17 Year old male with Male Patterned Baldness and some temple thinning

[dingdong12]

yous are all very quick to state that this wasnt an exceptional case etc, the doctor has studied god knows how many years to enable him to make such decisions. do you think he made the decision lightly , i dont think so!

 

agenttye , you may not think that hairloss is enough reason to commit suicide and to be honest it wouldnt drive me to such an extreme but who knows what self esteem issues this patient has perhaps compounded with lots of other issues.

 

the doctor and the patients psychiatrist and also the patients father deemed it a necessary procedure for the patient to receive. this shows the gravity of the patients mental state . self esteem issues are a very sensitive issue and whilst what may seem very minor to some people are major concerns to other .

 

yes the patient may lose more hair or he may be lucky and not. but for the meantime the patients mental state has improved and this has bound to be a good thing!

 

everyone knew what they were getting involved in and the result looks fantastic ! heres hopeing the patient hairloss issues are behind him now!

[Yiddo]

You have already posted this ??

[Dr. Ricardo Mejia]

My viewpoint is as follows.

The decision to do surgery on a patient involves a proper physician patient consultation. This involves a personal insight to the patients goals and objectives, his personality, his psychiatric assessment, his feelings, his past medical history, his family history of baldness, a proper examination of his donor area recipient area

, evaluating the area of miniaturization and the degree of hair loss. More importantly, it is a one on one dialogue the physician has with the pateint to understand why this patient wants the surgery, should he have it, and is it in his best interest based on his risk of future loss. Additionally, is the planned surgery realistic and natural appearing based on the consultation and the objectives set by both the patient and the physician. IF the answer is yes to the above and there is no harm to the patient and a benefit that far exceeds the risk, then the surgery is appropriate.

 

There are some men that do not eat chicken because they are fed hormones and they are afraid they will grow female breast. I do not have all the facts on chicken, but I eat like chicken. Everyone is entitled to an opinion above whether the surgery should have been done or not. But can anyone answer the questions above???

 

I for one as a physician do not know this patient nor any of the answers above. We can assume every 17 year old is an irresponsible kid? Do you know if the consultation was conducted along with his parents and approved by his parents? They are responsible adults looking out for the well being of their child? Are they not? Do you know who the parents are? Do you know how many seperate consultations they had with the Dr. to discuss the case?

 

For those that have the answers to the above patient dialogue and or consultation with the patient and or parents, then pick up the stone and feel free to cast it. I am sure Dr. Mohebi would be happy to hand you the stone as well. We are all welcome to an opinion and we do not have to eat chicken, but we have no knowledge or facts on this case.

I for one do not know all of the above. I would not expect Dr. Mohebi to summarize his whole consulation and examination with this patient which led to his medical decision. It is a difficult process we surgeons wrestle with every day and we have to live with our actions. Consequently, every patient is dealt with as an individual and evaluated differently case by case.

 

If this patient was 27 with the same pattern of hair loss would he be a candidate for surgery? Most would say yes. If this is the same patient at age 27 with a similar hair loss pattern as when he was 17, then why not give him ten years of enjoyment with his new hair if you agreed to transplant him at 27? Your answer will probably be assumptions based on who this person is at 17 or maybe what you were like at 17. Nonetheless, that is the key, it is an assumption not based on facts or any understanding of this particular physician patient consultation process.

 

I have previously posted that the internet and one paragraph summaries and comments is no replacement for a proper physician patient consultation. Online in a one dimensional world, It is here where you can not see the forest through through the trees. If you can, then please summarize everything the patient and his parents discussed with Dr. Mohebi.

 

I am sure Dr. Mohebi had a justifiably sound medical reason to proceed with surgery in "this particular" 17 year old based on his personal knowledge of this person, his character, his integrity, his maturity and his understanding of the whole hair restoration process. The patient and his parents were most likely counseled on the risks and benefits of the surgery, explained the diffuculties in young patients with the possibilities of future loss. The surgery was performed after both parties had agreed to a mutually acceptable plan of action which would be in the patients best interest. This is typically how many surgeons on this forum including myself would decide ultimately to transplant this patient. We are typically looking out for the patients best interest.

[hairthere]

Ok, I think that determining whether a 17-year-old is a good candidate must really come down to a case-by-case basis. On the surface, it seems like a bad idea, and I think we all can agree most 17 year olds should not be having HT surgery. We are not, however, privy to all the details here, as Dr. Mejia points out.

 

My question is, why post this case on the forum at all? That is what seems irresponsible to me. Surely Dr. Mohebi has plenty of other examples he can show of his work. What exactly is he trying to show us with this case?

[mahhong]

I think it's a useful case to post up, even if it is a divisive one. Dr. Mohebi made a choice to go ahead with this procedure and the case is interesting because it's relatively rare given the subjects age and background.

 

I for one am also very much unsure about this procedure, but we have to defer to the doctor really. Only he knows the specifics of this case and it would be rash to call his judgement wrong. To that extent, this case is a useful one to document and keep track of, making it all the more important these sorts of cases are referred to publicly.

 

Dr. Meija sums it up well I think. Hair transplantation is increasingly prevalent, increasingly effective and, therefore, the types of cases coming forward are increasingly different. Transplantation on a 17 year old does seem a risky decision, but that does not guarantee it will be a failure.

[hairthere]

Mahong, what exactly is useful about this case? There is nothing unusual about the patient other than his age. I think it could potentially send a message that it's OK for 17 year olds to have plastic surgery, which I really don't think is a good message nor is it wise to encourage. And I'm not saying Dr. Mohebi did anything unethical here, but as we all know there are several HT docs out there who do have questionable ethics and will perform surgery regardless if it's appropriate or not.

[aaron1234]

I sure hope he'll find a good wig when he becomes a NW7 at 23.

[mahhong]

Mahong, what exactly is useful about this case? There is nothing unusual about the patient other than his age. I think it could potentially send a message that it's OK for 17 year olds to have plastic surgery, which I really don't think is a good message nor is it wise to encourage. And I'm not saying Dr. Mohebi did anything unethical here, but as we all know there are several HT docs out there who do have questionable ethics and will perform surgery regardless if it's appropriate or not.

 

Well, it's useful because it happened. It is not a common case and the chance to understand what motivated a respectable doctor to perform the procedure is interesting and insightful, in addition to how the results bear up over the months and years.

 

In addition to the relative rarity of 17 year olds who will be seriously considering a hair transplant, I also think you underestimate how sensible most of them would be. This case is in no way suggesting it's normal and acceptable for any 17 year old to go and get a HT. It's pretty clear the family were involved and the doctor felt there were circumstances here which warranted the surgery.

 

The whole point of these forums is to show all sides of the hair restoration world in an honest and transparent way. No case condones or condemns anything - they are simply documents of an event that happened and the results over months, often years. Unethical doctors aside (they will unfortunately find their victims, of all ages, with or without anybody else's involvement) the overwhelming majority of 17 year olds who go to see a doctor will continue to be turned away. This case isn't going to represent a sea change for either doctors or patients, but it happened and we should be thankful we get to see even the most controversial of surgeries.

 

That's my opinion, anyway. We shouldn't be so quick to censor the work of reputable doctors because they don't fit the status quo of hair transplantation. As I say, I have my own doubts about how this case will pan out, but that makes it all the more useful that I have the chance to see it for myself. The doctor made his decision and this is a documentation of how that decision pans out - as transparent and honest as it can get.

[Bill - Seemiller]

Dr. Mohebi,

 

Thanks for providing this community with an explanation on this case. While I'm not a physician, as a patient, I do have some serious reservations about this case.

 

I don't agree with your decision to transplant on a 17 year old, especially one who has been diagnosed with depression. In fact, depression and/or other psychological conditions are often seen as reason enough not to transplant.

 

While a hair transplant may make this 17 year old feel better for now, I'm concerned about his long term hair restoration plan and emotional well being.

 

As you know, Propecia isn't a guarantee that this patient won't lose additional hair and hair loss at 17 can be an indication of potentially aggressive hair loss to come. I'm concerned what this patient will look like when he's 25 and how this will affect his depression.

 

What's your long term treatment plan for this patient in the event he becomes a Norwood 6 or 7? Does he understand the risks of future hair loss? Even if he has an abundance of donor hair and realistic expectations, does he have the financial means to keep up with several more procedures and thousands of grafts per procedure? How will he cope emotionally in the event male pattern baldness progresses rapidly and aggressively? Will his depression worsen if his donor scar becomes more difficult to conceal with subsequent procedures?

 

While you may have the answers to some of the above, there are just too many unknown variables and thus, in my opinion, I am concerned that this patient may not have been a good candidate for hair transplantation.

 

Knowing that transplanting on such a young patient is controversial, I'm also concerned as to why a detailed explanation wasn't initially offered in the first post on this topic. In the future, I truly hope any and all controversial topics will be followed by a detailed explanation from the beginning.

 

I know you stated that transplanting on patients this young is not the norm and you've stated your reasons for proceeding with transplanting on this patient as an exception. However, I do have concerns and hope you'll reconsider transplanting on such a young patient in the future.

 

Best wishes,

 

Bill

[agenteye]

Hopefully Bill, for the sake of Dr. Mohebi's reputation, there won't be any potentially controversial cases PERIOD!!!! I think most of us here would agree that this was extremely unacceptable!

[Parsa Mohebi, MD]

Thanks for all comments about this case. I think we have explore the idea of early Intervention for Hair Transplant Surgery a little bit more here:

 

Advanced Evaluation

Hair transplant surgeons used to have a strict criteria in past as of strictly not perform a hair transplant on anyone younger than 24. However, many things have changed since then. There are more treatment options as well as more documentation on the long term effects of hair restoration medications. Hair restoration doctors did not want to do a hair transplant until they can clearly see the pattern of baldness. Now we have the option to perform a miniaturization study with microscopic evaluation. This gives us a reasonably reliable way to predict the activity of hair loss in different areas with some certainty. We can predict the final pattern of male patterned baldness (MPB) utilizing the patient’s miniaturization study in addition to a thorough evaluation of his family hair loss history.

 

Psychological Considerations

It is important to recognize the greatest impact on individuals with hair loss is the emotional impact to their self esteem and self image. We know for certain that these two factors directly impact our quality of life. Today we have more insight to the negative consequences of hair loss and that fact it can be prevented in many cases.

 

In our "Psychology of hair restoration surgery" study that was presented in 15th annual scientific meeting of Internal Society of Hair Restoration Surgery in 2007 we sent questionnaires to 200 men who had only one hair transplant in past and we asked them about the psycho-social aspects of their lives following their procedures. We have compared the responses from the patients with higher classes of hair loss with early stages. We also compared the changes that younger patients experienced in comparison to the older ones. We have found a significant improvement in future outlook in younger patients who received a hair restoration as opposed to the older ones. I am attaching the graph right off the presentation I had back in 2007 that compares the impacts of a hair restoration on younger patients vs. older ones.

 

 

 

Ethics of Hair Transplant at a young age

 

I recognize as many people have mentioned that there has been unethical practices in some instances. As medical doctors we must hold to the highest of ethical standards and best practices. Performing a hair transplant when the miniaturization study and the psychological profile does indicate would be a breach of these standards. I appreciate the feedback in this forum and plan to write an article on the indications and specifications of “Early Intervention for Hair Transplant Surgery" soon.

[michaeljames]

Hi Everyone,

 

I am a patient advocate for Dr. Mohebi. I work with him and his team for more than a year now. First, I am exceptionally appreciative of the commentary of Dr. Meja. He underscores that only Dr. Mohebi and the patients psychiatrist not psychologist have the full facts and reasoning behind this particular case.

 

Certainly, it is a poor assumption by lay people to assume that two established and reputable medical doctors, and parents supported, recommended and performed a surgery without full cognizance of the patients best interest. That is not reasonable or fair.

 

Clinical depression is a serious illness that culminates in many cases in loss of life. This is not saying what this patient planned or would have done this. But it should suffice to say that a medical doctor who specializes in emotional health (his psychiatrist) thought it prudent to support further intervention for the well-being for his patient. Enlisting the esteemed services of Dr. Mohebi and his team certainly assured that this young man would not receive an unwarranted treatment.

 

In conclusion, the opinions expressed in this thread are as they are; but having first hand knowledge of the case and the ethics of Dr. Mohebi I can definitively express that considerations on performing earlier hair transplant surgeries for this patient was a success for him. This could in similar circumstances be beneficial tomore people.

 

All the Best, Michael.

Edited December 13, 2012 by michaeljames

[michaeljames]

Dr. Mohebi,

 

Thanks for providing this community with an explanation on this case. While I'm not a physician, as a patient, I do have some serious reservations about this case.

 

I don't agree with your decision to transplant on a 17 year old, especially one who has been diagnosed with depression. In fact, depression and/or other psychological conditions are often seen as reason enough not to transplant.

 

While a hair transplant may make this 17 year old feel better for now, I'm concerned about his long term hair restoration plan and emotional well being.

 

As you know, Propecia isn't a guarantee that this patient won't lose additional hair and hair loss at 17 can be an indication of potentially aggressive hair loss to come. I'm concerned what this patient will look like when he's 25 and how this will affect his depression.

 

What's your long term treatment plan for this patient in the event he becomes a Norwood 6 or 7? Does he understand the risks of future hair loss? Even if he has an abundance of donor hair and realistic expectations, does he have the financial means to keep up with several more procedures and thousands of grafts per procedure? How will he cope emotionally in the event male pattern baldness progresses rapidly and aggressively? Will his depression worsen if his donor scar becomes more difficult to conceal with subsequent procedures?

 

While you may have the answers to some of the above, there are just too many unknown variables and thus, in my opinion, I am concerned that this patient may not have been a good candidate for hair transplantation.

 

Knowing that transplanting on such a young patient is controversial, I'm also concerned as to why a detailed explanation wasn't initially offered in the first post on this topic. In the future, I truly hope any and all controversial topics will be followed by a detailed explanation from the beginning.

 

I know you stated that transplanting on patients this young is not the norm and you've stated your reasons for proceeding with transplanting on this patient as an exception. However, I do have concerns and hope you'll reconsider transplanting on such a young patient in the future.

 

Best wishes,

 

Bill

 

Hi Bill,

 

I am responding to your statement regarding the information initially posted. As many of the recommended surgeons here I post the cases by and for Dr. Mohebi based on the template he designed for this forum. It is very detailed regarding the miniaturization study the number of grafts used, types of grafts and their placement. The consistency in this template allows for forum participants to clearly evaluate the comparisons when viewing other posted success stories from US Hair Restoration centers.

 

Upon the development of controversy through this thread Dr. Mohebi addressed some of people's concern to the best level while maintaining patient confidentiality and adhering to HIPPA requirements.

 

Greatly, respecting people's opinion of disagreement I trust and because of proximity to the case that the medical professionals involved considered all the possible known potentialities prior to moving forward. Thank you to your efforts and the HTN team at providing an independent and informative forum.

 

All the Best, Michael

[michaeljames]

Ok, I think that determining whether a 17-year-old is a good candidate must really come down to a case-by-case basis. On the surface, it seems like a bad idea, and I think we all can agree most 17 year olds should not be having HT surgery. We are not, however, privy to all the details here, as Dr. Mejia points out.

 

My question is, why post this case on the forum at all? That is what seems irresponsible to me. Surely Dr. Mohebi has plenty of other examples he can show of his work. What exactly is he trying to show us with this case?

 

Hello,

 

I am responsible for selecting the cases for posting and to follow the US Hair Restorations clinics posting of this case.Given the virulence of discussion surrounding this case I think various considerations were put forward on the earlier age HT as an unintended consequence. That being said within this thread Dr. Mohebi directly provided further information within this thread which underscores the why and the validity of the commentary of Dr. Meja. If there is any error in the posting of the case on the forum then it is mine. This does not however negate the given medical reasons for which this patient received his hair transplant surgery. All the Best, Michael

[Bill - Seemiller]

Michael,

 

Thanks for weighing in. Transplanting patients at a very young age has been a hot topic amongst patients and hair restoration physicians alike for years. Thus, I was surprised to see that this wasn't recognized or referenced in the first post.

 

There really is no "template" for posting results. Ultimately, I've always advised physicians to be as descriptive as possible when posting so that the patient community can accurately weigh in. By not acknowledging the controversy of transplanting patients at very young ages and describing the reasons he made an exception for this case in the first post, it's only natural that members expressed concern. I happen to share these concerns.

 

It was noted that this patient's psychologist/psychiatrist felt that hair transplantation was an appropriate course of action for this patient. But how much does he know about the progressive and possibly aggressive nature of hair loss when men start losing hair at extremely young ages? How much does he know about hair transplant surgery and the need for subsequent sessions that still may result in a very thin look if he becomes a full Norwood 7?

 

At the end of the day, I believe that Dr. Mohebi is an ethical physician who believes he did the right thing by transplanting this patient. But I do have concerns about where this patient will be years down the road, especially if his hair loss is aggressive.

 

Best wishes,

 

Bill

[Rachmunas4life]

I am not trying to hijack the thread with my post but I believe in what I wrote below;

 

I remember around the time I signed up on the forum I was 23. I went to Dr Konior after seeing his excellent results on patients hairlines on the forum. I was not as knowledgeable then with H/T's as I am now. Dr Konior could have said that I was a candidate, but instead he educated me on my age and the possibilities of me progressing even more in the coming years. He pretty much told me everything that "Bill" posted with his concerns of this 17 year old patient in the years to come.

 

I am very thankful of that consultation as I am a month away from 30 and I've been on Finasteride for a few years now. I've maintained my existing hair and leaned so much on the way! I hope this patient will get the correct advice in the coming years.

 

I also have some friends who had hair loss under 21. Just a few years later there whole heads were bald. Now their heads are shaved. I can only imagine this kid 5-10 years later with no hair except for 1,200 grafts in his hairline. Plus the scar in back will never allow him to shave his head without being self conscious.

 

I wonder what advice his physiatrist will give him then??? Just my 2 cents.

[Gandolf]

Wow, 17 years old?!?!?! I thought that was a typo at first when I read the title.

 

I must say that I share the same viewpoints as the masses here, this was highly irresponsible given the patient's age, despite the fact that his parents and therapist were in support. The only imaginable circumstance I could think for doing an HT on a patient under 21 years old or so would be if they were already on their way to full NW7 baldness so you know exactly what their final donor/recipient areas would look like, and it goes without saying that a surgery in this type of case would have to have a very conservative placement of the hairline.

 

I am a little surprised that no one has asked about this, but for this particular patient, what was his family history of baldness? Did he have any fathers, grandfathers, brothers, uncles, etc. who had aggressive NW 6/7 baldness? Did he have other family members who started showing noticable signs of hairloss at such a young age? If so, how did their hairloss progress?

 

I don't doubt that this poor young man was extremely depressed and even potentially suicidal to be probably the only kid in high school going bald, and I believe that the Dr. thought he was being compassionate and helping him, I just don't think he was using good judgment. Here's to hoping we have better options for stem cells and hair cloning etc in the next 10-15 years.

[21YearsAndScared]

I'll start off by guessing that most posters who disagree with this decision are well above age 20.

Being a young man suffering from MPB myself, I know just how big of a blow it can be to one's self confidence and view of their life. This 17 year old patient may have less concern of the possible irregular hair he may have a couple years down the road (He may plan on shaving it then) in place of his near future. You must understand that these early years are very important in terms of aesthetics. I've started losing my hair at age 18, 4 years ago. Back then was my "prime", and I would have given anything to keep the hair I had then because looks were everything. Even though I am still young, as time goes on the importance I place on my looks lessens. By the time I'm late 20s - 30 years old, when It's "acceptable" to get a HT, I might not even have the desire to do so. So I am not in disagreement with the decision for this patient to undergo surgery (assuming the results were desirable) as the time period in one's life is very important.

[bowl81]

Overall, I think completing HT surgery on a seventeen year old seems really young to have hair transplant. I hope the surgeon referred the client to a Dermatologist and have tests completed & the parents consented.

Edited January 5, 2013 by bowl81

[Mickey85]

im absolutely shocked really... 17... the only way i could excuse this was if it were a burn victim or something along those lines. this is inexcusable and unethical.

[Yiddo]

I'll start off by guessing that most posters who disagree with this decision are well above age 20.

Being a young man suffering from MPB myself, I know just how big of a blow it can be to one's self confidence and view of their life. This 17 year old patient may have less concern of the possible irregular hair he may have a couple years down the road (He may plan on shaving it then) in place of his near future. You must understand that these early years are very important in terms of aesthetics. I've started losing my hair at age 18, 4 years ago. Back then was my "prime", and I would have given anything to keep the hair I had then because looks were everything. Even though I am still young, as time goes on the importance I place on my looks lessens. By the time I'm late 20s - 30 years old, when It's "acceptable" to get a HT, I might not even have the desire to do so. So I am not in disagreement with the decision for this patient to undergo surgery (assuming the results were desirable) as the time period in one's life is very important.

 

 

21yearsandscared.......The thing is your missing quite a few points and being a bit niave here. Firstly it has no relevance whatsoever what age most of us are that disagree with this HT. Your sounding as though none of us know what its like to be going bald at a young age. This is a hairloss forum, of course we know what its like, thats why we are here. We know exactly how important it is in the early years, we have been there and done it.

You refer to '' he may plan on shaving it then ''..well unless im mistaken, this was FUT, so he cant. That option has gone. I think you need to read through this thread again, read our concerns, his future loss, his state of mind if his hair loss gets worse. What will he look like when he is 40, or does life end at 25? Im not trying to patronise you here, but remember there are a lot members here who are 30 plus, who were 18 once, and started losing their hair.

Edited January 6, 2013 by Yiddo
word

[MyNameIsRich]

I'd love to know more about this patients assessment, and which factors really made him a suitable candidate for a HT at such a young age. Having read this whole thread, I don't think theres a lot I can throw in that hasn't already been mentioned, but I can only imagine this kid and his father were not making the most educated decision.

[michaeljames]

I'd love to know more about this patients assessment, and which factors really made him a suitable candidate for a HT at such a young age. Having read this whole thread, I don't think theres a lot I can throw in that hasn't already been mentioned, but I can only imagine this kid and his father were not making the most educated decision.

 

Hello Rich,

 

The comments on this thread have been thought provoking and Dr. Mohebi himself has given a thorough response. I would like to just again note that this young man is enjoying great results and progress according to him, his physcians and family. S

[GBU]

This would be a great case for a 2 year follow up .