Candidacy for a Hair Transplant
Candidacy for a Hair Transplant
Hair transplant surgery is a voluntary treatment, but patients must fulfil specific requirements to be considered suitable candidates for the procedure, irrespective of their desire to undergo surgery.
The following are the criteria that need to be met to be a candidate for surgical hair restoration:
- A confirmed diagnosis of androgenetic alopecia or any other condition suitable for hair transplant surgery.
- A history of trying medical therapy initially, and sufficient time is given for a full response (typically one year) if appropriate.
- Sufficient hair loss that has a visible impact on their overall appearance.
- Adequate availability of donor hair to fulfil both current and future needs.
- Realistic expectations regarding the potential outcomes of the surgical hair restoration procedure.
Determining candidacy for hair transplant surgery typically follows these basic guidelines for most patients. However, the process can be more complex for young male and female patients.
Hair Transplantation in Young Patients
Many young individuals who experience hair loss believe a single hair transplant can provide a quick and lasting solution to their current and future baldness. As a result, they often request a hair transplant during the initial consultation, without giving the physician an opportunity to examine them and provide recommendations on other treatment options. They expect the surgery to recreate their teenage hairline and restore their previous hair density. However, hair transplant surgery is not recommended for patients under 25 for five primary reasons.
Physicians face several challenges when considering hair transplant surgery for patients under 25 years of age:
- It can be difficult, if not impossible, to determine the extent of the permanent zone in younger patients.
- The stability of the donor area over time is also difficult to predict in young individuals.
- Early-onset hair loss tends to progress more extensively, making it less viable to pursue a hair transplant in the future.
- Younger patients may have unrealistic expectations about the desired density and placement of the hairline.
- Younger patients may not know how they want to style their hair in the future, and donor scarring caused by hair transplant procedures like FUT or FUE may limit their ability to wear their hair short.
Boundaries of the permanent zone
Determining the size and shape of the permanent zone in younger patients is challenging, as miniaturisation can occur at any age. Areas that appear stable in patients in their twenties can look different over time. This issue has become more pronounced with the growing popularity of Follicular Unit Extraction (FUE), which typically requires five times more donor area than traditional FUT/Strip procedures. To avoid the punctate scars of FUE from becoming visible over time, accurately delineating the extent of future baldness, particularly the upper demarcation of the donor area, is crucial. Moreover, FUE is usually the preferred method for younger patients.
Donor area stability
While the donor area is usually resistant to DHT over the long term in most patients, a less common type of androgenetic alopecia called Diffuse Unpatterned Alopecia (DUPA) can affect some individuals. In patients with DUPA, the donor area is unstable and will continue to thin over time. If a hair transplant is performed on a young patient with DUPA, the transplanted hair will eventually succumb to the effects of DHT, resulting in a loss of cosmetic benefit. Additionally, the hair in the donor area may thin so that the donor scars, usually covered by hair, can become visible. This applies to FUT’s linear scar and FUE’s small round scars.
Regrettably, there is no blood test to diagnose DUPA. Instead, it is identified by the miniaturisation or shrinking of hair follicles in response to DHT in the donor area. However, this can be challenging to detect in the early stages. Determining whether the donor area will remain resistant to the miniaturising effects of DHT over the long term is a critical question that may be difficult to answer during the initial examination.
Early hair loss as an indicator of extensive balding
The earlier a person begins to experience hair loss, the more likely they will become extensively bald. In cases of extensive hair loss, there may not be enough donor hair to cover the entire bald area with a hair transplant. While a young patient may want to restore their receding hairline or temples, typically the first areas to lose hair in patterned hair loss, doing so may worsen their appearance in the long run. For instance, a low hairline transplanted with an extensively bald top of the scalp can create an aesthetically unpleasing look. Similarly, hair transplanted to the temples may contrast sharply with an extensively bald scalp that may develop over time.
Delaying surgery in young patients and preserving existing hair through medical therapy is generally the best course of action until the extent of future hair loss can be determined. Medications such as finasteride (Propecia) and minoxidil (Rogaine) can be used to slow down or stop hair loss and even promote new hair growth. However, it is important to note that these medications are most effective when started early in the hair loss process. Therefore, young patients should seek medical evaluation and treatment as soon as they notice signs of hair loss.
Expectations
It is important for young patients to have realistic expectations and understand that a hair transplant can only redistribute existing hair, not create new hair. Additionally, hair loss is a progressive and ongoing process, so it is difficult to predict how much hair loss a young patient will experience in the future. Therefore, it is generally recommended that young patients wait until their hair loss has stabilised before considering hair transplant surgery.
Hair transplant procedures, both FUT and FUE, involve the removal of hair follicles from the donor area, often leaving scars. These scars may be visible with very short haircuts, making it difficult for patients to wear their hair in the same short style they preferred before the transplant. Therefore, patients need to consider the potential long-term consequences of a hair transplant, particularly if they anticipate wearing their hair very short in the future.
Future Styling
Young patients must consider the long-term implications of a hair transplant, as it can limit their future hairstyle options. For example, if a patient decides to shave their head in the future, the donor scarring from the transplant may be visible and affect their appearance. Therefore, patients need to discuss their future hairstyle preferences with their surgeon and consider all the potential implications of the procedure before making a decision.
Hair Transplants in Women
Women’s hair loss patterns differ from men’s, and their donor areas may be less stable due to hormonal differences. Therefore, fewer women are candidates for hair transplant surgery. It is essential to accurately diagnose the cause of hair loss in women and treat any underlying medical conditions that may contribute to hair loss before considering hair transplant surgery as an option.
It is important to properly diagnose the cause of hair loss in women before considering hair transplant surgery. If the cause of hair loss is due to androgenetic alopecia and the donor area is stable, hair transplantation may be an option. However, medical therapy such as minoxidil or spironolactone may be more appropriate if the donor area exhibits thinning. Other underlying medical conditions, medications, and pregnancy should be ruled out as causes of hair loss before considering surgery.
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