Q: I had a facelift about a year ago and the skin on the sides by my temples is really bare. It makes the scar a little obvious too. Can you transplant hair just at the temples to cover the scar?
A: Hair loss in the temple area following a facelift is relatively common and can be treated with a hair transplant. If there is scar tissue, the hair restoration will generally require more than one session.
Q: I heard that Rogaine only works on the crown and not on the front or top of the scalp. Is this true?
A: Rogaine (Minoxidil) has the potential to work where ever there is miniaturized hair, either the front, top or crown (however, it will not work in areas that are completely devoid of hair).
The reason for the misconception that it will not work in the front is because the clinical trial performed by Merck in the 1980’s, that led to FDA approval, only studied the vertex (crown) and thus the company was limited to this labeling. Several years later, Merck realized that this was a misjudgment in the design protocol and ran a new study (approximately one fifth the size of their Phase III vertex trial) to document effectiveness of the drug in the front of the scalp. This allowed them to avoid the vertex restriction in their label.
Another reason for the confusion is that since the hair in the crown seems to have a longer miniaturization phase than hair in the temples, there is a greater window of time in which the medication can act on these hairs. This goes for both minoxidil and finasteride (Propecia).
Q: I am in my early 20’s and I was told my hair loss pattern is a Norwood Class 6, on its way to becoming a Class 7. My hair is brown in color and medium to coarse and I was told I have high density in my donor area. Although I was told I could have hair transplants, do you think that I should based upon what I have told you?
A: The main concern I would have is that when someone is already a Class 6 by their early 20’s, he may eventually be left with only a very thin see-through fringe as he ages. A high donor density now does not insure that this will not occur – and coarse hair at 22 does not insure that it will not become fine over time.
Since the hair restoration would require one or more large sessions, there is a risk that the donor scar will not be hidden over time. If you had a widened donor scar, you would need to grow your hair longer on the back and sides to cover it (if that is even possible).
This may not be ideal for a younger person who would have otherwise been able to wear his hair short, and now would not have that option. Regardless of the maturity and good judgment you may feel you have now, your thinking may change as you age.
Hair transplants should generally not be performed in those under 25 because:
Q: My hair is receding in the front corners and I have a spot in the crown. I am 22 years old. I’ve been thinking of hair transplants for the past few years and I am 100% sure I want to take this step. I don’t go anywhere without my hat. I hate it. Should I consider hair transplants now?
A: We generally do not consider hair transplantation until a person is at least 25. There are a number of reasons why hair transplants are not indicated in someone younger than this.
When hair loss starts at an early age, the pattern is unpredictable and the hair loss has a greater chance of being extensive in the future. Also, the permanency of the donor area cannot be determined (see the Diffuse Unpatterned Alopecia (DUPA) page on the Bernstein Medical – Center for Hair Restoration website).
If hair loss is going to be extensive, then the best that one can expect from a hair transplant is to replace hair on the front and top of the scalp. There would usually not be enough hair to fill in the temples or the crown. This look is fine for a person in their 30’s or 40’s who is losing hair, but having a thin or bald crown is not generally acceptable for someone in their 20’s.
Hair transplants are more efficient if performed in relatively large sessions. Multiple, small incisions in the back of the scalp (either by Follicular Unit Transplantation (FUT) or Follicular Unit Extraction (FUE)) consume more hair than when the hair is harvested through a single incision. In addition, when hair loss is early and there is a lot of miniaturized hair in the area to be transplanted, the hair transplants can actually accelerate hair loss in the area in the vicinity of the procedure.
If one were to try and fill in the temples of a young person, a substantial amount of hair would be needed so that the density of the transplanted hair would match the density of the surrounding (already existing) hair. As the person continued to lose hair in the center, the densely transplanted hair in the temples would stand out as two permanent “horns” of hair. Hair placed in the crown would create the same problem, as enough density to satisfy a young person would result in a pony tail as the hair loss in the crown progressed and the bald area expanded around the transplanted area. With advanced baldness, there may not be enough donor hair to connect these areas together, so the result will be a very unnatural look.
In the adult male, the frontal hairline is normally recessed at the temples, so this should not be restored unless the patient’s donor density is very high and the ultimate hair loss pattern limited – two conditions that cannot be determined when a person is young.
On the other hand, medical therapy with finasteride (Propecia) can be very effective in early hair loss by possibly growing some hair back and more importantly by slowing or halting the balding process for many years. The sooner the medication is started the more useful it is, because it works far better in preventing hair loss than bringing it back once the hair is gone. Unfortunately, it will not grow hair back in the temples if this area is completely devoid of hair. Medications work by reversing the miniaturization process, so there must be some existing hair in the area for it to act on.
In sum, it is best to wait until you are a bit older before considering surgical hair restoration. By having hair transplants at a slightly older age, your expectations may be closer to what can actually be accomplished, and your eventual hair loss pattern will be easier to determine. In the meantime, medical treatment with Finasteride, is a good option.
Q: I am a Caucasian female that has experienced hair loss on the sides of my head from the height of the eyebrow to the ear due to traction. The hair loss has been present since my teen years. My job requires me to wear my hair up most of the time. Although I don’t wear it nearly as tight, I seem to continue to lose my hair in the front and on the top of my head. My hair also used to be very thick as a child and is now quite thin. I’m not sure if this is normal or something else is going on, but I am definitely interested in a hair transplant.
A: It sounds like you are experiencing continued traction alopecia. Unless the underlying cause is corrected (the traction), you can expect to continue to lose your hair. People that have traction alopecia can have thinning even from mild pulling that might not be a problem for others. Once you stop the pulling, it can take up to two years for the hair to return, although there may be permanent hair loss.
Surgical hair restoration is the treatment of choice for permanent hair loss from traction. If you have significant thinning on the sides, you may not be a candidate for hair transplantation since in this procedure we often need to harvest hair from the permanent area in the sides of the scalp as well as the back.
An additional problem (that you allude to) is that you may have underlying female pattern hair loss. This would further complicate the surgical treatment.
A careful examination (including densitometry) can sort these problems out and allow for more specific recommendations.
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Disclaimer: The purpose of the Hair Transplant Blog is to provide the public with general information on hair restoration. Information provided on this site should not be used for medical diagnosis and/or treatment.
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