us a virtual stage on which to shine.

The New Attitude Toward Hair Transplants

Not so long ago, men who underwent hair transplant surgery kept it a secret – as much as possible, that is. Their attitude paralleled that of women who had a facelift. Be it new hair growth on a once-balding scalp or a  firmer, younger-appearing face, patients perceived their rejuvenation as something that would be ridiculed by society, rather than admired. 

Fortunately, today’s attitude is much more open, as those who have benefitted from a hair transplant or cosmetic surgery procedure are proud of their journey and are often willing to talk about their experience to help others considering doing likewise. In either case, people no longer worry about being judged as vain. Instead, they see their physical transformation as also being emotionally and psychologically transformative, providing the boost in self-confidence and optimism that inspires them to achieve their goals.

Not Your Father’s Hair Transplant – Improved Techniques Provide Improved Results

Also relegated to years past are “pluggy” hair transplants, easily identified by large unsightly grafts spread apart unnaturally. As a leader in hair restoration procedures, Dr. Marco Barusco – Founder and Chief Medical Officer at Tempus Hair Restoration – has developed such advanced techniques as the groundbreaking No-Shave FUE. Short for follicular unit excision, the No-Shave FUE completely conceals harvested donor sites immediately, allowing you to resume your regular activities with virtually no evidence of the procedure.

Another leading-edge, yet proven procedure is the combined FUE and FUT (follicular unit transplantation). This technique covers large areas of baldness in a single surgery. Patients with advanced hair loss are typically required to undergo multiple hair transplant procedures to obtain coverage of their entire bald scalp – having to wait one year or more between procedures. This allows patients to achieve their ultimate goal sooner, with one procedure versus many.

Picture-perfect Facial Hair Transplants

Thanks largely to Instagram, eyebrows have become the center of a billion-dollar beauty industry dedicated to achieving the perfect arch. As an increasing number of women find their artistic talent and time are limited (not to mention the ongoing expense of cosmetics, and the often botched results of microblading and permanent tattoos), eyebrow transplants are becoming a popular alternative. 

This procedure uses your own hair, harvested from the scalp, with preference for the temporal areas, where the hair quality is more compatible to eyebrow hair (finer, more delicate hairs). Grafts are carefully selected to achieve the appearance of natural eyebrow hair once transplanted. The individual follicular units are then extracted and treated to ensure they remain healthy and viable when inserted at the recipient site.

Dr. Barusco’s technical skill and artistic eye places each hair in keeping with the angle and direction of natural growth – a critical factor for the natural look of any hair transplant, particularly the eyebrows. As a Fellow of the International Society of Hair Restoration Surgery (ISHRS) and Fellow of the American Academy of Cosmetic Surgery (AACS), his experience and credentials are unmatched in making Dr. Barusco uniquely qualified to perform eyebrow restorative surgery.

As for beards, their popularity shows no signs of abating. While many men strive for a full, healthy beard, some experience patchy areas with no growth. A beard transplant can provide what nature did not, or expertly camouflage scars where facial hair no longer grows.

The hair for facial hair transplants is normally taken from the sides and back of the head, which are the same areas used in typical hair transplant surgery for bald and thinning areas of the scalp. The only difference is that the hair removed is usually from lower down toward the neck, where the hair quality is more compatible to facial hair. Dr. Barusco understands how hairs from different areas of the body behave, and has the skill and artistry to harvest those that are the best match.

Be it Scalp, Brows or Beards, You Feel Your Best About Yourself When You Look Your Best

So hop on your next Zoom conference, update your dating app profile photo or take that selfie with confidence! You owe it to yourself to invest in yourself and reach for the new opportunities available to those who embrace change. Choose your surgeon wisely, and be ready to claim your online fame!  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!




Don’t Let a Technician Perform Your Hair Transplant Surgery

We at Tempus Hair Restoration have been witnessing a disturbing trend over the last few years. An increasing number of hair restoration practices and clinics offering a range of aesthetic services (such as cosmetic surgery) are using non-medical technicians to perform hair transplant surgeries. This practice is becoming so prevalent, that consumers have come to accept this as a typical, legitimate situation – which it is definitely not. These clinics gear their marketing and advertising to mislead the public into believing that technicians have a high degree of training and are just as capable as a surgeon to perform most – if not all – of the procedure. And that doing so allows them to offer hair restoration surgeries at a discount.

Don’t believe it. So serious is this problem that the International Society of Hair Restoration Surgery (ISHRS) – the world’s leading medical authority on hair loss treatment and restoration – has initiated a patient awareness campaign designed to help people understand why a surgeon is the only person who should be performing the procedure, and how to see through misleading marketing that makes technician-performed surgery seem safe and foolproof.

What is the ISHRS?

The ISHRS is a global non-profit medical association and the leading authority on hair loss treatment and restoration. With more than 1,000 members throughout 70 countries worldwide, the ISHRS is dedicated to achieving excellence in patient outcomes by promoting the highest standards of medical practice, medical ethics, and research in the medical hair restoration industry. The organization is dedicated to achieving excellence in medical and surgical outcomes by promoting member education, international collegiality, research, ethics, and public awareness.

As the ISHRS states the situation, the organization “… is concerned about the growing risk to patients of unlicensed technicians performing substantial aspects of hair restoration surgery. The use of unlicensed technicians to perform aspects of hair restoration surgery, which should only be performed by a properly trained and licensed physician*, places patients at risk of: (i) misdiagnosis; (ii) failure to diagnose hair disorders and related systemic diseases; and (iii) performance of unnecessary or ill-advised surgery all of which jeopardizes patient safety and outcomes. There may also be a risk that unlicensed technicians may not be covered by malpractice insurance.”

The ISHRS believes the following aspects of hair restoration surgery should only be performed by a licensed physician*:

  • Preoperative diagnostic evaluation and consultation
  • Surgery planning
  • Surgery execution including:
    • Donor hair harvesting
    • Hairline design
    • Recipient site creation
    • Management of other patient medical issues and possible adverse reactions
    • Post-operative care

Dr. Marco Barusco – Founder and Chief Medical Officer of Tempus Hair Restoration – is a Fellow of the ISHRS. This is a distinction that is only given to those who achieve certain landmarks on teaching and leadership. Currently, fewer than 10% of the ISHRS members are Fellows. As such, Dr. Barusco and the Tempus Hair Restoration team are proud to help the ISHRS in this important mission.

ISHRS policy states that hair restoration surgery should only be performed by qualified physicians who possess education, training, and current competency in the field of hair restoration surgery or other licensed health care professionals who are properly trained, performing the procedure within their scope of practice, and supervised by a qualified and experienced physician.

Penalties are now being handed down to physicians who commit such professional misconduct. The ISHRS reported on the suspension of Dr. Dennis Daly’s medical license by the New York State Board for Professional Medical Conduct for allegedly allowing unqualified and unlicensed individuals to perform a hair transplant procedure at the SNY Surgery Center in 2017. Effective February 7, 2020, the Board suspended Dr. Daly’s medical license for a period of three years (which suspension was stayed) and placed him on probation for 36 months, among other penalties, including dissolving his practice.

Hair restoration surgery is surgery

It is important to understand that hair restoration surgery is the practice of medicine. Although patients receive a topical anesthesia and are awake during the procedure doesn’t mean that a hair transplant is without the potential for a disastrous outcome with permanent damage if performed incorrectly. Imagine a heart surgeon allowing a technician to perform any step of a bypass, and you’ll get the idea.

Even minimally invasive hair restoration procedures are, in fact, surgery requiring medical expertise. Important clinical decisions requiring expert clinical knowledge must be made during each procedure. For example, diagnostic decisions are continually being made – along with full thickness incisions into the skin. Follicular unit hair transplantation (FUT) involves hundreds to thousands of tiny incisions. This is also the case for hair transplant procedures using the strip-FUT and follicular unit extraction (FUE) methods.

As the ISHRS states, any procedure involving a skin incision for the purpose of tissue removal from the scalp or body, or to prepare the scalp or body to receive tissue by any means – including robotics – is a surgical procedure.

“Such procedures must be performed by a properly trained and licensed physician. All FUE harvesting tools, including robotic devices, are considered extensions of the hand of the operator, and as such, all operators of these devices must be physicians.”

“Physicians who perform hair restoration surgery must possess the education, training, and current competency in the field of hair restoration surgery.”

Now, a minute to address anesthesia. If your only experience with anesthesia has been at the dentist office, you may consider it a minor issue. However, appropriate dosing of anesthetic medication is critical to patient safety, and patients must be medically monitored.

There are no shortcuts. Any doctor, practice or clinic that advertises otherwise needs to be avoided.

A look at deceptive tactics

Unethical clinics that employ technicians to perform surgery aren’t always easy to identify at first glance. Some may have attractive websites that make their methods seem advanced and high-tech. Those that offer a variety of cosmetic procedures typically position this as an advantage – a convenient “one-stop-shop” for any aesthetic improvements you may want to achieve. They also often claim that their technology-assisted techniques make possible a high volume of transplants, which results in bargain prices.

It is typical in such clinics that physicians purchase a robotic device that can help perform one step of the hair transplant procedure. Instead of performing the procedure themselves, they hire technicians to perform most, if not the entire, procedure – including surgery planning, hairline design, graft removal and making incisions to place the grafts in the scalp. Patients are led to believe that a doctor will be performing the procedure, or assured that the technicians are “experts” and just as good as the doctor in performing hair transplants.

As we noted earlier, hair clinics that advertise heavily can mislead those unfamiliar with ethical practices and safe surgical procedures. In particular, the widespread use of robotic and power-assisted devices greatly enables technicians to perform procedures – which can lead to disastrous outcomes. As the ISHRS website notes:

“Only a doctor has been trained to maintain high patient safety standards, care for unexpected medical problems, has medical board oversight, and has taken an actual oath to keep your best interest in mind while you’re in his or her care. If your doctor allows technicians to do surgery for them, they are neglecting their oath, and you should shop elsewhere!”

We also invite you to read Dr. Barusco’s insightful post about the risks of robot-assisted hair transplant surgery. Dr. Barusco relates his experience with an ever-increasing number of patients seeking help whose initial procedure was botched – sometimes irreversibly – by unqualified personnel using such devices.

“Over the years, it would be fair to say that I’ve developed a unique perspective on these machines. I closely follow their development and release in our industry. First, they were aimed to experienced, competent hair restoration surgeons. Then, since many of us did not see the advantages of having them, the number of machines sold was too small to sustain business and profit, and they started advertising to cosmetic surgeons, plastic surgeons, family practitioners and others who had no training and no experience in hair restoration surgery. These doctors are pitched a quick-profit procedure that they really do not have to understand, since one company supplies the technicians to do all of the work, and the other will train them on how to operate the robot and its software—as if this did not require good cosmetic sense and a deep understanding of hair loss and hair restoration. The result? Many unhappy patients.”

As for the deep discounts that such clinics claim, a botched hair transplant is no bargain at any price. The additional expense to correct bad results will be greater than had you initially chosen an ethical practice – assuming enough hair remains in the donor area to be harvested.

Choose your surgeon wisely

Choosing a hair transplant surgeon based solely upon the amount of advertising the doctor or practice does is no guarantee of good results. The ISHRS provides a Find a Doctor list, which is maintained and updated with the name, location, contact information and link to the ISHRS member page of each member.

In conducting research on individual surgeons, the ISHRS recommends learning about the surgeon’s training, credentials and experience in the field of hair restoration. This is important, as a plastic surgeon may perform great liposuctions and facelifts and be an authority on these procedures, but no experience in hair restoration surgery. Be certain the surgeon will give you the names and contact information of patients you can talk to, as well as show you several before-and-after photos to ensure you like the aesthetic quality of their work.

Questions you should ask a hair restoration surgeon

Our blog post – “Undoing the Damage of a Bad Hair Transplant” – includes the following questions:

  • Who will evaluate my hair loss and recommend a course of treatment? What is their education, training, licensure, and experience in treating hair loss? Only physicians, Physician’s Assistants and Nurse Practitioners are legally allowed to diagnose a patient and to recommend medical treatments. Otherwise, the person recommending procedures and/or treatments is practicing medicine without a license, a Felony crime in Florida and many other states.
  • Who will be involved in performing my surgery, what role will they play, and what is their education, training, licensure, and experience performing hair restoration surgery?
  • Will anyone not allowed by the State Medical Board be making incisions or harvesting grafts during my surgery? If so, please identify this person, explain their specific role and why they are legally permitted to perform it.
  • Is everyone involved in my surgery covered by malpractice insurance?

Knowledge is power

The best defense against falling prey to unethical clinics using technicians to perform hair restoration surgery is to learn as much as possible about the professional qualifications and standards that ethical surgeons attain and uphold. We hope we’ve provided you with the facts that you need to make an informed decision.

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!

Caring For Your New Hair Transplant Over the Holidays

‘Tis the season for holiday celebrations and travel for family get-togethers! If you’ve recently undergone a hair transplant, you can enjoy this special time of year while being mindful of giving your transplant the best possible conditions for success. Under ordinary circumstances, getting off-schedule during the holidays – as well as the stress of travel, family gatherings, etc. – can leave you at risk for coming down with a cold, flu or gastrointestinal distress. Keeping in mind that a hair transplant is a surgical procedure, exercising extra caution will help you see in the new year ready to achieve the full results you’ve been looking forward to!

However, it is also important to keep in mind that the post-op instructions given to you by your surgeon need to be followed, first and foremost. Dr. Marco Barusco provides instructions based upon each patient’s unique situation. Even when two people undergo the same procedure, each has their individual medical history, background and other factors that need to be considered. We provide the following recommendations in the interest of increasing your awareness about balancing fun (and a demanding schedule) with good choices.

Take care of the surgical site – Whether you are male or female, or have had a scalp or facial hair transplant, the site of your transplant is still healing. While the first two weeks post-surgery are the most critical, don’t assume you can engage in all activities soon thereafter. If you travel, it’s easy to disrupt your skin/hair care regime. Be sure you pack the products your doctor has prescribed or recommended, and use them accordingly. It may seem more convenient to use your brother’s shampoo, but it could be too harsh for your scalp.

Likewise, if you’ve been prescribed or instructed to use a topical medication or treatment, apply it as closely as possible to the time of day you’ve been using it at home. Skipping one treatment typically does no long-term harm, but hit-or-miss compliance is more likely to compromise long-term results. Don’t get so caught up in your activities that you fail to take the extra time necessary.

Consider your physical activities – If your plans include a good amount of outdoor activities – such as visiting theme parks or the beach, or golfing – wear a hat or loose-fitting cap to avoid sunburn on the scalp. Winter sunlight is still strong in Florida, which you know if you live here, or need to know if you plan to visit. As for swimming, the general advice is to not swim in chlorinated pools during the first 14 days after surgery, as chlorine (and other pool chemicals) may damage the grafts. Do not dive. However, ask your doctor if it’s safe for you to take a dip after two weeks have passed. Again, no two people heal at the same rate.

Be aware of other physical activities. If your family get-togethers include backyard football, “wrassling” or tumbling around with the grandkids, avoid contact with your scalp, or whichever area has had a hair transplant. Don’t let curious young ones reach for your emerging beard, for example!

Don’t overindulge – It’s human nature to give yourself a “pass” during the holidays. People tend to eat more than usual, as well as indulge in a greater amount of high-fat, high-calorie foods. There’s also a tendency to snack frequently, and increase alcohol consumption. Holiday binging takes a toll on health and well-being – which, in turn, affects your ability to heal and promote healthy hair growth. Just remember the considerable investment you made in your hair transplant before reaching for that extra cocktail or helping of baked ham!

Writing for Forbes, Noma Nazish provides valuable advice on staying healthy during the holidays. In addition to eating mindfully, Nazish points out the importance of maintaining proper hydration. Because water accounts for 60% of our body weight, we need to stay hydrated to maintain this ratio. Water is also necessary for several bodily functions, including maintaining cell fluids and delivering nutrients. Limit your intake of high-calorie drinks like eggnog, martinis and margaritas, she writes, and alternate your cocktails with a glass of water in-between.

Also, Nazish writes, boost your immune system with a variety of fruits and vegetables – which deliver vitamins and minerals. And make sure to get proper sleep. Need we say that following this advice throughout the year will pay off in improved health and overall well-being, as well as ideal conditions for optimum healing and hair growth?

What results can you expect to see by now?

Our February 2019 blog post – “New Year, New You” – features an interview with Dr. Barusco in which he covers questions about hair transplant procedures, healing time and what results patients can expect if they want a good amount of new growth for end-of-year holiday time.

“Patients choose this time of the year to treat their hair, so that their hair will be better for the following holiday season,” says Dr. Barusco, who observes that people tend to have realistic expectations regarding the amount of time required to heal from surgical procedures and to begin seeing hair growth – particularly growth that reaches the patient’s desired length.

“I think part of the reason is the information available about hair transplants on the internet. But sometimes, we find ourselves having to educate patients on what to expect as far as healing and results, so they may plan their life events accordingly. These patients need to be educated very well about short- and long-term expectations in order to correctly prepare them for what is coming and for the achievable results, so that they are happy in the end.”

So if your hair transplant is relatively recent, taking conscientious care of yourself this holiday season will increase your success for having a fuller head of hair – or fuller beard – to impress your family and friends at next year’s celebrations. Keeping your eye on the long-term prize will help you stay better focused!

If you’re considering a hair transplant and researching surgeons for their reputation, experience, results and standing within the medical profession, we invite you to explore this website to learn more about Dr. Barusco and the advanced procedures he performs. Dr. Barusco’s long list of accomplishments, notable artistic ability and successful surgical team make Tempus Hair Restoration a renowned practice worldwide.

Dr. Barusco also conducts virtual consultations for those who can’t travel to one of our 16 Florida locations, and our office will arrange travel and accommodations for out-of-area patients. Contact us to schedule your free consultation with Dr. Barusco. We look forward to meeting you and discussing your options.