Clinical Assessments regarding the psychological problem of hair loss

The physician’s resolution regarding the client’s motivations and expectations for medical and surgical hair restoration, is an important aspect of patient care.  As with any cosmetic surgical procedure, the hair transplant patient must have reasonable expectations. The question “What do you hope to get?” must be asked both from the point of view of technical and aesthetic desires and of his/her psycho-social aspirations.  Unrealistical motives and perfectionistic expectations may determine the patient’s final discontentment with the result of the treatment.  In fact, dissatisfaction after a hair transplant often arises from changed or irrational expectations, rather than from complications or poor results. For example, external social motivations (pleasing others, getting a job or a promotion, finding a partner) are less suitable to lead to satisfying the patient, than internal motivations concerning the self-image connected to improving their own body or lessening the obsession of their image.
In addition, the physician must examine the patient, recognize the primary cause of the patient's hair loss, and estimate the effect that time will have on the hair loss process. A precise education of the patient should promote an accurate perception (understanding) of alopecia, the alternative remedies available, the exact nature of planned procedures, any associated inconvenience or discomfort, the deadline and the probability for desired aesthetic results, and also the future requirements for maintaining them. Together with the patient, the physician must create a logical plan that will impart a natural-looking result both in the present and in the future.
Two crucial, interconnected questions that the patient must be asked are “To what extent do these feelings affect your everyday life?” and “To what extent does your hair loss affect your feelings about your appearance and yourself?” Most patients will describe moderate dissatisfaction that impedes self-confidence and produces annoying anxiety and preoccupation in certain contexts and, with a little embarrassment, most will admit to using a few defensive strategies in order to cover their discontentment.
They may cover it under hats, scarfs or they may spend excessive amounts of time in front of the mirror, fixing their hair.  They  may try a compensation by improving other aspects of their appearance (for example, by lifting weights or buying nice clothes).  Patients may avoid certain situations (for example, bright lighting of their head) or activities (for example, swimming) that might socially highlight their problem.  Patients engaging in most of these maneuvers and complaining about the fact that hair loss negatively affected their appearance and destroyed their lives, have more problems than alopecia itself.  They may be depressive or they may suffer from a distortion of the image of their own body more severe and invasive than the discontentment caused exclusively by alopecia.
A minority of patients have a condition named hypochondria of beauty. This condition of imaginary ugliness implies an exaggerated preoccupation with a non-existent or minor flaw, which is usually connected to a flaw perceived at a cranio-facial level.  These concerns of the patient regarding the image of their own body lead to a restless, uncontrollable checking of their appearance in the mirror; an intense self-consciousness on a social level; social isolation, evasion and depression.  Although the researchers’ evidence are not unequivocal, cosmetic procedures can’t provide a satisfying relief to such a patient.
Patients must be provided with both written and oral pre-operative instructions. They need to be instructed to discontinue blood-thinning agents, well before the hair transplant procedure, in order to regulate bleeding time. Most surgeons require patients to discontinue aspirin or aspirin-containing products a minimum of 5-7 days before surgery. An optimal care of the patient implies a continuous clinical assessment of the question if the patient’s expectations and requests are met both during the treatment and also after the treatment.  For example, as well as the satisfaction with the cosmetic result, the pacient must experience desired psycho-social effects such as improved self-image, self-confidence, social comfort. If the patient continues to complain about his/her appearance, this must be taken into consideration and sollutions must be found.

Table of Contents:
Implication of the hair transplant in patient care
Clinical Assessments regarding the psychological problem of hair loss
Clinical Management of Psychological Problems