Q: Does donor area hair thin with age? – T.W.
A: Hair taken from the donor zone is considered to be permanent and should resist changes related to androgenetic alopecia also known as genetic patterned baldness. In other words, it will not be lost. Through the natural aging process, hair diameters may decrease over time making the donor area appear thinner.
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Dr. Bernstein was featured in a wide-ranging interview published in the New York City-based, Japanese language magazine NY Japion. Among the topics discussed were the differences between FUT and FUE hair transplants, updates on robotic hair transplant technology, the type of procedure most beneficial for Asian patients, criteria that determine candidacy for a hair transplant, and more. Below are some selections from the interview.
On FUT vs FUE:
FUT is more economical than FUE and also more beneficial for patients who wear their hair longer. However, if your plan is to have the option of wearing your hair short, FUT is not for you. That is because with FUT you will have a fine linear scar after the donor area (the area where strip is removed) is sutured, and this may be seen visible with short hair.
On robotic FUE hair transplantation and the ARTAS Robot:
In the case of ARTAS, an advanced camera system and a computer analyzes images of the scalp and calculates angle and direction of individual hairs, hair density and number of hairs in each follicular unit instantly. Then, based on that calculation, the computer controls the punch so that it goes into the skin at the right angle and depth so that it will not damage hair root and/or surrounding tissues. So far, 135 systems of ARTAS have been installed worldwide. About half of them are in the United States and 11 are in Japan. Currently, 5% of hair transplant treatments are performed with ARTAS worldwide.
On which type of hair transplant is more beneficial for Asian people:
FUE is especially good for Asians, including Japanese. With Asians, scars tend to widen. In addition, Asians usually have coarse hair that grows more perpendicular to the skin than in Caucasian scalps, so a linear scar in the donor area (using FUT) may be more visible — especially if the hair is worn short.
On who is a good candidate for a hair transplant:
Some people are candidates for hair transplantation, but some are not. Since a hair transplant uses a patients’ own hairs and relocates them from the permanent zone in the back of the scalp to areas that are thinning or bald, it is necessary that patients have good and sufficient hairs for that.
On the appropriate age to consider hair transplant surgery:
Hair transplants are not for young people since their future balding is so difficult to predict. Young patients should not consider hair transplant as a technique to prevent hair loss. Prevention is best accomplished by medications. The most effective are Propecia (finasteride) and Rogaine (minoxidil). These medications do have some side effects that need to be considered before starting. In general, hair transplant surgery should not be performed for people under 25. There are exceptions, but I prefer for patients to wait until 30 and over.
Dr. Bernstein’s wife Shizuka Bernstein was born in Tokyo, and the two travel to Japan frequently. Shizuka is a master-aesthetician and owns an award-winning day spa by Rockefeller Center in New York City called Shizuka NY. Shizuka developed her own line of skin-care products based on powerful natural anti-aging ingredients and pure Mt. Fuji spring water. She has been seen on CNN, CNBC, Fox News, The Today Show, The Early Show, CBS’s The Doctors, and E!’s red carpet special leading up to the Primetime Emmy Awards.
Posted byQ: What is the problem with transplanting the crown too early? — P.L., Newark, NJ
A: If a person’s hair loss continues – which is almost always the case – the crown will expand and leave the transplanted area isolated, i.e. looking like a pony-tail. The surgeon can perform additional hair transplant procedures to re-connect the transplanted area to the fringe, but, as one can see from the photo below, this is a large area that can require a lot of hair. It is often impossible to determine when a person is young if the donor supply will be adequate. If there is not enough donor hair, then the island of hair may remain isolated. Most importantly, it uses up a lot of hair that might be better transplanted to the front and top of the scalp – areas that are far more important cosmetically.
The front and top of the scalp are more important to one’s appearance than the crown, and these areas should be the first priority when planning hair restoration surgery.
As an exception, 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.
View the Crown (Vertex) topic, the Age topic or see posts tagged with Early Hair Loss for further reading.
View Before and After Photos of some of our crown hair transplant patients
Read about candidacy for a hair transplant in young patients
Posted byThe 2015 hair restoration practice census, published by the International Society of Hair Restoration Surgery (ISHRS), showed that hair transplantation is an increasingly popular treatment for hair loss. The biennial survey found that 397,048 procedures were performed in 2014, an estimated increase of 28% over the previous survey, published in 2012. Three prior surveys found increases of up to 12%, so the rate of surgical hair restoration seems to be accelerating.
Since 2006, the number of procedures worldwide has increased 76%, with the estimated global hair restoration market now valued at approximately $2.5 billion annually.
Age
Over half of all men and women treated were younger than 50. Men aged 30-39 made up the biggest percentile at 31.7%, followed by those aged 40-49 (26.9%). It was the inverse for women, however, with those aged 40-49 making up the biggest percentile at 27.7%, followed by women in the 30-39 year old bracket (27.0%).
Gender
In 2014, 84.7% of surgical patients were men and the rest (15.3%) were women. The number of women receiving a hair transplant increased by 12% since 2012. There was also a 21% increase in non-surgical female patients.
Procedure
While Follicular Unit Transplant (FUT) procedures accounted for over half of all hair transplants, Follicular Unit Extraction (FUE) is gaining rapidly, with a 51% increase over the 2012 results (from 32.2% in 2012 to 48.5% in 2014). See the chart:
Q: Hi. I am 52 years old and wish to know if Propecia will work for people my age. I have started losing some hair a couple of years ago and it’s thinning out. Thank you very much for your help. — K.E., Boca Raton, FL
A: Propecia (Finasteride 1 mg) can hold on to hair at any age, but works best to re-grow hair in those who are younger.
The reason is that finasteride works to reverse miniaturization (the thinning and shortening of hairs due to DHT). Younger patients, with early hair loss, generally have more hair in the early stages of miniaturization where the changes are readily reversible.
Older patients are more likely have more advanced miniaturization or areas that are totally bald and will thus not regrow with medical therapy.
Posted byQ: What happens to hair diameter when you age? — K.L., Greenville NY
A: From infancy to puberty, hair gets progressively thicker. From adulthood to old age the hair becomes thinner again and this is exacerbated by the effects of DHT in susceptible persons. The later process is called androgenetic alopecia (common baldness) and is characterized by miniaturization – the progressive decrease in hair diameter and lengths as a result of DHT.
However, even without the effects of DHT, hair gradually thins over time in many people.
Read more about hair growth and hair loss in men and women.
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A hair transplant won’t be medically indicated in some patients. Hair loss treatments may not sufficiently restore fullness in every patient. But as an article in AOL’s Asylum.com makes clear, balding can be bad-ass.
Asylum.com reporter Brett Smiley interviewed Dr. Bernstein to get his take on hair loss and the balding pattern known as a “power alley”:
“Power alley is an accurate term for that type of balding,” says Dr. Robert M. Bernstein, a clinical professor of dermatology at Columbia University and world-renowned hair-transplant surgeon. “It’s Norwood Class III balding, which is the most common type.”
[…]
“People with bald parents are the most susceptible to hair loss,” says Dr. Bernstein. “And it can happen at any age. I’ve seen patients in their late teens begin to lose their hair.”
Even though we have a healthy head of hair, Asylum pays homage below to the many successful men — from athletes to video-game characters — who have proudly sported the power-alley look.
The article cheekily describes the hair loss and “alleys” of several celebrities, including: Bruce Willis, Samuel L. Jackson, “Iron Mike” Ditka, Jude Law, Danny Glover, ESPN NFL Draft expert Mel Kiper Jr., Florida Gators men’s basketball coach Billy Donovan, and everyone’s favorite virtual celeb, Pizza Pasta from Nintendo’s “Punch-Out!!”
If you are a new visitor to our website, Dr. Bernstein personally conducts hair loss consultations in our facility in midtown Manhattan.
Read more about the cause, classification, and diagnosis of hair loss in men.
Image c/o 20th Century Fox and Asylum.com
Posted byQ: At what level of thinning should the hair transplant be done? — V.K., London, UK
A: A hair transplant should be considered in an area of thinning when:
Other factors that are important include:
Q: I know that Propecia works in only about half of patients. Are younger people more likely to be helped by this medication? — V.C. Greenpoint, Brooklyn
A: The main studies by Merck looked at men between the ages of 18 and 41. The five year data (which, in my view, is most important) showed that 48% of men had an increase in hair growth and 42% had no change over baseline. Thus a full 90% held on to their hair or had more over a 5-year period. This compares very favorably to the placebo group where 75% lost hair over the 5-year period.
I think the most interesting question relates to the 10% who continued to lose hair in the treated group. Did these men lose hair at a slower rate than the non-treated group? Based on the action of finasteride on blocking DHT and DHT’s central role in causing male pattern hair loss, it is reasonable to assume that even these “non-responders” did have some benefit from the drug, albeit small. If half of those on the medication who continued to lose hair did so at a rate slower than the placebo group, then 95% of patients actually benefited from the medication to some degree – an extraordinarily high success rate, in my opinion.
Posted byQ: Why do some people have a full head of hair into their seventies or eighties and others start to go bald in their late teens or early twenties? — E.Z., Darien, CT
A: The difference is genetic with the inheritance coming from either side of the family.
Although a person will have the genes his/her whole life, a gene’s expression (also called phenotype) can be quite variable. The factors that cause this variability are still unknown.
Read more about the Genetics of Hair Loss
Posted byQ: I am 22 and want to go for hair transplantation. I want hair restoration surgery now because I have a concern about my donor area that it might diminish if I postponed my transplantation. Could this be the case? — T.J., Westchester County, N.Y.
A: The logic is not correct. Having a hair transplant at an early age does not protect the donor supply.
If your donor area diminishes over time, then the transplanted grafts will fall out as well. Hair does not become permanent just because it’s moved in a hair transplant. It is never any better than the hair in the area where it came from.
The longer you wait – i.e. the older you are when a hair transplant is performed – the more information we will have about the stability of your donor area and this will allow for optimal planning of the hair restoration.
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“Dermatologic Clinics” is a quarterly review with comprehensive, state-of-the-art information by experts in the field of dermatology. The industries most highly knowledgeable medical professionals provide current, practical information on the diagnosis and treatment of conditions affecting the skin. Each issue of Dermatologic Clinics focuses on a single topic. The July 2005 issue, entitled “Advanced Cosmetic Surgery”, published an article authored by Robert M. Bernstein M.D, and co-authored by William R. Rassman M.D. entitled “Follicular Unit Transplantation: 2005.”
In their article on FUT, the authors helped the dermatologic community to better understand the best practices of surgical hair restoration. Follicular Unit Transplantation (FUT) focuses on recognizing that the follicular unit is a discrete, anatomic and physiologic entity, and that preserving it through stereomicroscopic dissection is the best way to ensure the natural appearance of the hair restoration. Dr. Bernstein explains why this major step has brought hair transplantation into the twenty-first century.
This chapter also points out that the issues yet to be resolved in hair transplantation include determining the maximum density and number of grafts that can be used safely in a single session, deciding whether it is preferable to pre-make recipient sites or immediately place grafts into sites as they are made, and defining the precise role of Follicular Unit Extraction (FUE).
The authors conclude by stressing that the essence of providing the best care for hair transplant patients rests on proper patient selection, establishing realistic expectations, and using non-surgical management for young persons who are just starting to thin. When surgery is indicated, Follicular Unit Hair Transplantation is the ideal hair restoration procedure.
Read the publication Follicular Unit Transplantation: 2005
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