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A recently published study ((Bater KL, Ishii M, Joseph A, Su P, Nellis J, Ishii LE. Perception of Hair Transplant for Androgenetic Alopecia. JAMA Facial Plast Surg. 2016 Aug 25. doi: 10.1001/jamafacial.2016.0546.)) is the first to measure the perceived benefit of hair transplantation on a patient’s age, attractiveness, successfulness, and approachability – key factors that play an important role in workplace and social success. The pilot study, published in the Journal of the American Medical Association Facial Plastic Surgery, found that hair transplant recipients were perceived by others to be 3.6 years younger following their hair restoration surgery. The data indicate that the person’s attractiveness, successfulness, and approachability also showed statistically significant positive changes as a result of hair restoration surgery.

Background

Half of men over 40 experience hair loss. This may be associated with significant adverse psychological effects including reduced self-esteem and self-confidence, plus the social consequences that follow. Prior studies have shown that men who are balding are rated poorly when it comes to attractiveness, likability, and personal and career success. ((Wells PA, Willmoth T, Russell RJ. Does fortune favor the bald? psychological correlates of hair loss in males. Br J Psychol. 1995; 86(pt3):337-344.)), ((Cash TF. Losing hair, losing points? the effects of male pattern baldness on social impression formation. J Appl Soc Psychol. 1990;20(2):154-167.)) This perception motivates men to seek hair restoration in order to improve how they are viewed by others. The new study attempted to quantify, for both patients and their surgeons, the actual benefit of hair transplant surgery on these key perceptions.

Methods

The randomized, controlled study involved 122 participants — 47.5% men, 51.6% women — each of whom were shown a series of 13 sets of before and after hair transplant photos. Of the photo sets, seven showed men before and then after a hair transplant of approximately 1,200 follicular unit grafts. The control group were of men who did not have a hair transplant or any facial cosmetic surgery. Each participant was asked to rate how much younger the “after” photograph appeared, on a scale of 1-10 years. For the other metrics — attractiveness, successfulness, and approachability — the participants used a slider bar to indicate a positive or negative change.

Results

On age, the data showed a range of about one year younger to about six years younger for the “after” photos, for an average of 3.6 years younger in people who had a transplant. The “after” photos for the control group were perceived to be an average of 1.1 years younger, confirming that the post-transplant group appeared younger than the control group. On attractiveness, successfulness, and approachability, study participants rated the “after” photos with scores of 58.5, 57.1, and 59.2, respectively. This amounts to a 17% improvement in attractiveness, 14.2% improvement in successfulness, and an 18.4% improvement in approachability.

Summary

Since the first hair transplants in the 1950s we have observed that surgical hair restoration can significantly improve one’s appearance. Now, for the first time, we have concrete data that shows the extent of the change of perception in the person’s age, attractiveness, successfulness, and approachability that is caused by the hair restoration procedure. This pilot study should be encouraging for prospective patients, as the purpose of hair restoration is not only to improve one’s own self-image, but to improve appearance, attractiveness, and successfulness to other people as well. This study shows that this effect exists in a way that is both measurable and statistically significant.

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NYCityWoman.com

Dr. Bernstein was quoted in an article on NYCityWoman.com, where he spoke about the risks associated with popular hair extensions, such as weaves, wefts, and similar clip-in or add-on pieces. Extensions are a stylistic choice that allow women to dramatically change their appearance. However, their frequent use can contribute to a type of hair loss in women called traction alopecia – hair loss around the frontal hairline and temples caused by tight hairstyles pulling on the follicles.

Dr. Bernstein is quoted:

“Hair extensions can create a problem over a long period of time, as constant tugging on the hair follicles compromises their blood supply and may cause permanent thinning,” explains Robert M. Bernstein, M.D., a dermatologist in midtown Manhattan who specializes in hair loss.

Traction alopecia often causes thinning that reverses itself when the hair is worn loose, but if tugging on the hair follicles continues for an extended period of time, the hair loss can be permanent. In patients with permanent hair loss from traction alopecia, a hair transplant can typically restore the hair that is lost from sustained traction. See before and after photos of Patient BOI, Patient NBN, and Patient KAR for examples of women who had their edges restored by hair transplant surgery.

NYCitywoman.com is a website dedicated to lifestyle issues for “women on the right side of 40” — women who are smart, stylish, and eager to embrace new challenges and opportunities.

Read about Traction Alopecia
Read about the Causes of Hair Loss in Women

Before and after photos of women who had surgical hair restoration to repair thin edges:

Patient BOI
Patient NBN
Patient KAR

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Q: Doctor Bernstein, I was looking at your website and saw the photos of medical hair loss treatments only, with Rogaine and Propecia. Doctor, are all those pictures just with medical treatments or is there concealers as well? I don’t mean to sound rude or disrespectful, but are the pics all real and genuine? Those are some impressive responses to medical treatment. — A.D., Scarsdale, NY

A: The photos are un-retouched and without concealers. These are responses to medical treatment alone. Yes, medications (finasteride and minoxidil) can work really well in select patients. Patients with early stages of thinning usually respond the best. Contrary to popular belief, the medications can work in the front part of the scalp, as long as the area is not shiny bald.

Perhaps about 1/3 of patients respond well enough to be put on the site. Most others have a good response, but not necessarily improvement significant enough to be easily noticeable in photos.

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Q: Are the “result” photos from taking Propecia and using Rogaine legitimate? Some of the after photos look too good to be real and a few patients looked like they combed their hair to look like they had more coverage. — T.Y., Darien, Connecticut

A: The before and after photos of patients using Propecia and Rogaine are my patients. All photos on our website are un-retouched. When patients have a good response to medical therapy, they often have more flexibility in how they can groom and style their hair. This is reflected in the photos.

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