Hair transplant surgery is generally not advised for patients younger than 25 with androgenetic alopecia (male pattern baldness) for these reasons:
- In a young person, one cannot tell if the donor area will be stable over time. If the donor area is not stable, then there may not be enough permanent hair to transplant.
- The earlier one’s hair loss begins, the more extensive it will likely become.
- With extensive hair loss, the demand for hair may exceed the donor supply and, therefore, the coverage that would be possible with a hair transplant would not be enough to satisfy a young person (whose goal is generally a full head of hair and a low hairline).
Predicting Donor Area Stability
The donor area is the zone on the back and sides of the scalp where hair follicles are normally genetically resistant to the “miniaturizing” effects of the hormone dihydrotestosterone (DHT). This DHT resistance typically preserves hair on the back and sides of the scalp, even while the front and top of the scalp bald. In some patients, however, follicles in the donor area are not totally resistant to DHT and their donor area thins as well, making it a poor source of hair for hair transplant.
In a young person, particularly under 25, it is very difficult, if not impossible, to accurately determine the stability of the donor area, i.e. to determine which, if any, follicles will be resistant to DHT over the long-term.
If a surgeon performs a hair transplant on a young patient who has an unstable donor area, the transplanted hair would likely disappear over time and the cosmetic benefit of the transplant would be lost. The thinning donor area could also reveal either the linear scar of FUT or the small round scars of FUE.
A young person, anxious to have a hair transplant, may express the following rational for surgery: “If my hair transplant fails, I’m no worse off than before, and I can just shave my head and I don’t think that I will care as much when I am older. This logic is flawed, however, because scarring from the transplant, whether from FUT or FUE, would be noticeable when the head is shaved and people rarely stop caring about their hair.
For patients younger than 25, it is generally recommend to postpone the decision to have a hair transplant until the stability of the donor area can be more accurately predicted and we are sure that the hair restoration procedure will be successful.
Early Hair Loss Usually Means More Extensive Balding
Generally, the younger one begins to lose hair, the more likely the hair loss will become extensive. With a high probability of extensive hair loss in the future, the doctor needs to take into consideration the aesthetic consequences of a transplant in a patient that may become very bald.
Often, a young patient will want to fill in the “power alleys” that appear when hair recedes at the temples. If a surgeon were to fill in the temples, a substantial amount of hair would be needed so the density of the transplanted hair would match the density of existing hair. As the patient would continue to bald in the center, the densely transplanted hair in the temples would stand out as two permanent “horns”. Hair transplanted in the crown would create the same problem. The density required to fill in the crown would result in a “ponytail” as the balding crown area would continue to expand around the area of transplanted hair. With advanced baldness, there may not be enough donor hair to connect these areas together, so the result will be a very unnatural look.
Similarly, transplanting hair to bolster a low (adolescent) hairline runs the aesthetic risk of creating a hairline that looks artificially low when the remainder of the scalp continues to thin. Fortunately, some hair loss in the temples is normal for a person in their mid- to late 20s as this represents the progression to a mature male hairline.
In a person with significant hair loss, there is usually only enough donor hair to replace hair on the front and top of the scalp, but not the sides (temples) or very back of the head (crown). This look is fine for a person in their 30′s or 40′s who is losing hair, but for someone in their 20s, having a thin or bald crown may make their appearance noticeably worse and it might be better to just wear their hair shorter rather than have partial coverage.
Medical therapy with finasteride (Propecia) is the most reasonable course to consider for patients with early hair loss. The combination of finasteride (Propecia) and minoxidil (Rogaine) have the ability to stop and potentially reverse the balding process for many years. It is most beneficial in younger patients who start the medication as soon as there are definite signs of hair loss, because it works better to thicken existing hair rather than to grow hair once it has been lost.
Summary
It is best not to have surgical hair restoration too early. By having a hair transplant at a slightly older age, the pattern of your eventual hair loss will be easier to determine and your expectations may be closer to what can realistically be accomplished. In the meantime, medical treatment may be the most appropriate option.
