Good Surgical Candidate Vs Bad Surgical Candidate

Dr. Rassman,

Thank you for your very informative blog, it’s a daily read for me.

My question for you is simple. I’ve heard Dr. Bernstein say that one of the reasons why he has not undergone a surgery is because he is not a good candidate.

First, what makes him a bad candidate, and second, at what age would it have become apparent that he would become a bad candidate? I’m only 29, and although I’ve been told that I’m a good candidate for surgery now, I worry that down the road I’ll turn into a bad candidate because of future loss or donor thinning.

There are many things that make someone a good/bad candidate for hair transplants. A key problem for any candidate is a low donor density and a large balding area, which may mean the donor supply is insufficient to address the needs of the recipient area. I have had many patients that ran out of donor hair before they completed the transplant procedures they could’ve used. That is why I always stress a Master Plan for anyone undergoing a hair transplant.

Someone like Dr. Bernstein, with low density and a very large bald area, needs a great deal of hair to achieve any degree of fullness. The most he could have accomplished is to transplant the frontal area and leave the crown bald, so maybe he felt that the benefit was just not there. Dr. Bernstein is happily married and is not motivated to change his look. He looks handsome with his short hair style and is satisfied with that.

For you, at 29 years old, with the early use of Propecia you may slow down or stop the process and if your hair loss is confined to the front and top, then transplants may offer you a good option later if needed. Too many doctors want to push patients towards hair transplants because that is what they do for a living. The not-so-good doctors just do transplants without a Master Plan communicated to the patient. Many patients want hair, will pay for hair, want a bargain for the graft cost, and really have no concept of a plan.

In reality, they get no bargain and will pay for that ignorance in the future when their hair loss gets out-of-control and they find themselves out of hair and money. I see people every day in this situation and somehow I can not get the message out there that everyone needs to plan ahead for their worst case hair loss, because they will continue to lose hair for the rest of their lives. The question that should be addressed, as you so nicely pointed out, is about what you will look like 5, 10, 20, 30, and 40 years later.