Since it is impossible to anticipate how bald a man might become,
the surgeon must be extremely conservative during the planning stage
if the man is young. I periodically see cases in which a man received
transplants several decades ago but who has continued to lose hair
and now has the previously transplanted hair in areas which look strange
because of his current level of baldness. Typically, either the transplanted
hair is too low on his forehead or the transplanted hair is present
in an island-like formation surrounded by balding skin on the crown.
These are difficult cases to repair because usually these patients
are running out of hair to donate.
 Figure
6-2. Hair must be transplanted in a mature pattern.
A) If a man with early to moderate balding has a transplant
placed low on his hairline, B) as he continues to bald, he will
need to have the sides filled in. C) Unfortunately, he will
eventually exhaust his donor supply and be left with a “front
heavy” pattern. D) On the other hand, if the first transplant
is placed in a mature pattern, E) as he continues to bald, it
will be much easier to fill in the sides. F) Even when he exhausts
his donor supply, he will be left with a normal pattern appropriate
for his age. |
These days, many balding men choose to go to the other extreme
and shave their scalps. I caution patients not to have a transplant
if they are considering this because the transplant will leave a
fine, linear scar in the back where the donor strip was repaired.
Similarly, if the patient wants to keep his hair so short (burr-type
cuts) that someone could see through the hair to the scalp, then
I warn him that he should expect that the donor scar will likely
show through in the back. This is an especially common problem for
those in the military. On the other hand, if the patient wears his
hair long enough that someone cannot see through to the scalp, the
donor scar should not be apparent unless someone is picking through
his hair.
With previous forms of transplants, such as minigrafts, repeat
procedures were often necessary to hide the resultant “pluggy”
appearance. With follicular units, this does not
tend to be the case. However, depending on the area of the scalp
the follicular units are moved to, additional procedures may be
necessary for continued balding (a strong argument for the anti-balding
medications) or for additional thickness. I will discuss more on
the thickness available with transplants momentarily.
Right now I want to concentrate on the distribution in the recipient
area. The patient must be cognizant of how his transplant might
look in the distant future as he continues to bald. The transplanted
hair is permanent hair, which should not be susceptible to the hair
loss associated with normal male pattern baldness. If someone reaches
seventy to eighty years of age, he may notice a generalized thinning
of all of his hair. This is termed senile alopecia and is unrelated
to male pattern baldness. Otherwise, the patient should expect to
keep the transplanted hair permanently. This means that when designing
a transplant, the surgeon must plan a mature hairline, one that
looks normal no matter the patient’s age. Many men, especially
the younger ones who see their friends’ low hairlines, will
complain that these mature hairlines are too high for their liking.
Unless they can find a medicine that stops their hair loss, they
cannot forget about the inevitable progression of male pattern baldness.
Next Topics:
After The Hair Transplant
Choosing a Hair Transplant
Surgeon
Possible Hair Transplant Complications
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