Thank you for your question.
You submitted your question with an image of the top of your scalp. And you state that
you’re 26-years-old and you are trying to make a decision whether or not to do FUT or
an FUE for hair transplant procedure. And you state that you have friends who did FUEs
who did not appear to have the most optimal outcome so you’re looking for some guidance.
Well, I can certainly share with you how I counsel patients like yourself in my practice
when it comes to hair loss management strategies.
A little bit of background, I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial
plastic and reconstructive surgeon. I have been in practice in Manhattan and Long Island
for over 20 years. I am also the founder of TrichoStem™ Hair Regeneration Centers, a
system we developed to help people with male and female pattern hair loss, treat hair loss
non-surgically, has been quite a significant option as an alternative to hair transplant
particularly for people who are younger. So I think it’s important to understand a couple
of things and I think it is very challenging when people who are in your age group deal
with hair loss.
In terms of hair loss, the incidence of hair loss in different decades of life for men
basically referred to as the Rule of Decades. So in your 20s, only 20% of men have hair
loss while as you get into your middle to later decades, your 50s and older, well then
50% have hair loss.
The challenge with hair loss in your age group and your degree of advanced hair loss is what
do you do to manage your hair loss before you move forward with a hair transplant. It
is a common story that I get to hear in our practice when people come to me somewhere
in their 30s and they’ve already had one or two transplants in their 20s. Unfortunately,
the hair loss progressed and they have only some isolated transplants. And further, those
transplants are not anywhere close to enough to provide a significant amount of coverage
and so they end up in their mid 30s and beyond not looking like they had a lot of hair even
though they underwent anywhere from 2 to 4 surgeries.
The challenge really is to manage hair loss before doing surgery and I think it’s very
important. It’s also important to understand that hair loss is progressive and having an
early onset puts you in a more aggressive category. Basically, when it comes to this
Hair Regeneration treatment that I mentioned earlier, we developed a system based on our
experience first doing hair transplant. We were trying to help our transplant patients
get a better yield of their grafts as well as improve the healing of the donor area which
was this strip method. What we also got to see was that thinning hairs in a lot of patients
became thicker.
Move the clock forward, over several years, now going on close to 8 years, I developed
a system to address patients with male and female pattern hair loss. Further, I was also
able to identify essentially through a lot of challenges and obstacles and setbacks that
certain categories of patients have more aggressive hair loss than others. And so we developed
a classification system and that classifications system has to do essentially with gender,
age of onset, degree of hair loss, rate of progression as well as other medical issues
that are important to understand.
So one of the things I would say to most of my young patients, patients who are in their
20s, is that almost by definition, having an early onset, that it’s already obviously
hardwired in your DNA but I would propose that you also have a higher DHT sensitivity,
dihydrotestosterone, which is essentially one variable that is important in the progression
of hair loss. So a lot of my patients who are in your age group, I counsel to consider
strongly to take a DHT blocker such as finasteride. Of course, people looking in the internet
are very often afraid to take finasteride but I try to put things in context of current
clinical knowledge and the fact that this drug has been around since 1997. We try to
put things in perspective and look at every patient individually but I do routinely prescribe
this drug as another tool to help slow down progression.
In addition, we also do a treatment called Hair Regeneration. What we’re doing essentially
is reactivating hair that is not currently growing which by definition is due to androgenetic
alopecia where the thinning hair actually, the growth cycles get shorter and the resting
phases get longer which means there’s fewer hairs that are actually present. In addition,
we also find that thinning hairs get thicker as well as the prolongation of the hair growth
cycle.
Occasionally, when we see our patients, we are essentially seeing them in a snapshot
and there’s no way to know whether they’re in a stable or relatively stable phase of
their progression or whether they’re on their way down. And so sometimes, a lot of
these patients who are younger who have more advanced hair loss, their thinning hair is
almost, if not certain percentages, are already at the end of the growth cycle and never to
grow again which means they can still progress before they stabilize and before we can manage
maximizing their growth cycles to as long as possible and using a combination of a DHT
blocker and injection is a way that we are trying to help them combat a very aggressive
DNA program.
So I would say that it is important for you to think of stabilization and management before
you do surgery. I think that we have enough experience to know that a lot of people go
through surgery at a young age will later regret it because they still progress and
now they’re stuck with a certain look that doesn’t really work that very well for them.
So think about the seriously before you make this decision between FUT versus FUE. There’s
a mismatch between the amount of scalp that needs coverage and the amount of hair that’s
available in your donor area. Yes, more aggressive or more ambitious patients will undergo body
hair transplants which is a valid choice but you should also think of how to maximize the
lifespan of your existing hair for as long as possible to minimize and delay hair transplant.
At least from my perspective, I think that makes more sense than just doing transplant
after transplant.
So I hope that was helpful, I wish you the best of luck and thank you for your question.