Monday, 2 November 2015

Hair transplant: Why there is a recommended minimum age for surgery

Is there an ideal age for a hair transplant surgery? This is a question that is often asked by the younger clients who come into hair loss clinics usually within the earlier stages of hair loss wanting to rebuild the shape of their receded frontal hairline. In answer to the question on whether there is a minimum age the answer is yes. The preferred minimum is 25 years of age however 30 years or older is preferred. Why is this? Let’s explain this in detail:
1. Difficulty in forecasting long term hair loss

When being assessed for a hair transplant surgery there are two important things that need to be determined during the consultation. The first is the number of grafts that they require right now in order to treat the thinning area and secondly the number of grafts (via additional hair transplantation) that they may require over the long term as they lose more hair.

As an example, a 23 year old male wan
t hair loss treatment to thicken and recreate their frontal hairline back to what it looked like a few years earlier. As far as treating the area is concerned, it may be estimated that he needs 2500 grafts to complete the transplant properly. So giving them the result that they are after is not difficult. However the inability to forecast how much hair they may lose over the next 15 years can create a problem in the longer term. Donor hair is in limited supply because whatever is extracted for surgery does not grow back. If it was evident that the patient was going to become completely bald within 15 years, the hair transplant surgeon is going to be more conservative with the hairline position (meaning that the hairline would be positioned higher up in order to reduce total surface area on top). A strong probability of being completely bald also means that more total grafts will be required during their lifetime to maintain some level of coverage over the top.

If it concluded that a patient will end up with a very bald area the Doctor must decline requests for too much density or a very low hairline as this will severely deplete donor hair supply for future surgeries. Forecasting long term hair loss is very difficult in a 23 year old and quite easy in an older patient that is in their 30s.
2. Unrealistic Expectations in Young Patients

Young patients in their early 20s still hold onto the glimmer of hope that they can bring back the level of density as well as the hairline shape that they had during their teenage years. To them it was only a few years ago when they owned such a thick head of hair so they figure it is still possible and reasonable to request this during their consultation. Hair transplant patients generally end up with a hair transplantation density that is around 40% as thick as the density per cm of their donor region. To put things in perspective a completely bald man with a newly created frontal hairline and a medium density will be very satisfied because it is a significant improvement to what they had for so many years.

The young patient who ends up with a medium density 15-18 months after the surgery will express that they are not satisfied with their result and will blame a lack of growth. But the real reason for not being happy is a lower density compared to what they used to have and to what they were hoping to achieve. This is unrealistic expectation. Sometimes clients come in with a photo of David Beckham and ask, “Can you make my hair look like this?”... Enough said.

A young male will often demand a low hairline as well as a thick density. There are two main concerns about agreeing to this. The first is that the low hairline may suit them in the short term but will look very unnatural as they enter their 40s and 50s which can become a giveaway that they had surgery. The fact is that the older male will have a higher positioned frontal hairline in most cases. Along with this a low hairline increases their total surface area on top limiting the overall density they are capable of achieving should they need additional procedures in the future.

The other issue in relation to wanting a high density comes down to supply and demand. If 3000 grafts were dense packed within the frontal third of their scalp and they require more surgery, it may be possible that 5000 grafts is the most they can extract over their lifetime. This leaves only 2000 grafts to treat the remaining two thirds of their scalp which will produce a density that is only 33% of the frontal third that was initially transplanted at a high density. If a patient is going to transplant the whole top they will want to maintain a relatively consistent density from front to back. They certainly don’t want one region to be double or triple the thickness of the remaining transplanted areas.

3. Young patients don’t think about the long term

A common mentality is that in 10 years they will not care about their hair anymore and therefore they are living only for today. This is commonly heard when a Doctor Recommends hair loss medication for 12 months before proceeding with hair transplantation surgery. Many young patients who are still in the earlier stages of hair loss convince themselves that they will not lose anymore hair. They notice that the existing hair still looks thick and due to this doubt they could ever lose an extensive amount. Being recommended medication, a high hairline design and a medium density to preserve grafts for later do not interest the young patient. However it is up to the hair transplant surgeon to use their experience and to educate the client properly about all the risks and the potential of longer term hair loss.

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