Transplanting Younger Men — You Do It Too, Dr Rassman!

Dear Dr:

I visit your website everyday and find it really informative and reassuring….in some instances.

My question is, I see a lot of young people (between the age of 25-30) getting hair transplants. Now, I remember one time you had posted a message saying that people under the age of 35 should not be getting hair transplants because it is hard to tell the “final pattern” of a person’s baldness. So, why do you as well as other doctors elect to do transplants on young patients (even as young as 22 who have minor thinning but will go bald later on in life) when you know in the future the hair behind the transplants will fall out. It doesn’t make sense?

I’m sorry if I targeting you personally, I don’t mean to do that.

Your question is a good one, but firstly, I’ve never used the age of 35 as a minimum requirement. I will readily transplant any man if:

1. They have a hair loss pattern that is clear and bald. For example, a 22 year old Norwood Class 3 pattern patient who has lost his corners or his hairline has risen significantly above the mature male hairline (see Maturation of a Hairline — Moving From Juvenile to Mature). I will consider doing a hair transplant even on a younger man once I get to know them well and see the support of their family in the process.
2. They are mentally mature, understand that the hair loss process is progressive, and have the financial ability to stay the course.
3. They are on the drug finasteride for at least a month before surgery (to prevent potential shock loss) and agree to continue it for years (to halt the progressive nature of hair loss).
4. They have donor densities which are adequate for harvesting as well as enough reserves to follow the hair loss to mid-scalp. In this way if they became a Class 6 or Class 7 pattern and were willing to accept a bald crown (the worst case) then they would always be normal looking.
5. They are healthy and have no contraindications for surgery, such as bleeding disorders, etc.

Once the pattern is clear, the scalp is mapped for miniaturization, and the patient is on Propecia (finasteride 1mg), I don’t see how you could say that I’d “know” the native hair behind the transplants will fall out. That is not necessarily true, and is precisely why it is important to seek out a physician that will microscopically examine your hair rather than just waving their hands around the head like a magician and tell you what you want to hear.