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Original Investigation |

Perception of Hair Transplant for Androgenetic Alopecia ONLINE FIRST

Kristin L. Bater, BA1; Masaru Ishii, MD, PhD2,3; Andrew Joseph, MD, MPH3; Peiyi Su, BA1; Jason Nellis, MD3; Lisa E. Ishii, MD, MHS1,3,4
[+] Author Affiliations
1Medical student, Johns Hopkins University School of Medicine, Baltimore, Maryland
2Division of Rhinology, Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
3Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
4Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
JAMA Facial Plast Surg. Published online August 25, 2016. doi:10.1001/jamafacial.2016.0546
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Importance  Hair transplant is among the most common cosmetic services sought by men, with more than 11 000 procedures performed in 2014. Despite its growing popularity, the effect of hair transplant on societal perceptions of youth, attractiveness, or facets of workplace and social success is unknown.

Objectives  To determine whether hair transplant improves observer ratings of age, attractiveness, successfulness, and approachability in men treated for androgenetic alopecia and to quantify the effect of hair transplant on each of these domains.

Design, Setting, and Participants  A randomized controlled experiment was conducted from November 10 to December 6, 2015, using web-based surveys featuring photographs of men before and after hair transplant. One hundred twenty-two participants recruited through various social media platforms successfully completed the survey. Observers were shown 2 side-by-side images of each man and asked to compare the image on the left with the one on the right. Of 13 pairs of images displayed, 7 men had undergone a hair transplant procedure and 6 had served as controls. Observers evaluated each photograph using various metrics, including age, attractiveness, successfulness, and approachability. A multivariate analysis of variance was performed to understand the effect of hair transplant on observer perceptions. Planned posthypothesis testing was used to identify which variables changed significantly as a result of the transplant.

Main Outcomes and Measures  Observer ratings of age (in number of years younger) and attractiveness, successfulness, and approachability (on a scale of 0 to 100; scores higher than 50 indicate a positive change).

Results  Of the 122 participants in the survey, 58 were men (47.5%); mean (range) age was 27.1 (18-52) years. The initial multivariate analysis of variance revealed a statistically significant multivariate effect for transplant (Wilks λ = 0.9646; P < .001). Planned posthypothesis analyses were performed to examine individual differences across the 4 domains. Findings determined with t tests showed a significant positive effect of hair transplant on observers’ perceptions of age (mean [SD] number of years younger, 3.6 [2.9] years; P < .001), attractiveness (mean [SD] score, 58.5 [17.5]; P < .001), successfulness (mean [SD] score, 57.1 [17.1]; P = .008), and approachability (mean [SD] score, 59.2 [18.1]; P = .02).

Conclusions and Relevance  Men were perceived as being younger and more attractive by casual observers after undergoing hair transplant. Participants also rated posttransplant faces as appearing more successful and approachable relative to their pretransplant counterparts. These aspects have been shown to play a substantial role in both workplace and social success, and these data demonstrate that hair transplant can improve ratings universally across all 4 domains.

Level of Evidence  NA.

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Figure 1.
Representative Depiction of Survey Image Presentation

Observers were asked to compare the image on the left (A) with the image on the right (B).

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Figure 2.
Differences in Observer Ratings Across the 4 Domains

Ratings shown for years younger (A), attractiveness (B), successfulness (C), and approachability (D). Boxes contain values within the 25th-75th percentile. The solid line within the box represents the median value; whisker lines, range of values falling below the 25th percentile and above the 75th percentile; bullets, outliers of the data set.

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