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Even if someone does find a medicine that works, there is no guarantee
that it will always work or that the patient will not later develop
side effects necessitating the discontinuation of that medicine.
The more conservative the patient is willing to be with his hairline,
the better. The hairline can always be brought further down at a
later time, but the reverse is not true. If the transplant is performed
throughout the front and top of the scalp behind a mature hairline,
future procedures may not be necessary even as the patients continues
to bald. It is very normal in nature to have somewhat of an isolated
frontal forelock. If, however, the transplant is performed in isolated
areas such as the sides of a receding hairline, one could imagine
that it would be very necessary to have additional procedures performed
behind the original transplant if the preexisting hair continues
to disappear.
 Figure
6-3. A) If transplants are only placed in certain areas
of the recipient area, B) as the patient balds, this transplanted
hair will remain leaving strange patterns behind which likely
will require additional transplants to rectify. C) On the other
hand, if the transplants are placed throughout the front and
top of the recipient area, they will look normal even as the
preexisting hair recedes. |
In my opinion, it is much, much, cosmetically more beneficial to
concentrate initial procedures on the front and top of the scalp
rather than the back (vertex). There are some sizeable, potential
pitfalls associated with working in the vertex area. From a purely
aesthetic standpoint, making the front and the hairline look good
is much more helpful then filling in the vertex. There are plenty
of men who hate their bald spots in back, but the greatest benefit
from a transplant comes with the framing of the face by the hairline
and the hair immediately behind it. What we see when we talk face
to face with someone is many times more important then what we see
when we are sitting behind him. I am repeating this one more time
for emphasis—the patient should not even worry about the back
before he has the front and top looking good!
 Figure
6-4.Caution must be exercised in the vertex area. If
a man has the balding area in his vertex transplanted, as he
continues to bald, he will be left with a doughnut or halo-shaped
area of balding skin around the transplant. |
Perhaps the greatest risk with performing transplants in the vertex
area is the possibility of continued hair loss if medicines are
ineffective or not used. If the bald spot in back is filled in,
as the patient continues to bald, he will develop a doughnut or
halo-shaped area of bald skin around the transplant. This never
looks normal. It must be remembered that as the halo enlarges, the
donor area is simultaneously diminishing. The patient will naturally
feel compelled to return for transplants to fill in the bare area
around the transplanted vertex, but he will eventually run out of
hair to move. In addition, the more he moves to the back, the less
he will have available to move to the front or top if he wants to
later (and believe me, he will want to move it there if the hair
in front and on top disappears).
 Figure
6-5. Alternatives to help avoid problems with future
hair loss after a transplant in the vertex A) The hair can be
placed in a crescent-shape pattern. B) The hair can be transplanted
in a very thinning manner. |
There are several ways around this problem in the back if the
patient is realistic. One is to diminish the size of the bald spot
by transplanting in a crescent shape. If the patient does bald around
this, it is much easier to keep up with the bare areas since the
surgeon would just be replacing hair lost on the sides. Another
option is to only transplant the vertex in a thinning rather than
a thick fashion. This way, if the halo develops, it is a not as
noticeable and it would take less hair to keep any new areas of
hair loss filled in a similar thinning manner. The best option is
for the patient to just not worry about the vertex. Instead, he
could style his hair so as to comb it back over the bald spot. A
few hairs can easily be placed into the bald spot to simply act
as anchors for the hair combed back into it.
Next Topics:
After The Hair Transplant
Choosing a Hair Transplant
Surgeon
Possible Hair Transplant Complications
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