Short term vs long term surgical risks/results
Dr. Dow Stough just published an important article defining the long term risks associated with getting a hair transplant. I always stress the personalized master plan for every patient, laying out a worst-case scenario. Dr. Stough nailed this subject nicely.
Original Article
The Progressive Loss Risk Scale for Hair
Restoration Surgery
Dow B. Stough, MD, CPI*†
BACKGROUND Limited information exists on the long-term risks to individuals undergoing procedures in hair restoration
surgery. The short-term risks are well known and similar to other procedures in dermatologic surgery. The long-term risks
of hair restoration surgery are seldom discussed between the physician and patient.
OBJECTIVE The author sought to describe a classification system that can be used as a communication tool between
physicians and patients to define the long-term risk involved with hair restoration surgery.
METHODS The Progressive Loss (PL) Scale is an attempt at assessing the cosmesis because of future hair loss following
a hair transplant procedure. The PL Risk Scale has designated 5 levels, 1 to 5, with each ascending level representing a
higher level of risk. The PL Risk Scale can be assigned to an individual at the time of the assessment for hair restoration
surgery.
RESULTS Each patient can be assigned a risk level based on how future hair loss may affect the overall cosmetic result of
their hair transplant. This risk is dependent on age, and specific for the area to be transplanted. The younger the age of the
patient, the higher the risk. The larger the area to be transplanted, the higher the risk. It is not a static scale, because it will
be affected by age, donor area, location of transplantation, and other mitigating factors.
CONCLUSION Pattern baldness in men and women is progressive and unrelenting. The dichotomy of hair restoration
surgery is that a satisfactory short-term outcome can evolve to disappointing results because of progressive hair loss. The
PL Risk Scale can be assigned to every individual undergoing a hair restoration procedure. This scale assignment will
convey to the patient their lifetime risk associated with any given surgical hair restoration procedure for that age and the
specific area to be restored.
DERMATOLOGIC SURGERY • July 2022 • Volume 48 • Number 7
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