21 years old receding hairline, what age could I have surgery? (Photo)

Hello TheoBlake,This is a very important issue in the field of hair restoration surgery.  The problem with transplanting a young person, such as a 21 year old man, is that we don't have a solid idea of how much hair loss is going to occur over the next several decades.  As the saying in our field goes, "the good thing about hair transplant results is that they are permanent....the bad thing about hair transplant results is that they are permanent."  If, despite efforts to slow the hair loss, you progress to a Class 6 or 7 within the next 20 years, the original work done will still be along your hairline.  As this is not a pattern of hair loss typically found in nature, it is an unusual appearance that can be socially crippling later in life.  Therefore, approaching a frontal hairline reconstruction in a younger person should always be approached with caution and prudence.  Fortunately, recent advances in technology have expanded the ways and effectiveness of preventing hair loss.  Finasteride (eg: Propecia) has been around since about 1998 for hair loss.  More recently, the science of low-level laser therapy (eg: LLLT) has advanced such that a majority of those who use a high-quality LLLT device can expect the progression of their hair loss to dramatically slow down or appear to stop altogether.  In younger people, especially those under 25, there is a decent chance that some of the miniaurized follicles will become thicker and return to terminal (eg: thick, non-thinning hair).  Other therapies that have shown promise include platelet rich plasma with ACell (eg: PRP with ACell), and placental stem cell therapies are also being studied as ways to control the progression of hair loss.Personally, I require men under 24 to undergo at least 8 months of preventive therapy to see if the progression of the hair loss can be controlled with LLLT or PRP with ACell.

Dear TheoBlakeThanks for the question. There is no age limit as such for a hair transplantation. But people under the age group of 18 years to 80 years usually options for hair transplantation as the symptoms of balding and spot balding occur within this span of life. I wish you all the best.

You can have hair transplant surgery at 21 years old, but you should be conscious it is a young age to do it. A long term treatmant must be planned with your surgeon.

You need an exam and consultation by a doctor.  After you have an established diagnosis, you can explore treatment options.  Surgery may be one of them.  However, you need to understand all the consequences of surgery at such young age such as how to handle further hair loss.

Hair transpalnt surgeons used to believe you cannot do a hair transplant for anyone below the age of 24.  That has changed thanks to the more effective medication that keep people from losing hair as much and the new methods of evaluation of hair loss such as miniaturization study.  In fact the findings from microscopic evaluation of the scalp and your family pattern can help your hair transplant doctor make a decision as of what treatment to choose and if hair transplant is in order how aggressive it should be designed.

Can I have a hair transplant. What is the rush?  for a 21 year old, the first line of defense is (1) go to a good doctor, (2) have him put you on the drug finasteride to stop the hair loss if he made the diagnosis of genetic hair loss. (3) wait at least a year to see the results of the drug. Then develop a Master Plan with your doctor because you may continue to keep balding and you must know what is going to happen to you before you embark on a hair transplant program.

I’m a specialist in hair loss, board certified by the American Board of
Cosmetic Surgery and I have been performing hair transplant for many years. I
would like to commend you for understanding that there is an ongoing hair loss
progression and you have refrained from moving forward to having a transplant
while progression continues.



Currently, there are two medical treatments that are used in the United
States for hair loss: finasteride and minoxidil. Finasteride, or the trade name
Propecia, is a pill that you take every day that inhibits an enzyme called
5-alpha reductase. This enzyme is responsible for the conversion of
testosterone to dihydrotestosterone (DHT). DHT-susceptible hair follicles will
miniaturize and eventually disappear, so a DHT-blocker like finasteride can be
of value. Unfortunately, there is a lot of concern about the long-term sexual
side-effects of finasteride. Most of the males who come to our practice refuse
to take finasteride, or felt uncomfortable with the continuation of the drug. On
the other hand, minoxidil doesn’t do much in terms of preventing further loss. This
leaves you with very few other options.



With your progression at an early age and its fast rate, you cannot be
treated to your desired density with a hair transplant. Even if you were to
stabilize your progression, the amount of hair to restore what you had or close
to what you had is still a lot. In addition, the donor area has limited number
of hairs.



To address this, we developed a treatment called Hair Regeneration.
This is the use of a material called extracellular matrix (ECM) combined with a
material from your own blood called platelet-rich plasma (PRP). Hair
Regeneration is a formulation, method, and technique of delivery of treating
the scalp with an injection. This injection treatment has been so successful
for us that it dramatically reduced the number of hair transplants we do. In
the right candidate, the results of Hair Regeneration treatment can far exceed
the results of hair transplant.



People often misinterpret that through Hair Regeneration, we are
creating new hairs. We do not create new hairs, but we make thinning hairs become
thicker. There are genetics involved in the hair thinning process. Hair grows
in cycles, and with every cycle there is a shedding phase. When the hair is
thinning, the hair growth cycle called the anagen phase gets shorter. Then
there is the sleeping phase called the telogen phase where the hairs shed. Lastly, the middle phase called catagen phase
actually becomes longer. With each subsequent cycle, hair thins. The treatment
appears to salvage and restore the normal growth pattern of existing hair as
well as hairs that are dormant.



When a patient comes to our practice, we do a microscope examination of
the scalp and look at the ratios of the thinning hairs to the thicker hairs. We
also look at the top of the scalp at different angles with digital photography.
We have observed that in areas where we don’t see hair, we can still get
growth. We can save hairs that are salvageable, but if hair has been not been
present for more than 3-5 years in a given area, then it’s less likely that
we’ll be able to restore that hair. We’re often surprised by the robustness and
quality of the results of this treatment but at this point, we advocate early
intervention. There’s a large group of males who have early onset hair loss in
their late teens to 20s and with very aggressive rapid progression. This is
unfortunate because per the Rule of Decades, 20% of your contemporaries in your
20s have hair loss while 80% have a lot of hair. This can have a tremendous
effect on your confidence when you’re losing hair while everybody else has
great hair.



For us, Hair Regeneration has been very successful as our first line of
treatment. There are people who we even do second treatments on depending on
what we observe in salvaging dormant hairs. Sometimes those hairs come back
very thin, so we’ll do a second injection and they’ll come back even thicker.



I would dissuade you from considering a transplant. I think a
transplant will not be adequate with
your rate of progression you are experiencing. When you do your
research, you’ll see that there’s a large gap between medical therapy and surgery.
The internet is strongly advocating surgery, grafts, number of grafts and
technologies to get better grafts. The bottom line is there are only a few
hairs you can transplant. I would advise you to learn more about Hair
Regeneration, see if it’s available where you are and do more research to learn
about these options. Time is not on your side so intervention as early as
possible is something we advocate. I hope that was helpful, I wish you the best
of luck, and thank you for your question.



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This decision differs from doctor to doctor.   Most hair transplant specialist do not recommend hair transplant in patients younger than 23 years old.  That is because in most cases, a definite hair loss pattern and degree of hair loss has not been established at that young age. Ministration studies can be done, but the result is not definite.  Therefore in most cases, it is wise to start on some form of medical regiment and then decide to do transplant once the pattern and the degree of hair loss is established.