Thank you
for your question.
You state in your question that you are on the edge of getting a hair transplant. And
that you don't want to take finasteride. You don't want to take a drug for the rest of
your life. And that you have observed results of people who have gotten hair transplant
without finasteride which appeared to be impressive. Further, you have submitted photos of your
father’s scalp to ask whether or not he were to get full coverage without taking finasteride
if he were to undergo hair transplant. And I think this is the basic gist of your question
essentially, can you get a hair transplant without taking finasteride.
Certainly, I can share with you what is the important information that I discuss with
my patients when it comes to management of hair loss. And I think this is a key to understanding.
Hair loss is managed and no matter what, you’re not necessarily in any way considering a cure
but what you want to do is get the best appearance that works for the look that you want to achieve.
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. The
is a system that we developed to non-surgically treat men and women with androgenetic alopecia
or genetic pattern hair loss which makes 95% of hair loss patients.
I think, first to answer the question about your father’s scalp, I think that in every
hair transplant consultation, the discussion is pretty similar. The goal is for transplant
not to cover the entire scalp because there’s intrinsically a mismatch. Whether it’s with
an FUT or FUE, you have a limited area of harvesting from the donor area at the back
of your scalp. Yes, you can get body hair transplant but let’s stick with just that.
The top of the scalp has way too much surface area for you to be able to cover everything.
So doing transplants for as long as I have, I always discuss with my patients essentially
the goal which is to frame the face, to create essentially a frontal hairline as well as
coverage to the mid scalp to get a natural transition. But what does hair transplant
not do? It does not do anything to the progression of hair loss.
Now speaking to your concern, even though you didn't submit a photo, if you’re 21-years-old
and you’re on the edge of having a hair transplant, it might be fair to conclude that
you are losing hair at a relatively aggressive pace and that speaks to many issues about
the feasibility of hair transplant.
Essentially, it has been generally a standard amongst hair transplant surgeons to limit
or avoid doing surgery in men under 30. Why is that? Well, when it comes to hair loss,
if you have an early onset and a relatively rapid rate of progression, then the hair transplant
is not likely to keep up with your rate of progression. The typical ideal candidate for
hair transplant in my opinion is a middle aged man with a later onset of hair loss who
has more of a frontal balding progression. So basically, they have a later onset, a slow
rate of progression and they need hair in the area in the front where a transplant can
be placed and their rate of progression is relatively slow which means that they may
or may not choose to take finasteride but they will appreciate and get the benefit for
many years. Hair loss will still progress but that is in contrast to a younger person
who has an early age of onset, rapid rate of progression and more advanced loss. This
is not somebody who is an ideal hair transplant candidate. I think it’s very important to
understand that there is no cure but there are strategies to manage hair loss.
So when I meet a patient who is in their 20s and we have this discussion everyday in our
practice, we treat patients with Hair Regeneration from around the world. And briefly, this is
a system we developed out of helping patients with hair transplant. The challenge with hair
transplant has always been getting really effective coverage, getting the survivability
of the grafts to be maximum as well as minimize scarring. But with transplant was always the
challenge of maximizing the longevity of the appearance and that meant encouraging our
patients to take finasteride to slow down progression.
It is my perception that although finasteride may be more effective for some people compared
to others, a lot of this has to do with really the specific genetic pattern and relative
aggressiveness as well as relative sensitivity to DHT. So arguably, someone who has later
onset has lower DHT sensitivity than someone who has an early onset. It’s not exactly
always black and white like this but it’s a good framework to decide how to manage a
person who has hair loss.
So a lot of our younger patients, I will talk to them about considering taking finasteride.
I provide them the clinical information that is relevant and not just what is the information
that is more popular in the internet as well as a strategy for Hair Regeneration treatment.
Essentially Hair Regeneration treatment is an injection treatment combining platelet-rich
plasma (PRP) with Acellular matrix based on algorithms I’ve developed over the past
7-8 years. And those algorithms are based on gender, age, age of onset, rate of progression,
degree of progression and other medical factors in terms of dosing, timing and placement of
this injection. However, I would uniformly say that most younger people, I would have
this discussion about finasteride. Patients will choose whether or not to take the drug
but it is part of that discussion.
Hair loss is progressive. Everybody eventually loses hair with rare exception but it essentially
depends on when that hair loss begun and how aggressively it progresses in determining
who is a good candidate for transplant and who isn’t. Even people who have a later
onset, if they have a more diffuse thinning pattern, they’re not going to be a great
candidate for transplant. Like I said, the ideal candidate from my perspective is a middle
aged man with frontal balding. That is the ideal candidate. When you talk about your
dad’s situation, yes I would still encourage someone with that hair loss pattern to still
consider finasteride but it is a different rate of progression compared to a younger
person.
So I think it’s important that you learn all this. Do some consultations. Figure out
what works best for you. I’ll tell a lot of our patients who are in their 20s that
before you think about taking a pill for the rest of your life, understand that a lot of
people and being in practice for over 20 years, I can tell you this from experience that a
lot of men may think that hair is important to them in a certain stage of their life.
But as they get older, they may consider it less important. It’s a personal decision.
So I’ll say that if you are committed to managing your hair loss, well it probably
makes the most sense to use every tool you can and not just ignore something. Now people
who are more middle aged and have a later onset, they have a little bit more breathing
room but there is also typically less of an urgency related to their situation compared
to younger people.
So I hope that was helpful, I wish you the best of luck and thank you for your question.