Michael Vories, MD

Your best bet is to a consult a physician about beginning finasteride. Restoring the crown through surgery is very difficult, and involves a high number of grafts. Better to try medical therapy first to stabilize the crown.

Based on the photos I would estimate between 2000-2500 FUE grafts to fill in the apex (corner areas) of the hair line and frontal forelock. Generally hair loss is progressive, but because your father has a similar hairline may indicate your hair loss will slow down.

Shock loss can mean two things- loss of the transplanted hair and loss of the native hair. Shock loss of the transplanted hair should be expected, and happens about two weeks after the procedure. This is temporary and the permanent growth begins around the third month. Shock loss of the native hair rarely happens in hairline cases because the native hair maintains it blood supply behind the transplanted area. There is no need for minoxidil for the procedure, although minoxidil can be useful for maintaining the native hair from typical male hair loss progression.

You can place black scalp hair to the beard, but there is a concept of recipient dominance, where when the black hair is placed in the beard, it will over time take on the characteristics of where it was placed. This means that if the existing beard hair is white, the transplanted hair will likely turn white within the next year or so after the transplant.

This certainly appears to be androgenetic alopecia or male pattern hair loss. While an FUE procedure can restore the hairline and apex areas, it is just as important to try to slow down the hair loss. The earlier the hair loss begins the more aggressive the pattern, so beginning finasteride and minoxidil is suggested. When designing the hair line for the procedure indicate to the physician to stay as conservative as possible with the hairline placement to conserve the limited number of grafts you have in the donor area

If there is an obvious asymmetry with the hairline, there is no reason to have to wait for a touch up procedure, it can be done anytime.

The age of a patient undergoing hair transplantation is not as important as the health of a patient and the goals of the patient. We have done many procedures on patients in their seventies with the results as impressive as with younger patients. Actually, the results are often better because gray hair contrasts less with the scalp as dark hair (in caucasian patients), so the results look fuller.

This certainly looks like alopecia areata, but can only be confirmed by direct physical examination for the presence of “exclamation mark” hairs. Often a scalp biopsy is also performed to confirm the diagnosis.

From the photos this appears to be the beginning of androgenetic alopecia (AGA), or male pattern hair loss. Given your age it is important to see a physician to consider beginning finasteride to mitigate the hair loss as it evolves over time.

At this point I would hold off on surgery. Adding Rogaine to finasteride maybe your best bet to hold off future hair loss and perhaps grow some hair in your crown. Surgery at this point would only give minimal improvement, and use up grafts you may need in the future as the hair loss progresses.