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.