This story about two patients who underwent a hair transplant using leg hair starts with a problematic premise: that male pattern baldness is a medical condition causing “enormous stress” that needs to be treated with surgery. But even with that framing, this story fails to deliver most of the basic components necessary to provide readers with the necessary tools to make good choices. Benefits and harms are not quantified. The limitations of the research are not discussed. Costs and availability are not explained, and alternatives are not explored. The story reads like a sales pitch, and, it’s no wonder. The sole source in the story is the surgeon trying to sell this surgical technique.
The gradual medicalization of every aspect of human life has sped up in recent years, and cosmetic surgery has been especially adept at finding new ways to persuade people to pay hefty sums to “cure” themselves of all the things that happen as you age. Instead of aiding in the disease mongering and fear mongering that feed the medicalization hype machine, reporters have a duty to their readers to ask critical questions about the research, starting with the most basic one not asked here: “Why is a review of two surgical cases performed by one surgeon worth a news story by the most well respected newspaper on the planet – even if it’s only on its blog?”
The closest readers are given about any sense of costs is the amount of work involved. The story says “On average, a procedure involves 1,500 to 1,800 follicles and takes about eight hours, with breaks.” Cosmetic surgeons don’t work cheaply, and insurance is likely not to cover these procedures. All it would have required is one question to the surgeon, “How much does it cost to transplant 1,500 to 1,800 follicles”?
There is no clear quantification of benefits. The story says, “About 75 to 80 percent of the transplanted leg hair grew successfully on the patients’ heads after the operations, and both men were happy with the results, Dr. Umar said. “The hairline was fully grown and soft-looking by nine months” in the 35-year-old, he wrote, “at which time the patient started combing his hair backward and sporting a ponytail, exposing his hairline comfortably.” What does successfully mean? How does one judge happiness in a case like this? What is the long-term potential for this hair to stay in and to continue to grow normally? Will, as is often the case with hair transplants, the transplanted hair stay in one spot while the hair the men were born with continue to thin?
All surgeries carry the potential for harms. None of the harms were discussed in this story.
The story does not provide a true picture of the process involved in the two patients. Prior to the 8 hour transplant procedure, the patients underwent harvesting of leg hair, “…once or twice daily for a variable period of 6 weeks to 6 months before surgery.”
There is no discussion of the quality of the evidence here. Everything is taken on faith and presented in the most positive light.
A significant missing piece in the story is that the procedure is likely to be limited to, “.. selected hirsute individuals who have poor aesthetic results of harsh hairlines created previously using coarse terminal hair from the SDA of the head.”
The story engages in the worst kind of disease-mongering by overstating the potential benefits of the unproven procedure and by attempting to turn one of the most naturally occurring phenomena of aging into a medical condition that requires treatment. The story says, “The procedure has the potential to restore the hairlines of millions of men with male pattern baldness, the most common cause of hair loss and often an enormous source of stress.” Then it goes on to use the term that hair transplant surgeons love to use to market their techniques, “The condition, also called androgenic alopecia, typically begins at the hairline and eventually creates a horseshoe-shaped pattern of hair around the ears. It stems from a sensitivity — largely genetic — to the effects of hormones on hair follicles.” Yes. It’s genetic. It’s called being born with an X and Y chromosome. Given this description, roughly 50% of the world’s population may be potential victims of this genetic problem.
There is not a single independent voice in this piece. Instead, it ends with a sales pitch from the surgeon marketing this technique. In a story about a review of a cosmetic procedure in just two patients, a story should never include a phrase like this: “It’s life-altering for them when they realize that this is possible.” Yet, this is the message that readers are given as a take home.
The story does talk about how transplants are most often done, but it does not explain that there are a wide variety of techniques being used, many of which have very little in the way of peer reviewed evidence supporting them. After introducing the concept that hair loss creates “enormous stress” for men, the story might have talked with a researcher who has studied male self-esteem to find out whether cosmetic procedures can create their own anxiety because of exactly what this story describes: outcomes that “end up looking harsh and pluggy”. The story also does not mention that the men chosen for this surgery were men who the doctor describes as having hair thick enough on their legs to work for a transplant to the head. Not all men would be candidates.
The story also doesn’t mention any of the alternative strategies used in hair transplant. In addition to transplanting hair from other areas of the scalp, chest, thigh, leg and pubic hair have been used.
From the claims made at the top of the story, one would think that there is only one place in the world to undergo this technique: a clinic in Redondo Beach, California. That does not appear to be the case. In a brief online search, we were able to identify multiple dermatologists who suggest transplanting of hair from legs, chest and pubic region.
In the first sentence, the story makes a claim of novelty: “A new report highlights a novel way for doctors to replace thinning hairlines: transplanting leg hair.” Later it says that, “Men’s leg hair had successfully been transplanted before to the back of the head”. All it takes is a cursory review of the types of hair transplant methods being hawked to find multiple references to leg hair being used all over the head, including this Australian cosmetic surgeon promising, “you can even use your own body hair (chest, legs, arms) as donor and transplant them to thinning areas in your scalp.” Given that this is a review of what happened with just two patients, it is difficult to even call it a study, let alone back up the claim made in the story that, “believed to be the first documented cases of leg hair being used to restore the hairline.”
The story does not appear to be based on a press release