question for all hair transplant doctors

[stillhere]

I was wondering of all the doctors that visit and reply on this site, what is the youngest age of an individual that you would perform on, in any case of a NW 2 to a NW 7?

[stillhere]

I was wondering of all the doctors that visit and reply on this site, what is the youngest age of an individual that you would perform on, in any case of a NW 2 to a NW 7?

[Guest]

Stillhere:

All cases are different and need to be evaluated on an individual basis. That said, I feel you can safely transplant young men in their twenties, as long as you stay with a conservative frontal forelock approach. That means not planting the temporal recessions. This obviously excludes any NW2 and most NW3 cases. Also, I would not transplant a young man's vertex (crown).

The reason for this approach is to ensure that if a young man experiences extensive loss in the future a frontal forelock pattern can stand on its own or easily be augmented.

This approach excludes many young men, as often they want to plant the temporal recessions, which can lead to an inappropriate hairline as they mature. You have to remember that what is done today, you have to live with forever. My goal is to help young men avoid this mistake and wish they had never had a transplant. Sometimes you have to just tell a patient transplantation is not appropriate.

Wrapping this up, I fell appropriate candidates who are young should be at least a NW3A. They also should be thoroughly counseled regarding what future loss might mean to them and encourage them to make medical management a part of their overall treatment plan.

Brad Limmer, MD/jac

 

Dr. Limmer

[Dr. Michael Beehner]

I would agree with everything Dr. Brad Limmer said. The problem with a young man in his early 20's is that it almost doesn't make that much difference whether or not he is a Norwood III (receding and/or early crown thinning) or VI ("U"-shaped baldness on top), because you still don't know how bald the patient before you will be in 20 years. Any miscalculation or bad assumption on the hair surgeon's part could result in a very unhappy patient when he reaches his late 30's or 40's. As Dr. Limmer said, a "forelock" type of transplant, with a gradient inward toward its center is the only proper way to transplant a man in his younger 20's. I try very hard not to transplant young men under the age of 23, as the pace of hair loss can be awfully rapid and accelerated during this period from 19-23. It can also accelerate after 23 too, of course, but if a man over 23 is losing the framing of his face and wants it restored, I don't think it's fair to deny him a forelock type of framing, which can be modified later to "stand alone" and look natural, regardless of what occurs later on.

I also try very hard to put all young men on Propecia or Proscar, but I'm not sure the surgeon really is that much smarter 3-4 years down the line than he was when he first interviewed the patient at age 21 or 22, because the Propecia "masks" the normal hair loss that these patients will have and actually increases the hair mass in around half of the men taking it. The main advantage for holding off on transplanting and using medical therapy is probably to allow the young man to get a little older, a little wiser and more mature, so that he might be more likely to accept a more conservative "forelock" type of approach. There are a few men in their 20's in whom their hair loss is akin to a stampede of buffalos and Propecia only slightly slows down the pace of hair loss, and it's nice to have the luxury of those 2-4 years to see if a given young man is one of these.

Mike Beehner, M.D.