HT planning in a younger patient

[Guest]

If a young guy (under 25) has advanced hairloss, say a NW 3 or above, it can be typically assumed that he will progress to a NW 6 or 7. If he chooses to do surgery to restore a NW 3 hairloss pattern, then he will probably run out of donor hair as his hairloss progresses. Correct?

 

So, if a younger patient goes into his HT's with his doc with the idea that he will progress to a NW 7, could he still proceed with HT surgery? By creating a thin look in the current bald areas with a high hairline, he would still have some donor hair remaining when he needs more procedures as his hairloss continues. If he does indeed progress to a NW 7, he obviously wouldn't have enough hair to restore a full head, but wouldn't he have enough to create a thin head of hair over the front half of the head? at this point, he wouldn't look "great" after all is said and done, but he would at least look natural. If he doesn't progress to a NW 7 when he gets older, then he'd still have enough donor to go back and create more density and have a relatively more full look. Would this plan work? Would this be considered going with a conservative approach? If he does progress to a NW 7, would he still look natural? I know there wouldn't be a ton of hair on top, but wouldn't there be enough to brush and make you look younger?

[Guest]

If a young guy (under 25) has advanced hairloss, say a NW 3 or above, it can be typically assumed that he will progress to a NW 6 or 7. If he chooses to do surgery to restore a NW 3 hairloss pattern, then he will probably run out of donor hair as his hairloss progresses. Correct?

 

So, if a younger patient goes into his HT's with his doc with the idea that he will progress to a NW 7, could he still proceed with HT surgery? By creating a thin look in the current bald areas with a high hairline, he would still have some donor hair remaining when he needs more procedures as his hairloss continues. If he does indeed progress to a NW 7, he obviously wouldn't have enough hair to restore a full head, but wouldn't he have enough to create a thin head of hair over the front half of the head? at this point, he wouldn't look "great" after all is said and done, but he would at least look natural. If he doesn't progress to a NW 7 when he gets older, then he'd still have enough donor to go back and create more density and have a relatively more full look. Would this plan work? Would this be considered going with a conservative approach? If he does progress to a NW 7, would he still look natural? I know there wouldn't be a ton of hair on top, but wouldn't there be enough to brush and make you look younger?

[Dr. Michael Beehner]

Dear Steven62,

You pretty much answered your own question quite nicely. The answer is "yes," a man in his mid-20's can be transplanted, but usually only in a very conservative way, and, hopefully, with the person also on finasteride medication (Propecia or Proscar).

When a young man presents to me (or one of any age, for that matter), if I see the outline of a border shaped like a "horseshoe" on top, within which there is a demarcation of thinning or what we call "miniaturized hairs" within that area, then I assume that they are eventually going to go on to become at least a Norwood VI pattern of baldness some day (this is complete balding on top, with high fringes). In these young men, I prefer to do what we call a "forelock" design, which features an oval area of increased density in the front-center of the scalp, with finer grafts to the sides, blurring the space between the central area and the side fringes, so that it looks natural. We generally stay out of the rear vertical vertex (crown) in men of younger age. I try very hard not to transplant men under

the age of 23. I hope that helps in answering your question.

Mike Beehner, M.D.

[Guest]

Yes it does, thank you. any more comments are welcome!

[Guest]

Steven62:

HT in a young patient always needs to be approached in a conservative fashion. In the scenario you describe, I would counsel the patient extensively about probable future loss and the need for aggressive medical management to prevent as much loss as possible.

Regarding surgery, if the patient fully understands what can and cannot be accomplished, we could proceed with a frontal forelock transplant. No work would be done in the temporal recessions. This approach would keep us in a position that we could easily address future loss, even if it progresses to a pattern 6 or 7.

A forelock pattern can stand on its own even if he progresses to a pattern 6 or 7. This pattern occurs naturally, so we are just mimicking a natural pattern. If a patient desires additional restoration, a Norwood 3 could also be done. The density/volume of the transplant would depend on the patient's hair quality and remaining donor. But a pattern 3 could be accomplished.

Brad Limmer, MD/jac

 

Dr. Limmer

[bigboy]

i am currently 26yrs old and began losing my hair when i was 20yrs old. i've been currently taking propecia for about 1yr now but i think my hair is still thinning out.i also recently began incorporating minoxidil twice daily for my crown area. my question is safe to up the dosage to 1 1/2 mgs per day. i recently bought a pill cutter to do so. my stats are 5-10'' and about 215lbs. my goal is to stop the hair loss and possibly get a hair transplant.