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? — L.H., Scarsdale, N.Y.
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.
Posted byQ: I heard that Rogaine only works on the crown and not on the front or top of the scalp. Is this true? — D.D., New Haven, Connecticut
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).
Posted byQ: 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? — D.W., Pleasantville, N.Y.
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 ensure that this will not occur – and coarse donor hair at age 22 does not ensure that it will not become fine over time. In fact, there is a significant chance that it will.
Since the hair restoration would require one or more large sessions, there is a risk that the donor scar(s) will not be hidden over time. If you had a widened linear donor scar from an FUE-strip procedure, you would need to grow your hair longer on the back and sides to cover it (if that is even possible). And this look of longer hair on the back and sides would not be a good one for a young person, especially if there was not enough donor hair to fill in the crown.
On the other hand, large FUE sessions leave a very wide band of small round scars in the back and sides of the scalp that can become visible if the anticipated permanent donor zone was not truly permanent and narrowed over time.
When we are younger, our decisions are often more emotion-based and impulsive. When one is older, and our tastes change, we may change our mind about having had surgical hair restoration, but the hair transplant, once performed, is not reversible.
Read about the Candidacy for a Hair Transplant
Posted byQ: 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. — M.H., Larchmont, NY
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.
Posted byQ: I am a 36 year old female who has been diagnosed with Chronic Telogen Effluvium. Although I do not have any bald spots yet my hair is much thinner on both of my temples as well as in the back of my head. Is a hair transplant an option for me or am I just going to shed the new hair as I am shedding my current hair? — R.K., Providence, R.I.
A: Since Chronic Telogen Effluvium is a generalized condition, it is not amenable to correction by a hair transplant. The reason is that there is no stable area to take donor hair from. Chronic TE is generally self-limited, so try to be patient.
Posted byQ: Over the years, I have worn my hair in braids and extensions. My hair is not growing at my hairline and temples. Can the braids be the cause and can this be treated with a hair transplant? — Williamsburg, Brooklyn, NYC
A: The name for hair loss is this area is called alopecia marginalis. It is almost invariably caused by continued traction from braids or hair extensions. When this is the case, the condition is also called traction alopecia. If the problem is long-standing, the hair will rarely come back, even if the braiding is stopped, and a hair transplant would be indicated.
If there is enough hair loss on the sides of the scalp that the donor supply is significantly reduced, surgical hair transplantation may not be possible.
Posted byQ: I’m currently 24 years old. Ever since turning 20, my hair on top began to thin little by little. I have noticeable thinning on the top part of my scalp and on my crown, but have no recession at the temples. My hairline looks amazingly young and hair on the donor areas seems quite thick. Am I in the early stages of male patterned baldness? I cannot place myself in the Norwood scale since my thinning doesn’t seem to follow the classic pattern. I just started on Propecia. Should I be considering a hair transplant? — B.R., Landover, MD
A: From the description, it sounds like you have typical Diffuse Patterned Hair Loss or Diffuse Patterned Alopecia (DPA). In this condition, the top of the scalp thins evenly, the donor area remains stable, and the hairline is preserved for a considerable period of time. Please see: Classification of Hair Loss in Men for more information.
Propecia would be the best treatment at the outset. When the hair loss becomes more significant, patients with DPA are generally good candidates for surgical hair restoration. It is important, however, that your donor area is checked for miniaturization to be sure that it is stable before a hair transplant is considered.
Posted byQ: If my hair is just starting to thin, when should I have my first hair transplant? — T.O., Bayonne, NJ
A: It is best to wait until at least 25 before considering hair transplant surgery, although there are exceptions. The most important thing is to wait until you have hair loss that is a cosmetic problem. A hair transplant is a treatment for hair loss — it should not be used as a prevention. When hair loss is just starting, medical therapy is generally a better choice than surgery as it can both regrow hair and prevent future loss.
This issue is detailed in the publication Follicular Transplantation: Patient Evaluation and Surgical Planning.
Read our page on Hair Transplants in Young Patients
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