Male: Am I a candidate for Hairline Lowering Follicular Unit Extraction? How much would it cost? As you can tell by the photos, I have a receding hair line. My expectations with surgery would be to have my hairline lowered, to give me a more youthful look. I'm 22 years old. If it means anything, my hair is straight, being that I'm West Indian. How much would this cost and is it possible?

Dr. Prasad: Thank you for your question. You're 22 years old and you submitted photos, asking a question about whether or not you're a candidate for FUEs, or Follicular Unit Extraction transplant surgery. You explained that your hair is straight, related to your West Indian origin. So to answer a question like this, first, the point of understanding whether or not you're a hair transplant candidate has to begin with the question about your recession or receding of your hairline. You've noticed, at a very young age, that your hairline is receding. So the question is where will that hairline be three years from now, five years from now, ten years from now.

One of the questions that is always raised about surgery is how many grafts can you actually place, but what the more important question is how much hair do you have to graft? You see, when you are young and you have some receding, technically, it's not difficult to address that relatively small amount of recession with transplant, but you have to remember that the donor area, the area where you transplant from, is limited.

Think of the baldest man you've ever seen, and in the medical field, we refer to that as Norwood 7, which is a very thin rim of hair. That rim of hair is referred to as genetically resistant. That means that no matter how old they get, that hair will always be there. Hair transplant is the selective use of this genetically resistant area and transplanting it to other areas, which means that there is a limit to how much hair you have available to transplant. It's like having only so much money in the bank. You can't use it all up, because you may need the money later.

So look at your family history. See what other male members of your family, whether it's father, uncles, cousins, etc., what is their hair loss pattern like? Within a family, hair loss is not determined by any specific pattern, such as dominate or recessive or the common myth of maternal uncle. It's not the case. It's variable. Even within siblings, it can be variable. One brother can have a lot of hair, another brother can have thinning hair or hair loss at a relatively young age. Think about the future before you try to address the amount of recession you have now.

Now, in thinking about other options besides transplant, in the United States, there are two drugs that are approved for hair loss. One is Minoxidill, which is a topical solution or a foam; and the other is Finasteride, which is an oral medication which blocks an enzyme called 5-Alpha Reductase. 5-Alpha Reductase blocks the conversion of testosterone to dihydrotestosterone. A specific sub-group of men with male pattern hair loss have what's called androgen-sensitive hair follicles. Those androgen-sensitive hair follicles will thin in response to circulating dihydrotestosterone or DHT. What that means is that by taking Finasteride, you will reduce DHT, thereby restoring the functionality of the hair follicle.

The problem is, there are two problems, really. One is a significant percentage of me do not respond to Finasteride. Many men have come to us for hair transplant or hair loss solutions because they were taking Finasteride and they lost hair in spite of it. A more well-known issue right now is that there is question about the long term sexual side effects of taking Finasteride. This has led, in our practice, for a lot of men to come in who are in the 20s and 30s to seek an alternative.

What we've developed in our practice is this alternative that we call hair regeneration and what it is is the application of a material called extracellular matrix combined in a specific way with platelet rich plasma. And what we've done is, over the past several years, with hundreds and hundreds of patients coming from all over the world, we've developed our own method, our formulation and customization based on a large clinical pool of data. So what we do is actually a one-time injection that appears to last up to five years, up to this point, and has been of remarkable benefit for men who don't want to take Propacia or Finasteride or men who are taking it and are still losing hair. It also has proven beneficial for female pattern hair loss.


Hair Transplant at a Young Age Is Not the Best Idea -- Here's What to Consider Instead

Dr. Amiya Prasad discusses how hair transplants performed on men in their 20s will not stop progressive hair loss and how a non-surgical treatment can thicken thinning hair and stop progressive hair loss.