Here are some helpful guidelines for evaluating Before and After photographs of individuals who have undergone hair restoration:
For each photo, ask the name of the surgeon who performed the surgical procedure on the patient.
This is important because in some chains and group practices, you may be presented with pictures of patients who underwent a procedure with a doctor no longer affiliated with the practice.
Are the photos of patients with exposed hairlines or is the hair combed forward over the hairline?
If the hairline is not visible in the photo, you will not be able to determine if the physician uses the latest medical technology and surgical hair restoration procedures. In close-up Before and After photos of hairlines with the hair combed back, you will be able to determine if the doctor used follicular units, which provides the most natural appearing hairline.
Note: A lot of times when patients come into my practice and they look at our patient portfolio, they tell me they want to comb their hair to the side rather than straight back. We assure our patients that they will be able to comb their hair anyway they want. We ask our patients who participate in the Before and After photography to allow us to comb their hair straight back (for the photos only) in order to allow others to clearly see both the original and restored hairlines. The most detectable part of a hair transplant is the first inch. And, that is the part that requires the majority of my attention to get it to look right.
Study the hairline and note differences in hairlines. Hairlines should not be straight across. Some of them should have a gentle recession and curve in the corners and in the temples.
Does the hairline curve around in the temples?
Is the hairline straight across?
Is the hairline staggered?
Is the hairline a straight line or a jagged line?
Does the hairline have a wavy randomized design?
Ask yourself, “Does the hairline look right?”
Trust your gut feeling. Does something bother you about the appearance of the hairline?
Remember, it is not necessary to have an expert’s eye. Just as if you were to meet someone on the street and they told you they had a nose job, you would look to see if it appears natural. You would make a judgement about whether or not the nose job is good or bad by visually assessing if it fit the individual’s face. You might think the post surgery nose looks too thin, too pointy or too small.
When you evaluate hair restoration patients’ photos, ask yourself, “Does that person’s hair look right or is there something just not right about his hairline or temporal points?”
If he’s got hair right above his eyebrows and he’s bald back to his earlobes on the side, you should wonder what’s going on there?
Before and After photos should not be retouched.
If the lighting does not match in the Before and After photos, this is a warning sign that the photographs have been altered. Also, look at patients’ posture and facial expressions to see how they match-up.
Not all hairlines should be created equal.
Look at how the hair fits each individual patient. Every hairline should not look the same or like the doctor uses the same template on every patient. It is important to see a variety of hairline restoration results. For example, you should see fifty-year-olds with low hairlines and fifty-year-olds with high hairlines; forty-year-olds with intense temporal point reconstruction and forty-year-olds with more moderate reconstruction.
Watch for the “high and wide” hairline.
The hairline should not be very high up on the scalp or what is known as the “high and wide hairline.” This hairline is very common, especially in older style procedures, where physicians were purposely being conservative about where they tranplanted hair.
Study the proportions of the patient’s portrait.
You should look at each photo as if you were studying a painting by an artist. Study the proportions. Look at where the hairline is in relation to the face. Does it fit the face? Does it fit the patient’s age?
More than “Mug shots.”
It is essential to see more than just mug shots (straight on photos). You need to see the hair and the head from several angles, including profiles, the top and back of the head. While it is difficult to include every photograph of every patient in a hair restoration surgeon’s portfolio, you will want to evaluate coverage, density and appearance from multiple angles.
Ask for an overview of each patient’s treatment plan. Here are some questions to ask:
What was the surgical treatment plan?
How many grafts did the patient receive?
What size grafts?
Had the patient had any previous hair restoration surgery? If so, how many?
Was any adjunctive therapy used? (e.g. medical, laser/phototherapy, nutritional supplements)
Was that patient on Propecia?
Did the patient use Minoxidal?
How many months after the procedure were the photos taken?
Which doctor performed the surgery shown in each photo? (As mentioned earlier, in many practices, it is not disclosed that different doctors performed surgeries on different patients showcased in the practice’s portfolio. And, it is quite possible, that an individual patient may have had more than one doctor perform surgical procedures at different times).