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Dr. Rassman,

I am 25 yrs old and I have a receding hairline. I understand that you can’t tell me whether I’m a candidate without seeing me, but can you tell me what percentage of men my age are candidates for a hair transplant? Also, what characteristics make these men candidates?

Assuming that you do not have a maturing hairline, then your candidacy for a hair transplant relates to how much the hair loss bothers you. Hair transplants are a cosmetic surgical procedure and are completely elective. I always tell my patients that if their hair loss does not bother them, do not consider hair transplant. If you are genetically balding, then drugs like Propecia (finasteride) will stop or slow the hair loss.

As to percentages of balding men at age 25, I would have to guess that some balding may be present in 10-25% of men at your age. Men over 45 years old have a 50% chance of showing some balding.

Hi Doc! I have another question that I haven’t been able to track down an answer via search engines. I had my last transplant surgery 16 years ago, and all the recipient sites where they put the grafts are light red in color. Is this usually a histamine reaction or some kind of blood stain? It shows more after I get out of a warm shower. Please let me know what this is, and if there is a fix for it (laser resurfacing, etc.) Thanks a bunch!!

16 years is a long time for recipient sites to look anything but normal. Histamine response to heat may be possible, causing increased circulation with the shower heat… but I am just guessing and I’m not enthusiastic about that explanation. I would like to see you if that is possible, but if you’re located too far from my offices in California, I’d suggest you go see a good dermatologist.

Hi! Been reading your blog for quite a while now. I know that you are against body hair transplants onto the scalp, BUT — I don’t want to have body hair transplanted anywhere but into my strip scar. The reasons I saw you give in the past for avoiding body hair transplants were because body hair doesn’t grow out very long, so it would be bad for styling. Well, I would like it transplanted into my scar so I can cut my hair much shorter than I currently can without it being noticeable.

I have looked at my chest hair, and they’re not curly. I plucked out a few and compared them to my scalp hair. They’re quite similar. Is this still a terrible idea? I honestly don’t want to FUE scalp hairs because in case this simply doesn’t work and I end up deciding to just say “Screw it…I’m shaving my head and i’ll live with a visible strip scar,” I would then also have to live with little white dots all over the back of my head. I know, they’re not supposed to be very visible, but I don’t want to add to more scarring on the back of my head. I really don’t.

It’s actually not a terrible idea. I am not against using body hair to repair a scar on the scalp, provided that you realize that the telogen (resting) phase is very long… which means only about 50% of the hairs will be growing at any point in time. I would want to evaluate you first if you want me to do this.

Dear Dr.,

I had a hair transplant (840 3-4 follicular grafts) in February of 2009. The areas treated were the large crown and also throughout the temporal areas. I still do not see a drastic difference. I am not sure why. I am continuously also using Rogaine foam and Propecia. When under any bright lights, I see such thinning as to where the transplant was supposed to have worked. I am not sure if something went wrong, or everyone’s bodies are different; thereby it may look better within another year. Have you heard of my situation? Does a hair transplant take up to another year in order to see better hair density results?
Thank you!!!

Without knowing more about your case, it would be difficult to provide much precise information. Sometimes a thin look can appear under harsh lighting because of your hair color, hair character, thickness, etc. The Rogaine and Propecia are good to continue using, but after a year you should’ve seen results by now from the surgery. Everybody is different, every surgery is different, and every medical group is different, but it generally takes 6 to 8 months to see the beginning results of a hair transplant surgery. Either your surgery has failed or you continued to lose more of your native hair and what you are seeing is the lost native hair. I have seen transplant failures, and generally these occur because of surgical errors, inexperienced or sloppy teams or techniques, or rarely the presence of some associated disease like diffuse alopecia areata (though this is unlikely in men).

I’d discuss this with your surgeon to find out his/her take on why your grafts haven’t grown. Be sure to compare your current look to pre-operative photographs, because sometimes patients don’t realize just how bald they were before the surgery (the hair grows in gradually so its hard to notice if you’re not focused on it all the time).

See this recent post for more — If There’s No Growth a Year After My Hair Transplant, Should I Just Get Another One?

This patient is in his mid 20s and showed a Norwood class 3 pattern with additional recession in the temple area. The results posted below are after one procedure of 1733 grafts, with the photos taken only 8 months after surgery. I fully expect additional growth in the transplanted area with more time, but the patient is very excited with the way things have turned out so far. I hope to have updated photos to post in a few months when we get to the 1 year mark.

It’s worth noting that the patient styled his hair forward in the corners of the hairline, and the “after” photo is not a straight line as it may appear to some. Click the photos to enlarge:

After (1733 grafts):

Before:

When attempting to find a good HT Doctor, should one that doesn’t do a Miniaturization test be a strong factor in determining whether to use them?

There are many doctors that do not map the scalp for miniaturization. It is a relatively easy procedure, and in my hands it is basic to using medications like Propecia, in determining the health of the donor area, and in developing a long term Master Plan for the patient. If they do not use a high-powered video device to examine the hair, they will miss things like diffuse unpatterned alopecia (DUPA) on many patients who have it. And to continue that example, I am sure that if they end up performing surgery on a person with DUPA, they will absolutely harm them.

I am not a fan of doctors that do not do a complete examination of the scalp before they go forward with hair transplantation surgery. Of course, you should make your own determination of that issue.

If I get a hair transplant but develop senile alopecia many decades from now, when I’m in my 70s or so, will it be a problem?

If you develop senile alopecia when you are much older, if your doctor produced a Master Plan for you, this should not be a problem. The doctor would have accounted for such a process in the plan, provided that he performed follicular unit transplants in a pattern that would give consideration to such a change.

Transplanted grafts will mimic the changes in the donor area, so if the donor area lost 30% of the hair, then the hair transplants will lose 30% of the hair in the grafts. Unfortunately, there are not statistics on this available, but this conclusion is based upon years of observations that I have made.

Hi Doc,
Firstly I would like to say great site!I have two questions:

This is speculative but could be me in a few years: I know that you are not reluctant in performing transplants to you people, but if a 23 year old male came into your office having taking propecia for 4 years with a norwood class 4A balding pattern would you carry out the transplant if this person insisted and that a master plan had been established?

What is the age of the youngest person that you have performed a hair transplant to?

If there is a balding pattern like a Norwood Class 4A, no matter what the age, he would probably be a candidate for a hair transplant provided that:

1. He had enough maturity and knowledge at hand with realistic expectations.
2. He understands the financial short and long-term nature of paying for the process.
3. His examination shows that he has the required donor hair to meet his needs.

As for the youngest… well, I have done hair transplants in a few children as a result of accidents, brain surgery, and birth defects. These are unique cases and not like re-establishing a hairline or crown swirl.

I read your posts everyday and I would like to thank you for educating me and keeping me up to date. I’ve noticed several different times that you say there is no official age limit for a hair transplant. I would agree. I’m 21 years old and I had a hair transplant 10 months ago. For the first six months things did move pretty slowly but I would like to say things are going great now. My hair is looking better than it has in years and should continue to get even better. At the time of the transplant my hair loss was an advanced Norwood 3. I had been on propecia for 12 months. My density is slightly above average and I have a lighter medium course hair. With all that being said I still don’t know if my doctor would have performed surgery on me had I not been as educated as I was.

My biggest piece of advice for all of the younger readers out there who are serious about getting a hair transplant is you have to be informed and know what you’re getting into. You have to understand the process; see if your hair loss is more than just a maturing hairline, find out how good of a candidate you are for the surgery and be able somehow finance it. Also, find a good caring doctor.

Obviously, if a teenager doesn’t like his maturing hairline, that doesn’t make him a candidate for surgery… but the “rules” about minimum age for hair transplantation are flexible to a point. As a physician, I won’t perform a procedure that wouldn’t be in the best interest of the patient down the line. Not all doctors follow these same guidelines, but educating yourself is key to not becoming a victim. Nobody should ever rush into a hair transplant, because this is a permanent procedure! I’m glad you found the site helpful and I hope your grafts grow in nicely.

Hey Dr. Rassman,

I must tell you that your blog has become an important part of my daily routine and can not thank you enough for your continual work on it. I know you probably have your reserves about this head tattoo procedure, but how about getting it done just on the scars from a HT procedure, it seems like a great way to cover up scars for people who want to shave their heads, especially on the sides and back, where you do not have to worry about losing hair. I am thinning on the top and receding and I am hesitant to get the procedure done on the top of my head in case i ever want to grow my hair out again and continue receding, but at least on my HT scar it makes sense? What are your thoughts? Thanks.

Tattoos can work if they are stippled so that they look like hair, but changes in color of the tattoo can be a real problem (imagine a green tattoo over time). As I understand it, most inks won’t change color, but from the few patients I’ve seen with a tattooed scalp that hasn’t been the case. Be sure to research the tattoo issue, as I’m not that informed about the various inks and methods.

I am not sure if you had a hair transplant and have a scar or if you’re considering a hair transplant and are worried about the scar. In either case, scars can be largely prevented most of the time, but if you have one, a revision of the scar (at least one attempt) should be made. Each case is different, so a good doctor is what you want to have. Ask your doctor about the frequency of scars and the sizes that he/she sees. Consider sending me a photo of your scar if you have one.

The photo below is a 4 year old scar after a single procedure of 2090 grafts done here with a trichophytic closure. There is a scar, but it is barely noticeable, typical of trichophytic closures in my hands. Click to enlarge.