Posts Tagged: Norwood Class 7 Hair Loss

Should Young Person Start with Hair Transplant at Crown?

August 21st, 2007

Q: I am 26 years old, have had two successful hair transplants, but am still losing hair in the crown area. The doctor I have worked with told me that he does not do crown work on anyone until they are at least 40 (due to lack of donor area). I have very thick hair and the transplanted area looks as if nothing was lost. Would you do work on someone my age in their crown area if they have enough donor hair?

A: Although I am hesitant to start with the crown when transplanting a younger person, if you have good coverage on the front and top of your scalp from the first two sessions then extending the hair transplant into your crown may be reasonable.

It depends upon your remaining donor supply and an assessment of how bald you will become. I would need to examine you.

If it is likely that you will progress only to a Norwood Class 6, then transplanting your crown can be considered. If you will progress to a Class 7 then you should not since, in the long term, hair that was placed in the crown might be better used for other purposes, such as connecting the transplanted top to receding sides.


Posted by Robert M. Bernstein M.D. at 8:31 am

Can Hair Transplant Treat Early Hair Loss for Person in Early 20s?

April 4th, 2007

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:

  • Very short hair/or a shaved head can be an acceptable look
  • Receded temples and a thin crown is not a good look for a young person
  • When hair loss begins at a young age, the course is unpredictable and will more likely than not result in extensive hair loss
  • Young persons tend to have worse/more stretched scars than older patients
  • When we are younger, we generally tend to think more short-term
  • When we are younger, our decisions are often more emotion-based
  • When you get older, you may change mind about having surgical hair restoration, but the hair transplant procedure, once performed is irreversible.

Posted by Robert M. Bernstein M.D. at 10:39 am

Hair Transplant Starting with Crown?

October 5th, 2005

Q: What are your thoughts on performing a hair transplant to the crown first?

A: It depends upon the person’s age, how bald he is likely to become, and the donor supply.

As a general rule, the crown should not be transplanted in a younger person (under 30) as the extent of his balding is hard to predict and crown thinning at this age often suggests that the person will become at least a Norwood 6.

If a person has enough donor hair (i.e. good donor density) and scalp laxity, so that coverage of the entire bald area can be accomplished if the patient becomes a Norwood class 6 (and it is unlikely that he will become a Class 7), then transplanting the crown before the front is reasonable.

If a person has a family history of baldness limited to the crown, even at an advanced age, and the person in question is following this pattern, then earlier treatment of the crown may be considered.

Lastly, if you do treat the crown in a younger person, or one with whom the extent of hair loss is uncertain, the crown should be transplanted with light coverage only. That way a limited amount of hair will be used up in this area and there will be enough left over for the more cosmetically significant top and front of the scalp.

For a complete review of this topic please read: Follicular Transplantation: Patient Evaluation and Surgical Planning. Dermatol Surg 1997; 23: 771-84. A copy in PDF format, and other hair transplant publications, can be downloaded at the Bernstein Medical – Center for Hair Restoration Medical Publications page.


Posted by Robert M. Bernstein M.D. at 1:43 pm






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