For those younger men considering a hair transplant

[johnny24]

I wish to touch on this topic as it seems to be coming up alot, in articles and the like and I often get told by people (without them putting in some thought) that age should be considered when considering getting a hair transplant.

 

In my opinion your age is irrelevant when considering hair transplantation. At the end of the day it comes down to your hair loss to date. If all men lost hair at the same rate, then I would say yes wait until you get to a certain age to consider hair transplantation, but obviously that is not the case.

 

We all have a different genetic predisposition for hair loss. Due to genetics I lost a great deal of hair at a very early age, and by the age of 23 I was a Norwood IV. This means i didn't have much more hair to lose, so why would i wait until i am 30 or 35 and lose all those years being unhappy and down on myself? I have work colleagues who are in their 50's and have a fuller head of hair then I did at 23.

 

If you are a Norwood III and above, then you have noticed considerable hair loss, and "going bald" is what you think when you look in the mirror. So if you decide after careful research that you wish to undertake a hair transplant then speak to your potential surgeon and come up with an effective and sustainable solution to transplant the hairs you need now in order to satisfy your current aesthetic needs and obtain decent coverage. That way if you continue to lose more hair (remember at a Norwood IV, you really don't have much more hair to lose, you have already gone past half-way) you still have enough donor hair for a future transplant if required.

 

Remember guys that there is an EMOTIONAL driver behind the decision to consider a hair transplant. We DON'T NEED hair on our head for any reason, it is purely an emotional decision (we look in the mirror and get pissed off looking at our shiny heads!). So if you want hair on your head, your younger age should not be a deciding factor at all.

 

So to answer your questions, especially those mothers worrying about their young sons spiralling into low self-esteem due to hair loss, the more appropriate question should be "At what level of hair loss should we consider hair transplantation surgery" not "What age should we be before considering hair transplantation surgery."

 

Another very important aspect of hair transplantation which should be taken into account is generally younger men in their 20's will obtain better results than a man in his 40's or 50's getting a HT at the same level of hair loss. So a 23 year old male is a Norwood IV and another male is 43 also a Norwood IV, more often than not the 23 year old will obtain a better result from the same HT. This comes down to healthier donor hair, which a 23 year old would be expected to have and obviously better blood flow/circulation to the scalp, and protein/nutrient synthesis is more efficient in a younger male. These variables are vital to obtaining a good result from your HT.

 

Now the above is my opinion and i would appreciate an effective discussion into this topic as i imagine it is a BIG QUESTION on many young guys minds on this forum.

[Raj Jayukdht]

Nice write up Johnny, your right in what you are saying, but in surgeon’s eyes they look at the future of the patients hair loss. I agree if a 23 old patient is NW IV, than yes do the hair transplant, as they have nothing much further to lose for the future, however if a patient who is NW 3 and 23 yrs old, than the surgeon will need to think about patient’s hair loss for the future which can be a difficult task.

IMO a 23 yr old patient should have a transplant if he is NW3 or above as Johnny mentioned, “mothers worrying about their young sons spiralling into low self-esteem”

[TakingThePlunge]

Johnny,

 

It's interesting that you bring this up as I just published this topic to our HTN Blog. Perhaps you saw it since this is exactly the situation I wrote about.

 

Is Hair Transplant Surgery Advisable for Young Men in Their Early Twenties?

 

I never discourage anyone from consulting with ethical hair transplant surgeons. Ultimately, that's where they're going to get the best advice.

 

I agree that age is not a "one size fits all" descriptor for determining candidacy for hair transplant surgery. Age is just one of the factors that must be considered but, in general, surgery is not an appropriate choice for a lot of very young guys. While, in the case of a young man who's lost about all the hair he can lose, planning for future hair loss is not a concern, what may be a concern is the young man's expectations. Also, I've personally heard many young guys state that they just want to look good now. They won't care how they look at 30, 40, 50 and beyond. As someone soon to turn 47 I can tell you this is not the case but I would have said the same thing in my youth.

 

Speaking from my own experience, I started receding at around the age of 20. For me it was devastating because I was all about my long hair in those days. I've included a pic of me in about 1990 around age 22 below. I was hiding a hairline that I was ashamed of. I was at a wedding this day and I remember constantly checking my hair in the mirror to be sure that my hairline wasn't exposed. My sister had to tell me to quit because I looked obsessive.

 

Around this time I had consulted with Dr. Shelly Friedman in AZ, Bosley in CA and a third, grimy and shady clinic also in AZ about restoring my hairline. Dr. Friedman and Bosley advised me that I was not yet a candidate for surgery and suggested I come back in about a decade. The shady clinic was ready to operate on me if my wallet was fat enough.

 

The point is that I had unrealistic expectations: More so considering the state of surgical hair restoration in those days. But, I would have eagerly said yes to anyone promising to restore my juvenile hairline at that time. Fortunately for me I was broke and they wouldn't finance me or my hair restoration story would be a different one today.

 

A 30, 40 or 50 year old Norwood V or VI is likely going to be happier with his potential results than a younger man with the same degree of hair loss while a young guy in the situation I was in would wish to restore a juvenile hairline and potentially end up looking odd later when he loses too much hair to maintain a natural appearance.

 

We all know that hair restoration physicians are well paid. There is no money in turning patients away. Ethical physicians will advise what they feel is in the best interest of the patient long-term.

 

Any young, balding guys who may find this thread, I recommend consulting with a skilled and experienced hair restoration physician like those recommended by our community. Strongly consider Propecia (finasteride) and Rogaine (minoxidil) and do your due diligence when researching hair loss, hair transplants, medical hair loss treatments, etc. No one will watch your back as carefully as you will.

Edited May 22, 2015 by David - Moderator

[Dr. Michael Beehner]

I agree with everything David said. It's important that a hair surgeon approach a 21 year old male a lot different than a 31 year old. There are two major reasons for being conservative and going slow, which includes for most of us - being a little reluctant to perform surgery on men under 23.

Reason #1: Male pattern baldness is PROGRESSIVE throughout a male's life. You can never look at a man in his 20's and say you know how far his hair loss will extend to. Virtually all Norwood IV's and V's go on to become Norwood VI's, and a sizeable percentage of young men with Norwood VI pattern go on to become a Norwood VII with the side fringe located somewhere down the side of the head. There is a large risk for turning that young man into a freak later in life. This can lead to a reclusive life-style, depression, and rarely even to suicidal states. The decision to transplant a young man in his late teens or early 20's should be taken very seriously. The surgeon is making permanent marks on that person's head that he will have to live with the rest of his life.

Reason #2: Many young men from 18 up to the late 20's have not really psychologically accepted the fact that they are going to be bald later. Many are very angry about it and feel cheated at this loss of their self-image. At our clinic I have informally adopted a rule to try very hard not to perform HT surgery on anyone under 23. There have been a handful of exceptions, in which I judged the patient to be mature beyond his years and missing the framing of his face in the front-central portion of the scalp. In such cases I have started the front part of a "forelock" type of pattern in order to restore this "framing."

Mike Beehner, M.D.

[Raj Jayukdht]

OMG David your hair was long

[TakingThePlunge]

OMG David your hair was long

 

What can I say Raj? I'm an old headbanger! \m/

[pkipling]

This is always one of the most interesting debates for me in the hair transplant world, as their seems to be no clearcut answer to this. It really does vary from individual to individual, and ultimately it comes down to trusting that the hair transplant surgeon will do what is truly in the best interest of the patient.

 

I actually just had a conversation last night with a 25 y/o NW3 who is really struggling with whether or not to go through with his HT, for all the concerns already mentioned above. It's this age group that I feel has the toughest decision to make, as they're right on the cusp of that age cutoff. As Dr. Beehner stated above, as a general rule, he won't perform surgery on anyone under 23, with some surgeons going as far as not operating on anyone under the age of 25. So in the case of someone like the guy I spoke with last night, he's right on the cusp. Past the suggested requirement given by some surgeons, but not yet into his 30s, which many say is ideal.... So what's the best approach for these guys in the 25-30 age bracket?

 

Yes, he could wait until he turns 30-35 and see how it is then before proceeding. However, while I agree that we will all still continue to care about our appearance/hair well into our older age, I do believe that helping a young guy in his 20s restore his hair has a far greater impact on his life than someone in his 40s. Is this naive to think this way? I'm 31, btw, so speaking from somewhere somewhat in the middle of the two sides).

 

Ultimately, I'm torn - and I agree with the original poster about this all being determined on a case by case basis. These seem to be the most important factors: 1) If the patient doesn't have a clearcut genetic predisposition to eventually becoming very high on the Norwood Scale (based on family history), 2) He's able to get his hair loss stabilized through the use of medication, and 3) A thorough microscopic evaluation of the scalp/hair by an ethical surgeon supports that it is unlikely that the patient's hair loss will drastically increase in the coming years, then a conservative approach would be warranted, even at a young age.

 

Does this seem like the main criteria that should be considered? Unfortunately, none of us have a crystal ball that will definitively tell us where our hair loss is heading - but the above tools/information can allow us to make an educated guess so that we can be proactive sooner, rather than later.

[Dolph1969]

. They won't care how they look at 30, 40, 50 and beyond. As someone soon to turn 47 I can tell you this is not the case but I would have said the same thing in my youth.

 

So, so true.

 

That's from someone about to turn 46....

[KO]

Ultimately IMO, more than age the bigger question is if the patient has stabilized his loss via finasteride. If he is taking fin, the whole loss profile changes.

[johnny24]

DAVID OMG love the hair dude, damn you were a rock star back in the day..

 

I appreciate as much input as possible into this topic as i have been getting asked this question and yes i did come across the post on the HT Facebook page which is what drew me to start the discussion.

[TakingThePlunge]

DAVID OMG love the hair dude, damn you were a rock star back in the day..

 

I appreciate as much input as possible into this topic as i have been getting asked this question and yes i did come across the post on the HT Facebook page which is what drew me to start the discussion.

 

Thanks! Not the best pic and I just realized I have virtually the same expression on my face as in my profile pic. What's up with that?

[Rawkerboi]

David is that really you? Gosh that's really long hair

[MAGNUMpi]

1. Doesn't Finasteride eventually lose it's efficacy? So conceivably 10 years down the line when you need it most it might stop working.

The surgeon is making permanent marks on that person's head that he will have to live with the rest of his life.

2. A lot of men seem to lose a good deal amount of hair in their 50-60's so they would be looking strange even if they got a HT at 40.

Sorry to throw a couple of wrenches in, but what do you guys think about these 2 points?

[1978matt]

I disagree with the general principle that it would be fine to transplant 'anyone' in their early 20s. I only have to stand in the elevator at work and look at the back of some 30-35 year olds heads and the distinct lack of donor hair they have left.

 

For anyone interested there is some good information on Dr Unger's website in the Publications section. One link talks about whether it is a good idea to transplant early stage MPB.

 

He suggests excercising caution and transplanting in a conservative way that there is always enough donor area to maintain an acceptable look throughout a patients life. Unfortunately that is often not a satisfying result for a 21 year old NW 3 or 4 when all his friends look like Justin Beiber.

 

I think as Dr B says you have to piece it all together and exercise caution on anyone in their early 20s. Unfortunately there are and will continue to be doctors who aren't so caring.

[TakingThePlunge]

1. Doesn't Finasteride eventually lose it's efficacy? So conceivably 10 years down the line when you need it most it might stop working.

 

2. A lot of men seem to lose a good deal amount of hair in their 50-60's so they would be looking strange even if they got a HT at 40.

Sorry to throw a couple of wrenches in, but what do you guys think about these 2 points?

 

Not necessarily. This again is a matter of expectations. I don't think many young guys who are looking to hair transplant surgery would be happy with the hairline of a 40 or 50 year old man.

 

The assumption is that by the time you're 40, your eventual hair loss should be predictable and your expectations more realistic. Whatever Norwood class you'll end up, you and your doctor can either formulate a plan that will look natural on you for the remainder of your life or you can opt out of surgery.

 

Certainly, the risk of running out of donor hair is real at any age if the plan is noo good.

[TakingThePlunge]

David is that really you? Gosh that's really long hair

 

Yep! I cut my hair short at age 25 because I was tired of hiding my hairline. It bought me a few more good years of thicker looking hair before the inevitable happened.

[Spanker]

Not necessarily. This again is a matter of expectations. I don't think many young guys who are looking to hair transplant surgery would be happy with the hairline of a 40 or 50 year old man.

 

The assumption is that by the time you're 40, your eventual hair loss should be predictable and your expectations more realistic. Whatever Norwood class you'll end up, you and your doctor can either formulate a plan that will look natural on you for the remainder of your life or you can opt out of surgery.

 

Certainly, the risk of running out of donor hair is real at any age if the plan is noo good.

 

Finasteride use really changes what is predictable imo. A 24 year old on fin at the first sign of loss may not show a true pattern till his late thirties.

 

I do think transplantation can be a gamble for early balders especially.

[TakingThePlunge]

Finasteride use really changes what is predictable imo. A 24 year old on fin at the first sign of loss may not show a true pattern till his late thirties.

 

I do think transplantation can be a gamble for early balders especially.

 

Spanker,

 

I can't tell if you're agreeing with me or not but I think we're on the same page. That is the point I was trying to make.

[Spanker]

I was bouncing off of the risk if running it off donor at any age.

 

That said, your new hairline is one that I'd consider but too conservative. What would have been the outcome if you would have originally planted that hair line instead of moving it forward later in life? Maybe it's too early in your journey to form an option in that?

[TakingThePlunge]

I was bouncing off of the risk if running it off donor at any age.

 

That said, your new hairline is one that I'd consider but too conservative. What would have been the outcome if you would have originally planted that hair line instead of moving it forward later in life? Maybe it's too early in your journey to form an option in that?

 

I'm not sure what you mean by "your new hairline is one that I'd consider but too conservative."

 

I had my first hair transplant at the age of 40. I'm about to turn 47. My new hairline is the one I wanted from the start. Dr. Alexander was adamant at the time that the hairline needed to be much higher.

 

When I returned a year later for a touch up I requested that the corners be lowered and they were. I liked that much better but still I felt it was too high. I was limited in how I could style it and felt I was still trying to hide it creatively. I think I could have had the hairline I have now from the start but I would have needed a much larger session to pull it off.

 

It's also important to note in my case that my first hair transplant had lower than expected yield. That was the main reason for the touch up. I couldn't say how many grafts were potentially lost but it certainly affected what I could expect from subsequent procedures.