Should Young Patients Have Hair Transplants? | 3,000 Graft FUT Result | Dr. Bloxham | Feller & Bloxham, NY

[Dr Blake Bloxham]

One of the more debated topics on the forum is whether or not "young" patients should undergo hair transplant surgery. The controversy revolves around the fact that these patients are very early in the hair loss process and have an unpredictable future ahead. Using too many grafts now or starting with an "aggressive" plan may set a patient up for a lifetime of multiple surgeries or deplete donor resources before acceptable coverage can be achieved. There is also controversy surrounding the donor area in young patients: Will it thin aggressively and end up only providing a small "strip" of safe donor in the future? Are grafts taken from the "expanded" donor area in a young patient actually safe or will these thin in the future? 

For these, and other, reasons, many hair transplant doctors do not like to perform hair transplants on "young" patients. While cutoffs vary, many do not like to take patients under the age of 25 and others want to wait until their hair loss pattern has really revealed itself -- which can often take decades. 

My philosophy on young patients is a little different. I frequently perform hair transplantation on appropriate "young" patients as long as a few absolute "musts" are understood and accepted by the patient. If the patient is mature thinking and accepts the "long term" reality of hair transplantation at a young age and the potential for future surgeries up the road, I feel like they do quite well. 

In order to successfully undergo hair transplantation at a young age, I feel a patient must acknowledge and really feel comfortable accepting the following: 

1) We must start conservative with the hairline. 

Many young patients remember a very low, flat, immature hairline from only a few years prior. And sometimes it is hard to get them to understand that this is not advisable. If a young patient insists on rebuilding an immature hairline, I do not think they should have a hair transplant. However, if the patient understands that hair transplants are permanent and the hairline must "age well;" if they understand that starting conservative now will allow us to get coverage from front to back as they continue to thin and we can go lower later once things cool off and the majority of the scalp has been treated with hair transplants; and if they understand that the lower we go now, the more grafts we use in the front that we now cannot use in other areas, then I think they are good candidates. 

2) We must start with FUT 

Not to stoke the flames here at all, but I insist on starting all young patients as FUT. Not only is this the only way to truly maximize the amount of donor grafts available over a lifetime, but it is also the only way to really take continuously from the small true safe donor area (SDA) zone. We never know how these patients may thin up the road, and grafts taken from even slightly outside the safest part of the donor area may be susceptible to hair loss and fall out in the future. We need to maximize donor potential and only work where we absolutely know it is safe until these patients are older. Then we can usually augment with FUE. 

3) The patient must accept that he will very likely want/require more procedures up the road 

Androgenic alopecia is a progressive process and while hair transplants do thicken and restore thinned areas, the procedure does not treat the progressive hair loss. Patients who are thin enough to seek hair transplantation at a young age will likely continue to thin in the future. With a hair transplant plan "started" in one area, the patient will likely want more. We never design anything that would absolutely require a patient to have more surgery up the road, but chances are that you will want to address additional thinning regions at a later date. The patient needs to accept that this is likely not a "one and done" deal. 

4) We really should (maybe not "must") start in the front and work back

The frontal third (hairline, frontal scalp, and slight transition into the mid-scalp) is the most visible region of the scalp. It also is responsible for re-framing the face and really creating the appearance of thick, full hair from the perspective of how most of the world sees you (IE "front on" or from the sides). Furthermore, if this region is done properly the rest of the scalp can thin and still look natural. For these reasons, we really should address this area first in young guys. Many times younger patients are focused on the "bald spot" in the back, but starting in the front and working back if and when necessary creates the greatest cosmetic impact and prevents creating anything that may look unnatural up the road. 

To better demonstrate this philosophy, I want to share a case: 

The patient in this video is a young guy in his early 20's; he's in that transition between college and the rest of his life. He has aggressive thinning for his age and is likely to become a NW VI up the road. I discussed all of the above with him and he completely agreed and wanted to move forward. We did a 3,000 graft FUT and everything went very well. I saw him back at 6 and 12 months. The first video features an explanation of how I approach young patients (similar to what I wrote above) and a detailed 6 month result video. The second video is an update at 12 months. 

6 month results:

 

12 month results: 

As a final note: I do think all young patients considering hair transplant should do their research carefully. If you do it as out outlined above, I think you will be happy for many years to come; however, there are some potential "pitfalls" for younger patients. So do your research, ask your questions, and remember to start conservative and keep the long-term in mind. 

Hope everyone enjoyed the presentation. Look forward to the discussion. 

Dr. Blake Bloxham 

Feller & Bloxham Medical, PC 

[Lennney]

Great result. Did the patient mention anything about the persistent tuft of hair in the front? The likelihood of him loosing that tuft in next several years is very high: was it possible to have incorporated the tuft as a sort of "widow's peak" hairline? In a way that looks good as a hairline now, and again should he lose the tuft? Or was the tuft too far off center, and would not have worked as a natural hairline?

Life changing result regardless, great job!

[Dr Blake Bloxham]

Hi Lenney, 

Thank you for the kind words. 

I think you are referring to the area in the frontal hairline I started behind? I like doing this when possible. The patient has a standalone transplanted hairline built behind it. So if and when he does lose it, he will not have a hole or anything like that. It will just look like the center part of his hairline is a little higher and in line with the rest. And you can see it is miniaturizing and will likely thin completely -- leaving him with the scenario I described above. In the meantime, however, we can use it to his advantage as it adds extra irregularity to the hairline and takes advantage of those very fine singles which are often even softer than those we select for the frontal line during a transplant. It adds an extra degree of naturalness to the result. 

You could use this tuft as the starting height for the hairline. However, I think it may have been a little low for his specific case. In other patients, no problem; for him, however, we want to err on the side of caution and start high with the hairline. Once everything is settled, we could always do some more frontal work and bring this down to that level. But remember: you can always go a little lower with a higher hairline later, but it is very, very difficult to raise a hairline started too low -- not to mention the number of grafts used to create it that low which are much better spent elsewhere and may not survive the "raising" and redistributing process. 

 

[PlzRespond]

Great work that will likely help this young man get through his 20s with a good appearance of hair.

 

percentage wise, how much has this patients hair “popped” and also matured?

[Dr Blake Bloxham]

Hi Plz, 

Thank you for the kind words. He is very pleased with the results and I think the approach worked well and will continue to serve him well for many years to come. 

The second video was taken at 12 months, and I would say he is pretty well grown. In fact, he was a bit of an early grower. Probably almost everything has "popped" and he will likely only see small changes from here up through the 18th month mark (I think hair transplants really do continue to thicken up and mature through 18 months). 

[Sadlybalding]

Cool.

 

 

Edited April 26, 2019 by Sadlybalding

[AhmadF1284]

Very nice work and well written advice doc. 

[Matt J]

Very nice results