This 23 yo man received 1978 follicular unit grafts and represents several principles of importance. The first is at what age is "safe" to transplant? The answer is heavily dependent upon where grafts are needed and where grafts are placed. It must be assumed that a person in his 20s and even 30s may become very bald and, therefore, will not have enough donor hair to graft any pattern other than an "upfront" one as shown here. By upfront, I mean designing a hairline that shows some recession and which will look acceptable from a profile view if a large area of balding develops in the crown. A large area of balding in the crown may make a hairline that is designed too low look "abnormal" or "unnatural". How much recession has to be designed depends upon the shape of the skull and the ratios of the various facial features.

This upfront pattern will have the temples grafted to form a "bridge" that will connect the permanent hairs on the sides, which are unlikely to bald, to the hair in a forward position up on top of the head. This hair on top will in all likelihood be exclusively grafted hair by the time the large crown balding has developed.

There will be no more donor hair available for anything more than this pattern (a version of the 3 vertex) if the man's balding progresses to a stage 6 or 7 over his next 20 to 40 years. This limitation of donor hair is why, in my opinion, it is unwise to graft the young man more extensively than where this present case demonstrates.

A man should not put significant density of grafts into his crown until he has a pretty good idea of how advanced his balding will progress in his future. This is probably no earlier than his 40s. A low density coverage is a consideration in some situations.

I get many emails from potential patients who seem not to understand the limitations imposed by the unknowns of the progression balding. There are other unknowns to consider as well, including family history and stability of the donor hair. I hope this issue is well thought-through by those of you thinking of hair transplantation in your younger years.

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William Reed, M.D.
Member of the Coalition of Independent Hair Restoration Physicians