The decision to undergo a hair restoration procedure is the result of a personal journey. Whether you want to increase your self-confidence, present a more youthful image to the world or be more competitive in the job market, the motivation that begins your search for a hair restoration specialist is personal. This, however, is the critical stage. Most people have no experience in how to evaluate the practices and clinics with which they’re about to schedule a consultation. How do you know what to look for, or what questions to ask?
Dr. Marco Barusco – founder and Chief Medical Officer of Tempus Hair Restoration – is a tireless advocate of consumer education in his field. People seeking treatment who have little to no knowledge of best practices are vulnerable to poorly qualified, unethical practitioners who misdiagnose patients and/or perform an unnecessary procedure – or even the wrong type of procedure. For this reason, Dr. Barusco emphasizes the importance of consultation. Knowing how the surgeon should conduct the consultation – and knowing what questions to ask – are essential to finding the right surgeon to trust with your procedure.
Dr. Barusco’s informative YouTube video – “The Importance of Consultation” – is a comprehensive discussion of what you should expect during your hair loss consultation. Running at just over 24 minutes, this video covers every aspect in detail – complete with Dr. Barusco’s candid observations about how less-than-conscientious practitioners fail their patients. This article is based upon the video, which includes a link to a Hair Loss Consultation Checklist to print out and take with you to your consultation appointment.
Taking the approach that hair loss is a medical condition that should be treated by a physician, Dr. Barusco says the following:
“So what is important in a consultation? A medical consultation involves a few steps. Whether you go for diabetes, high blood pressure or thyroid disease, hair loss is a medical condition. It may not be considered a disease, although many of them are. The only one that’s not considered a disease is genetic hair loss – or angiogenetic alopecia as it’s known – which is the most common. But there are many other types of hair loss that are diseases. You may have one, but you won’t know if you go with someone who doesn’t take the steps and doesn’t understand hair loss. They’re going to miss it. So you need to go with someone who specializes in hair loss.”
Following are the categories of questions that Dr. Barusco asks during every consultation – as well as the process leading up to diagnosis. Whoever you consult, these are the areas that should be covered. But first, be sure that you will be talking to the surgeon who will be performing your procedure – not a salesperson or medical technician. If you’re told the doctor cannot or will not meet with you, leave – or don’t schedule the consultation in the first place. This is a red flag that should not be ignored!
Hair Loss History
Asking about when you started noticing your hair loss, which areas of your scalp were first affected, how the loss is progressing, etc., provide important information that can help the doctor start to form a complete picture of the cause and treatment options for your individual case. Even if you think a detail may be insignificant, mention it to the doctor.
Your Family History of Hair Loss
You should be asked if your immediate family members (including females) had/have hair loss, and if so, what kind. How did it start and progress over time? Says Dr. Barusco, “If your physician or provider is not asking these questions and you don’t know to volunteer this information, they’re not going to give you the correct diagnosis.”
Your Medical History
The doctor should ask for a detailed medical history. Such conditions as diabetes, heart or thyroid disease – and the medications you take for them – can affect or accelerate hair loss. For women, irregular or painful menstrual periods need to be noted. Says Dr. Barusco, “That information is important because it will help us see what kind of hair loss you have, and if any of these things are influencing your hair loss. If you don’t treat the source of that problem, you’re not going to get the best result from your treatment.”
Your Past and Current Medications
Some prescription medications can cause hair loss. “If I don’t ask you about them, you’ll assume it’s not important,” says Dr. Barusco. “But if I do, and you tell me, we’ll know it’s influencing your hair loss.”
Your Allergy History
Your doctor should ask if you are allergic to any medications or have had an allergic reaction to anesthesia. Dr. Barusco notes that the medications he prescribes are well-tolerated by most people, but some could have a rare reaction. Knowing if this has occurred is important in prescribing an alternative medication.
Your Surgical History
Your doctor should ask if you’ve had surgery of any type. Again, this can provide additional information about a medical condition that could be relevant to your hair loss, as well as your ability to tolerate anesthesia. Says Dr. Barusco, “If you tell me you almost passed away after anesthesia was administered and you had to be resuscitated, or you had terrible bleeding, this is important for me to know. As a surgeon, it will help me plan my surgery better. Again, you may not think to tell me if I don’t ask.”
A Timeline of Your Hair Loss
A good hair restoration physician should start creating a timeline of your hair loss based upon all of the previous information he/she has gathered from your answers. “I try to frame it in a timeline and try to associate that timeline to the various stages of hair loss with things that are important,” says Dr. Barusco. “For example, your hair loss started getting worse five years ago, and you had your thyroid disease for six years. Was that a factor in your hair loss? Did you start taking birth control pills, or a blood pressure medication prior to that period?
“I am a hair loss specialist, but I’m also a physician. I understand how your body works, and how that impacts hair loss. Unfortunately, from what I’ve seen, many people out there either don’t know, or they forgot what they learned in medical school. As a result, they’re not serving you as best as they could – and that’s wrong.”
Your Goals for Your Hair
Dr. Barusco has had patients who wanted hair on areas of the scalp that he considered secondary – that is, not as obvious as the hairline – yet that was the area on which the patient wanted to see hair growth. Learning what the patient wants is an important part of the consultation.
“However, patients need to be realistic. If you say you want the hair you had when you were 18, that will not be possible with a hair transplant. No one will be able to give you that unless you get a hair piece. But if I don’t tell you that – or worse, I lead you to believe that can happen – that’s wrong. If I don’t know what your goals are, I may make a recommendation that’s not appropriate.”
Examining Your Scalp
Just as your regular physician examines your body during a checkup, a good hair restoration specialist should examine your hair and scalp – which are also parts of your body. “If I’m just looking for hair loss and forget about everything else, I might miss clues that are hidden under the scalp or in other areas that may indicate an underlying condition that could be causing hair loss.”
Dr. Barusco first examines the scalp, looking for miniaturization of the hair follicles, redness and inflammation, swelling, dandruff and skin cancer. He then examines the hair. Is it coming out of the scalp very easily? Is the hair breaking? Are there patchy bald areas? If your consultation is in-office, the doctor should also have such tools as a magnification camera.
“I have patients who come to me and say that the other doctor they saw for a consultation never touched their hair. ‘They just saw me across the table and made a recommendation for a transplant, and I left the office.’ That’s not right.”
Online consultations can be conducted in a thorough manner that provides the information the doctor needs. Dr. Barusco has been conducting online consultations for many years – even before COVID-19 made them a necessity throughout every field of medical practice. During an online consultation, Dr. Barusco instructs the patient to take pictures of his/her scalp with a smartphone. This can be done by the patient, or with assistance from another person in the room. If he isn’t sure about an area of the scalp based upon the photos, Dr. Barusco will ask the patient to schedule an in-office consultation.
Examining Other Areas, Complementary Tests and Consulting Other Specialists
Dr. Barusco will perform a basic medical examination, which includes listening to the heart and palpitating the thyroid area. He will talk further with the patient about any issues that may have been brought up during the medical history portion of the consultation. As a licensed physician, he is qualified to do so. This is intended to further rule out or identify any underlying medical condition that could be causing hair loss, or better inform Dr. Barusco about which course treatment should take.
If necessary, Dr. Barusco will refer a patient to the appropriate specialist. He will also order a scalp biopsy and blood work to look for underlying conditions. In the case of patients who have a history of heart disease or another condition that could place them at risk during hair transplant surgery, Dr. Barusco may ask for a medical clearance In the case of patients who have a history of heart disease or another condition that could place them at risk during hair transplant surgery, Dr. Barusco may ask for a medical clearance Although hair transplants are generally safe, some fatalities have occurred (not among Dr. Barusco’s patients). Although hair transplants are generally safe, some fatalities have occurred (not among Dr. Barusco’s patients).
“The procedure is not as simple as many people assume. It is the obligation of us – the physicians treating you – to look after your safety.”
Arrive at a Diagnosis of Your Hair Loss
Only after Dr. Barusco has all the information he needs, he arrives at a diagnosis, or a tentative diagnosis. Although not generally known, people can have more than one type of hair loss. For this reason, Dr. Barusco may have two or three ideas of the cause – which is known as a differential diagnosis.
Review Your Goals and Discuss Expectations
Once the diagnosis is given, your doctor should again review your hair restoration goals and discuss expectations – which should be realistic. Dr. Barusco tells patients what they can expect from treatment based upon his diagnosis. Being honest is the only way to build trust – which is why Dr. Barusco has treated family members of his patients.
“They know I’m going to give them the best advice, regardless of money. That’s what you need to expect from a professional, and that’s what I don’t see happening very much right now. It pains me to see it, because I see people getting hurt all the time by misdiagnosis and procedures that were too aggressive – procedures they never needed, and a lack of counseling on their hair loss.”
A plan to prevent future hair loss also needs to be part of this discussion. “You have to prevent hair loss. That’s as much or more important than any transplant – to save the hair you have so you don’t continue to lose hair – or at least slow down the loss. If you have a hair consultation without any kind of discussion on hair loss prevention, you need to run away from the place and never come back.”
Discuss a Treatment Plan with You
Finally, your doctor should discuss a treatment plan that is right for your individual situation. Areas to be covered should include the type of surgery, why this type of surgery is recommended, which areas of the scalp will be involved, how the surgery will be performed and the results you can expect. Medications that will be prescribed should also be covered – including possible side effects and the number of times a day you’ll take them.
After that, it is up to the patient to decide whether to proceed. Dr. Barusco does not pressure people to make a decision during the consultation. Any hard-sell at this point is another red flag you should heed.
“You will leave the consultation with all the information that you need, including prescriptions and the estimate for the cost of the procedure. A follow-up schedule is also very important, because surgery, medications and the course of future hair loss has to be followed up. I never see a patient only once.”
If Procedures are Recommended, Ask Questions
Educating consumers about hair restoration best practices and ethics is Dr. Barusco’s mission. Dr. Barusco is a Fellow of the International Society of Hair Restoration Surgery (ISHRS) – the world’s leading medical authority on hair loss treatment and restoration. 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.
“If someone recommends a procedure to you – be it a hair transplant, PRP, etc., ask questions! Do not take it at face value. Ask about how much donor hair will be used. Who will actually be performing the surgery? Technicians are not legally allowed to perform surgery, but they do in too many practices. Ask about the experience of the doctor. If you’re not seeing the doctor at that point in the consultation, I don’t think you should even be in the same room.”
Knowledge is Power – Learn All You Can and Choose Your Surgeon Wisely
Continuing his commitment to consumer education, Dr. Barusco posts videos to his YouTube channel on a regular basis. Our website’s FAQ page also provides a link to Dr. Barusco’s channel, and direct links to his videos that answer common questions about hair loss and hair loss treatment. Each video is essential viewing for anyone who is considering hair restoration treatment.
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!