Am I a Candidate?

Hair transplantation requires meeting specific criteria:

• Diagnosis of androgenetic alopecia or another suitable condition
• Prior exploration of medical therapy
• Significant hair loss impacting appearance
• Adequate donor hair for present and future needs
• Realistic expectations about results

Candidacy varies, particularly for females and young males.

Hair transplantation in young patients
Hair transplantation in young patients requires careful consideration due to several factors:

1. Determining permanent zone boundaries is challenging in youth.
2. Stability of the donor area over time is uncertain.
3. Early onset hair loss may lead to extensive baldness.
4. Unrealistic expectations about density and hairline position are common.
5. Future hairstyle preferences and potential donor scarring must be considered.

Boundaries of the permanent zone
In younger patients, determining the size and shape of the permanent zone is challenging due to miniaturization, which can start at any age. This is especially crucial with FUE, which requires more donor area. Precision is key to avoid visible scars from FUE over time, making it the preferred choice for younger patients.

Donor area stability
In some patients, the donor area is resistant to DHT, but those with Diffuse Unpatterned Alopecia (DUPA) may not have a stable donor area. If a young patient with DUPA undergoes a hair transplant, the transplanted hair may not withstand DHT, leading to lost cosmetic benefits. Additionally, donor area thinning may expose scars from FUT or FUE. Detecting DUPA early is challenging, as there's no blood test. The long-term resistance of the donor area to DHT remains uncertain at the initial examination.

Early hair loss as an indicator of extensive balding
Starting to lose hair at a young age increases the risk of extensive baldness. Often, there's insufficient donor hair to cover the entire bald area. While filling in receding hairlines or temples might seem tempting, it could worsen appearance over time. For instance, a low transplanted hairline with extensive baldness on top isn't aesthetically pleasing. Similarly, transplanted hair to temples may contrast sharply with future baldness. It's advisable for those under 25 to postpone surgery until future hair loss is clearer. Preserving existing hair with medical therapy like finasteride and/or minoxidil is a sensible approach until the hairline matures.

Expectations
When hair loss begins, one may long for their original density and youthful hairline. However, returning to this state isn't usually possible, especially for young individuals facing extensive baldness. Early transplants may leave insufficient hair to cover subsequent loss behind a transplanted hairline. Keeping hair very short might be the best option for those experiencing significant hair loss, but this choice may be forfeited after a transplant due to visible donor area scars, applicable to both FUT and FUE. Often, there's not enough donor hair to cover the entire scalp, particularly in younger patients who desire full coverage. In such cases, it's often best to maintain short hair and not draw attention to balding areas, especially the crown. As one ages and their needs evolve, a hair transplant may become a viable option.

Future Styling
While there may be enough donor hair to cover thinning areas in youth, extensive baldness, especially in the crown, may exceed donor capacity. To address this, transplant recipients may opt to grow their transplanted hair longer, covering the crown. Alternatively, keeping hair very short or shaved can minimize the appearance of baldness, but this choice is no longer available post-transplant due to potential scarring from both FUT and FUE procedures. Young individuals may not foresee their future preferences in hairstyle.

Hair Transplants in Women
In women, hair loss often manifests as overall thinning across the scalp rather than the typical male pattern baldness. This diffuse loss is influenced by DHT levels and aromatase interaction, potentially leading to an unstable donor area. Consequently, fewer women are candidates for hair transplants. Before considering transplantation, women should undergo densitometer assessment to evaluate donor density and exclude underlying causes of hair loss. If androgenetic alopecia is confirmed and the donor area is stable, surgical restoration may be suitable. However, if the donor area shows signs of thinning, medical therapy is preferred.

Summary
Patients must ensure their chosen physician conducts a comprehensive examination before recommending surgery. Younger individuals should inquire about DUPA and carefully consider the long-term implications of permanent procedures. Women should confirm androgenetic alopecia diagnosis through densitometry and, if necessary, undergo extensive testing to eliminate non-androgenetic causes of hair loss.