Preventative Transplants vs. Restorative Transplants

[FUEgetaboutit]

I wanted to get people's opinions and, if you've got 'em, experiences with two different styles of hair transplants I've noticed. Let me try to illustrate with an example:

Say you've got a receding hairline and you're thinning on top. The thinning isn't so bad, but it's obvious you're likely going to lose a decent amount of hair there in the future. However, what's really bad is the recession. It's really nasty. Here's where the two methods differ:

Restorative transplant:
This is pretty much what every HT doc does. They'll fill in the parts that are totally bald or thinning pretty noticeably. These docs WON'T go into the thinning-but-not-so-bad areas on top out of fear of provoking shock loss, or because they think it's poor planning to fill in an area the future appearance of which is just not clear at this point.

Preventative transplant:
A lot of HT docs either discourage this and some just outright won't do it. This involves going into the thinning-but-not-bad areas and restoring their density to the natural area's density. If and when you lose the surrounding natural hairs in the transplanted areas, you won't have a really bad balding phase there. It may look thin later on in life, but never straight-up bald.

Here's me, as an example. I've had some docs (including @Blake Bloxham) suggest a preventative transplant and some docs advising against it, only focusing on the balding or bald areas at the edges. I like the idea, as I'm sure I'm going to lose more hair in the future. It doesn't look bad when it's grown out, but I really don't want to go through that ugly balding phase.

Anybody with any experience with either have any pros or cons for each? Did you wish you had done the other type instead at any point?

[Melvin- Admin]

I think reinforcing the forelock is a good idea, but you should be on finasteride. In the event of shock loss, you’ll need the hair healthy enough to return. Otherwise, you’ll end up with net gain, or slightly worse. 

The issue with not reinforcing the forelock, is you may end up with horn like hairs if the forelock starts to go. 

[FUEgetaboutit]

Yeah, I definitely don't want the horn hair thing. Though the one thing I'm considering is that maybe if it starts to thin a bit more in the forelock after transplanting the receded parts, I can get away with styling my side hairs to hide the thinning. Then I can fill in those parts with new transplants. I'm not thrilled with that idea, though.

I am taking finasteride at this point to help soften the blow of any shock loss. Minoxidil, too.

[Melvin- Admin]

Overall, best strategy in my opinion is to reinforce the forelock. 

[Gabreille Nelson Mukhia]

3 hours ago, FUEgetaboutit said:

I wanted to get people's opinions and, if you've got 'em, experiences with two different styles of hair transplants I've noticed. Let me try to illustrate with an example:

Say you've got a receding hairline and you're thinning on top. The thinning isn't so bad, but it's obvious you're likely going to lose a decent amount of hair there in the future. However, what's really bad is the recession. It's really nasty. Here's where the two methods differ:

Restorative transplant:
This is pretty much what every HT doc does. They'll fill in the parts that are totally bald or thinning pretty noticeably. These docs WON'T go into the thinning-but-not-so-bad areas on top out of fear of provoking shock loss, or because they think it's poor planning to fill in an area the future appearance of which is just not clear at this point.

Preventative transplant:
A lot of HT docs either discourage this and some just outright won't do it. This involves going into the thinning-but-not-bad areas and restoring their density to the natural area's density. If and when you lose the surrounding natural hairs in the transplanted areas, you won't have a really bad balding phase there. It may look thin later on in life, but never straight-up bald.

Here's me, as an example. I've had some docs (including @Blake Bloxham) suggest a preventative transplant and some docs advising against it, only focusing on the balding or bald areas at the edges. I like the idea, as I'm sure I'm going to lose more hair in the future. It doesn't look bad when it's grown out, but I really don't want to go through that ugly balding phase.

Anybody with any experience with either have any pros or cons for each? Did you wish you had done the other type instead at any point?

I think both the approaches make sense. The restorative would be more suitabke for people who take finasteride. The existing hair do thicken up with finasteride. The preventive transplant is usually adopted by people who don't take finasteride. However, with the native hair gone, the transplaned area will look the same or worse in the long run.

[Rolandas]

General idea of Hair Transplant is to reconstruct what's being lost. Medication are for preventing further loss. Any good surgeon would suggest to hop on finasteride for certain time before surgery to see how well you're doing with it as well as to see what it can do for you.

As @Melvin-Moderator said, your hair has to be strong enough to prevent permanent shock loss. It would be counterproductive to do it otherwise. You would get new grafts by destroying native ones.

It's possible to get it done with diffuse thinning pretty well, as a matter of fact lots of great surgeons do amazing job by going in between, but you should always remember there can be a "side effects" as shock loss.

I personally decided not to go into miniaturised area and give medication at least a year and instead fill in only bald area. On my second round I would go to that area and do HT as I've done my best to help native hair. If they won't get stronger - nothing much I can do, if they will - great.

Remember, surgery is the last resort, so should be your approach to it.

[FUEgetaboutit]

Thanks for the thoughts, everyone. Anyone have any experiences with a preventative-style surgery? Any regrets? Anybody wish they had done a surgery like that?

I'm leaning more heavily towards preventative. I understand that finasteride typically works very well, but I figure a preventative surgery is the best method for someone who wants to ensure he doesn't go through an ugly balding phase. If I stay on finasteride, it may keep my hair looking good enough for the rest of my life, but there's a not insignificant chance that it'll yield to worse balding down the line. A preventative surgery seems like a costly and extreme, sure, but likely very effective solution. I know it's a last resort, but the odds are too good for me (even if they're relatively small) that my balding is going to progress.

[ciaus]

For prevention I would confine it to the hair line on the top and temples that frame your face -but when it has receded enough that you have something mature, don't want a young man's hairline your whole life.  For the middle and crown areas, depending on how aggressive your loss is, and hair style/type/color you may be able to use concealers like dermatch, toppik to delay having procedures for years, minimizing the total you have over the course of your life. And they would cost you less because you would be getting more grafts done per procedure. And if your loss turns out to be more aggressive down the road you can be more strategic about using your remaining donor.