When should an autologous hair transplantation be considered at the earliest?


Dear Readers,

with the following article I would like to address in particular young people who would like to inform themselves in this way about a hair transplantation. Again and again I receive inquiries from young men who would like to undergo a hair transplantation. Although the reasons for this desire are often different, it is often accompanied by strong emotions, which indicate a deep insecurity, because these men have suffer from the feeling that something would be wrong with their appearance. This also means that young people in this situation are susceptible to the offers of dubious providers of hair transplantions, who perform this procedure at any age solely to satisfy their own financial interests, without regard to individual consultation needs and a sustainable treatment result.

Against this background, I would like to encourage young people who are interested in having their own hair transplanted to take a close look at the subject and to critically question the promises made by some dubious providers. It should be clear to them that this is an intervention in the body, which – if the surgery is not carefully planned and sufficient car eis not provided to the patients – the intervention may not have the desired long-term success. In the worst case, it can also cause damage that can not be corrected, for example, if the hairline is placed too far on the forehead.

Since the long-term well-being of my patients is my top priority, this means that I repeatedly have to tell young people during the assessment or consultation that an intervention is not possible in a medically responsible manner. In the following, I would like to explain to you, dear readers, why it is always a good idea to wait a little longer with the procedure if you have doubts about an autologous hair transplantation.

Therefore, enjoy reading!
Yours, Angela Lehmann

Worries about appearance put many young people under pressure

Social media platforms such as Facebook or Instagram often cause young people to believe that a perfect appearance in all situations is possible and desirable. Beauty and attractiveness are closely linked to success, and it is not uncommon for cosmetic or plastic surgery procedures to be presented as something that counts little. All in all, the image is that beauty is a commodity that is available everywhere and at all times, if only one wanted it.

With this knowledge, young people today are under enormous pressure and have correspondingly high expectations of themselves. If they feel that their appearance is negatively affected, this usually causes stress, if not even great distress. Of course, these young people then quickly look for ways to meet their self-expectations again and this can become problematic in particular when they meet dubious providers who offer them the possibility of performing the procedure in any case, even in the field of cosmetic surgery.

Such providers sometimes shamelessly exploit the plight of young people in order to pursue their own – often exclusively financial – interests. These providers are usually not interested in whether the treatment is low-risk and sustainable, and young people have little opportunity to question this because the information provided about the treatment prior to the procedure is often insufficient. In my view, this practice represents a major deplorable state of affairs, because in terms of responsible treatment of patients, some of whom are very young, a reputable provider must refuse to perform the procedure.

Unfortunately, this practice can also be found again and again in the field of cosmetic hair transplantation. Therefore, it is important to sensitize young people who are looking for information about this procedure to the fact that it is an surgical intervention in one’s own body that is not an option for everyone at any time in life.

Many young people are interested in autologous hair transplantation

Recently, young people – especially young men in their early 20s – visit my clinic again and again to find out about the possibilities and limitations of an autologous hair transplantation. Most of these men feel that they are already suffering from hair loss at a young age.

In fact, many men experience hair loss in the course of their lives. This is also known as an-drogenetic alopecia or hereditary hair loss. In principle, there is no age limit from which men can be affected by this form of hair loss, which means that even young men can experience hair loss. With this in mind, young men in particular come to me for advice and information about hair transplantation techniques. Although there are also young women who suffer from hair loss, it is much less common because hair loss in women is often associated with hormonal changes such as during pregnancy or menopause. Instead, younger women are more likely to ask for a consultation if their hair has been damaged by hairdressing treatments. In men, on the other hand, hair loss can begin around the age of 18, a time when physical maturation is not yet complete.

Often, young men suffer greatly from hair loss with early onset, so that some are nearly desperate. I often experience that these patients have the feeling that there is a deeper underlying problem with their body or that the hair loss is due to certain lifestyle habits (use of too much shampoo and chalky tap water or due to wearing the headgear during military service). Many are also sad and urgently seek help. In the case of such patients, it is first important to listen openly and with empathy, since many are not able to correctly classify the problem, especially since the necessary knowledge about the hair loss, its causes and possible ways of treatment is lacking.

As mentioned above, androgenetic hair loss can start as early as around the age of 18. This is a growth disorder of those cells in the scalp that are responsible for the formation of hair. Androgenetic hair loss is mainly determined by a person’s genes; hence, it cannot be influenced by lifestyle habits and is therefore beyond the control of those affected. The decisive factor for its occurrence is the hormonal balance, which in the case of young men stabilizes at the onset of adolescence. This is also the reason why men can be affected by androgenetic hair loss at a young age.

The treatment of hair loss must be done very carefully, especially at a young age

Basically, hair transplantation is performed by transplanting hair-forming cells (follicles) from one area of the head, also called the donor site, to another area, the recipient site. In this way, it is possible to “fill up” areas of the scalp already affected by hair loss with hair again. The area that can be replenished with hair in this way depends mainly on the available donor area of a patient – and this is precisely the big problem of autologous hair transplantation in young patients: If, for example, an 18-year-old patient, who already has a pronounced receding hair-line, presents with the request for a hair transplant, a serious practitioner must assume that the hair loss in this patient will continue to progress with increasing age.

If – against the good medical practice – a hair transplantation is performed to fill up the receding hairline, several problems arise: Due to the fact that no one can seriously predict how far the hair loss will pro-gress and which scalp areas will be affected, responsible treatment planning is not possible. If the hair loss continues from the forehead towards the center of the head, bald patches may appear behind the treated areas. However, hair loss may also continue laterally. In any case, the newly formed hairless areas require further interventions, for which, however, only a limited donor area is available. In addition, there is the problem that untrustworthy practitioners often place the hairline too far forward, which also leads to the fact that more donor area is required than is actually available. In such cases, there is a prominent risk of unaesthetic treat-ment results in the further course of androgenetic hair loss. Both practitioners and patients are well advised to be patient – even if the problem seems urgent – because only when it becomes clear how the hair loss will progress and a possible final state can be estimated, a solid treatment plan can be made in which it is known exactly how much donor area is available to replenish the areas affected by hair loss.

This demonstrates that it is never too late to perform an autologous hair transplantation with regard to age, but it may very well be too early if it is not clear whether the androgenic hair loss is still progressing. Practically this means that I usually do not treat patients before the age of 24, because I can expect a sustainable treatment result at the earliest from this age. On the other hand, there are dubious providers who perform hair transplantations years earlier, despite their professional experience. Apart from financial interests, I can only assume that these prac-titioners unfortunately do not care about the patient’s well-being. Legally, this dubious behav-ior is not questionable, because in Switzerland there is no minimum age for performing a hair transplantation.

The illustration above shows a possible course of progression of hair loss in young people from a lateral (top) and the view from the front (bottom). While initially only the area of the receding hairline is affected (left), the hair loss then first continues towards the top of the head (centre left) and then progresses further towards the back of the head (centre right), while hair loss at the sides of the head is already increasing. As hair loss further progresses, the temples and sides of the head are also increasingly affected (right). If young people now want to undergo an autologous hair transplantation, the main difficulty is to predict which areas the hair loss will affect in the future. This usually makes serious treatment planning impossible before the age of 24.

In rare cases early treatment with an autologous hair transplantation is possible

There are a few cases in which, after careful examination, I perform hair transplantation even in patients who have not yet reached the age of 24: These are mostly patients who have lost their scalp hair as a result of a (usually severe) trauma, such as after a traffic accident or extensive burn. In addition to the fact that the physical and psychological consequences of the accident must be dealt with by the affected person for years, they also suffer greatly from a possibly disfigured or scarred appearance, which causes enormous suffering. If I can help to alleviate this suffering with an autologous hair transplantation, then this is also possible before the age of 24. In practice, however, such cases are a rare exception.

Regardless of whether the patients are female, male, young or old: If someone wants to undergo a hair transplantation, in any case a thorough and responsible consultation and assessment of the patient are indispensable to enable a sustainable and successful treatment. Only when I can take sufficient time for the individual assessment of a case in a personal consultation can a treatment result be achieved that is satisfactory for all parties. Such a process also includes informing sometimes young patients, that – at least at present – hair transplantation is not yet a viable treatment option due to their age.

I would like to encourage the young readers of this article in particular to keep in mind that the fastest treatment option is not always the best one, even though there are many providers on the market who promise the opposite. Take enough time to consider the possible course and consequences of an intervention and do not make an decision based on emotions and promises made by others! Sometimes it takes some time, especially if you feel that you are suffering from your current condition, but do not forget that it is not only your appearance that makes you beautiful, but first of all your soul!

If you are still undecided whether a hair transplantation is the appropriate treatment option in your individual case, I encourage you to contact me to arrange a personal consultation in our clinic. Together we will find a responsible and sustainable solution.

Yours, Angela Lehmann