15 Year Old Son Is Losing His Hair, Need Help - Can He Get a Hair Transplant?
Written by Raymond J. Konior, MD on December 24, 2007
My 15 year old son has been losing hair in the shower and when he combs his hair. He feels his hair is thinning and is worried about it. We are also very concerned because he had surgery on his head when he was an infant which left a very large scar and also left his skill asymmetrical which has always been covered by hair. We are interested in finding a physician to help his hair loss and see if it is possible to have hair transplanted onto his scar. Does it sound like he would be able to have a hair transplant? What could be causing his hair loss at such a young age? Please help we need a Christmas miracle.
Your son’s situation is quite complex and needs to be carefully analyzed. Although he may be an excellent candidate for surgical hair restoration, surgical intervention can lead to a variety of problems later in life if he develops a more extensive balding pattern than what is being predicted at this time.
First off, follicular-unit grafts seem to grow quite well in many scars. Follicular-unit restoration has proven to be a very successful technique for camouflaging the adverse cosmetic appearance of scalp and facial scars. I tend to favor a much more conservative approach when placing grafts in scar tissue. Scar tissue has a significantly reduced blood supply compared to intact skin. A compromised blood supply can adversely affect healing and graft regrowth. A conservative approach means that fewer grafts are inserted during any grafting session in order to minimize the chance of a poor graft yield. Patients have to accept the fact that multiple sessions of low-density grafting may be necessary to safely establish sufficient density for an acceptable aesthetic result.
Prior to considering any type of surgical hair restoration, however, it is absolutely imperative that the nature of this new thinning process be evaluated by a competent, medical hair loss expert to determine its cause. Male pattern hair loss is relatively uncommon at his young age and a reversible cause, such as a nutritional deficiency or stress-related hair loss, needs to be investigated. Proper medical management of a reversible cause would prevent any unnecessary surgical intervention.
If he is diagnosed with male pattern hair loss at this young age, extreme caution has to be taken with respect to surgical intervention. This caution applies to any form of restoration – either to boost density within the generalized balding scalp region or to provide hair coverage within the scar itself. The primary difficulty in managing this case is his young age. There is simply no way to predict what the final balding pattern will be in a very young individual. The uncertainty of not knowing how far a balding pattern will progress with advancing age means that the stability of the donor region can not be guaranteed. This makes donor harvesting somewhat risky. If the surgeon removes graft material from an area that will bald later in life, the graft hairs will eventually fall out and the donor site scars will become visible. For this and other reasons, young men with early thinning are typically offered medical management with Propecia and/or Rogaine in an attempt to stabilize the balding process. Surgery is best deferred in young men until one can determine with a reasonable degree of certainty what type of pattern will develop.
The option of grafting into the scar at his age will depend on its location and on his risk for developing advanced male pattern baldness. The best scenario would be if the scar was confined to the donor region of the scalp (sides and back). Grafting a scar in the donor region would not be affected by any future hair loss since the donor site is resistant to balding. Treating a scar in this location would provide a lifelong restoration. Grafting a scar that is located on top of the scalp will also result in a lifelong success as long as male pattern baldness does not develop in the region of the surgically restored scar.
Problems can develop, however, if grafts are placed into a scar that is located on the top of the scalp and he later goes on to bald in the area around the scar. Given this scenario, grafting a scar on top of the head will look good while he is young and still has his youthful hairline. As hair falls out with the progression of male pattern hair loss he will eventually develop a hairy strip where the grafts were inserted into the scar. This hairy strip develops because the grafts have donor site hair which is immune to male pattern hair loss. As you can see, his risk for developing progressive hair loss must be identified prior to surgery to avoid a calamity like this.
Finally, there are many scalp scars that can benefit from scar revision techniques. Scar revisions, when applicable, are beneficial since their success has no relation to the male pattern balding process. These techniques simply reduce the scar width via excision of the old scar and the creation of a new, finer scar. Good candidates tend to have excellent skin elasticity in the region surrounding the scar.
Raymond J. Konior, MD
Member, International Alliance of Hair Restoration Surgeons
This fifteen year old needs to have his iron ferritin level checked. My son started losing his hair at sixteen, is twenty now, and a year and half ago his ferritin level was checked and he is now being treated by one of the best dermatologists in the country at Cleveland Clinic. His hair has shown great improvement. The goal was to save what he had and to hope for some regrowth. Doing a google search should lead you to the report.