To transplant or not to transplant (27yo curly with MPB). Harsh honesty appreciated! (photos)

Thank you for your question. You’re 27-years-old and are aware of your hairline receding so you ask some basic questions: the predictability of your hair loss based on certain family members who have similar hair; one who started losing hair much younger; one who kept his hair until they were a little older; also about the progression and the benefit of curly hair in this situation; and your concerns about continuing to lose hair after transplantation. You’ve had a consultation where 100 to 130 hair per square centimeter density was measured in your donor area.  You’re doing the right thing by learning more about your options, and the prospect of a hair transplant with concerns about progression, which is a very important point to keep in mind.
A little background about myself, I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I’ve been in practice in Manhattan and Long Island for over 20 years. I performed hair transplants for over 20 years, and I’m also the founder of TrichoStem™ Hair Regeneration Centers that offer a non-surgical solution for male and female pattern hair loss we developed from technology we first used for hair transplant surgery. Let me give you the same guidance I give similar people to yourself who come to our practice.
You have to understand that at 27, with the level of hair recession that’s a worst case scenario, not the best case scenario in terms of predicting the progression. It’s a general rule in hair loss called the Rule of Decades: if you are in your 20s, only 20% of men have hair loss, while when you hit your 40s or 50s, you’re going close to 50% and beyond. For you to have a family history where there is a younger person, who developed hair loss at a younger age, chances are you inherited some genetics to have your hairline noticeably receding at your current level.
The next question is can you feel confident your transplant would be adequate for a certain length of time. When I was in training back in the early 90s, it was rare us to offer transplantation for men in their 20s, because at an early age of onset, we had limitations of what we could offer patients in preventing progression. In 1997, a drug called Propecia, generic name finasteride, came into the market and helped people slow down their progression. The challenge is finasteride only helps about 60% of men, and with concerns about long-term sexual side-effects, a lot of men do not want to take the drug, or men who took the drug but felt they had side-effects so stopped taking it.
In our practice with someone like yourself, in addition to educating you about finasteride, the first thing we recommend is something called Hair Regeneration. Hair Regeneration is something that we developed over the past several years using platelet-rich plasma which is derived from your own blood that’s a concentration of the healing and growth factors for wound healing,and combine it with extracellular matrix. This is an injection treatment that can stop progression, reactivate hair that’s not growing, and stimulate hairs to shed and then grow into thicker hairs.
We’ve been able to help many people who come from all over the world, notably men in their 20s who have struggled with the limitations of hair transplant. If you’re considering a hair transplant, a solution to stabilize hair loss before a hair transplant in our practice is Hair Regeneration.
In terms of curly hair as well as your density, those are both advantages. Having curly hair means you are able to cover more scalp. Having high density as you do means there are more hairs per square centimeter, therefore, you’ll have more hair to transplant. In your situation, I have typically advised someone to do the Hair Regeneration treatment. We follow people every 3 months and document how they do. I usually suggest waiting until after they are 30 to consider transplantation.This personalized video answer to your question is posted on RealSelf and on YouTube. To provide you with a personal and expert response, we use the image(s) you submitted on RealSelf in the video, but with respect to your privacy, we only show the body feature in question so you are not personally identifiable. If you prefer not to have your video question visible on YouTube, please contact us.

If you are not happy with your hair line or hair loss, you may be a candidate for surgery. You still need to see a doctor for a formal consultation to make sure surgery is right for you.

It's impossible to predict at age 27 just how much future hair loss you may have. That said, you are clearly not following in the genetic footsteps of your GF (?) who was bald by age 25, and your many bald uncles had probably lost more hair than you have by the time they were 27. So you may very well keep a lot more hair over the years than some of the other men in your family--and quite possibly as much as your 60 y/o uncle. Your best bet for stabilizing things would be for you to get started on finasteride. As far as a hair transplant goes, your curly hair is a big asset since graft for graft, you will have the appearance of having more density than someone with straight hair. (Check out the B & A photos in the link below to see what 1288 curly-haired grafts can look like.) And God forbid, if you do have some additional recession behind the transplanted area, your curls will do a much better job of camouflaging it than straight hair would.

I hope this was helpful--
Dr. Ballon

I love people with curly hair because after a hair transplant the curly hair covers much better than straight hair. it looks like your hairline receded upward and this is very easy to fix, see video below