Ask the doctor: Hair transplantation


Regular user
Author ebba3t
Submitted: 04-04-2006


Hair transplantation


I'm a 21 year old guy who've seen my temples recede quite a bit by now. My grandfather has almost no hair left, except for a nice 'circle'. But it seems that the hair loss diminishes from one generation to the next. My father has neither a bald spot, nor is he thinning, but he has very receded temples.

For some years now I've contemplated having surgery, as this is a major problem for me. A hair transplant seem unevitable.

My question goes to, whether it would be wise to have a hair transplant now, or if it would be better for me to wait and see how much more hair I'm going to loose. Of course, I'd much rather do it now!

Best regards



Author Mazhar Hussain
Submitted: 10-04-2006
Clinic My Hair Clinic
Education Speciallęge i almen medicin


Dear Esben

Thank you for you mail and your question. The issue you raise contains a very complicated dilemma, and you must prepare for a comprehensive explanation.

Visible hair loss is often a cause of concern, regardless of age. Visible hair loss in the late teens or in the early twenties can be an even bigger burden, because only very few of the same age will be in the same situation. You stand out! And already in this very young age, you experience the first signs of ageing, even though you don't notice the ageing anywhere else on your body. Therefore hair loss can seem as something foreign and completely unacceptable. Desparation kicks in: Something must be done! And it isn't unusual to start wishing for a hair transplant.

Technically, a hair transplant will seem like a simple solution. However, there are many considerations that must be made. First and foremost it's important to make clear that there is NO documented method for predicting the extent of your future hair loss. The younger you are, the more uncertain any predictions will be.

Let's assume that you have a hair transplant resulting in good density in the temples. In 6-8 months you will probably be very happy with your new hair. The transplanted hair will remain in place for the rest of your life, and your hair loss has in fact stabilised, so everything is in good order.

If, on the contrary, your hair loss continues, which is definitely a possibility, you will risk loosing hair behind the transplanted hair in the temples, and in the central forelock (the area in the front between the temples). Good density in the temples and a bald central forelock will clearly not provide a natural appearance. In other words, for all practical purposes you will be left with two options: Either have the transplanted hair removed or have an additional hair transplant. In most cases, filling out the temples (or creating a lower hair line in case of a high forehead) will define your hair line for the future. The younger you are, the lower hairline (in the middle and in the temples) you'll normally want.

As long as you have enough donor hair to "replace" the future hair loss, there's no problem. But if you at the age of 21 get a hair transplant, defining a hair line that's too low, it's not impossible that you in 10-15 years will run out of donor hair. For each cm the hair line is moved forward, you need abount 1000 grafts or about 2500 single hairs - of course depending on the desired density in the recipient area.

This means that having surgery in a (too) young age may well solve your problem here and now, but also brings the risk that you're paying for getting a problem in maybe 10-15 years. Many young patients in their teens or early twenties express the opinion that "as a 30 or 40 year old, I wont care about loosing my hair anyway". Even though this can be true, it rarely turns out to be. To give an example, I'll be performing a hair transplant on a 58 year old man, who's having his second FUE hair transplant! Many have the surgery in the age of 35-50.

In your age I generally recommend using Finasteride 1 mg and/or Minoxidil 5%, and massaging your scalp. This can help limit the hair loss, even though the effect isn't permanent. Furthermore you'll loose the "saved up" hair, as soon as you stop using these medicaments. So the final goal is to postpone the hair loss until you're older.

It must be said that not all patients can benefit from the medicine, and some can't live with side effects. Unfortunately the medicine is also quite expensive.

If you can't live with the hair loss and don't want to use medicine, hair transplant surgery is of course an option, keeping in mind the risk that this brings for the long term result. In cases where a hair transplant is performed on a young person, I take the following circumstances - among other - into consideration:

In order to make the surgery more "future proof", the hairline shouldn't be made too low. A low hairline looks unnatural on a 40 year old, and it makes a big cut into the limited amount of donor hair. To save on the donor hair, the density of the transplanted hair shouldn't be too high. The patient must sign a declaration, stating that he's aware of the problems with having the surgery at his present age, and that he despite this with to go through with the surgery. These precautions are made to transplant as few hairs as possible. In agreement with the patient, we must find an acceptable compromise between his wishes and expections on one side and the insecurity about his future hair loss on the other.

Regardless of age I'll generally recommend an FUE hair transplant above strip surgery, because of the risk of an unsightly scar in the donor area from the strip surgery. By having the surgery at a young age, meaning that the amount of hair used must be limited as much as practically and cosmetically possible, the FUE method carries the benefit that only the required amount of grafts need to be transplanted, and this won't damage the donor area or leave a displeasing scar. Further to this, FUE makes it possible to perform little "refills", when the need arises due to subsequent hair loss.

Hair transplantation is definitely an international market. At my clinic in Pakistan, I've solely treated patients from Northern Europe and North America, while a few local patients has found their way to my clinic in Norway. The majority are patients from abroad.

The international market, distances, language barriers, and other circumstances can make it even more difficult to separate serious treatment providers from the less so. I've oftentimes been contacted by young people who "just" want to get a quote for a transplant of x number of hairs, so they can decide where to have their surgery.

Sadly it shows that many patients are quite young, and often they haven't been informed about the whole age dilemma. This itself can indicate whether a clinic is trustworthy or not.

Back to your question: If it's in any way acceptable for you, I'll suggest that you start using the above mentioned medicine and wait having a hair transplant. If you do decide to have surgery at this point, you must keep in mind that it isn't a simple and problem free solution, even though you'll probably be very happy with the result in the short and medium term.


Mohammad Mazhar Hussain
Specialist doctor in general medicine