Why Hair Transplants Are Not Advised for Young Men, and Cannot Provide Full Scalp Coverage

Why Hair Transplants Are Not Advised for Young Men, and Cannot Provide Full Scalp Coverage


Thank you for
your question. You state in your question that you are on
the edge of getting a hair transplant. And that you don’t want to take finasteride. You
don’t want to take a drug for the rest of your life. And that you have observed results
of people who have gotten hair transplant without finasteride which appeared to be impressive.
Further, you have submitted photos of your father’s scalp to ask whether or not he
were to get full coverage without taking finasteride if he were to undergo hair transplant. And
I think this is the basic gist of your question essentially, can you get a hair transplant
without taking finasteride. Certainly, I can share with you what is the
important information that I discuss with my patients when it comes to management of
hair loss. And I think this is a key to understanding. Hair loss is managed and no matter what, you’re
not necessarily in any way considering a cure but what you want to do is get the best appearance
that works for the look that you want to achieve. A little bit of background, I’m a Board-certified
cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I have
been in practice in Manhattan and Long Island for over 20 years. I am also the founder of
TrichoStem™ Hair Regeneration Centers. The is a system that we developed to non-surgically
treat men and women with androgenetic alopecia or genetic pattern hair loss which makes 95%
of hair loss patients. I think, first to answer the question about
your father’s scalp, I think that in every hair transplant consultation, the discussion
is pretty similar. The goal is for transplant not to cover the entire scalp because there’s
intrinsically a mismatch. Whether it’s with an FUT or FUE, you have a limited area of
harvesting from the donor area at the back of your scalp. Yes, you can get body hair
transplant but let’s stick with just that. The top of the scalp has way too much surface
area for you to be able to cover everything. So doing transplants for as long as I have,
I always discuss with my patients essentially the goal which is to frame the face, to create
essentially a frontal hairline as well as coverage to the mid scalp to get a natural
transition. But what does hair transplant not do? It does not do anything to the progression
of hair loss. Now speaking to your concern, even though
you didn’t submit a photo, if you’re 21-years-old and you’re on the edge of having a hair
transplant, it might be fair to conclude that you are losing hair at a relatively aggressive
pace and that speaks to many issues about the feasibility of hair transplant. Essentially, it has been generally a standard
amongst hair transplant surgeons to limit or avoid doing surgery in men under 30. Why
is that? Well, when it comes to hair loss, if you have an early onset and a relatively
rapid rate of progression, then the hair transplant is not likely to keep up with your rate of
progression. The typical ideal candidate for hair transplant in my opinion is a middle
aged man with a later onset of hair loss who has more of a frontal balding progression.
So basically, they have a later onset, a slow rate of progression and they need hair in
the area in the front where a transplant can be placed and their rate of progression is
relatively slow which means that they may or may not choose to take finasteride but
they will appreciate and get the benefit for many years. Hair loss will still progress
but that is in contrast to a younger person who has an early age of onset, rapid rate
of progression and more advanced loss. This is not somebody who is an ideal hair transplant
candidate. I think it’s very important to understand that there is no cure but there
are strategies to manage hair loss. So when I meet a patient who is in their 20s
and we have this discussion everyday in our practice, we treat patients with Hair Regeneration
from around the world. And briefly, this is a system we developed out of helping patients
with hair transplant. The challenge with hair transplant has always been getting really
effective coverage, getting the survivability of the grafts to be maximum as well as minimize
scarring. But with transplant was always the challenge of maximizing the longevity of the
appearance and that meant encouraging our patients to take finasteride to slow down
progression. It is my perception that although finasteride
may be more effective for some people compared to others, a lot of this has to do with really
the specific genetic pattern and relative aggressiveness as well as relative sensitivity
to DHT. So arguably, someone who has later onset has lower DHT sensitivity than someone
who has an early onset. It’s not exactly always black and white like this but it’s
a good framework to decide how to manage a person who has hair loss. So a lot of our younger patients, I will talk
to them about considering taking finasteride. I provide them the clinical information that
is relevant and not just what is the information that is more popular in the internet as well
as a strategy for Hair Regeneration treatment. Essentially Hair Regeneration treatment is
an injection treatment combining platelet-rich plasma (PRP) with Acellular matrix based on
algorithms I’ve developed over the past 7-8 years. And those algorithms are based
on gender, age, age of onset, rate of progression, degree of progression and other medical factors
in terms of dosing, timing and placement of this injection. However, I would uniformly
say that most younger people, I would have this discussion about finasteride. Patients
will choose whether or not to take the drug but it is part of that discussion. Hair loss is progressive. Everybody eventually
loses hair with rare exception but it essentially depends on when that hair loss begun and how
aggressively it progresses in determining who is a good candidate for transplant and
who isn’t. Even people who have a later onset, if they have a more diffuse thinning
pattern, they’re not going to be a great candidate for transplant. Like I said, the
ideal candidate from my perspective is a middle aged man with frontal balding. That is the
ideal candidate. When you talk about your dad’s situation, yes I would still encourage
someone with that hair loss pattern to still consider finasteride but it is a different
rate of progression compared to a younger person. So I think it’s important that you learn
all this. Do some consultations. Figure out what works best for you. I’ll tell a lot
of our patients who are in their 20s that before you think about taking a pill for the
rest of your life, understand that a lot of people and being in practice for over 20 years,
I can tell you this from experience that a lot of men may think that hair is important
to them in a certain stage of their life. But as they get older, they may consider it
less important. It’s a personal decision. So I’ll say that if you are committed to
managing your hair loss, well it probably makes the most sense to use every tool you
can and not just ignore something. Now people who are more middle aged and have a later
onset, they have a little bit more breathing room but there is also typically less of an
urgency related to their situation compared to younger people. So I hope that was helpful, I wish you the
best of luck and thank you for your question.

5 Replies to “Why Hair Transplants Are Not Advised for Young Men, and Cannot Provide Full Scalp Coverage”

  1. Sir I am losing hair due to change in environment, especially nutrition. The food I currently have access to is very bad and I've been eating this food for nearly an year and in that period I lost a lot of hair. Can this be reversed with good nutrition?

  2. Is it mandatory to use finasteride after fue? Will the transplant fail (i mean will the hair not grow?) if the patient does not take finasteride?

  3. could regular prp Treatments replace finasteride ?.
    because i heard about the side effects of finasteride and i don´t want to take the risk even if it helps with hair loss progression

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