Hair Transplant | Ability To Cover a Progressively Balding Scalp After a Hair Transplant

Ability To Cover a Progressively Balding Scalp After a Hair Transplant

I understand that my male pattern balding will continue to progress throughout the crown area on my scalp, leaving the typical horseshoe effect that I’m sure I will inherit from both of my grandfathers. I will be having a hair transplant in about 8 months to restore my receding hair in the front. It recedes about two inches from where my original hairline was once located, and also in that very flattering spot right in the very back.

I am 26 years old and will be 27 before my surgery, have very light blond and extremely curly hair. I will be having follicular unit hair transplants by a reputable company (HC). My question: If I continue to bald in the crown area over my lifetime, can I have additional surgeries to assure that the crown area is covered by hairs not affected by DHT by having this done?

Also, I have read about donor areas and the amount of one’s own hair available to use as transplantable hairs. Say I will eventually develop a horseshoe pattern without surgery and Propecia, does one have enough donate-able hair to cover the whole crown area, and thus keep undetectable natural looking hair transplants?
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The ability to cover any given balding scalp region depends on several factors. The most important factor relates to the relationship between donor supply availability and recipient site needs. Unfortunately, the donor supply is a fixed commodity that does not renew itself when grafts are harvested. In light of the fact that there are a finite number of grafts that can be harvested from your donor site, you must realize that there is a limit to what can be done to produce coverage and density. A finite number of grafts can be spread over a large area to produce thin coverage, or they can be placed selectively into a localized zone – such as the front hairline – to produce a region of thicker hair.

One of the most confounding variables relating to the prediction of scalp coverage possibilities is the age at which the patient presents for surgical evaluation. A young man with an early balding pattern has the potential to become an old man with an advanced balding pattern. It is absolutely critical for a young patient to understand that his actual graft availability is related to his final pattern - something that may be impossible to accurately quantitate for decades. In addition to the donor site surface area reduction that occurs with time, some patients also develop age-related diffuse thinning within the donor site. Diffuse thinning will reduce graft availability even beyond what is lost from the shrinking donor site surface area.

Variations in hair texture, hair-skin color contrast, hair shaft caliber, average follicular-unit hair count and donor site elasticity also influence the final result for any given individual. Patients with favorable physical characteristics can create the appearance of higher density over larger areas than those with unfavorable characteristics.

The uncertainties associated with age-related balding progression should instill a sense of caution in any young man undergoing surgical hair restoration. Caution simply means fully understanding the limitations of surgical restoration and not trying to do too much with a limited, non-renewable donor supply. The younger a man is when beginning surgical hair restoration, the more caution he should take in devising a surgical plan. This is simply related to the fact that a very young man has more years available for his pattern to advance in an unpredictable fashion.

You indicated that you are having surgery by a “reputable company”. Your consult should have already provided you with detailed information relating to possible future needs. The planning phase of surgical restoration should have as high a priority as the technical phase of the procedure. A well executed procedure can result in long-term dissatisfaction if future balding is not taken into consideration. This is especially true when beginning hair restoration in a young man.

Questions you should ask your surgeon include:

1) What type of pattern will I develop with time?
2) How will my donor site change over time?
3) Will I be able to cover newly developing areas of balding?
4) What type of density can I expect to achieve over those areas?
5) What is the long-term surgical plan?
It is imperative that you have all of your questions answered and that a logical, long-term plan be proposed prior to undergoing any surgical intervention. This will minimize your risk for disappointment and assure your long-term satisfaction.

Raymond J. Konior
Member, International Alliance of Hair Restoration Surgeons
Member, American Hair Loss Association