How Would You Manage This Man If He Was 30, 40, 50, 60 or 70?

Dear Dr Rassman,

Your blog entry of 17 July 2007 includes before and after pictures of a man with a receding hairline who has been transplanted. I am curious how you would mange his follow-up care if he was 30, 40, 50, 60 or 70?. Is balding in this particular pattern common in younger or older men? Am I right in assuming that most men with this kind of hair loss will need more transplants later on as the balding progresses?

His before photo is on the left; after photo on the right. Click the photos below to enlarge. For more photos, see Results After a Single Session.

This patient has a Norwood Class 3 balding pattern, and yes, it is quite common. He is over 50 years old but we commonly see this pattern in men in their 20s and 30s,. The older they are, the more stable is their hair loss. As he is 50, I would not expect his pattern to advance much at all. If he was 25 years old he could lose hair behind the transplants particularly if the balding pattern was really much worse. Many men like this develop crown balding (a Norwood Class 3V pattern) which may require another procedure. For men with only frontal hair loss like this patient (age 50+), I would probably not use Propecia (finasteride) but in men 20-40, that would probably not be my position. By taking Propecia (finasteride 1mg) the hair loss pattern may not progress very fast and is more likely in younger men. I don’t like surprises and nor do my patients, which is why miniaturization mapping and a good Master Plan in the hands of a caring, experienced and focused doctor go together hand in hand.