Being “ready” for hair transplant surgery is a very personal decision, however it has been well established that a significant percentage of  younger patients are simply not emotionally equipped to handle a less than perfect outcome. Hair transplant surgery is real cosmetic surgery and with it comes the same medical and emotional risk. Spencer Kobren and Joe Tillman speak with one happy patient who waited until he was “ready” to undergo hair transplant surgery and who emphasizes that developing realistic expectations was part of his process.

Spencer Kobren: Well Allen, let me ask you, how old were you when you had your first transplant?

Allen: I've had two--I'm in my late 40s. I think Joe and I are about the same age. I had both of them in my mid to late—sort of mid 40s I guess I’d say. I started balding very young. I literally, I rode it all the way to the bottom before I got surgery.

Spencer Kobren: Well, you know what, that's actually not such a bad thing. You were also emotionally prepared and equipped and experienced to make the right decisions and to really sit back and figure things out the right way. You're still emotional about it, just the way that it is. It's a very emotional aspect of our lives an emotional situation, but you didn't look in it, weren't looking at it through pure emotions and that's what happens with young patients in general, and that's why it's so important to hear--

Allen: I had plenty of times where I was a nut bag over it when I was younger. Really bothered me and I was driven to destruction by it. I remember 20 years ago reading about Fleming/Mayer flaps, and some part of my brain was like, "Oh, that's appealing," but the rest of my brain was like, "Don't do that," like, "That's not the answer," like, "Don't do that."

Spencer Kobren: I considered it. I considered having--There was a time when Garth Fisher who is the original plastic surgeon for the ABC show. What was that show, Joe, the first plastic surgery show? I can't remember it. Anyway, he was married to Brooke Burns or Brooke Burke and he was really a famous plastic surgeon. To make a long story short he went to Japan. He had something called Free Form Flap which is in the jury flap. Essentially they removed the entire peninsula of hair.

When you separate it from the blood supply and then put it into a trench and then re-attach it to the blood supply, he had some really good work done on himself and he looked really good. He has decided he wanted to offer it in his practice. He doesn't offer, to my knowledge, anymore. I actually flew out to Los Angeles from New York, he was kind enough to essentially reject me, and said, "I'm not even a candidate for anything," and I should wait.

Unfortunately, back then, there was no finasteride yet so I was just using my minoxidil and was freaked out about it. What I learned from that consultation was something that no one had told me when I called Fleming/Mayer, that part of tissue can die or all of it can die, and--

Allen: And there is no shortage of images online of scalp necrosis from Fleming/Mayer flap.

Spencer Kobren: Absolutely. During my phone consultation initially I did not get anything that I felt was really an honest conversation. I chose, when I was out here, could have seen stop by Fleming/Mayer, I chose just to go see Garth Fisher and see what he had to the say because the phone conversation was very--Even though his consultant at that time was basically saying this was, this is how old we are, the Cadillac of hair transplants.

[laughter]

Spencer Kobren: It was still--And she said, "If it works." That was very important to me.

Joe Tillman: When it takes [laughs].

Spencer Kobren: Yes, and he said, you see Doctor Fisher. And he looks great. I don't know this for sure, I don't wanna spread rumors, he might be wearing behind it now as he got older because he has a very--He has a full looking a lot of hair now. But whatever it is, it got him through his life and there are people who've been helped by it. But the Fleming/Mayer flap, the Jury Flap in my opinion--Even if it does work the hair is growing in the wrong direction.

Allen: Wrong direction.

Spencer Kobren: People are really screwed in my view.

Allen: But the point I was trying to make was, I look at a lot of stuff over a lot of years and I would look-- You'd see people on the world, like, oh, I had some work done and into the 80s and 90s even the 2000s of like, "Ah, it's not quite good enough." I did meds for forever. I still do some meds. But I felt I had reached the critical mass where I was unhappy enough with how I looked and I was seeing enough good solid results online from a couple of docs and I felt, you know what, now is the time to leap.

Spencer Kobren: Yes, and you did and you're happy.

Allen: Yes, I'm very happy. I had two surgeries that went very well. One I would say a decent procedure one sort of a smaller procedure just to add fullness, but good result. This thing has one other point is, you see a lot of people online saying, "Oh, I'm 20 I just wanna look good till I'm 30 then I won't give a crap." That's the biggest pile of shit of all.

Spencer Kobren: You care more.

Allen: If you're somebody who wants you will always get a long hair. You know what I’m saying?

Spencer Kobren: Absolutely. It only gets worse actually as you get older.

Joe Tillman: Say that to my 80-year-old patients who have had surgery.

Allen: Great. Well, and the other thing too is some people--The lucky ones are--They're fine with it. They really genuinely are. They’re cool with the hair. They can walk around like Captain Picard, they’ll shave their hair or whatever, and it’s great. I always thought I will get used to it. And then one day I realized I don’t like it and I don’t want to get used to it--

Spencer Kobren: [laughs].

Allen: That was the thing that pushed me over the edge like, "I could get used to this, but I don’t want to."