“Good judgment is usually the result of experience.

And experience is frequently the result of bad judgment.”

                    -- Barry LePatner, testifying before a House subcommittee on science and technology (1982)

 

“Wisdom is the experience you gain throughout life, that you can share with others.”

                    -- Robert Fulghum

 

“It’s not even that I shave it. I crop it. ...... It’s my fuck-you to all those ads who say you’re not a man if you’re losing your hair or your hair’s thinning. All that horsehsit is just commercialism to buy their bullshit hair growth products. I don’t make a big deal of it. Whether you’re a man or not comes from your heart, not from how much hair you have on your head. I get so many compliments from guys who say thank you for championing this look.”

                    -- Bruce Willis, Maxim magazine, February 2005

responding to the question “Any advice for readers who are thinking about shaving their heads?“

 

 

So, you’re going bald ....

 

 

..... and not feeling too good about this situation? You’ve heard your peers joke about your hair loss (hopefully good-naturedly). And even when a fellow member of the follicley-challenged-club tries to lift your spirits by commiserating with you, it just doesn’t seem to help? Then this paper -- one persons’ viewpoint on hair loss & restoration -- is meant for you.

Why you might care about my opinions:

ü       Like you, I’ve got a hair loss problem. My hair has been exiting my scalp at various rates since I was in college, circa 1980. As a result, I have researched hair restoration methods since 1984, I’ve tried minoxodil & propecia, and I am a hair transplant veteran (first surgery in 1985 at age 25).

ü       I’ve spoken to enough bald men who’ve sought solutions to their hair loss problem to think that my collected opinions ought to have some value to others. There are many common experiences and emotions (obviously negative) among men who are losing their hair.

ü       Unlike hair restoration firms, who will give you a rosy view of their products & services, I do not gain or lose money based on your decisions.

Why you should take my opinions with a grain of salt:

ü       Although I claim to have researched hair restoration, you do not know how thorough that research is. I am not a medical professional. I do not spend all of my free time looking into this field. There will certainly be no shortage of people who will disagree with points made here, and some of their arguments may be quite valid.

ü       Although I am disappointed in much about the hair restoration industry, there are men who are satisfied with what that industry has provided for them.

This paper is an offering by one man who has made some mistakes in his life with regard to his hair loss. It is an effort to help others avoid repeating them. It is a guerrilla-warfare act of consumer-to-consumer education. So, take what you will from this. In any economic exchange, the burden is on the consumer to research the goods and services under consideration. With many major goods and services, opinions and advice from other consumers is readily available. Not so in cosmetic surgery, where other consumers, whether happy or not with their experiences, often want to remain anonymous. This puts future potential consumers at a great disadvantage. Perhaps this essay can help correct that.

This may be a tough read if you are losing your hair and starting to explore hair restoration, because I am going to try to talk you out of seeking the cosmetic solutions that you are anxiously researching, in favor of less radical action, and you may not want to hear that. You want to believe that a drug or a hairpiece or surgery can restore hair or at least hold hair loss in check, without causing new problems. You want to believe that a medical doctor would never operate on someone without putting the patients’ interests and appearance above all else. You want to believe that an established business could not remain in business if their products or services made their clients look foolish. You want to believe that any procedure or system of hair restoration that didn’t produce good results would have become extinct in the free market. You don’t want to believe that any established hair restoration method could produce results worse than the natural balding process itself. Let me remind you that there was also a time when you wanted to believe in Santa Clause, too. You discarded that myth, now you can discard the myths about hair restoration. You need to realize that you may not always be as rational as you’d like to think you are, that your analytical side can be overwhelmed by your emotions. Especially when that emotion is the primal one of fear ..... fear of lost social capabilities, lost virility, etc., that are associated with lost hair. So no matter how tough this document is to read, I’ve written it because it is what I wish someone had told me when I was younger and first exploring hair restoration.

You can’t pick up a newspaper or magazine, or turn on the radio or TV today without seeing ads for Minoxodil, Kevis, Regenix, hair transplant surgeons, or hairpiece manufacturers. You are the target of these ads (and I do mean target). You are losing your hair. You don’t like losing your hair one bit. So, why don’t you “go for it” as the ads say? Read on, and I’ll tell you why you should NOT “go for it” ......

Reasons to avoid hair transplantation.

The final appearance may not look natural. The results can be worse than the natural balding process. There are still doctors producing the picket-fence / pluggy / corn-row / toothbrush / dolls-head look. The fact that there are so many unflattering names to describe some of the results of hair transplantation should raise some doubts in your mind. Even the best results, that avoid the pluggy look by using micro- & mini-grafts, can produce thin coverage. “Of course we can put hair on your head!”, the physician will say. But will it be natural looking? Will it be dense enough to be called HAIR, or will it just be considered less-thinning-than-it-was-before-but-still-thinning hair? Is your baldness so disturbing to you that you are willing to risk looking worse? No matter how undesirable baldness may be, it is still natural .... a bad hair transplant is NOT.

The lighting of your environment will have a big influence on how natural the transplants look. In all cases, the less bright, the better. When indoors, incandescent light sources are most flattering to hair transplants, while fluorescent lighting is the worst. It is no small irony that many men who choose (and can afford) hair transplantation are white-collar professionals who work in offices, many of which are lit by fluorescent lighting, resulting in many hair transplant clients spending a lot of time in cosmetically unflattering surroundings.

There may be a difference between what hair transplants can achieve and what you want. At one point or another in your pre-surgery consultations, you may hear the physician say “you must have realistic expectations”. Translation: you must lower your expectations. You want the hair transplant to be a Mercedes-Benz, but you’re more likely to get a Chevrolet, and you take the risk of ending up with a Yugo. This highlights the difficulty in determining an objective definition of someone’s 'expectations', especially in a largely subjective endeavor like hair transplantation. The physician may have one mental picture of what the results should look like and you may have a different mental picture. His is based on the reality of 1000’s of previous hair transplant surgeries that he has seen or performed. Yours is based on a wish of how you’d like to appear. Two people about to embark upon a journey together, each with a different destination in mind, combined with the subjective nature of judging the ‘destination’, is a formula for disaster. Your disaster. Clear, two-way communication with the surgeon is critical. If you express any discontent with the results of the transplant, your concerns may be dismissed as the result of ‘unrealistic expectations’, or you may be labeled as a perfectionist or chronic complainer.

The issue of realistic vs. unrealistic expectations raises some serious questions. Why should the prospective patient invest thousands of dollars and years of his life going through the necessary surgeries/transformations, to make a permanent change to his appearance, if the end result may be substantially less than what he really wants? Why should the customer have to lower his expectations? In the rest of the real free-market economy that we enjoy in this country, the seller succeeds only if they can raise the attributes of the product or service to meet customer expectations, not the other way around. Are the patients’ goals flawed, or is the technology of hair transplantation flawed? As an analogy, recall that in the 1960’s, America set a national goal of putting a man on the moon and returning him safely. If we had failed in the attempt, how would the public & congress (who paid $billions for the effort) have felt if NASA and the aerospace industry (who consumed those $billions) had turned around and said “Well, we tried our best, but you had ‘unrealistic expectations’. Hey, getting halfway to the moon before the capsule exploded was still further than we’d gone before.”?

You may find your intermediate appearance[1] (after each surgery and over the years as you are ‘under construction’) disturbing. Are you prepared for this possibility? If you feel uncomfortable with this appearance, how will you camouflage it? If you can’t adequately mask an unacceptable intermediate appearance, will the resulting social dislocation be any better than that which is now due to baldness? Are you convinced that the end results will be worth spending tens of thousands of dollars and years living with one form or another of appearance-anxiety and the resulting disruption to social life? Many patients report feeling that they want to hide in a closet until the transformation is complete. How big is your closet?

Your hair may be of a character, density, texture, etc., that will not yield good results. There are a some hair types that are good for transplants and some that aren’t. Men with curly, bushy hair have the potential to achieve excellent, undetectable results (i.e., Black men and Michael-Keaton-hair-alikes). Research!

Transplant Physicians are notorious for expounding the best-case scenario, but poor at informing you[2] of the potential downsides. There are potential complications that can occur with all forms of this surgery from plugs to scalp reduction to flap surgery. Certainly many of these complications are quite rare, others less so. In any case, your task is to identify them and their likelihood before committing to any kind of hair restoration surgery. Research!

You have serious deficiencies as a consumer of this industry’s services. Here’s my comparison of 2 different purchases: a new automobile and a total hair restoration procedure. This should give you some perspective on your relative position of weakness as a consumer when you consider hair transplants as compared to an expenditure of similar cost.

 

	Automobile	Hair Transplantation
1. What is the rough, ballpark total cost?	$10,000 - $30,000	$10,000 - $30,000 (assuming patient starts as a Norwood type-6)
2. Is there widely available information on the fundamental technologies common to all products/service providers?	Yes.	Yes.
3. Is there widely available information on the features differentiating competing products?	Yes.	Somewhat, though limited. Buyer needs to do much research.
4. Is there widely available, independent, objective, 3rd-party-collected information to evaluate the satisfaction levels of previous customers of this product (independent of specific vendors)?	Not really applicable: the product is too pervasive, reliable, and essential to society for the question to be valid.	No.
5. Is there widely available, independent, objective, 3rd-party-collected information to evaluate the satisfaction levels of previous customers of specific vendors of this product?	Yes: extensive newspaper, magazine, & TV coverage, J.D. Powers & Associates, Consumer Reports, etc.,	No.
6. Nature of product evaluation in cases of disagreements & arbitration between buyer & seller.	Mostly go/no-go, works/doesn’t work, & quantitative evaluations. Very little subjective evaluation.	Almost exclusively subjective evaluations. The metric of counting ‘# hairs per plug’, is rarely practical especially not in the popular techniques of extensive mini- & micro- grafting. Think about who would & could objectively count 1000’s of hairs & how it would be done.
7. What recourse do you have if you are dissatisfied after purchase of product?	‘Lemon’ laws. Numerous precedents. Warranty. Buy a new & different model.	Expensive lawsuit? Any precedents? Doctors often agree to re-do graft sites that don’t produce hair, but (a) identifying specific graft sites among 1000’s is difficult at best, and (b) you’ve still wasted precious donor hair. Live with it or cover it with a hairpiece!
8. What are the risks to the vendor if the customer is not satisfied?	Legal action! Unhappy consumers not shy about their disappointment with product (bad word of mouth reputation for seller). Men especially take pride in demonstrating their knowledge of cars, directing others from/to various makes & models. Mass media is aggressive in pointing out design & manufacturing defects.	Legal action? Unhappy clients fade into the woodwork (want to hide the results and not draw attention to themselves). Cultural factors give Doctors an automatic credibility boost, that weights their opinions more than many other civilians (compared to, say, a car salesman or the doctors’ patient). Their claim that patient had ‘unrealistic expectations’, is harder to argue.

 

More than any other branch of health care, cosmetic surgeons are in business first, medicine second. Your interests may be sacrificed for money. For some cosmetic surgeons, the elective & competitive nature of the business may force them to replace the physician’s maxim “First, do no harm ...” with “First, get the money ... second, get the client’s ass in the surgical suite and therefore committed to the process so that we can be assured of more money in the future ... and third, try to do no harm as you make the surgical results the best they can be (even if the best overall results would have been leaving the client alone and doing no surgery - we don’t generate income from recommending that).” It’s one thing for used-car salesmen to prey on the weak of spirit. It’s unethical for doctors to do it! (See the Dateline NBC story “Splitting Hairs”, first broadcast 1/12/97.)

The number of surgeries, that it will take to achieve the look you want, is unpredictable (if the look you want can even be achieved!). Therefore, the cost is unpredictable. The degree of satisfaction that you can expect is unpredictable. Are you getting the picture, yet? If you speak to a hair transplant physician about a surgical plan for restoring your hair, demand absolute clarification as to what is being guaranteed vs. what is being estimated and get it in writing. You are gambling with your money & your appearance. All successful gamblers (both of them) know how to play the odds. Do you know the odds of successful hair transplantation surgery? SUCCESS IS NOT defined by whether the transplanted hair will grow. There is little risk of that not occurring. SUCCESS IS defined by whether the transplanted hair that grows will be of a quantity, direction, and distribution[3], all with respect to the remaining natural hair, that is pleasing to the patient and inconspicuous to most people he’ll encounter (i.e., Stealth Transplants!). Have you ever seen any surveys of hair transplant patients (conducted by an objective, independent, 3rd-party organization) that attempt to gauge their level of satisfaction? I haven’t. Such a survey would be an indisputable measurement of the success rate of hair transplantation.

It is a permanent, irreversible process, there is always some uncertainty about what you are going to get, and you may not like your options if it doesn’t turn out the way you expect. What are your contingency plans[4] if the result of your hair transplant surgery is (a) mildly disappointing, or (b) miserably, devastatingly, catastrophically disappointing? If you try hairpieces or medications and decide that you don’t like them, you simply stop and let your natural hair loss continue. But if you start hair transplantation and decide you don’t like the process or the initial results, you no longer have that option. The freakish appearance of an incomplete hair transplant against the backdrop of an increasingly bald scalp essentially commits all but the most unselfconscious man to do something about covering his balding head, whether that is a hairpiece, or further surgery, or medications, or .... a baseball cap! Are you prepared to embrace those lesser solutions if the preferred solution (transplant) turns out to be unsatisfactory?

The trauma to the scalp of hair transplant surgery can accelerate your hair loss. After the surgery, as the trauma subsides and the scalp recovers, this prematurely lost hair might NOT necessarily grow back (to then fall out again at the gradual rate of your natural hair loss). Some will argue that “Well, that hair was going to fall out anyway ....”, but the drawback is that soon after surgery, the patient suddenly has less natural hair to help camouflage his undesirable intermediate appearance, described previously. Oh, by the way, although the natural balding process is depressing, accelerated balding is very depressing!

What you thought was going to happen, sometimes doesn’t happen. My 1995 surgery resulted in the doctor moving some of my donor hair to a place where I had specifically told him I did not want transplants moved. I emphasized this requirement in many pre-surgery consultations, including the moments prior to surgery. Although the amount of mis-placed hair was small and this wasn’t a major problem, it was very unnerving to have had my instructions ignored or forgotten. I had dismissed this as a one-time-only mistake, but I have since discovered other patients of this doctor who had similar experiences. In one of those cases, the consequences were much worse than mine. This may not happen very often in this industry, but now you have been warned that it can happen.

There are important questions to ask, and the answers will be discouraging. I recommend that anyone considering hair transplantation for the first time ask their prospective physician(s) the following questions before committing to the surgery:

Question # 1: Is there any data, collected by an objective, independent 3rd-party, to demonstrate what percentage of your (and/or the hair transplant industry’s) past patients are (a) delighted with their results, (b) satisfied with their results, (c) dissatisfied with their results, and (d) miserable with their results?

Question # 2: If my hair transplants don’t produce at least satisfactory results, will you be willing to pay all lifetime costs for my hairpiece? If yes, are you willing to put this in writing?

Of course, the answer to both questions will be NO. Although you won’t have a statistical measure, you will have a better intuitive idea of the real success rate of hair transplant surgery and how much the surgeon believes in his own work. The answer to Question # 1 is NO, because the results would be embarrassing to the doctors, even if they never made those results public. The answer to Question # 2 is NO because the disappointment rate is too high to sustain a profitable business, so warranties are out of the question. The answers to Question #1 will remain NO as long as the desperate men who sign up for this surgery don’t demand this kind of information.

The answers to Question #1 must be supplied by an objective, independent, 3rd-party organization in order for consumers to have confidence in them. We’re all familiar with “Nielsen Ratings”, a system used to gauge viewership of programs for use in selling television advertising. Who pays the A.C. Nielsen Company to perform this service? Both consumers (advertising consortiums) & sellers (TV Networks). They both share in the cost to ensure fairness to both sides. Unfortunately, a similar system for hair transplantation is not feasible at this time. The sellers (hair transplantation doctors) already have a good idea that the results of such a survey would be unflattering, and the consumers (prospective patient community) aren’t organized at all, let alone organized enough to consider financing half of the costs for the research. In hindsight, having an answer to Question #1 seems like such a basic, fundamental prerequisite to going forward with this surgery. Yet, it apparently doesn’t occur to most men who undergo the procedures. Why? Panic & fear of hair loss overwhelm such common-sense thinking. Implicit (& misplaced) trust that no doctor will let you go forward with something that isn’t appropriate and safe. Also, there is an underlying assumption that the privacy of past patients can never be violated. That is true in terms of publicly disclosing their medical/cosmetic history, but I see no confidentiality or stigmatic issues in the case of a discretely conducted survey to better understand the aftermath of their experiences. In this case, the days of a ‘hands-off’ attitude toward past patients should be over. Don’t you think you should know the real success rate of a procedure that is going to make a permanent change to your appearance? Especially a procedure that will extend over several years, cost many thousands of dollars, and is purely elective.

History is prelude to the future .... unless consumers change. Hair transplantation has advanced quite a bit with the advent of mini- & micro-grafting beginning in the late1980’s. Although the results are still too thin for me to recommend the procedure to anyone, they are superior to what had been done before. Nevertheless, reviewing the history of this industry reveals some disturbing impressions. For the 25-30 years prior to the advent of extensive mini- & micro-grafting, hair transplant physicians didn’t seem to mind producing the pluggy look. It was ‘the standard’. And a horrible standard it is, by any measure. Yet, it was inflicted on the general populace of balding men for those 25-30 years. In recent years, scalp reduction seems to have fallen into disfavor. Why? Because more than a decade of these procedures has created too many scarred scalps & inadequate reduction in bald area. Yet for a good part of the 70’s & 80’s it was presented to patients as a natural, low-risk tool in the physicians’ arsenal. A picture begins to emerge that, at least for the first 3 decades of its’ existence, the hair transplant industry has, to some degree, treated patients like guinea pigs. How much, if any, have things changed? Should their past collective behavior compromise the degree of trust that we should invest in hair transplant physicians today? Yes & No. A lot of the fault may lie with the doctors, but I’m afraid to admit that perhaps more of it lies with us, the consumers. In retrospect, it isn’t too hard to understand why hair transplantation wasn’t kept in the laboratory until it could produce truly good aesthetic results .... a consumer population filled with enough confidence-deficient and panic-stricken men to sustain the business, despite poor results, will induce suppliers (doctors) to produce something -- anything -- to satisfy that demand. Frankly, it’s hard to blame them. We’d all like to make a nice living, and if I were a doctor (who’d spent $100,000 for medical school) and some patient was desperate enough to pay good money for junk (pluggy transplants), then maybe I’d produce junk, too. Ultimately, it is up to consumers to reject substandard products, and accept nothing short of excellence!

Physician selection is filled with subtle traps. Physician selection is the most important decision for the prospective hair transplant patient. One issue that doesn’t get discussed often is: should you go with a physician who does this part-time or full-time? At first glance, the obvious answer would seem to be to go with the doctors who do hair transplants full-time. However, there is a trade-off depending on where you are in the process of restoring your hair. Full-time hair transplant surgeons have the apparent advantage of getting the most practice and they are the most likely to be up-to-date with the technologies in this field. But their disadvantage is that since hair transplantation is their only line of work, they have more incentive to get you into the chair even if you aren't a good candidate, because they don't have other income to fall back on if prospects don’t sign up for surgery. The part-time hair transplant surgeon has the advantage that the diversity of his practice, and therefore the diversity of the medical procedures that generate his income, attenuates his need to get you into hair transplantation. His disadvantage is a possible reduction in technical & artistic skill due to less practice. One part-timer I knew told me how much he wanted to adopt new laser technology for hair transplant surgery. That caused me to re-evaluate my opinion of his hair transplantation skills, since it is common knowledge (or so I thought) that while a laser makes the surgeons job easier, it also cauterizes the recipient site, thus restricting blood supply to the graft and reducing it's chances for survival. For someone who hasn't had any hair transplant surgery, he may be more likely to get an honest opinion on his suitability from a part-time hair transplant doctor, but for results and true state of the art technique, the full-timers might be better.

It is difficult to find a hair transplant physician who can (or will) give you an honest, independent evaluation of your suitability for the process (i.e., Do you have the appropriate hair type and adequate density & quantity of donor hair for the area of baldness to be covered?). The dilemma here is that the only surgeons who are knowledgeable enough to offer a qualified opinion are ones who do hair transplant surgery, and they may have an ulterior motive to get you signed up for their services. Consider that, these days, virtually all consultations with hair transplant doctors are free. Then consider how many things you’ve received in your life that cost nothing and were of real value. My suggestion: Among the physicians that you are considering for your surgery, pick one that you think is good, but for one reason or another you’re not likely to select for the actual surgery (i.e., too expensive). Arrange a consult with that surgeon, but make it clear that you insist on PAYING for the consult ($50-$100?) with the explicit understanding that this doctor is NOT a candidate to perform any of your possible surgery. The idea here is to remove that doctors’ motivation to sell you the sugar-coated version of hair transplantation. It is better to pay something upfront for the possibility of at least one honest professional opinion, instead of just paying nothing upfront to hear a lot of optimistic sales pitches.

Reasons to avoid hair transplantation while in your 20’s or in the early stages of hair loss.  

[Many hair transplant doctors are producing videos and conducting open house seminars to help sell their services. Invariably, one or more of their clients who are giving testimonials will state “I wish I had started this sooner.” Be aware that these clients are probably being coached by the doctors’ sales staff to say this, and they are almost certainly being compensated for their testimonial. The author did “start this sooner.” The result? At 25, he wanted to get a natural-looking head of hair. In middle age, his hope for future surgeries is to avoid appearing too freakish.]

Your expectations, influenced by your recent history, are unrealistic. You probably have a mental image of yourself from the last few years when you had a full(er) head of hair. Consciously or subconsciously, that image is still your expectation of what any hair restoration should achieve. Unfortunately, hair transplants aren’t going to give it to you. They can give you some coverage, but they won’t give you the density that you used to have .... the density you still want (you will see the glass as half empty). For a mature man who has lived a number of years at, or close to, his ‘final state of baldness’, the coverage that he gets with good hair transplants may be satisfactory to him (he will see the glass as half full). But those of you in the early stages of hair loss are too likely to be disappointed with hair transplantation.

You probably haven’t lost enough to know your final amount and location of hair loss. As stated before, success in hair transplantation is defined by whether the transplanted hair that grows will be of a quantity, direction, and distribution, all with respect to the remaining natural hair, to be pleasing to the patient and inconspicuous to others. If you don’t know your final hair loss pattern, then you don’t know two critical parameters: (a) the boundary line and density of your true, permanent donor hair, and (b) the area of baldness that you’re ultimately trying to cover. To borrow Dr. William Rassman’s analogy: the absence of that information is like trying to build a house before you know the size of the lot and the amount of lumber that you have available. Premature commencement of hair transplant work can result in ....

ü       Moving scalp that doesn’t really contain permanent donor hair.

ü       The hair that is moved is misplaced in relation to the final baldness pattern.

ü       The hair restoration process may extend over years or even decades, seemingly with no end in sight. Surely you’d feel frustrated if your home was in a constant state of renovation. Would you feel differently about your head?

ü       Anxiety over the contrast between transplanted areas and new bald/receding areas, and how & when to fill these in with the least amount of disturbance to your appearance (see the section 1.4 ‘intermediate appearance’).

.... Transplant work done at a young age is risky and mistakes may be difficult or impossible to correct in the future. Unfortunately, the hair loss patterns of your male relatives are only useful in GUESSING your final hair loss, they do not provide any measure of certainty in KNOWING your final hair loss. This is due to the unpredictability in the “degree of expression” of any genetic trait, in this case baldness. You must let the balding process complete, or near completion, to know your final pattern. Be suspicious of anyone who tells you otherwise. Unfortunately, few doctors will warn you about this, because the younger the prospective patient is, the more sensitive he is about his hair loss, and the easier it is to sell him on hair restoration. Medical school ain’t cheap, and in the war for the hearts and minds of physicians, sometimes greed wins out over “doing the right thing.”

If you are in your 20’s, a big part of your motivation for restoring your hair may be women. Your attitudes about them will change (a lot) as you mature. Unless you are an actor or a salesman, chances are that your main motivation for considering hair restoration at this point in your life is social (i.e., to attract women), rather than professional. Typically, men in their 20’s have a heightened interest in women of exceptional physical beauty (yes, I know, men of all ages value beauty in a woman, but for young men, the importance of that characteristic often seems to swamp out many other deserving attributes that women possess). The stereotype is that such women often focus on physical appearance, to the exclusion of personality and character, both in themselves and in their potential mates. Your perception is that she expects the same level of attractiveness in the men she will want to be with. Hence, your interest in eliminating your baldness. When you are in your 30’s and beyond, you will have a better appreciation of a balance between appearance and personality in women. You will realize that many of the bombshells that appealed to you in your 20’s, regardless of their physical assets, may not be the women of substance with whom you will want to have real relationships. The kind of woman you’ll be attracted to as you mature will gladly accept your hair loss in exchange for the intelligence, humor, personality, and sensitivity that you can bring to a relationship (i.e., as people age, they get better at setting priorities). This will result in less pressure to strive for perfection in your appearance. So, what seems like a critical need to eliminate baldness in your 20’s, may become greatly diminished or unnecessary as you mature. Note: The subject about whether hair loss should be corrected for personal vs. social vs. professional reasons is another debate for another day. Suffice it to say that there is no shortage of actors, salesmen, and men in every other profession who are successful & happy, in both their professional & personal lives, despite their hair loss. It turns out that talent, skills, personality, and a mans’ actions have more value than his hair! Go figure.

Your emotional state may not be conducive to making long-term, permanent decisions. If you are a young man experiencing aggressive hair loss, you may feel that you are one of the very few balding men in your peer group. This minority status along with the relative social successes those peers may be experiencing can create a level of anxiety that puts you into Panic Mode about the state and direction of your hair loss. The 11th commandment should read: thou shalt not make irreversible decisions about anything whilst in Panic Mode! You must take a long-term view: when you are in your 30’s and beyond, you will feel the camaraderie of seeing about 1 out of every 3 men in your peer group also experiencing hair loss and you’ll notice that their lives have not collapsed as a result (I’m not saying that guys over 30 who lose their hair aren’t upset to see it go, but they ought to know better than to shit a brick over it). Armed with that and coupled with the maturity that accompanies age, you will no longer feel the anxiety you may now be feeling, and you can make panic-free decisions. Guaranteed! I will never forget the day, having just turned 25 years old, when I was discussing my forthcoming first transplant session with my doctor. On the outside, I was composed and calm during our dialogue, but inside I was screaming to him “Doctor, stop talking and just move some damn hair to cover my receding hairline!” Wrong! In my case, the equation became: Panic + Youth = Big Mistake. Of course, I was quite rational compared to the story I once read of a balding 19-year-old who asked his doctor to remove his testicles (the 19-year-old’s testicles, not the doctor’s), after he’d discovered they were the source of the DHT hormone that plays a key role in hair loss. Wow! Reality Check, please!

Reasons to avoid hairpieces.

[My comments here concern hair weaves, where the piece is tied to the top of your remaining fringe hair, not the old tape or glue toupees which are rarely used today, especially not by active people.]

Your financial obligation is perpetual. You will have to replace the piece, at full cost ($1,000’s), every 1-2 years. You will have periodic maintenance visits, every 4-6 weeks, at about $50-100 a pop for a haircut and cleaning & refitting of the piece, to compensate for the gradual loosening that occurs as your real hair grows.

Your logistical obligation is perpetual. The necessary periodic maintenance visits will bind you to the hairpiece salon that you chose for as long as you use the hairpiece. Every time you need a haircut and the hairpiece to be ‘re-tied’, you are going to them, not the hair cutting outfit that offers the convenience or quality that you’d like. If you decide to relocate, you are restricted to those cities that have a firm that can service & replace your hairpiece, at the same or better quality level that you’ve come to expect. I don’t care to be indefinitely bound to an enterprise of this nature[5]. I want the freedom to go where I want, when I want. Having to set aside half a day to visit “The Hair Club For Insecure Men”, or their ilk, every month for the rest of my natural life, does not appeal to me.

It is difficult to keep your scalp clean. Skin oils build up underneath the foundation of the hairpiece and the scalp only gets thoroughly cleansed during your maintenance visits.

It can cause further hair loss. The ‘weave’ puts tension on your real hair to which it is anchored. This will be important only if you become disenchanted with the hairpiece and decide to go natural again, or if the hair loss is so great that you need a bigger hairpiece before you get the most out of your investment in the current one.

Although they can achieve plenty of density, hairpieces can not achieve a natural look. There are 2 flaws in hairpieces that are responsible for their detectability: (a) the hair has to be styled in certain ways around the forehead to mask the lack of a normal hairline and (b) the scalp can’t be seen, especially where you part your hair. This looks more unnatural as the user gets older, since all men, even those with a ‘full’ head of hair (with the exception of Ronald Reagan), experience some thinning as they age and more of the scalp should be visible. The conspicuousness of the hairpiece will only increase as the scalp remains hidden and the hairstyle looks too much like that of a 16-year-old.

It substitutes one form of anxiety for another. If you feel anxiety about people focusing on your baldness now, will it be that much better when you are worrying if people are focusing on your head because the piece is coming loose and/or the hairline looks unnatural?

Reasons to avoid Minoxodil, Propecia, etc.,.

Your obligation is perpetual. You are bound to it for life. Stop using it and you lose the hair that it had grown or kept from falling out.

Limited success. The manufacturers claim it grows hair on 1/3 of those who use it. As usual, the definition of “grows hair” is subjective, and appears to be grossly exaggerated by those manufacturers. The substantial hair growth that we all want seems to occur only on a very small percentage of Minoxodil users. If modest growth or just retaining the hair that you still have is an acceptable result for you, then Minoxodil may be appropriate.

Limited location. When it works, it works on the crown, but not the front part of the hairline ..... just the opposite of every balding man’s priorities in hair restoration.

Reasons to avoid Regenix, Folimax, Kevis, etc.,

They don’t grow hair; nor do they claim to (the U.S. FDA would clamp down on them if they did). At best, they give some cosmetic buoyancy to your hair, the appearance of more fullness.

So, what CAN I do?

Mental stuff in your head. Your problem is not hair loss, but your feelings of inadequacy due to hair loss. Your problem is psychological, not physical. I don’t mean that you are crazy. And I don’t mean that the psychological problem is yours alone. The problem also belongs to the millions of other men who spend their money (and worse their time and energy) on bogus efforts to end their baldness. It also belongs to those segments of our society that offer certain opportunities and rewards to men with a full head of hair, but less so to bald men. Unfortunately, there is little you can do to solve others’ problems. You can only change you. And that is the first thing that you must recognize and address. The anxiety and negative feelings that you are experiencing are a reflection of inadequate self-esteem and confidence. You owe it to yourself to work on this before you consider any cosmetic ‘solutions’. An old Chinese saying (or maybe it was a fortune cookie) best sums up my feelings about hair loss: “Nobody can make you feel bad about yourself, unless you permit them to.” Now for the bad news. I don’t have a perfect formula for you to produce the necessary self-esteem that it will take for you to accept & enjoy living with the hair that you’ve got. But I do have some suggestions for you to try.

1.        You need to do some honest soul-searching to understand why you are so upset about your hair loss. Do you think that some person or persons will regard you negatively if you were bald? Are such people really important to you? If yes, then why are they important to you? What do they offer you in the way of real friendship, love, social or professional opportunities, etc., that you can’t get elsewhere in this world? If these people were to react the way you fear they will when you lose your hair, then what degree of shallowness would that attitude reflect about them? Now, ask yourself again: are these people really important to you?

2.        Talk to someone you can trust. Somebody who is unlikely to poke fun at your concerns or dismiss them as trivial. It has taken me half a lifetime to discover the immense benefits that can be had from openly discussing my problems with the right people. It can have a cathartic effect and helps to put things in perspective.

3.        Try support groups, in cyberspace (alt.baldspot) or the old-fashioned real-people-in-a-room-together kind.

4.        As extreme as it sounds, consider counseling from a professional psychologist.

Unfortunately, none of these options occurred to me at the time when I needed to be thinking instead of doing (I was in Panic Mode). I wish they had. I want you to exhaust these options before you write that check for some hair restoration service. In essence, that’s the goal of this paper. I told you I didn’t have a perfect formula to help you come to terms with the hair that you’ve got, nor do I have such a formula for myself, either. My present philosophy of how to deal with baldness is a byproduct of the mental fatigue of worrying about my disappearing hair for 17 years, combined with the harsh lesson of having done the wrong thing (hair transplantation) at the wrong time (in my 20’s). May your revelation not be as costly.

Physical stuff on your head. Do what you can with what you got. I have found that thinning hair looks best when it is cut short and neat ..... very short and neat. Growing some facial hair often helps. Short and neat applies there as well. I personally think that a mustache or mustache/goatee looks good, but not a full beard. And don’t forget the golden rule: no comb-overs!

Physical stuff below your head. You can improve your appearance a great deal by being fit and trim. Regular participation in whatever exercises/sports appeal to you, combined with healthy eating will make a tremendous difference in the way you feel about yourself (physically and aesthetically), and therefore the way others perceive you.

Don’t worry, be happy. A pleasant smile will improve your appearance ten times more than a full head of hair.

Examples: Bruce Willis in the movie Pulp Fiction and Andre Agassi since he dropped the wig and got a buzz cut. Both of them are lean in the hair, lean in the gut, and they smile instead of mopping around with their head hung low, discouraged about their hair loss. In short, they look good.

Who really cares? Gay people have a term -- or so I’ve heard -- called GADAR (Gay rADAR), the ESP-like ability to detect if a person who isn’t overtly Gay actually is or is not Gay. Likewise, I’ve discovered a phenomenon called HADAR (Hair rADAR), which consists of the ability to (a) detect other men with transplants or hairpieces, and (b) notice when other people are sneaking glances at your head, and the hair restoration efforts on same. Now, here’s the kicker: I’ve noticed that 99% of the people who seem to have HADAR are other men with hair loss issues. So, most of the folks who have HADAR are in no position to make comments about our hair problems, and the people who don’t have HADAR don’t give a shit about our hair loss, anyway. It appears that, for the most part, we are alone in our obsession with our hair!

Realize that you have 3 broad paths that you can follow: (a) take the advice I’ve outlined above, and move on and enjoy life, or (b) be miserable and sit around waiting for the magic pill that the bio/genetic engineers might come up with someday to re-grow your hair to it’s full prepubescent state, or (c) pursue one of the presently available cosmetic solutions, and tolerate their flawed results and the anxieties that accompany them. It’s your choice! Think about it, though: the vast majority of bald men in this world are leading happy lives without doing anything in the way of correcting their hair loss. Their numbers are too big to ignore. If they can conquer their hair loss through the power of their will, then why can’t the rest of us? Then again, if you’ve given my advice your best effort, and you’re still yearning for some hair on your head .... what can I say? Pick the best technique that serves your needs, and as the ads say: “Go for it!” I wish you the best of luck.

What do I regret most about my attempts to correct my hair loss?

Is it the thousands of dollars I’ve spent for marginal results? No (although I wouldn’t mind having that money back). It’s the time, mental energy, and social opportunities & relationships that I’ve passed up, because I was worried about how other people might judge me due to this God-Damned trivial hair loss!

Conclusion

Is all this meant to shut your mind from pursuing hair restoration? As much as I wish it could, I know that I can’t expect to completely extinguish the curiosity that motivates you to explore what’s out there, given the strong cultural values that society puts on hair. But this paper is meant to dissuade you from hair restoration. It is meant to make you think twice (or three or four times) before you act by spending your time, energy, and money on it. It is meant to point out the drawbacks of each technique. It is meant to help you approach the hair restoration decision from a balanced perspective, the foundations of which are a healthy amount of self-esteem and adequate knowledge of the risks as well as the rewards. I sincerely hope that you got something out of this paper, besides the obvious sense of my personal anger or disappointment.

Congratulations. You are now a more educated consumer. And hopefully a wiser person. So, the next time you encounter an advertisement for a hair restoration technique urging you to “Go for it”, you have the option of responding by reciting the .....

 

 

© 1997-2006 by Bill Lenihan