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I am looking into finding a doctor to discuss my plan of attack for hair loss, and i was wondering what is the ISHRS International society of Hair Restoration Surgery? Is finding a doctor off of that website reliable as finding one from the American hair loss association website?

The International Society of Hair Restoration Surgery (ISHRS) website lists doctors who are members of a learning society. The American Hair Loss Association (AHLA) is a similar site. You must understand that any doctor can be a member of these associations and societies as long as they pay a yearly membership fee. These societies do not have the power to enforce or regulate a doctor’s practice and skills, and the hair restoration/hair transplant field does not fall under the American Board of Medical Specialties (ABMS).

In the United States, there are 24 approved medical specialty boards that are overseen by ABMS, a not-for-profit organization. Certification by an ABMS member board has long been considered the gold standard in physician credentialing. To be ABMS board certified means that the physician has undergone formal educational and clinical training at a medical institution after earning their medical degree, and has successfully passed a level of competence via written or practical or oral examinations.

Since hair transplant surgery is not a part of the ABMS, there can not be any physician that is board certified as a hair transplant surgeon. This is mainly because there is no formal training or credentialing in hair transplant surgery. You read that correctly — there is no board certification in hair transplant surgery! There is no standard curriculum. There is no oversight or direct review of the quality of the work being done. Unfortunately, there is no ABMS sanctioned facility to enroll and learn hair transplant surgery. To date, the only way to learn how to perform hair transplant surgery is to read a book, attend a seminar, or become an apprentice to a private practice hair transplant surgeon. Even ABMS board certified plastic surgeons do not receive training in hair transplant surgery as part of their formal training.

I’ve been writing about hair transplant failures more and more on this site lately, because it is a growing concern. I have been seeing, on average, 1 patient per week (from outside my office) who had a hair transplant with a significant failure of the grafts to grow (greater than an 80% failure).

I just saw another patient who had received over 2000 grafts a few years ago. He was not a happy camper. There was very little growth and he had a very detectable scar which did not allow him to cut his hair short. He had such high hopes that the new hair from the transplant a few years ago would solve his image problems, but after much consternation and considerable anguish, he found that his situation was worse off than if he never had any procedure at all.

The patient explained that he did not like his doctor’s lack of concern in addressing the failure of his transplants to grow nor the detectable scar that plagued him every day. He was disappointed that his research on this particular doctor left no clue to the quality of this doctor’s work, nor his indifference to his plight. Before the surgery, when the doctor’s team “sold” him on the transplant solution, the environment was welcoming… but after the grafts failed to grow, he did not feel welcome by that particular doctor as he was made to feel that the failure of the transplant was his fault, not the doctor’s problem.

This particular patient had as much focus on his scar as he had with the failure for the transplants to grow, because he had the same look from the front and top view as he had before the surgery. He had no deformities from the surgery and his recipient area healed well with no scars present.

So what could be the possible causes for a failure of transplants to grow?

I should start off saying that I have never seen the cause of the problem stemming from something the patient did or did not do. Many of the patients who come to see me because their transplant did not grow felt that they were responsible for the failure. I think that patients feel that the surgery is a mysterious process and that there must be something wrong with them.

Dr.Rassman/Dr.Pak,
Is it possible for you to provide a step-by-step guide describing the procedure a patient would undergo during a first consultation at NHI, please - are there particular requirements a patient should consider in preparation for such a consultation (e.g. hair length, washing instructions, medical records, etc.)?
Thank you.

During a consultation, we get to know the patient, understand their personal issues about hair loss, and recommend possible treatments. That is it!

It’s not all that complicated, if you think about it. You come to see us because you are losing hair. We examine the hair, measure the hair density, look for any microscopic patterns which may not be obvious (miniaturization study). If your hair is long enough we can do bulk measurements. But most of the time (for men) the balding is obvious and thus the reason for the visit. So we mostly talk about options and educate the patient. We actually spend a good 30 to 45 minutes on the first consult on most patients. Some more, some less. And while we often think about charging a fee for the amount of time we spend with the patient, we decided the first consult will remain free for a while, at least.

As a final note, at NHI you see the physician (Dr. Rassman or Dr. Pak). You will never see or be screened by a sales man or an associate or any other version of a middle man. Getting a doctor’s opinion always reflects your best interest and because there is no sales personnel involved in the process, there is no motivation for commissions that will be earned for a successful sale. We encourage prospective patients to come to our Open House events which are held monthly. In this way, you will know that what you see is what you are going to get. Nothing is hidden.

I know you are primarily a hair transplant specialist, but who would you recommend as someone who only specializes in hair loss? It seems most doctors a visit are more knowledable about transplants than they are with hairloss.

Some people see a dermatologist, but hair transplant doctors are generally the most knowledgeable when it comes to hair loss, because they specialize in hair. Just don’t get pushed into surgery, but use their expertise to help determine a treatment plan (or rather, a Master Plan).

Hi!

I was wondering what the procedure is to apply for a fellowship at your facility. I tried to speak to the ISHRS but as of the last 8 months, apparently all their programs are currently inactive so yours might be the only one still training people.

Please let me know.

Thanks

While we have trained many doctors in the past, at this time we are not offering training for hair transplantation skills. Sorry.

The annual meeting of hair surgeons was in held in Alaska this past week. The meeting was very well organized, but because of the location, many physicians chose not to travel the long distance. The weather was ideal, as good as California in its best season. About 15% of the 260 doctors who registered were new to the field and used this meeting as an educational opportunity to enter the world of hair restoration.

The following review is very selective and is biased by the things that were interesting to me (Dr. Rassman) and what I thought could be interesting to some of the readers. Since there’s so much to cover, I’ll break this up into multiple posts to make things easier. Stay tuned for more.

There were many innovations in surgical tools that may be too technical for most, so I won’t discuss them too much here. That said, I did write a little about some tools that might have some interest, so let’s begin with those…

***

 
Tool for measuring scalp laxity

A new instrument for assessing the safety of strip excision as it correlates to the size of a donor strip was introduced by Dr. Parsa Mohebi. He presented the second version of his Laxometer, which should be used to measure the limits of the width of a donor strip.

 
Using HairCheck for bulk measurement

The HairCheck hair bulk analysis system, which we have been using for a year or so, was reported by many doctors as a positive tool for measuring the hair mass of scalp hair. Readers of this site probably know how much we’ve mentioned hair bulk analysis, and it’s good to see it finally gaining some traction in the physician community.

The reason we like it is because it enables doctors to compare results over time with real numerical values, which shows the value of drugs like finasteride, and allows physicians to make the diagnosis of genetic hair loss in young men now more certain. Many young men with hair loss in the family who are concerned that they will also inherit the hair loss gene can now be evaluated for the presence of hair loss in its earliest stage. Proper diagnosis should cut down on unnecessary use of hair loss drugs.

 
Keep checking back for much more.

Doctor, love the blog, lots of useful information. I was hoping you could give a little career advice. What would you say to the students in medical school interested in getting into the field of hair transplantation? Would this not be a wise decision with companies such as histogen/replicell potentially achieving positive results using non-invasive techniques?

For a medical student thinking of a specialty to choose, I would not recommend hair transplant surgery. Not because it is not a great field, but mainly because there is no formal hair transplant surgery training or residency that would give you the requisite skills you should have. There is no consistency in the field of hair transplantation. I do believe the community of hair transplant doctors is improving and striving for consistency and it has greatly improved in the last decade. In fact, there is a board certification for hair transplant doctors, but it isn’t recognized by the American Board of Medical Specialties (ABMS).

If you still would like to pursue the hair transplant field, I would pursue a ABMS approved residency program of your interest. First get basic training in some official specialty like dermatology, and then get a fellowship under some well recognized expert in the hair transplant field who will take you under his wing.

Dr. Rassman
I’ve been a licensed cosmetologist and cosmetology instructor for 20 years. I’ve witnessed all types of causes of hair loss from simple improper hair care, chemical damage, braids and hair extention damage, alopecia, medications, lupus,chemo and radiation.

I now find myself ready to embrace a higher level in my profession. I’m eager about becoming a trichologist and a hair transplant technician and was wondering if you had and advice on how and where I should start to embark on these two career paths. My passion and curiosity about the hair and scalp has got me wanting to absorb all I can so I may better service the public and feed my need for more knowledge. Any insight you have would be greatly appreciated.

The training of a hair transplant technician is done only by doctors who are looking for new people and are willing to take on a trainee. Most people come from a medical assistant school and most states certify MAs, although the doctor can do the training in specific cases.

You need to contact a hair transplant doctor in your area and ask if he/she is taking on new people. It is a great career and for those who master the technical skill, they are generally well paid.

Hello, first of thanks for this blog it helps dismiss all the paranoia and rubbish that is usually on the internet concerning hairloss. Im 17 and im worried about hairloss. I don’t know whether I’m a Norwood 2, perhaps a 3 its difficult to tell, but I’m somewhere around there, I’ve read your blog regularly and educated myself on the process of the hairline maturing and how it usually forms a gradual convex recession that is common to see on most fully developed males. My hairline though a Norwood 2 is not convex or gradually receded but more sudden almost exactly like that on the Norwood scale - is it safe to assume that if my hairline is not developing into a convex or gradual shape then what I am experiencing is male pattern baldness at an early age? I’ve never had a straight juvenile hairline like you’ve described, its always receded a little.

One more thing, I’ve read your blogs on getting miniaturization mapping done. Where I live the health care system does not offer such a test. I did however go to my doctor, who, in the final stage of MPB himself, ran his hands through my hair made a few “uhuh” and “yes”, sat back down and said it looks fine to him, and that my hair is the same density all the way round, he always said that I was far too young to be effected by MPB, but then went on to say that he started going bald at 18 only a few months older than I am. He then prescribed me a anti-fungal shampoo “just in cause”. I remember reading somewhere where you said if your doctor reacts like this run for the hills or something like that. Is it possible my doctor did a fair examination or should I seek further consultation?

Thanks

I am going to assume you do not look bald at Norwood 2. You are very worried about some thinning in the front. The doctor you saw is likely a general internist who does not see hair loss patients as his primary practice. And even if that doctor is the most caring and sympathetic doctor in the world, if he does not treat patients with hair loss on a day-to-day basis as his number one priority, they would most likely not pay attention to young men who do not look bald. I do not think it is the doctor’s fault, but it is just the way doctors are trained. You see, hair loss is not considered an illness or a disease. It does not affect your health. So doctors really do not learn about it and its treatment in medical school.

If you want a good examination and evaluation of your hair loss state, you need to find a hair transplant doctor in your area. You can check ISHRS.org for doctors that specialize in this or since you indicated that you’re in the UK, you can see Dr Bessam Farjo in London.

I’m often outspoken about the problems with ethics in our industry, and I know I just wrote about transplant failures a couple months ago… but I continue to see a large number of patients who are unsatisfied with the growth after their hair transplants. Part of me really hates writing these types of posts, because I just know I am turning some people off to the idea of surgery altogether. But really, these posts should serve as a way to educate yourselves. Transplant failure is a problem that can not be denied and an increasing number who received surgery from various doctors all over the world are visiting my office to ask for help as to why they aren’t seeing the growth they were promised. I’ve even received emails about the same issue. Although there are a number of reasons why a transplant could fail, it seems that these failures are mostly technical in nature and related to the hair transplant staff. In other words, the problem is avoidable.

So how does one avoid losing donor hair or paying for grafts that aren’t going to grow? Finding a surgeon with a staff that knows what they’re doing is a good start. An experienced staff is hard to hire, and I have been training my own technicians for years. The drop-out rate from training is high, but for those that we retained, the high quality of our work reflects the quality of our staff. I know what I am about to say is self-serving, but I do very limited promotion here and wanted to point out that we have a travel reimbursement program which offsets the cost of travel and hotel for those patients coming from out-of town. With our standby rates, it is hard to compete with the value NHI offers and in 8 months, few worry about what actually grew out.