In todays modern day hair restoration creating a master plan is essential to any hair restoration, a comprehensive plan to acheive a long lasting natural result. With so many desperate young men suffering from hair loss each day, it is easy to get caught up in the problems of today without considering the future. What is disturbing is the amount of young men that opt for pre-pubescent hairlines with significant balding in their early 20's. Needless to say that is a recipe for a disaster, not only is it highly likely that they will continue to bald significantly in the coming years, but the hairline is placed too low and will appear unnatural when they become older.
Microscopic scalp and donor evaluation is crucial for your surgeon to create a master plan, the percentage of miniaturized follicles is a good indicator of where you are headed in the future. Family history can also be helpful but not necessarily fail proof, male pattern baldness gene is often expressed differently even within family members, for example my father who is 59 years old is a Norwood III whilst I am a Norwood VI at age 31, a combination of scalp, donor evaluation and family history can provide a good idea of what the future holds.
Once you have an idea of where you are headed, the planning begins, hair transplantation is all about maximizing the grafts you have, knowing where to place the grafts and knowing how to style your hair afterwards. Front loading the hairline excessively is unnecessary, there is no need to achieve true density when visual density can be achieved utilzing less grafts, the conservation of grafts is necessary to address further balding in the future. Framing the face is by far the most important aspect in hair transplanation, secondly followed by the mid scalp, and last and certainly least is the vertex/crown. It is often said that the crown is a black hole for grafts, this is because of the size of the vertex followed by the angle the hairs must be placed. Because the hair naturally lays flat around the swirl in the vertex it takes more grafts to achieve visual density as opposed to the hairline or midscalp, for this reason it is illogical to think that complete density can be achieved in the vertex.
A natural conservative age appropriate hairline with visual density, a miscalp with visual density a strong vertex transitional zone and lateral humps are what need to be considered in any master plan. If donor density is good the vertex can be restored however visual density is unlikely.