Hi i started balding when i was about 19 and now i am 23. I have had 3 transplants within that time period and have got some coverage on the front of my scalp, but it still is thin and it makes my forehead look big. My problem now is the crown is balding and i don’t think i am going to have enough donor hair for the crown. Is there something else i can do or what do you think my best option is because it still is thin in the front but is getting alot worse on the crown. Thank you

You may be in big trouble. I would want to know things like:

1. What was your Master Plan for hair loss?
2. Did your doctor tell you about the possibility of running out of your donor hair?
3. Were you led to believe that you could get all of your hair back with good coverage?

Regular readers of this site may notice that I’ve written time and time again about the problem with transplanting younger men with early hair loss — and it is for precisely this reason. I am concerned about a 23 year old (who is probably still balding) asking me a question like you did. If you ran out of donor hair (or are about to), then you need to sit down with a really good doctor (hopefully you have one) and get some basic answers to questions about your future. An in-person exam with an expert is key for you right now. You should be worried.

Dear Dr. Rassman:

Thank you for your outstanding blog. I have a question about hair transplants. Most of the before/after pictures that I’ve seen show patients with substantial balding who then receive very noticeable new coverage. I wonder, though, whether it is possible to design and begin to execute a H.T. Master Plan beginning in the very early stages of hair loss, so that — rather than suffering noticeable loss and then receiving visible new coverage in that area — the transplants can instead be inserted into areas that are just beginning to thin but still have substantial coverage.

It seems that people who work in the public eye — television anchors, actors, and so forth — must have a way to plan out their transplants so as to seem simply to retain their hair, rather than seeming to lose it and gain it back. Does transplanting into areas that still have coverage make the eventual loss of the remaining hair in that area transpire more quickly? Can transplants be performed BEHIND a fairly solid hairline if the surgeon determines that declining hair counts make it inevitable that this area will eventually go bald?

I’m a 29-year-old male, and I began using 1.25 mg/day of finasteride eight years ago. I still have quite decent coverage — noticeably thin in the vertex when under bright lights, somewhat recessed temples with miniaturized/vellus hairs at the temple hair line, and a decreasing hair count that is only noticeable to me in the first two inches of the frontal hairline. After noticing fairly quick loss in college, the erosion has been very slow during my eight years of finasteride treatment. However, I am aware of the five-year finasteride studies showing hair counts dropping after two years of treatment and continuing down from there.

I understand the need for conservative transplant treatment at my relatively young age, in order to preserve appropriate reserves of potential donor hair. (This is why I know it would be inadvisable to move my hairline FORWARD toward its adolescent location.) However, I am hoping that I can replace hair BEFORE I entirely lose it — including bolstering the hairline and several inches behind it before the inevitable loss there becomes noticeable. So, I wonder if you could tell me: do HT surgeons ever transplant into an area that still has substantial coverage, so that the loss doesn’t need to become noticeable before it is replaced? In other words, can a Master Plan be devised to prepare for inevitable future loss before that loss actually fully occurs, rather than waiting for visible baldness before surgery takes place? (I wonder how else, say, actors and television anchors are able to avoid the appearance of “losing and regaining.”)

Thanks very much for your time! I appreciate it.

I have firmly established a viewpoint to not transplant people before they are ready. Preventing visible hair loss with transplants is performed by some doctors and those happen to represent the doctors who are more in this for money rather than the welfare of their patients.

As good as you think you might be able to predict what will happen to you, you might be surprised to see that the balding will actually occur differently than you expected. As the supply is limited on everyone who will become significantly bald, you could run out and not complete what you will need if you are too aggressive. I am often humbled by the balding process, but I am also the biggest fan of being conservative.

I’m considering a hair transplant due to my receding hair. I’d like to think I’m a class II hair loss patient with an extreme widows peak, not Jack Nicholson yet, but give it two years. The thing is I’m 22 years old. What would you say is the average age of transplant patient? Is their a preferred age? Would 22 be to young? I’d like to get a transplant before everyone knows me as bald. Bad decision?

Fan of you’re work, thank you for you’re time.

No, I would most likely not transplant a 22 year old Norwood Class 2 patient. Hair transplants are much too early for a Norwood 2 patient and at such a young age you may precipitate more hair loss. You are probably not balding, but maturing your hairline. I’ve transplanted men your age, but their hair loss pattern was much more advanced.