I’m a Class 4 evolving to a Class 6 pattern. My concern is if I have a transplant now and am happy with the result, but the hair loss pattern continues to a Class 6, that I may find myself chasing this problem for potentially many transplants and then run out of donor hair and regret the decision altogether. I’d hate to have an un-natural hair loss pattern many years from now because of this. As I understand it, you can do a test to map the scalp for miniaturization which can help in developing a long term Master Plan and help determine if the hair in the donor area is healthy and how much is available for moving. Can you comment ?

After mapping out your scalp for miniaturization and knowing your donor density, scalp laxity, and your hair and skin characteristics, I can usually tell where your hair loss pattern is going. Your question is appropriate about a long term Master Plan. Generally, if we transplant the frontal area to a line drawn between your ears, that area can almost always be made to look normal and the density in that area is something that is worked out with your surgeon. The area from the line between the ears to the very back of your head (the crown area) is significant if your density is low. If your density is average or higher and you want the back of your head transplanted, we must ascertain the available donor supply to do that in a worst case scenario.

If you take drugs like Propecia (finasteride) then the hair loss to a Norwood class 6 may be improbable. Most of our patients focus on the frontal area first, and then based upon desire, the crown if there is enough donor hair to manage a possible expanding crown. A frontal to mid-head reconstruction works for most people, as the man in the mirror is who most men want transplanted. Under a worst case scenario where you progress to crown loss, you can look perfectly normal with a full front and a thin or balding crown (which can be covered like this patient did).

It’s pretty common gossip in Europe, but what do you think about the hair transplant of Silvio Berlusconi (Italy’s PM)?

Mr. Berlusconi’s hair transplant makes a big difference in his appearance, as evident in the before-after comparison above. I have some mild criticism in that the hairline should be a bit more irregular and possibly very slightly lower, but it does make him look younger than his 73 years. The facelift he had also didn’t hurt his desire to have a more youthful appearance.

I should note that the photos I’ve seen tend to be a little blurry and I haven’t been able to find any great high-resolution photos of his transplanted hairline.

I had a hair transplant done over a year ago. My hair grew in great but I feel my hairline is a little too far back. I would like to move it forward 3/8 of an inch. I understand when creating a hairline it looks more natural when grafts of single and double hairs are used. So my question is how far back are the grafts of single and double hairs placed? My concern is whether or not I could the procedure done by the means of the strip method or would I have to get it done with the FUE method? (Also, do you have a rough estimate of how many grafts would be needed? Medium course, fairly straight, blonde hair)

At the very least, I would need to see a good digital photograph with your eyebrows lifted high so that the forehead creases are visible. This would help to determine placement. Some surgeons do not put single hairs in the front, so I can not comment on what you had done without seeing you. Clearly with a medium coarse blonde hair, you should require less grafts than those with darker fine hair, but again, I would have to see how wide the area which will be transplanted has to be lowered to meet your goals. Follicular unit extraction (FUE) or strip harvesting can address a transplant successfully.