Here is a question I received from a prospective patient and my answer.

Question: My wife keeps telling me that I need a hair transplant so here I am doing some research. Here’s my situation, I am 31 years old and seem to be a 3V on that baldness scale. One of my friends is taking propecia a says it’s great stuff, but I am afraid of the side effects that I keep reading about. Is it even worth having a hair transplant if I don’t take Propecia to stop the rest of my hair from falling out?  I’ve also read that once I start this process I might have to go through several surgeries and if I don’t take Propecia I can still look bald in time. Please advise. Thank you.


This is an excellent question. Firstly, there have been reports of sexual side effects with Propecia, but the vast majority of people taking Propecia report no adverse side effects and the benefits of taking Propecia, especially in younger patients, are significant. In my practice, I have all patients read and sign a detailed Propecia consent form that discusses in depth the benefits of Propecia as well as all the possible side effects and any associated risks. I let the patients know if they start to feel any of the adverse side effects to discontinue the medication. In addition, to patients who are thinning in the crown region, which it sounds like you are, I also recommend Rogaine 5% foam twice a day. Studies have shown that patients who use Rogaine and Propecia together experience a synergy between the 2 medications which show more positive results than either medication taken independent of the other. I routinely perform a video microscopy on the scalp with my patients and if I see a large amount of miniaturization of follicles I may also recommend low light laser therapy. I have become a fan of the new LaserCap which, with it’s ease of use, provides excellent compliance among patients. I have seen great results with it low light laser therapy in patients who have a large amount of miniaturization. Finally, in order for me to determine if you are a candidate for Hair Transplant surgery I would need to see you in consultation or look at your photos, but if you are a 3V it sounds like you likely could be a candidate. I always tell my patients that you will definitely have between 2-4 procedures in your lifetime to keep up with continuing hair loss. The number of procedures is affected by the rate of your future hair loss, which Propecia, Rogaine, and Laser Therapy can markedly slow down. I hope this answers your questions.

All the best,

Marc Dauer, M.D.

Hello all, over the past few years I have been performing an increasing number of Hair Transplant / Hair Restoration procedures on younger individuals, so I thought that I would outline my general approach to these patients.

As the new technologies in Hair Transplantation have improved, the numbers of individuals seeking out a permanent treatment to hair loss have increased. This has included younger individuals who are anxious to treat their hair loss. Many times hair loss in younger individuals can have even more devastating psychological consequences than in older patients. These psychological issues must be as carefully managed as the medical plan to treat these patients. It is very important to take a thorough medical and psychological history to assess the patient’s psychological well being as well as their hopes and expectations. In most cases, I will not consider transplanting a patient younger than 25, as often the full extent of their eventual hair loss cannot be fully determined at such a young age, and therefore it is in the patients best interest to wait until their late 20’s when a more complete picture of the patients eventual hair loss is better determined.

Patients that have a more moderate degree of hair loss can still be candidates for Hair Transplantation in their mid 20’s, and in the right cases, by performing the Hair Transplant earlier, it allows the patient to “stay ahead” of the hair loss that they will be experiencing in the future. Barring any medical contraindications, I usually encourage all my young patients to begin on a regimen of Propecia and Rogaine. I also think there is some positive scientific evidence to support the benefits of Low Light Laser Therapy in these patients. Another issue I am commonly confronted with in regards to Hair Transplantation in younger patients, is hairline design. Many patients wish to have their hairlines restored to the hairlines they had as teenagers. I often encourage my patients of all ages to bring in photos of them in their youth to give me a complete picture of what the patient looked like before their hair loss set in. In designing a hairline in a younger individual, it is very important to explain to the patient that there is a very finite amount of donor hair in every patients “hair bank” (the permanent hair on the sides and in the back).

Sometimes the problem with bringing the patients hairline down too low is twofold. The first issue is that young patients with hair loss are set in motion to have a significant degree of hair loss as they get older. Medical therapies can help slow this progression, but rarely stop it all together. When the hairline is brought down too low, it then forces the Hair Transplant Surgeon in successive surgeries to spend large numbers of grafts to “fill in” the areas just behind these low hairlines, and sometimes this is at the expense of other balding areas that can no longer be addressed, because of the overall lack of donor hair. In addition, a hairline that may look natural on a 25 year old, will probably not look natural on a person in the 50’s or 60’s.

I tell all my younger patients to think as conservatively as possible on their first Hair Transplant. I tell them that they have a finite number of donor hairs in their “hair bank”, and that it is very important that every hair is used in the most effective manner, and placed in the exact appropriate location. Hairlines can always be brought down, but once they have been brought down too low, the patient is faced with either the prospect of permanently removing valuable transplanted hair in the hairline, or trying to fill in just behind the hairline, at the expense of balding areas on the top of the head. Just like hair loss is a progressive phenomenon, so too, the approach to Hair Transplantation is usually that a typical patient will undergo 2-4 Hair Transplant sessions over their lifetime. The transplanted hairs we put in will never fall out, but most patients will continue to have loss of their surrounding native hairs in the areas prone to genetic hair loss.

It is important to educate the patient that proceeding more conservatively on the first procedure can give the patient many more options as they get older, and as their hair loss progresses. I hope this clarifies some of my approach to Hair Transplantation / Hair Restoration in younger individuals. Please feel free to email me if you have any additional questions.

All the best,

Marc Dauer, M.D.