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The Medical Advisor

Microtransplantation Q & A

Question: Since you wrote about hair transplants, I followed up on your research and decided that microtransplantation has the best chance of giving me a new hairline and natural look. But when I tried to get local surgeons to give me a list of their patients that I could contact, as you advised, I couldn't seem to get more than one name from each- and after meeting those few people, I'm not convinced they actually had transplants at all. Can you give me the names of experts in microtransplantation? —W.K. Los Galos, Calif.

The four microtransplantation surgeons recommended by their peers were:

Edmond I. Griffin, MD., Assistant Professor of Dermatology, Emory University; Dermatology Associates of Atlanta, 5555 Peachtree-Dunwoody Road, 190, Atlanta,GA 30342; (404) 256-4457

B.L.Limmer, MD., Professor, Division of Dermatology, University of Texas Health Science Center; 14615 San Pedro Ave., 210, San Antonio, TX 78232; (210) 496-9929

David J. Seager, MD.,Cente-nary Health Center, The Court 401, 2863 Ellesmere Road, Scarborough, Ontario, Canada; (416) 287-3733, (800)
668-6662

Dowling B. Stough IV, MD., Professor, Dept. of Dermatology, University of Arkansas Medical Science Campus, 1 Mercy Lane, 304, Hot Springs, AR 71913; (501) 623-6100

A: Many operations, such as heart, orthopedic and gynecological surgeries, have measurable outcomes - complications, infections, more surgeries or death - and potential patients can ask surgeons about their records. But those objective measures usually aren't made in low-risk cosmetic surgeries, such as face lifts and hair transplants. The determination of a good or bad result is often just a matter of opinion. And, as you've discovered, some cosmetic surgeons have well-orchestrated marketing campaigns that can make it difficult to identify results that you, at least, feel are good. We identified only four microtransplantation experts by checking the medical literature and asking the surgeons themselves for referrals.

At least half of all men have some baldness. Most male baldness is progressive and permanent, and determined by heredity. If male baldness starts in the late teens, it will usually be extensive. Some men lose hair because of stress, or a disease such as low thyroid activity or diabetes.

There are three main surgical treatments that place hair into bald areas: grafts, flaps, and the less frequently used scalp reduction. In many cases, a combination of techniques is used.

Grafts are the most common form of treatment. Over time, grafts have changed from transplants of a few hundred 4-millimeter-wide plugs of hair to micrografts and minigrafts of 1,000 to 2,500 hair sections in 9- to 12-hour operations.

In hair grafting, surgical complications and infections rarely occur. There are two measures of success:

Did The Transplants Survive?

Hair follicles must be handled carefully; grafts that fail are double loses, since no new hair grows in the desired site, and hair does not regrow at the site where the graft was taken.

How Does The New Hair Look?

Many doctors take up hair restoration because it is a low- risk, high-cost procedure - $3,000 to $9,000, often paid in cash, since it's not covered by insurance.

There are virtually no professional standards, any physician can claim and advertise that he or she is an expert in hair restoration. The training of many such "experts" is a three-day seminar. There is no way to compare surgeon success rates.

Anyone considering hiring a hair-transplant surgeon should ask for a list of a number of patients who have had the same surgery, then select a handful to see. Any surgeon who can't provide such a list should be dropped from your consideration. The four surgeons we list all said they provide such lists.

To give you the names of acknowledged experts, we started to compile a list of authorities by searching the medical literature, via the database Medline, for surgeons conducting transplant research and reporting their results. (Members of the public can access Medline through many on-line services.)

Then we asked those 15 researchers, "To whom would you send your brother for micrograft hair-transplant surgery?" based only on surgical skill and esthetic results. That gave us about 20 more names of people who hadn't recently published but were reliable practicing physicians.

Next we had all 35 physicians review the list and strike those they couldn't recommend. In the end, only four physicians were recommended by everyone we asked - and none of them was in California.