Dr. James Vogel Discusses Poor Hair Transplant Results from the Past, Repair Procedures, and Modern Hair Surgery with Online Plastic Surgery Journal

PSP: Why are men seeking revision hair restoration surgery now?

JV: These men are in their early 30s or early 40s and had procedures in their early 20s that were ill-conceived, and now they are also having progressive hair loss. They look bizarre with progressive hair loss on top of clumps, pitting, or sunken-down grafts. In some cases, shorter hairstyles are rendering scars in the donor area visible, and people are interested in camouflaging or improving these scars.

PSP: How do you approach these patients?

JV: The first and most important thing has nothing to do with the scalpel. It has to do with understanding the problem and showing these patients that you are someone who cares. A lot of men are angry and distrustful as a result of their initial surgery. The surgeon has to be able to convey that he or she has the expertise to do the work and understands the problem.

PSP: How important is expectation management in this patient population?

JV: It is extremely important. You must explain what can and can’t be done, and make sure the patient’s expectations are realistic. The last thing you need is to gain their trust and then not meet their expectations. You have to make sure what you are offering will satisfy them. Let’s say a male in his early 30s wants his hairline filled in. If it is already too dense, they don’t need more grafts and you can’t just fill in hair in front of plugs. The more procedures a patient has had, the more limited their options. Their natural resources are scarce, so the revision surgery must be very well-thought-out.

On modern hair transplant surgery:

PSP: Will this increase continue or trickle down now that primary revisions are so much improved?

JV: The good news is that advances and improvements in hair transplantation are making revisions less and less common. The technology has improved with follicular unit transplantation using strip harvest technique as well as follicular unit extraction (FUE), and so has awareness about progressive hair loss. The need for revision is definitely less and will continue to decline.

PSP: How long does a hair transplant last?

JV: A hair transplant will last a lifetime. The donor hair is genetically different than the lost or shedding hair in the recipient area. The shedding hair is sensitive to the hormonal regulation, whereas the donor hair is not. This concept of donor dominance is the fundamental contribution of Norman Orientreich, MD, who is credited as the father of modern hair restoration surgery.

PSP: So transplants are better. What about progressive hair loss?

JV: Today, we also use finasteride (Propecia). Men treated in the 1980s and 1990s were never put on finasteride, which slows down or stops hair loss. In addition, laser treatments, RetinA, and compounded minoxidil (Rogaine) are also nonsurgical options which can aid in slowing hair loss, and in some cases promote growth. There are also early reports of other exciting possibilities to incorporate the body’s own growth factors in the form of platelet-rich plasma (PRP) and other growth constituents to promote growth and retard hair loss.

As a bonus, below is a video of one of Dr. Vogel’s grateful repair patients discussing his hair restoration journey:

Please join me in congratulating Dr. Vogel on his recent interview!

____________
Blake – aka Future_HT_Doc

Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Hair Loss Learning Center, the Hair Loss Q&A Blog, and the Hair Restoration Forum

Follow our community on Twitter

Watch hair transplant videos on YouTube