Hair Loss and Hair Restoration in Latin-Americans

91 Hair Loss and Hair Restoration in Latin-Americans

David Perez-Meza

Summary

When treating Latin-American patients with hair loss and hair restoration, it is important to consider their differences in terms of personalities/cultural norms, skin and hair colors, hair diameter and textures, goals, expectations, and hairline designs. These factors will play a significant role in ensuring a successful surgical outcome.

Keywords: Latin-American hair loss hair transplantation complications wound healing graft survival hairline design alopecia

Key Points

•Latin-American hair loss patients include those with different skin colors (white, light brown, dark brown, and black) and hair characteristics (straight, wavy, curly, and coarse), which should be kept in mind by a surgeon aiming for successful and natural results.

•The hairline design and location should be customized according to patient’s donor availability, skin color and hair color contrast, and realistic goals and expectations.

•Latin-American male and female hair loss patients want to be seen specifically by the doctor from the initial consultation and evaluation to the end of the postoperative period.

91.1 Introduction

The Latin-American group is extremely varied. However, there are some generalizations that fit this population more frequently than not. Latinos are friendly, openly emotional, and value long-term friendship. In social situations, personal contact is extremely common. Some people joke that for Latin-Americans there is no concept of personal space or off-limit jokes. Hugs, effusive handshakes, kisses on the cheek, etc., are a standard part of the culture. The concept of beauty—both looking and feeling good—is very important in the Latin-American culture. So, hair loss in men and women can be devastating in some cases. For many men and women, hair is a critical part of the personality and the trauma of losing hair can be nearly paralyzing to their self-esteem.

Ibero-America consists of 22 countries with a global population of approximately of 440 million habitants. And the Latino area includes multiple racial groups such as the Mestizo (Indigenous American and European descent), pure Europeans, and Mestizo with African descent. So racial characteristics in LatinAmerica are often linked to American, European, and African ancestry or a mixture. We can find hair loss among all skin types (white, light brown, dark brown, black), hair color (black, blond, dark brown, black), and hair type (straight, wavy, curly, and any combination; Fig. 91.1).

Fig. 91.1 Typical Latin-American male patient.

Cosmetic surgery cases among Latin-American patients have been increasing according to the American Society of Plastic and Reconstructive Surgeons. International Society of Hair Restoration Surgeons (ISHRS) in its 2015 practice census showed a noticeable increase in hair transplant surgeries in Latin America. From 2012 to 2014, the extrapolated worldwide volume of surgical hair restoration procedures performed in the past year increased 82% in Mexico/Central and South America, with a total of 28,456 procedures performed. From 2006 to 2014, the percent change in these procedures in Mexico/Central and South America increased 167%.¹

Hair restoration specialists should have a broad knowledge of different hair loss characteristics and treatment approaches. It is critical to customize our approach and techniques for each patient specific to their situation and needs. Generally speaking, the author divides hair transplant surgery into six critical and important steps for achieving excellent and natural results. These include the following: (1) consultation and hairline design, (2) donor harvesting, (3) graft preparation, (4) recipient site creation, (5) graft placement, and (6) postoperative care. All these steps have been discussed in detail elsewhere in the textbook. We will go through these steps and discuss what the author feels are important points in general and for the Latin-American patient specifically. Since Latin-Americans have such a mixed heritage, many of the points apply to other populations as well.

91.1.1 Step 1: Consultation and Surgical Plan

This step is critical in our evaluation of a Hispanic and Latin-American patient; it is our first connection and the foundation of the relationship with our hair loss patient. In most Latin-American countries, we do not have physician assistants (PAs), nurse practitioners, or other assistants available to the doctor for the purposes of consultation. So the Latin-American patients know they will be seen directly by a doctor and this is a part of ourculture; as a result of this tradition, we often build strong relationships with our patients.

At the initial consultation, the doctors ask all the questions related to the patient’s medical and family histories, determine when the hair loss started, determine the extent of its progression, as well as learn about any medical and/or surgical treatments in the past. After this initial history, a detailed dermoscopy scalp evaluation is performed, in addition to a pull test, and, if necessary, a scalp biopsy to determine the hair loss cause and the candidacy of the patient for transplant surgery.2 Again, it is helpful to use experience gained from the treatment of other ethnic groups to inform the approach to Latin-American patients, because they do represent a broad mixture of racial groups.²^,³^,⁴^,⁵

In today’s modern era, social media plays a huge role in our patients’ daily lives and has become a big element of communication for potential patients considering hair restoration surgery. In fact, potential patients can use social media for research, consultations, and to ask general questions about hair loss or hair restoration surgery. We need to follow local and/or national health laws/guidelines for social media communications with our patients, too. Today it is not unusual to have initial contact with our patients via social media; however, it is not a substitute for an in-depth face-to-face evaluation.

Many patients access the internet, desperately looking for answers to their hair loss problems, including “ magic treatments” to regrow their hair. Unfortunately, Dr. Google, more often than not, offers invalid and nonscientific treatments, leaving the patients more confused and overwhelmed than educated. So direct communication with patients (including Latin-American patients) is KEY to give them a better understanding of what can be realistically offered in their case. Most Latin-American hair loss patients are confused about the follicular unit excision (FUE) technique and what it entails. Most do not realize it is primarily an alternative method of harvesting the donor grafts. Marketing has given them the impression it is a totally different technique involving all aspects of surgery. The author makes it a point to explain that the two harvesting techniques available are FUE and strip excision and that both require significant surgical training and experience to produce healthy quality grafts.

Latin-American patients will often present with precise and detailed ideas regarding what they would like done including where they would like the hairline, the area they would like covered, and the density they are expecting. Like many cultures but probably more so in the Latin culture, their goals can be on the inappropriate aggressive side. The consultation must address the patient’s goals and expectations. If the surgeon and patient cannot agree on the medical and/or surgical plan and/or expectations, it is best to avoid scheduling surgery and schedule a second or third consultation for deeper evaluation of their case. If there is no agreement after additional consultations, it is best to avoid surgery altogether. Patient selection is very important during the first step of hair transplant surgery, and we should be aware of any red flags, such as body dysmorphic syndrome (BDS), during the consultation.

Hairline Design and Surgical Plan

It is important to keep in mind several factors before marking the hairline and making a surgical plan in Latin patients. This includes age, current degree of hair loss, possible future hair loss, donor supply and follicular unit (FU)/cm², hair characteristics (color, curl, and texture), and, in some cases, budget, goals, and expectations. It is critical to keep all these factors (and others) in mind when recommending a medical and/or surgical plan.

In some areas of Mexico and Latin America, we can find men with rounded face and broader nose, which will impact and modify our hairline design and surgical plan (Fig. 91.1). Latin-Americans also have a tendency to request for lower hairlines and greater density (Fig. 91.2). We need to customize our technique and surgical plan for each patient taking into consideration donor/recipient ratios and hair characteristics.