Accountability Advocates for Better Hair Restorations. Who Are We? A Historical Prospective.
- Mar 12, 2019
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The hair restoration or Transplant Industry as a whole has come a long way when one thinks about “Accountability” But this took much time and effort from people who cared (Very Few of us in the beginning) about bringing the standards of hair transplants to a place that was acceptable to the masses. The problems started much before my entry into the industry. A time where “PLUGS” was a ubiquitous and happy key phrase in every hair restoration clinic. Back in these days, before and after the 1980’s through the 1990’s, the Wild Wild West of the Hair Restoration industry was in full force. There were other Hair procedures besides the Hair Plugs that have been all but abandoned if not completely BANNED from the United States. Here is one such black eye for the industry:
[Code of Federal Regulations]
[Title 21, Volume 8]
[Revised as of April 1, 1992]
TITLE 21–FOOD AND DRUGS
CHAPTER I–FOOD AND DRUG ADMINISTRATION
DEPARTMENT OF HEALTH AND HUMAN SERVICES
SUBCHAPTER H–MEDICAL DEVICES
PART 895 — BANNED DEVICES
895.101 Prosthetic hair fibers
Paraphrased with accuracy-“Prosthetic hair fibers which are devices intended for implantation into the human scalp to simulate natural hair, consisting of various materials; for example, synthetic fibers, such as modacrylic, polyacrylic, and polyester; and natural fibers, such as processed human hair are fully banned from any and all USA and its jurisdictional territories clinic practices. These synthetic fibers are directly related to multiple infections across many hair restoration clinics as well as have been associated with unethical promises and fees to the receiver.” -FDA
What a huge blow to an industry IN healthcare that had not even for one: Gone through its worst black eye AND two: Had not matured yet. Hair Transplantation was still in its remedial infancy where upon the all mighty dollar got in the way of proven results. This has changed… but yet again… it is still a problem.
After the biofiber synthetic hair debacle, there was still hair restorations being performed by way of flap resections and other archaic techniques. And a note worthy concept of that Era was… NO INTERNET YET. So a hair transplant clinic might put an ad in the newspaper stating miracles of hair returning to your bald scalp. You could pretty much state anything that would peak a balding man who routinely read the newspaper… (95% of the population) and say you could return their hair to when they were 18 and men would go. Then a word of mouth would spread that someone in town is correcting bald heads so this would ramp up the scheduled surgeries. BUT THERE WERE NO RESULTS to back this up! There was no internet with opinions, reviews, or pictures of results.
Its kind of funny when you think about how life is cyclical. The hair industry would still have what I wrote above’s issues repeating itself several times and continues to as more technologies enter into the industry.
An important concept to understand is that “ANYTHING HAIR RELATED TAKES TIME” . Hair transplants take time. It takes a full year on all hair restorations to know the full yield. The first three months there is not any evidence at all, for that matter, that the transplant took or is growing. SO this slow to vested yield creates a window of opportunity to continue the method until the results start coming out. Well guess what? Back during these times, the results may have come out but who was going to know about them? Mainly the patient and probably the doctor if the patient was angry from a poor result. It would take years before the word would get out that this hair transplant clinic you should stay clear from. Was this a problem of a shady doctor? No and Yes… there just wasn’t a fast enough return of information of how the procedure was doing TO the doctor AND there were doctors that were shady. I could go on in detail all day with each of these plagues of my beloved hair industry that I am going to list in somewhat of an order but not exact:
- Synthetic hair-BANNED– for infection and unethical practices.
- Scalp Reductions-ABANDONED-Surgically removing the bald spot off the person and joining the hair edges. Spot returns, Unnatural hair borders and direction of hair.
- The Brandy-Lift-ABANDONED-Horrific procedure that does not need explanation. Quickly burned out. Major scarring.
- Plugs-ABANDONED-A disastrous approach by using a 3-4mm biopsy punch to core hair from the back and place in the top. Horrible shotgun looking scarring in the donor. Islands of unnatural hair that gave rise to the “pluggy look” and a “doll’s hair appearance”.
- Surgical FLAP or Rotation of scalp good hair.-SOME BANNED-MOSTLY ABANDONED-Unnatural everything involved which include: Death of flap, Hairline unnaturally located. Direction of hair not even understood, And extremely invasive and painful.
- Micrografting/MiniGrafting-MOSTLY ABANDONED– The first refinement in hair restoration. The first “Strip” hair restorations. Excising a strip of scalp tissue, and dividing this int several large sections that contained several follicular units. Hair placement and direction of hair still had an issue. Pitting, cobblestone recipient appearance, massive scarring of the donor. Transections rampant-loss of follicles due to the inability to see the follicle bulbs during dissection.
- Microscopes used for Dissection- STILL USED– Drastically changed the industry for the better. Increased the numbers of hair transfer. Provided the ability to see the follicle bulb during dissection.
- Follicular Unit Grafting (FUT)-STILL PERFORMED-An additional refinement for the better. A drastic shift in the industry by dividing follicular units into its individual grouping of 1’s, 2’s, 3’s, 4’s,etc. Still a standard procedure although does not monopolize the industry anymore. HT became closer to naturalness. Problems were that it is still a strip. Horrible scarring potential in the donor. Still had hairline direction issues, pitting and cobble stoning is still a problem.
- Hair Transplant Conglomerates Corporations-STILL AROUND-A shear genius business approach however not necessarily for the benefit of the industry. A marketing campaign that used Television as its main delivery platform… and a doctor training program that moved hair restoration to every state in the US (also locked these doctors in a tight contract with major penalties if violated). These corporations were the imminent name in hair restoration, not for results per say, but more for its popular late night infomercials that dragged in the clientele by the droves. Problems were the inability to keep a tight QA and the amount of training for each doctor IN hair restoration. (usually 6 months or less) posed potential problems. Another problem was the business approach to meet hair case quotas. LASTLY, an issue that was not predicted. Who could perform the consultations? Doctors? Sales Reps in white coats? Doctors only? That was an odd problem because many people are qualified to educate a patient, even schedule one, however acting as though you the consultant acting as a doctor giving medical advice to the uninformed patient who believes fully that the white coat is a a doctor but is not, created ethical issues. This problem was somewhat changed but later no one cared anymore as long as the white coat was thrown out altogether. for non-doctors.
- The INTERNET- STILL USED-Another large inadvertent change for the better and later for the worse of this industry. The internet changed the industry first by having accountability spewed onto it publicly and quickly. There was no more waiting for results to get the word out for at least 5 years before the word of mouth made it to the masses. If you had bad results, pictures could be posted and unregulated reviews or rants as I called them could be unleashed from home. Quickly did bad folks shut their doors and as a side positive note…. Quickly did the good hair transplant clinics become popular. The early popular clinics benefited the most and still do today, however there was still room for more.
Accountability for the first time began to take shape and what one would think keep everyone in line. Part 2 of the Internet is to come.
- Shapiro Hairlines-STILL PERFORMED-A refinement for the better and another major shift in HT. Dr. Ron Shapiro of Minneapolis, MN studied actual hairlines closely whereupon he mapped out what a natural hairline should look like in terms of orientation of the 1’s, 2’s, 3’s, etc., then transplanted in the same manner… It worked beautifully. However the industry was slow to take this on in their practice. Problems were only that in my opinion it does not take the smallest size of sites to create a natural hairline like the Shapiro. Nevertheless it does take smaller sites AND a specific angle and direction found in humans. Women too had its own specificity in hairline design.
- Follicular Unit Extraction (FUE)-STILL PERFORMED-Probably the single most exponential paradigm shift in hair restoration to date. A refinement AND re-visit of the old large plug biopsy circular punch.
- The INTERNET Again-STILL USED- Became a double edged sword in the hair industry. Marketeers both at the clinic level and Doctor sponsored Hair Web-Forums, also Television Infomercials as mentioned previously now brought to a global level, and unfortunately Maniacal Doctors who promised the world but could not deliver although collected thousands in advance or those that wanted to corner the market literally or make other doctors pay for their knowledge.
Yes I do not joke around when I say this was a bad time yet again in the industry. It started by a single idea that was created by a hair transplant enthusiast Patient who in the beginning innocently created a Web-forum to discuss good techniques or clinics and bring to light other bad hair restoration techniques. Then later did this become a half million per year money generator sponsored by the physicians that had the monthly disposable income of $1500-$3000 USD per month as a fee to the web forum owner for him to do 3 things: 1. Highlight his/her work-seems innocuous right? 2. unfortunately keep him/her protected by shielding them from ANY negative publicity brought to the forum to the paid sponsor. 3. The web-forum owner shuffled potential hair transplant leads (a very lucrative commodity) to the sponsored doctors. Of course who paid the highest fees received more leads. This unfortunately created a vacuum of unethical partnerships. Let us not forget that with hair transplants, comes products involved around hair transplants, i.e. surgical instruments, shampoos, hair remedies for hair loss, equipment. All of these people paying a fee to the web owner or the doctor to be the only product available of course. And of course copy cat hair web-forums
- Who now helps the industry for the Rights of the unwary susceptible to the marketeer, the Charleton, the Photoshoper. Who are they? The Accountability Advocates For Better Hair Restorations. These started as a select few who continued to do the right thing by sharing of ideas even if it was new, or special to you. These advocates came in different forms. Subtly as a physician just teaching his technique that helped the industry or more drastically by those who directly called out those who…More to come at a later Blog:
More Proof: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2840892/