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 was googling the address for John lord when I got your article. im in my 40’s and want to inquire about hair transplant. someone i knew went to him and was happy about the result and it was also inexpensive. wanted to try it but very scared about his history, outcome if i were to go elsewhere and the amount i will end up paying. my hair is thin and i just want a thicker full hair especially front area.

John Lord is not a doctor, but somehow owns a surgical hair transplant clinic. This is illegal in California, but he was able to skirt the law. His clinic was responsible for the only reported death in the history of hair transplantation just a few years ago. The patient who died came to see me a couple of weeks before he had the transplant that killed him. Our clinic fees were a bit higher so to save money he ended up at John Lord’s clinic. And well… you know what happened next.

Our facility is fully accredited with the AAAHC (Accreditation Association for Ambulatory Health Care), which guarantees that our processes are first rate, infections are very rare, and safety is paramount as it is built into our system. We are audited every three years and all of our records are reviewed by this agency for safety and poor outcomes. We’re one of the very few hair transplant clinics to go through this rigorous auditing and accreditation.

I had the opportunity to see a few of the patients from John Lord’s clinics and the results were clearly substandard. Maybe the bad transplants are the only ones that came to see me for repairs. As for the cost of hair transplantation, that depends on how much hair needs to be moved. I’m in Los Angeles if you’d like to make an appointment (it’s free).

Dear Dr.,

I had a hair transplant (840 3-4 follicular grafts) in February of 2009. The areas treated were the large crown and also throughout the temporal areas. I still do not see a drastic difference. I am not sure why. I am continuously also using Rogaine foam and Propecia. When under any bright lights, I see such thinning as to where the transplant was supposed to have worked. I am not sure if something went wrong, or everyone’s bodies are different; thereby it may look better within another year. Have you heard of my situation? Does a hair transplant take up to another year in order to see better hair density results?
Thank you!!!

Without knowing more about your case, it would be difficult to provide much precise information. Sometimes a thin look can appear under harsh lighting because of your hair color, hair character, thickness, etc. The Rogaine and Propecia are good to continue using, but after a year you should’ve seen results by now from the surgery. Everybody is different, every surgery is different, and every medical group is different, but it generally takes 6 to 8 months to see the beginning results of a hair transplant surgery. Either your surgery has failed or you continued to lose more of your native hair and what you are seeing is the lost native hair. I have seen transplant failures, and generally these occur because of surgical errors, inexperienced or sloppy teams or techniques, or rarely the presence of some associated disease like diffuse alopecia areata (though this is unlikely in men).

I’d discuss this with your surgeon to find out his/her take on why your grafts haven’t grown. Be sure to compare your current look to pre-operative photographs, because sometimes patients don’t realize just how bald they were before the surgery (the hair grows in gradually so its hard to notice if you’re not focused on it all the time).

See this recent post for more — If There’s No Growth a Year After My Hair Transplant, Should I Just Get Another One?