Thank you for your question.
You submitted several photos and you state in your question that you’re 23-years-old
and that you’ve been undergoing PRP or platelet-rich plasma treatments and it appears that your
hair loss has been stabilized. And you’re specifically concerned about the temples,
particularly the right temple in an area where you have observed a cowlick that has become
more visible. And you’re asking is it appropriate for you to consider hair transplant although
you are still young if you were to continue doing PRP every 6 to 9 months moving forward.
Well, I can certainly share with you how I address this type of question in my practice
which we deal a lot with. 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. Hair transplant and hair
loss treatment has been a major part of my practice. And I’m also the founder of TrichoStem™
Hair Regeneration Centers. This is a system we developed starting about 7 years ago to
help men and women of all ages treat hair loss non-surgically. And this is actually
using PRP as well as Acellular matrix something I’ll discuss further momentarily. So I would
like to explain to you few things about your situation that still makes me hesitant to
ever consider a hair transplant for someone your age.
To begin with, you have to understand that hair loss is a progressive condition. And
the age of onset and rate of progression are the most important variables when it comes
to strategizing a surgical intervention. So what does that mean? When you think about
it, there’s a concept called the Rule of Decades. And the Rule of Decades basically
is that when you are in your 20s, 20% of men have hair loss while 80% do not. And as you
get older, 40s and 50s, it gets closer to 50%.
So when we think of hair loss, I like to think, especially when we’re doing what we do in
our practice a treatment called Hair Regeneration, when I look at patients in a way retrospectively
over the many years we’ve been doing this and essentially, I’ve categorized people
into different levels of risk in terms of progression and a relative aggressiveness.
So when you think about someone your age group starting to lose hair, essentially by definition,
your hair loss is more aggressive. This is in distinction to a man who comes in who is
in his 40s or 50s who has a similar appearance. In that situation, the hair loss is less aggressive.
Now the aggressiveness of hair loss can be variable. For younger people, people in their
20s, men, I have observed that essentially, you can have a progression that is very rapid
or where you can practically be bald or not bald by your early to mid-20s as well as moderately
progressive in terms of the time that it goes on so that you can be well into your late
20s and early 30s and still have a decent amount of hair. Now the challenge is in categorizing
people in a way so that you can develop an appropriate prognosis but unfortunately, the
appearance can be very similar in the more aggressive as well as in the moderately aggressive
situations at any given point of time when people come in essentially for consultation.
So when we think about the technology of PRP and what we’ve done in our practice with
Hair Regeneration, PRP which is now becoming much more well established as an intervention
for hair loss is still a treatment that is in effect, slowing down progression. It’s
not stopping progression. When you think about hair loss treatment as it stands today, whether
it’s medical such as the drug finasteride, whether it’s PRP, whether it’s Acellular
matrix, platelet-rich plasma combination that we’ve developed called Hair Regeneration
as well as transplant, what are you essentially doing? We’re essentially managing hair loss
progression. You’re not curing.
So when we developed Hair Regeneration and it’s something that may be worthwhile considering
in your research and learning about this technology, what we’ve learned is that the effects of
combination of Acellular matrix and platelet-rich plasma (PRP), formulated and injected in a
particular way depending on an individual’s particular hair loss characteristics, we’re
able to establish significant prolongation of growth as well as reactivation of the hair
that isn’t growing as well as thickening hair that was previously thinning.
Now something to also be mindful is whether or not it is worthwhile for you to consider
being also on a DHT blocker such as finasteride. When I look at people in terms of this relative
aggressiveness model, I think a lot about their relative DHT sensitivity. Now DHT is
not the only cause of hair loss. We know this because when people are on finasteride and
they’re on finasteride for 15 years or more, a lot of the patients are still progressively
losing hair. But what I would suspect is that they have more hair than they otherwise would
have. What’s happened is that progression has slowed down.
So again, when you think about this concept, with Hair Regeneration, what we have done
is we’ve developed a system where we can do an injection, a single injection. And in
the right candidate, we can extend that lifespan of that hair and see improvement for more
than 5 years. We have a subgroup of younger people who have more aggressive patterns who
it appears that we can extend only to three years. There’s a distinction there even
if it’s as effective as our treatment.
So the take home message here is, with the PRP, the PRP may appear to have stabilized
your hair loss because you’re not losing hair currently. But what you don’t know
how long this effect is going to last. There is no treatment that stops hair loss for the
rest of your life. It is still about managing hair loss. So in your situation, you’re
only 23, you don’t know whether this PRP treatment will be as effective 2 years from
now, 4 years from now. And what I recommend to my younger patients is do everything you
can to avoid a hair transplant for as long as possible. Hair transplant is not the answer
to everything. Hair transplant is limited. It’s limited by the amount of hair you can
get from your donor area and just getting a natural full volume appearance. For example,
if you want to treat your temples, just think about what would happen if you got the transplant
and then the temple hairs that were present currently receded then all you would have
will be transplanted hair and that doesn’t look very good.
So I would recommend that you wait for as long as possible. Certainly, continuing the
PRP treatments seems to make sense in your situation. Learn about Hair Regeneration,
PRP, Acellular matrix which we developed from a wound healing concept. And also consider
a DHT blocker like finasteride. As I said, wait as long as possible before considering
hair transplant and I would recommend probably not until your 30s.
So I hope that was helpful, I wish you the best of luck and thank you for your question.