I have very much changed my opinion on the subject over the years as I have seen case after case. It’s very easy for someone to say to a 22 year old – DONT GET A HAIR TRANSPLANT! However, I had my first transplant at 23 and it was the best decision of my life going forward. It’s not so cut and dry.
This article is going to discuss the ethics, pros and cons and the ultimate question you are wanting to know: Am I a good Candidate? Should I get a hair transplant?
The article posted on March 12 2012 on how to calculate how much hair you have lost and how much donor you have would be a required read on top of this article as we discuss.
There are five parts to this question:
1) Age of patient
2) Current hair loss and final hair loss pattern
3) Type of Extraction method in the donor and how many grafts are required
4) PATIENT EXPECTATION!!
5) THE CLINIC DOING THE TRANSPLANT
I want to talk about a client from 2 weeks ago. I’ll call him Jim.
Jim is 22 years of age. He is a NW 3 clearly progressing to a NW 6.
My first opinion of him was that he was very young for a transplant based upon 1) Age 2) Current hair loss and final hair loss pattern.
However, I have learned that inevitably it all comes down to 4 & 5 – Client expectation and what the clinic will do.
My first question was (and this is something you should consider when you have hair loss) – “What are you hoping in a perfect world we can do for you and worse case what would you be happy with?”
He of course, as everyone does, said he would love a full head of hair but had done enough research to know this was not possible. MISSION 1 accomplished. Now you see, if I was unethical – I would have told him like many B.S. clinics out there – that he had 15000 grafts in the donor and we could give him a full head of hair. He would have loved me and I could have said “let’s get aggressive and dump 4000 grafts into your hairline and give you a very low hairline you had a 18. This is of course deep down what he wanted. Who would not at 23?
I told him – “You only have probably at best, 3 surgeries in you, and 6000-8000 grafts over those surgeries. If you go to a NW 6 you can only achieve a solid frontal hairline, and a thinning crown unless you decided to get into BHT (Body hair transplants) which is costly and largely ineffective when compared to the price. “
I have him an erasable pencil and asked him to draw the hairline he wanted. What I had expected is what happened. He drew the hairline he had when he was 18. (**Funnily enough most people always tell me they had a very low hairline when you can see it’s not that low – we imagine things always to be better when you’re younger…sigh. I used to be able to not sleep for days on end in Uni and party all the time…yet really – I probably slept more than as I didn’t have to wake up at 7am for work!)
So this poor 23 year old draws this hairline. I explain to him that 1) With this low hairline you’re going to look ridiculous in 15 years even if you had a full head of hair. 2) You would need about 3500 grafts in the hairline to achieve what you want leaving at best 3500 grafts to cover ¾ of you head which will leave you with this huge pie shaped hole at the back of your head and looking stupid.
I then asked him – what would be the highest hairline you would go with. He was not sure. I drew a hairline with receded temple points and a higher mid-frontal tuft point. He was not over the moon with it; however, I said to him – what would you prefer – 1) To have a lower hairline and look stupid in about 10 years and not have enough hair to cover future loss 2) Have a hairline that looks a little higher now, but still frames your face which you can always grow longer if you want to give the allusion of a lower hairline and leave enough hair for future loss.
He thought about it and realized he’d still be much happier with the hairline I was proposing then not having a hairline at all.
I also explained to him that with what I was suggesting he’d use only about 1500 grafts which would be reasonable to FUE on him and 1500 grafts would not be so significant in the donor to make it look thin and moth eaten.
I’m going to take second here and talk about FUE. SIMPLY: You are crazy if you think you can harvest 4000+ GRAFTS FROM FUE AND YOU WILL NOT SEE SCARRING OR YOUR DONOR WILL NOT LOOK THIN! I HAVE SEEN DOZENS OF PATIENTS WHICH HAVE COME TO OUR OFFICE FOR REPAIR WORK FROM THOSE CLINICS CLAIMING AND DOING 3000+ FUE – AND THE RESULTS HAVE ALWAYS BEEN POOR AND THE DONOR looks poor. SORRY – That’s the truth of the matter.
I also explained to him that 1500 grafts of 8000 would leave so much more hair to be used in the future as he aged. If he wanted to shave his head or keep it at a 1 guard, he would see the dots yes, but he wanted to have at least that Vin Diesel outline of a hairline – which I completely empathize with and cosmetically agree with. If I was a NW7 – I would want to at least have some hair in the hairline to at least frame the face and keep it short- buzzed with FUE.
I told him at his age I would not do STRIP on him thus leaving a very long scar which would remove the chance of him ever shaving his head. I also said that if he wanted to do further surgeries he would have to convert to STRIP if he did not want to have that moth eaten look in the Donor which does exist and looks far worse. I also told him he MUST do treatments or I would not agree to do the surgery.
He agreed. I felt this was reasonable.
When I talked with the Dr. F about it – he was hesitant at first, but then I said to him one simple thing.
If this kid was 40 years old and evolved to a NW6 – we would have drawn a lower hairline than I was giving him at 23 and would have taken 3000 + grafts. So what is the issue with taking 1500 grafts, being conservative, giving the kid what he wants, allowing him the ability to shave his head in 10 years if he stops caring?
There was no downside to this and Dr. F agreed to do it.
Thus:
1) Age: While young we went with a higher hairline
2) Knowing he would go to a NW 6 – we went with a low density hairline of 1500 grafts to allow for much more donor hair to be used in the future
3) Allowing to use FUE to minimize scarring and allow for the option to shave his head later in life
4) The patient was happy with this compromise
5) I DID MY JOB HONESTLY, WITH THE PATIENTS BEST INTEREST IN MIND. We are not doing anything wrong.
It is of my personal opinion that most clinics who do these young kids will take 3000 grafts and dump them into a low hairline. This is not in their best interest and is nothing short of an unethical money grab.
However, the reverse is that we don’t give this patient a hair transplant and he will always find someone who will do it and ruin them for life.
So what do you do? Refuse them? NO. You explain to them the realities, take the several hours to really go through the pros and cons and find a compromise to make them happy now and also make them not regretting the decision in 20 years.
I would say 99% of patients are receptive to the realities when you explain to them the TRUTH about what can and can not be done. For those rare few who do not want to hear it – what can you do? However, I feel no pity for a 22 year old – who is old enough to be smart about what they should not do and still do it anyway.
Bottom line is:
No matter what your age and degree of loss, if you appropriately plan for the worse case scenario of hair loss and plan this out properly and are aware of what may happen and use common sense to COMPROMISE between what you want vs what is realistic – you will ultimately be satisfied and happy with your decision.
It’s not just an AGE VS Degree of loss situation. It’s mostly proper planning for future loss with realistic expectations.
