Q: Can you use a hair transplant to treat radiation-induced permanent hair loss in pediatric patients?
A: Yes, but there are a number of things to consider:
- As in adults, if the hair loss from radiation is extensive, or involves the permanent zone of the scalp, there would not be enough donor hair to make the procedure worthwhile.
- Depending on the nature of the scarring, it may not take grafts well and always will require multiple procedures to achieve adequate density.
- Hair transplant procedures (both FUT and FUE) leave scarring, so future treatments for tumor recurrences that cause hair loss (radiation or chemo) may expose these scars and be an additional cosmetic problem.
- There is a concern that the younger patient may eventually develop androgenetic alopecia and this would be a problem if extensive and occurring early. Family history, of course, is important, but there is no way to tell with certainty the prognosis of AGA in a young person.
- For those that might develop AGA, finasteride is not indicated in males under 18 and there is no way to tell in advance if the person can tolerate this medication.
- The hair transplant procedure is long, so local rather than general anesthesia is used. That said, 12 y/o is generally the minimum age that a patient can tolerate the procedure and a 12 y/o needs to be mature and motivated. Certainly, waiting until the patient is older makes it easier surgically.
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.
Q: I am 24 years old and just starting to thin. I was told by another doctor that it was too early to have a hair transplant, but the hair on the back and sides of my scalp seems really thick. Shouldn’t I have a hair transplant now, just in case I am not a candidate in the future? — A.S., Cherry Hill, NJ
A: The most important criteria in determining who will be a candidate for a hair transplant is the presence of sufficient permanent donor hair. When hair loss is early, it is often hard for the doctor to determine this, since early on the donor area can appear very stable. It is not until the front and/or top of the scalp has significant thinning that the donor area may also show thinning. Therefore, it is only at this time that the stability of the donor area can adequately be assessed.
It has been argued, that one should have a hair transplant early, before the donor area can thin. This is not a reasonable argument, since doing a hair transplant early, does not make the donor hair more permanent. If the donor area is not stable, the transplanted hair will continue to thin after it has been moved to the new location. This will cause the hair transplant to gradually disappear and also risk the donor scar from becoming visible as the hair covering it continues to thin. This problem can affect patients undergoing both FUT and FUE procedures.
Age itself is another factor to consider. The donor area in young people almost always appears adequate. However, the older a person is, the more likely he/she will show donor changes. Therefore, the older a person is, the more confident we are of donor area measurements being accurate. In very general terms, it is very difficult to assess the permanency of one’s donor area in patients under 25 year of age.
Q: I am 25 year old who just started going bald. My doctor confirmed that I have pattern baldness and put me on Propecia and Rogaine. I don’t want to go bald at any age. So, instead of prolonging the process for 5-10 years and then having a hair transplant, isn’t it easier to just let the hair loss continue and then have a HT, so that I can save the money on drugs for years. — Z.B., Greenwich, C.T.
A: It is far better to keep your own hair using medical therapy. The medications (i.e. finasteride and minoxidil) are relatively inexpensive if use the generic forms and will be far less expensive than surgery – even on the long-term. Keeping your own hair will look fuller than a hair transplant, since a hair transplant just re-distributes a diminishing amount existing hair. When the ability to multiply hair (cloning) is available this, of course will change, but this technology is still years away.
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.
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.
Q: I am a 21 year old male experiencing the first signs of hair loss as of late. I looked at your before and after pictures of hair transplant patients and honestly right now I have a lot more hair than the patients, even in the after photos. By no means do I intend to criticize your work at all, but I noticed that they still had a receding hairline. I myself am an artist and pay close attention to detail. What I want out of a hair transplantation procedure is to basically have the full head of hair that I had even before puberty. Is it possible for this to be done? — P.N., New York, NY
A: Your concerns and goals, although understandable, are impossible to achieve through hair transplantation and is exactly the reason why we don’t perform hair transplants in young persons.
Surgical hair restoration can never give you your original density back since we are just redistributing a smaller amount of hair.
In addition, your original hairline should not be restored since a transplanted hairline is permanent and will not evolve naturally as you age. A mature hairline must be built into the design of the first hair restoration procedure, regardless of a patient’s age.
Q: Is there ever an age where you are too old for a hair transplant? — L.K., Norwalk, C.T.
A: One can be too young for surgical hair restoration, but not too old (as long as one is in good health medically).
Older people generally make excellent candidates for hair transplantation since their expectations are generally more realistic and the future extent of their hair loss more predictable than in those who are younger.
We have successfully treated a number of people in their 80s. In spite of the fact that their spouses and friends asked them, “What do you need a hair transplant for at your age,” the patients were uniformly happy that they did the surgery.
Q: 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.
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