DOCTOR-PATIENT RELATIONSHIP IN HAIR TRANSPLANT:
PSYCOLOGICAL ASPECTS

Until few decades ago, hair transplant was a technique superficially known or even ignored by the doctors themselves.

Today, thanks to the perseverance of those who have believed and have dedicated many years to this technique, it has now gained its own identity and has become a "speciality within the speciality".

Now we travel from one end of the world to the other to participate in the many meetings on hair transplant and to present to our collegues our surgical experiences and new techniques for better results, but rarely we speak about our patient.

After all, today this branch of surgery exists only thanks to people who have made hair loss a problem, and sometimes a serious one.

The many and different reasons that bring a patient to our attention for a hair transplant, are well known to those of us who have performed this particular surgery for a long time.

How many times have we asked ourselves what really pushes a person to seek our help, and why there are people like myself that live their baldness without embarassement, and others that would do anything to get back their hair.

This is why I think that the psychological aspect is very important, in order to understand who our patient is, and what we can really do for him.

Many times I have asked myself if our duty is simply to give him back his hair, or if there is something else. I think that, in order to operate with more professionality, we must know our patient better.

I am addressing especially those colleagues who have begun now to practice this discipline attracted maybe by the economic aspect of it, apparently easy to achieve, and who often ignore that, the fragile patient they have in front of them, when asking for his hair back, is searching for an interior self confidence.

A famous phisician of the XVI th century, Giovan Battista Della Porta, in his book "De Humana Physiognomia", stressed the importance of the hair as a protection for the head against heat and humidity.

For others the hair is also an ornament, the frame of our head. Losing our hair means changing the way we see ourselves: we no longer resemble the model that our society has always proposed.

Baldness is a problem that has affected men for a very long time.

The young has always experienced in a drammatic way the loss of his hair, thus influencing his relationship with other people.

The patient suffering from androgenic baldness is almost always introverted, shy, nervous, and has problems socializing with others.

Sometimes he tries to hide his nervousness behind the shade of egocentrism, but at the centre of his attention is always his hair.

Our duty is to help him psychologically, and therefore we must never disappoint him.

Although the patient will often refuse the advise of a psychologist, this may be very useful.

Sometimes it might be better to invite our patient to talk about it in another moment so he has the chance to decide wether to undergo surgery or not.
Not rarely the patient, at a second visit, changes opinion accepting his condition and deciding not undergo surgery: In fact this would only result in the substition of his previous complex with a new one.

Therefore we must explain frankly the situation, and nothing must be hidden from the patient, because there is nothing to hide: Transplanted hair will grow for sure, and we know it.

Rarely the patient's expectations coincide with those of the surgeon.

What the patient wants is lots of hair. But how many?

We must be able to describe the reality of the transplant, in order to tell the patient that it is not a miracle, that we cannot multiply his hair and that we could never restore the hair density which he expects.

Often the patient wants back his looks, and hence shows us a photograph of himself before his problem, or a famous person that he wants look like.

He then asks us if, after the surgery, the scalp can be seen against the light, if the scars of the recieving area will be evident, what will the occipital scar look like, and many other questions.

We must stress the point that he will never gain the hair density which he imagines because, as I have previousely said, the hair is not multiplied but distributed on a larger area.

Therefore the larger the area to be covered, the less dense it will be.

We cannot take Mother Nature's place, and our patient must also comprehend that, in any case, to restore the original density in the receiving area, means to remove from the donor site an area as large as the area to be covered, thus creating a new problem at the donor site.

Our patient is often somebody who, during his search for a solution to his problem, has encountered all sorts of persons, even not doctors, and often quacks, who did not hesitate to offer all kinds of solutions, like miracolous lotions and therapies of unknown composition and doubtful effectiveness in order to make money.

Our patient is now discouraged, confused, disinformed, and does not trust anything or anybody.

We have a hard job to do.

We have to fill him with trust and make him understand that if he wants back long lasting hair, that will grow, the only scientific answer is the transplant.

We must fight an invisible and dangerous enemy: DISINFORMATION.
Even worst when it is spread out by our collegues.

Our duty is also to understand if the solution to the problem can be found by means of a hair transplant,or somewhere else. We must not perform the transplant if it is not the right answer.

Our patient is not only the bald, but also the young man who is afraid to become bald. He wakes up in the morning and finds more hair than usual on the pillow, starts to pass his hand on his head, and counts the fallen hair. Then he compares himself to the young men of his age, in silence, afraid to be teased, and at the sight of a bald person he imagines himself in the same situation. It all starts as a funny joke between friends, and soon it may become a psycosis.

When to operate.

It is difficult to establish.

Someone suggests not before the age of twentyfive, when the inserted area is already defined, or almost, and time has made a natural selection of who has recovered and who has not.

I think that we are not the ones who must decide.

We must only suggest. We are not the ones living with that problem. A problem that varies from person to person. A problem sometimes dramatic for who has deal with it. And we can never enter his world and identify it whit him, no matter how hard we try.

Hair transplant must never be considered only as a surgical procedure, but also as medical therapy, and therefore the best time to operate is when the surgeon's opinion and the patient's motivations coincide.

Sometimes a compromise such as transplanting only few but well distributed hair is sufficient to make a depressed patient feel much better.
Sometimes a more demanding transplant, aesthetically satisfactory for the surgeon, might worsen the patient's depression.

It is very important to give a good advise on where and how to place the grafts and it is therefore useful to understand the patient's wishes and, when necessary, to correct them with a more appropriate frontal drawing which considers the patient's future looks, when he has lost all the hair he was supposed to, and is left only with the transplanted hair. Only then it will be clear whether our job has been useful or not.

Almost all these patients would like their hair as low as possible at the forehead and at the temples, because that was their aspect during their youht. They don't realize that as the years go by, their looks change. The baldness at the temples itself is part of these changes which turn a boy into a man.

And so we must carefully think of what our patient will look like in the future, and make sure that he will continue to accept himself. Even then.

This is what we must always consider, especially when we intervene on a defluvium.
We must provide him with all the time he needs to make his decision. We must never hurry him.

When we always keep in mind all these principles, only then it can said that we have worked especially for the patient.