When hair loss strikes it is always unexpected and never fun. It starts with noticing a few less hairs in one spot on our hairlines or it may even, unfortunately, start with a comment by a friend or family member and these comments always seem to present themselves in the company of others. Sometimes we notice that our hair is not quite as full as it once was. Regardless of how it starts, it always ends up going in the same direction; down the drain.
I get a lot of younger people that come to see me to discuss their hair loss problems and they always seem to be eager to have a hair transplant. The surgical option is the most visually beneficial option as it creates the biggest aesthetic impact. Where once there was no hair there is now a lot of hair. It is much more effective than the average medical response such as those seen from minoxidil (Rogaine®) and finasteride (Propecia®) and even with most platelet rich plasma (PRP) therapies as well. However, there is one problem that remains with almost all of my young patients. They’re just too young to have surgery.
Being young means that it is difficult to see the long road ahead. Young people simply haven’t lived long enough to understand that many of the decisions we make now will affect us for the rest of our lives. It is one thing to say one understands but it is another thing entirely to understand based on experience. That is why it is imperative to have guidance when dealing with hair loss from those that are more experienced and educated on the matter.
For instance, the case below is that of a young man that had two hair loss issues he was dealing with; crown loss and temple recession. He was on his way to being a NW3V and beyond. Once one starts to get beyond this level of male pattern hair loss long term planning becomes even more important. However, he had the foresight at the young age of 20 to begin medical treatment with finasteride and by the time he came to visit me he had already been on the medication for four years and he was reporting a stabilizing effect with no further hair loss. He was now, in his opinion, ready for surgery. I disagreed.
I spent considerable time with this patient discussing his options and how he may be better served with alternative hair loss treatments. Once surgery has been performed there is no going back so it is imperative to exhaust all other options before making such a commitment. This is why when he first became my patient I suggested he try my PRP/ACell combination treatment and to see how it may work for him. He agreed and after his treatments were completed I told him to return to see me six to nine months later and we would reassess based on his results.
Below is a comparison of his before and after photos. Photo #1 on the left is representative of four years of Propecia. Photo #2 on the right represents one year after a treatment with PRP/ACell. The improvement is obvious. We also know that this improvement is only due to the PRP/ACell treatment I administered because finasteride only continues to improve for the patient for 24 months at most. Since he was on finasteride for four years before his PRP/ACell treatment we can eliminate finasteride as having had any additional benefits contributing to these results.
As is not entirely unexpected the patient was quite happy with the improvement but he was not happy enough that he was no longer going to worry about his appearance. I discussed his future with not only him but his family as well as this was a big decision for all involved. The patient understood the need for a guarded approach in that the front could be addressed for a dramatic visual improvement but the crown would only be moderately addressed as using too many grafts in the crown could have negative consequences. The patient and his family understood and we proceeded with a procedure.
The patient received 3049 grafts via FUSS in a one-day procedure. The majority of the follicular units harvested were used for the frontal zone and the temples to recreate a stronger frame for his face. The design is appropriate for younger men but is not so aggressive that it will look unnatural as he ages. The crown received approximately 600 grafts to give a fuller appearance for the crown. The benefit is not only the number of additional hairs he has in this area but also the caliber of the hairs. They are fuller and stronger than the native hairs so they give a healthier degree of coverage. More hair can be placed in the crown but we also wish to preserve the donor supply for future needs if necessary and the patient is happy with his final result as it is.
This is a case that exemplifies what it means to plan ahead. We did not rush into surgery and we used alternative methods to improve the patient’s appearance. The PRP/ACell procedure did not restore a full amount of hair but it was enough that it allowed 600 grafts to do a wonderful job for coverage. Had the PRP/ACell approach not been attempted he would have needed 1000 grafts in the crown to achieve the coverage that he received with only 600 grafts.
Jerry Cooley MD