Psycho-social impacts of hair restoration surgery on men

This lecture was presented by Dr. Parsa Mohebi at 15th annual meeting of international society of hair restoration surgery. Hair loss has significant impacts on men’s mental health. Balding is a known cause of anxiety in younger male patients who are involved with an active social life. The rate of depression is reported to be higher in bald men compared with their normal counterparts (1, 2 and 3). Negative impacts of hair loss are reported and are obvious to all hair transplant surgeons and medical staff involved with hair restoration. Negative effects of hair loss on self-esteem and self-image is also reported and seen on a daily basis among hair loss patients. We also know that hair loss impacts some men’s sex lives and their stability with regard to career choices.

Despite solid evidence in the published literature regarding the psychological impact of hair loss, the corrective effect of medical and surgical hair restoration has never been studied. Observing drastic changes in patient’s lives, we were motivated to look into the psychological impact of hair restoration on different aspects of patients’ life. We performed a questionnaire based questioned at new hair institute.

We used the indexes of psychological variables that were previously studied comparing balding and non-balding men. We focused in on eight major criteria that have been reported and documented as variables associated with hair loss in the literature. We collected a subset of them in our pilot study. Included were questions regarding the general level of happiness, energy level, feeling of youthfulness, anxiety level, self confidence, outlook on the future, and impact on their sex life.

Our initial study on the psychology of hair loss included the patients who had their first hair transplant surgery between one to three years prior to the time of our research, so they could have seen the final results of their hair transplant surgery with a fresh memory of their condition prior to their hair restoration procedure. We used the most recent years to have a uniform group in terms of the technique of the surgery we used.

We limited the study to male patients with androgenetic alopecia. Patients had exclusively follicular unit transplants that reflected our standard of care for that period. Comparison of patients’ before and after surgery condition in eight different criteria including level of happiness, energy level, anxiety level, youthfulness, self esteem, impact on sex life and career were done. Patients had significant improvements in all eight criteria regardless of their stage of baldness or their age. Table 1 Shows the improvement of eight variables in male patients with hair loss who had their first hair transplant surgery between years 2004 and 2006. We examined patients in two groups: (1) those who had Norwood IV patterns or less and (2) those with Norwood V patterns and above in an attempt to compare psychological changes that patients experienced in different stages of baldness.

We observed the most significant changes in two categories: sex life and career experience. Patients with less balding had a greater impact on their sex life and career when compared to patients who had more advanced stages of hair loss. These changes were not age related.
We also compared younger patients and the older ones to evaluate differences between the two groups. The index that changed more significantly for the younger patient was the impact of hair transplants on their future outlook.

Our conclusion of the questionnaire based questions confirmed our clinical observations. Hair restoration surgery can affect many aspects of a patient’s life and can potentially reverse psychosocial negative effects associated with hair loss. In the early stages of hair loss, patients may have more awareness of their condition and they might be more affected than men in the later stages of hair loss.

Patients who experienced hair loss at an early age while involved in an active social life were more prone to the negative side effects of balding and appeared to benefit most from hair restoration procedures. These patients’ negative outlook seemed to reverse after surgery. Our next step is going to be performing a similar study on a larger scale with providing incentives to the patients who respond to our questionnaires to increase the response rate a validity of the study.

By increasing the significance of the study I hope we can pave the way to have hair loss recognized more as a disease that needs special care and attention. Establishing the relationship between hair loss and its psychological consequences and the positive effect of hair transplant in improving those conditions might even help hair loss patients to get insurance coverage for their hair restoration procedure in the future.