Bernstein Medical Center for Hair Restoration

Should Young Person Start with Hair Transplant at Crown?

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.W., Brooklyn, N.Y.

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.

Can a Hair Transplant Treat Hair Loss that begins in the Early 20s?

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? — 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 by Robert M. Bernstein M.D.

Can I Use Laser Therapy to Treat Advanced Hair Loss?

Q: I have been told I am a Norwood Class 6; will the HairMax LaserComb or other types of laser therapy work for me?

A: Laser treatments, as with other medical treatments for hair loss, only work when there is some existing hair in the area.

Posted by Robert M. Bernstein M.D.

What is Best Hair Transplant Density and do You Measure Maximum or Overall Hair Density?

Q: Dear Dr. Bernstein, a full head of hair averages ~100 FU/cm2. To achieve the appearance of fullness with a hair transplant 50% is required. In one of your articles you say that you recommend 25 FU / cm2 to your patients. Is that the density per one session or the final one? If that is final density, then it is far below the 50%. Please explain as I am profoundly confused. — W.N., Easton, C.T.

A: If a person is to become a Norwood Class 6, the hair that we have available for us to transplant is only about 12% of what was there originally. This, of course, will vary from patient to patient depending upon one’s donor density and scalp laxity and a host of other factors.

We make the hair restoration look good by restoring 25-50% in the front, and proportionately less in the back. Logically one cannot restore 1/2 of ones original density to an entire bald scalp with only a thin strip of donor hair – there is just not enough hair, even with multiple sessions.

I transplant 25-35 FU/mm2 in one session, but this is the density created in the front, not overall.

Due to follicular unit graft sorting (placing the larger follicular units in the forelock area) this provides even more density than the actual numbers suggest. If someone is relatively certain to have more limited hair loss, then the numbers can be increased, but it is risky if you underestimate the degree of eventual hair loss.

Please carefully read the article on Hair Transplant Aesthetics.

It will answer your excellent question in greater detail. The article is a bit old, but the principles are the same.

Posted by Robert M. Bernstein M.D.

Which Gives More Donor Hair: FUT or FUE Hair Transplant?

Q: I am Norwood Class 6 and have read about both Follicular Unit Extraction (FUE) and Follicular Unit Transplantation (FUT). Which will give me more hair? — D.D., Highland Park, T.X.

A: In general, FUT will give you more hair since, in FUT, the best hair from the mid-portion of the permanent zone of the scalp (also called the “sweet spot”) can be utilized in the hair transplant.

With FUE, since only the hair follicles are extracted and not the surrounding bald skin, if too much hair is removed, the donor area will begin to look thin as hair is removed. This will limit the amount of hair that can be harvested.

Although in FUE additional areas of the scalp can be utilized to some degree, this will generally not compensate for the inability to access all of the hair in the mid-permanent zone and the total amount available for the hair restoration will be less.

Read about Follicular Unit Extraction (FUE)

Read about Follicular Unit Transplantation (FUT)

Posted by Robert M. Bernstein M.D.