Age 25 is a reasonable cut off for hair transplants for most men
I'm often asked to see males 18-23 years of age for a hair transplant consult. Sometimes, the young man comes alone. Sometimes with a parent. Sometimes with two parents. They are surprised to learn that a hair transplant is not the right choice for them.
If one could see 50 years into the future for the given person, it would be possible to figure out if a hair transplant theoretically could be done for a man 19 or 20 years of age. But we can't. Nobody can. No test, questionnaire, assay or measurement can determine 'exactly' how a man will bald. But we do know that men who develop hair loss at 19, 20 or 21 are fairly likely to have more significant balding by age 50 than a man who develops hair loss at 41. That is the one thing we do know for sure.
Humans do not have infinite hair
If humans had infinite hair, this wouldn't be an issue. This blog would not even have been written. But we don't. Humans have anywhere from 0 to 8000 follicle units to move from the back of the scalp to the front. Yes, some men have 0 and are not even candidates (i.e. men with DUPA). Others have 8000. Can we predict how many hairs a patient has? Yes! But not very well until age 30-35. At age 20, it's nearly a complete guess. If one does a hair transplant of 2000 grafts at age 20 and it turns out the patient really is not a candidate, then the transplanted hairs thin out. Yes, some transplanted hairs can thin if not taken from the right area of the right patient.
How many hairs might I need someday?
If an individual goes very bald, they really need 10,000-20,000 follicle units to fully cover the balding area. Since there are rarely more than 5,000-6,000 follicle units available for most men, it becomes clear that one has to choose where to put these hairs. Putting them right in the frontal area is the priority for most men. If some are left over, the crown becomes a second priority.
What is the priority for a young man age 20? Usually the frontal hairline - making it flat. making it youthful looking and the way it was age age 16. It is never a good idea to restore this look. Further balding is guaranteed to occur behind it and more and more grafts will be needed to be moved into that area (i.e. more transplants) to make the hairline continue to look good. Many men who get transplants at age 20 will simply run out of hair.
I often hear the argument that if a man at age 20 has a hairline that looks like he's 40 ... then it's okay to have a hair transplant at age 20. I disagree. If a man at age 20 has a hairline like age 40, he may never ever be a good hair transplant candidate. The more bald someone is likely to become, the more cautious we have to be!
Key decisions for the 20 year old
The most important decision for the man in his early 20s is whether to use non surgical treatments to try to save the hair - minoxidil, finasteride, laser, PRP. In other words, e there is nothing to do now. The period between now and the mid 20s is focused on trying to figure out how to keep the hair that is on the scalp now. Discuss medical options with your physician.
It basically works out to this
• Getting a transplant at age 19, 20 or 21 "might" allow one to have improved frontal hair density in the early 20s but carries with it a huge, huge risk of having an unnatural and even strange look in the 30s, 40s and 50s.
• If an individual wants the best hair possible throughout his 30s, 40s and 50s and right up until he's 95, there is only one option... and that is to wait to review hair transplant options until 25.
Someday when medical science figures out how to create infinite amount of hair, it will be okay to have a hair transplant and 19. We are not there.
Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Vancouver office at 604.283.9299