In the last 20 years that I have been doing hair transplant, I am more and more convinced that androgenetic alopecia is an evolutionary process. Humans have been known to have evolved from the primates and first lost the copious body hair and then the tail and later their brains evolved and today we consider ourselves the most evolved of all living inhabitants on Earth. Or that is what we would like to think!
On the lighter side, just as when Man started to lose his tail there were tail transplants surgeons, we now have hair transplants surgeons. But as more and more Humans lost their tail, it became fashionable to be without a tail and these tail transplant surgeons became extinct just like the humans with tails. So is gradually happening with hair transplant surgeons. As more and more Humans evolve and lose their, our number will begin to decrease.
How is Story!
Now getting serious- Over the 20 odd years that I have been in practice, I have been witness to the fact that the donor area is become increasingly miniaturized at a younger age.
Today it is not uncommon for a 15-year teenager to be brought to my office with considerable thinning and even over balding.
And increasing numbers of patients have so much miniaturization that they are ineligible for a hair transplant.
So coming back to the primary topic- When is it the right age for a patient to be eligible for a hair transplant?
So when you are young, say 22 years of age and there are signs of thinning, it is a fact that the scalp donor is not yet stable.
We, therefore, cannot determine whether the donor will be able to support a hair transplant or not till a patient is 25.
It is not that we wait for 25 because that is the age for a hair transplant. 25 is not an age milestone cut in stone for eligibility for the procedure. We wait for 25 to know whether you are a candidate for a hair transplant.
A patient at 22 years has high, irrational expectations from a hair transplant in terms of density and coverage since he compares his hairstyle with his compatriots of the same age. Where a person who is 35 will accept a moderate improvement and will be better able to understand the limitations of a hair transplant, a 22-year-old young man will not compromise.
If a patient has up to Grade 3 pattern baldness at 25 with a moderate donor scalp, I will perform his procedure.
On the other hand, if he has upwards of Grade 4 pattern, even with a moderate donor, I would ask him to wait for another year or 2, so that the hair transplant works and does not turn out to be an exercise in futility.
For, if we do a hair transplant without the scalp donor being stable, the transplanted hair will be lost if the donor starts to miniaturize or thin.
This will be a huge emotional tragedy for the patient not only because he would lose the hard-earned gains, but also he has invested considerable time effort and money in his hair roller coaster restoration journey.
More importantly from the hair transplant surgeon’s point of view, his low density in the scalp donor may appear patchy and scars may begin to show.
Hasty decisions in hair transplants are condemnable.
A hair transplant surgeon is put through emotional stress & his endurance is tested when he is requested by a patient & his parents to operate at the age of 22 or younger. It is very important to not succumb and to give psychological counseling to the patient and continue to support him with his knowledge and experience till he is fit for a hair transplant.
So what does a 22-year-old do to bide time?
Well, he can keep a short hairstyle or the buzzed look and be on medication.
So to sum up, the 5 take-home points are:
1. Baldness is an evolutionary process.
2. A patient at 22 years has high, irrational expectations from a hair transplant.
3. The scalp donor is not stable before 25-27 years of age.
4. It is not possible therefore to assess whether the scalp donor will remain permanent before 25-27 years age.
5. This does not mean that at 25 years you are a candidate for a hair transplant.
6. A badly timed procedure may not only lead to a failed procedure but may also expose scars in the scalp donor leading to considerable emotional distress to the patient and his family and in turn stress the hair transplant surgeon’s practice.
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