Young man started treating balding in the old days (15+ years ago) first with scalp reductions trying to cut out the bald spot, eventually getting transplants into the bald spot. He continued to bald and ended up with an oasis of hair surrounded by a bald scalp. This is the way it was, thankfully, not today. In those old days he rushed to get a hair transplant in the front, getting the old type of plugs transplanted into his head yet he continued to bald leaving him with terrible looking plugs, like a corn field on his head. The more transplants he did, the balder he got. His doctors made a lot of money out of him with multiple transplant sessions and three scalp reductions (where the bald spot was removed surgically for the thousands of dollars) never thinking of any Master Plan which would accommodate his balding progression. In the old days, Propecia/finasteride was not on the market so he could not slow the process down.
What can we learn from this and let’s compare the 1980’s to today.
1- The balding progression time-line has changed because of the use of finasteride today and this drug will absolutely slow hair loss down so that many people may not reach their final balding pattern in the youth. A balding man who might develop a Class 6 pattern without surgery in 1985, might develop that pattern before they are 30, but today on Propecia/finasteride, they might not develop that balding pattern for 10 or 20 years later, but it can happen sooner and it may be safe to assume that it will happen sometime in his older age.
2- If you have a 2 inch round balding spot in the back of the head and get it transplanted, you may lose hair around it to a 3 inch round bald spot in 5 years, it will look like you have an Island of Hair with surrounded by your normal hair. This is why I don’t like to transplant the crown, particularly if the drug finasteride can restore the hair. If the hair is not restored by the drug (with or without minoxidil) and the density of the hair in the donor area is average or better than average and if the frontal balding pattern has been addressed with transplants, then the crown can be transplanted provided there is enough hair to finish what was started (worst case planning is critical) and the patients final balding pattern can be defined by the surgeon. Only an experienced doctor who is not after your money but cares about your long term look, can make this judgment. Today, many doctors will transplant the crown without regard to this Master Plan I am talking about here.
3- The same rules apply to frontal balding. What is the worst case scenario? Finasteride does not usually work to reverse frontal hair loss but it will slow down the frontal balding process. So when you get your frontal area transplanted, ask your doctor what is his/her thinking about the progression of your frontal hair loss. If there the doctor has no good answer to this question, get the hell out of his/her office.
Why am I discussing this with you today. Because even today, we continue to bald no matter what we do. If we are lucky, we can slow the time line down enough never to face the end stage of balding that we are genetically programmed for, even with the use of finasteride. But to be safe, you must assume that you will not be the lucky one and figure out a worst case scenario with your doctor. You and a good doctor can build a Personalized Master Plan for your short and long term hair loss. Think about this and its meaning. Good planning is always the right way to go in managing your hair loss.