Why is having transplant at a young age discouraged?

[HighTopFade]

I see members scorn newbies who are 20-24 range who are considering a HT.

 

I've seen young guys who've had them and they dont "look bad."

 

Is it discouraged because the hair (both native and transplanted) continues to fall out post surgery due to the genetics?

[moses0324]

There are numerous reasons:

 

1. Hair can continue to fall out post HT surgery thus leaving a odd looking balding pattern

2. When you are young the severity of hairless is not known. As a result the doctor does not know how to distribute the donor hair (density)

3. Some young patients can get to a Norwood 6 or 7 in which HT's are useless. This can expose the scar later on in life. The safe zone is not yet known.

 

To be honest I think the primary reason is the first one. If you have the surgery and a year later hairless has continued, you are gonna waste a lot of money, time, effort, and donor hairs annually. That is the reason it is smart to get on the drugs. Stabalize the hairloss and implement a plan. At least with the hairloss somewhat stabilized...the patient can go 5-7 years between HT's.

 

Hope this somewhat helped

[biscuit]

It's mostly because at a young age you don't really know where your hairloss is heading. Basically, if you are going to end up being a NW6 or NW7 it's almost impossible to transplant enough hair to create a good look. And if you lose that much hair it's likely that you'll have visible scarring from the transplant.

 

Another factor is emotions. Young patients typically think they're invincible, so they don't take into considerations a lot of important factors. They make decisions based on short term goals, like finding a girlfriend.

 

Look around at guys who are 50/60/70 years old and ask your self if those guys should have a transplant. Diffuse thinning, aggressive hairloss, grey hair. I sat behind an older guy yesterday and he had a very small horseshoe of grey hair and a huge area of baldness. If he had a transplant when he was young it would have been a disaster.

[phil mascallpen]

 

I've seen young guys who've had them and they dont "look bad."

 

 

 

Not looking bad should not be your goal for an HT. But like the other guys have said the main reason is that you have no idea how you're hair loss will progress.

 

Another factor is that in your early 20s hair loss first manifests itself, usually, in temporal recession. This results in the appearance of a mature hairline. A mature hairline is what most good HT doctors will try to establish for a patient. So initially you recognize your hair loss in the temporal region but a responsible HT can not address that area. This is where the waiting comes in to see what would be a placement for a hairline that leaves you enough donor to use for loss behind that point.

 

If, at a young age, you are seeing more than temporal recession, like diffuse thinning or crown loss, this would suggest aggressive MPB and you are probably not a good candidate for HT.

[RodG]

Hi,

 

Basically, if you are going to end up being a NW6 or NW7 it's almost impossible to transplant enough hair to create a good look.

I am NW6 and I think it depends on your own expectations regarding what a good look constitutes regarding a HT. I had 3743 grafts 4.5 months ago and at this stage I am progressing well. I may not end up with a full head of hair but propecia etc was not available to me 20 years ago when I needed it. I am 49 years old and I have minimal amount of grey hair as well. I have seen some major improvements with hairloss sufferers who are NW6 or 7.

 

Back to the original post I do agree that the main problem is that a persons hairloss hasn't progressed enough to indicate what is achievable and what isn't. The last thing that a person needs is to look odd when they are in their 30's after undergoing HT's when they were younger.

 

Regards

 

Rod

[biscuit]

Hi,

 

I am NW6 and I think it depends on your own expectations regarding what a good look constitutes regarding a HT. I had 3743 grafts 4.5 months ago and at this stage I am progressing well. I may not end up with a full head of hair but propecia etc was not available to me 20 years ago when I needed it. I am 49 years old and I have minimal amount of grey hair as well. I have seen some major improvements with hairloss sufferers who are NW6 or 7.

 

Back to the original post I do agree that the main problem is that a persons hairloss hasn't progressed enough to indicate what is achievable and what isn't. The last thing that a person needs is to look odd when they are in their 30's after undergoing HT's when they were younger.

 

Regards

 

Rod

 

Congratulations, I wish you the best of luck with your HT results. My experience is that 3700 grafts on a NW6 is not going to provide what most people consider to be satisfying results. My general rule is that you need 1000 grafts for every Norwood number, and that's just to achieve what I consider Moderate coverage. Forum members in their 20's will most likely not be satisfied with your results if you show them photos. That's part of the problem too, expectations are very different when you're 20 years old.

 

Rod, I encourage you to start a blog and document your progress before/during/after photos so others can benefit from your experience.

[RodG]

Hi Biscuit,

 

'Beggers can't be chosers' I underwent this process to re-establish my hairline and I believe that I have reasonable expectations. I understand that a 20 year old wouldn't be happy with the result that I'm hoping to achieve but I have lower expectations and I'll be happy with a thinning head of hair.

 

I have seen many good results of people undergoing HT's with my level of hairloss. Thinning hair is much better than totally bald which was going to be my outcome in the next couple of years unless I had a HT.

 

I'm considering another HT procedure in the future subject to a successful outcome of this one.

 

Regards

 

Rod

[Dr. Michael Beehner]

I will try to give a hair transplant surgeon's point of view of this problem of "what age is too young to transplant at?" For me personally, 23 is my somewhat "unofficial" cut-off age for transplanting a young man. I have made a couple of exceptions in recent years and done a 21 and a 22 year old, but only with very conservative framing of the face with a front-central forelock of hair to help out their appearance. Two other unofficial "rules" I follow in my practice is not to transplant the rear vertex or the side temple (sideburn) areas in men under the age of 35. This is because, if the man goes on to extensive baldness, then these grafts will be sitting out "high and dry" by themselves without hair to support it in the temples, and, even worse, will look like a "bulls-eye" in the vertex. Then you have a patient who is a social recluse and very bitter about ever having done it.

The replies given so far have been excellent and right on the money. I would start by saying that a 19 or 20 year old is almost never mature enough to appreciate the whole situation. He knows one thing: his peers have full heads of hair and he is afraid he is losing his. At this age, when your social life and dating the opposite sex are so important, that young man will have blinders on to everything else. In such a situation, if he is a man who because of family history or already extreme miniaturization way out wide, you fear he will someday be a Norwood VII, he is not going to appreciate the fact that any transplanting has to stay out of the rear crown area and out of the recession/temple areas, or that a "forelock" type of pattern is perhaps the best one for him in terms of avoiding an abnormal look later in life.

The second obvious reason is that male baldness pattern is progressive throughout life and you have no idea, when looking at a 19 year old or even a 21 year old, how bald he will be when he is 40 or 50. We do start to get some hints of where he will end up as the patient gets into his middle and late 20's. For that reason, when I do transplant a 23 year old, I am always conservative and assume the worst case scenario will develop. I use a forelock design, which does connect to the sides, but with a definite gradient of density stronger in the front-central and tailing off as it approaches the sides. What I am trying to do is mimic a natural stage of hair loss that a significant number of males normally pass through on the way to balding. That way, anyone looking at them, even 20 years later, will not pause and wonder if what they see on his head is normal or not.

The corollary of not knowing how bald someone will be is not knowing how much "safe" donor hair will be available over the long haul. A lot of men also have what we call "nape thinning", which is a loss of hair from the neck up into the lower occipital hair in back.

One final point: Like everyone else, I try to put all young men on finasteride for all the obvious reasons. It does not hold off the eventual hereditary pattern that man will get however. Some of us think it puts it off by 8-12 years or something of that order. So when a young man presents to see me at 23, 24, or even 26, who has been on finasteride for a few years, it is even harder to tell where he is heading, because the finasteride MASKS what would normally be happening if the patient weren't on it. Some people on these forums comment as though going on finasteride somehow confers some permanent benefit for the young man. That is not true. It's great for holding on to or even increasing the "native" hair for several years more than it would normally be around, but it doesn't change the eventual long term picture.

Mike Beehner, M.D.

Edited January 4, 2011 by Mike Beehner, M.D.

[Sparky]

I agree with everything you said, I was 22 when I had my first completely uneeded HT, I had extremely minor loss in the temples, I was basically a NW1 and the crooks at Norton clinic cut a strip out of the back of may head for 100-200 grafts! All this for 750 pounds, its not like the guy needed the money, he had a new Porsche Turbo at the time FFS!

 

I was lucky that now at 35, I might of recessed to NW2 at the most and haven't lost any hair since 2002 even though my Dad started losing his hair at 19 and is now bald. He was almost bald by the time he was the age that I am now.

 

If I had, had an ethical doc that talked some sense into me at 22, then I wouldn't of needed corrective surgery last year, or any surgery at all, and I'd be a lot better off in terms of money.