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Are you a good candidate for hair transplant surgery?

A hair transplant can have life-changing effects. However, not everyone who suffers from hair loss is eligible for this procedure. This article discusses the factors that determine whether you will be a good candidate for hair transplant surgery.

Hair transplant surgery is a common treatment option for patients dealing with hair loss. But, just how successful are hair transplants? Advancements in medical science have resulted in more precise and natural-looking hair transplant procedures than ever before. 

Dr Bonaros is often asked, “Can anyone get a hair transplant?” Unfortunately, the answer is no. Despite medical advancements, not everyone suffering from hair loss is a good hair transplant candidate. If you are considering this procedure, it is essential to educate yourself about who can get a hair transplant.

Dr Bonaros performs trichoscopy in Glasgow hair transplant clinic

Who is a good candidate for a hair transplant?

How to know if you are a good candidate for a hair transplant procedure depends on several factors. These are always considered in conjunction with one another. While a patient might have a low density of hair follicles in the donor areas, other favourable characteristics can offset this disadvantage.

Here are some key factors Dr Bonaros will consider during your consultation to determine if you are a good candidate for hair transplant surgery.

Hair loss diagnosis

Before undergoing a hair transplant, it is essential to diagnose the reason for your hair loss. There are many possible hair loss causes, and not all of them can or should be treated with hair transplantation. 

Male and female pattern baldness is the primary indication for hair restoration surgery. Other common examples include:

  • Scars from accidents or burns
  • Traction alopecia
  • Complications from prior cosmetic procedures

Please note that only licensed physicians and trichologists should perform the diagnostic evaluation and consultation of patients presenting with hair loss.

Male and female pattern hair loss

In men, the diagnosis of androgenetic alopecia is generally straightforward. It is based upon the characteristic pattern of associated hair loss, as well as signs present in trichoscopy. If these signs are absent, further examination may be necessary. 

When it comes to women, determining the exact cause of hair loss can be more difficult. In some cases, an underlying condition such as hypothyroidism may have to be treated before the patient can undergo hair transplant surgery.

Male and female pattern baldness usually affects hair follicles on the front and top of the head. Those on the sides and back of the head remain largely unaffected and may be transplanted successfully to thinning areas.

Diffuse unpatterned hair loss

Diffuse Unpatterned Alopecia (DUPA) is a relatively uncommon condition, affecting only 2–6% of men with hair loss. Unlike with androgenetic alopecia, DUPA lacks a stable donor zone considered safe for surgical transplantation. 

With DUPA, hair thinning takes place along the front, top, back and sides of the scalp, and the majority of hairs are or will eventually become miniaturised. Hair transplantation, therefore, is not a viable treatment option.

A hair transplant performed on a patient with DUPA may look good for a few years, but the transplanted hairs are likely to thin out over time. In addition, existing hair in the donor area may appear severely depleted. Keeping this in mind, it is best to manage DUPA with non-surgical medical treatment options like minoxidil, finasteride, and low-level laser therapy.

Patients with DUPA and alopecia areata are not good hair transplant candidates
Hair transplantation is generally not recommended for patients with DUPA or Alopecia areata

Alopecia areata

Alopecia areata, also known as spot baldness, is an autoimmune condition in which hair loss occurs in some or all areas of the body. It can cause bald patches on the scalp, each about the size of a penny. Generally, patients with alopecia areata are not candidates for hair transplantation. 

Hair transplantation can be considered if the affected area is small, has remained unchanged for several years, and a scalp biopsy shows no evidence of inflammation below the scalp. However, this would require a very detailed discussion with an expert physician. Additionally, patients need to be aware of and accept the risk that the transplanted hair is susceptible to falling out again at any time. 

Scarring alopecia

Scarring alopecia, otherwise known as cicatricial alopecia, is a condition most common in women between 30 and 50 years of age. It refers to irreversible inflammatory follicular damage — the immune system permanently damages hair follicles’ stem cells, resulting in scarring and hair loss.

Primary scarring alopecias include: 

  • Lichen planopilaris 
  • Frontal fibrosing alopecia 
  • Central centrifugal cicatricial alopecia 
lichen planopilaris, frontal fibrosing alopecia patients are bad candidates for hair transplant surgery
Lichen planopilaris and frontal fibrosing alopecia patients are not ideal candidates for hair transplant surgery

Hair transplantation is not recommended for patients with active cicatricial alopecia. Not only is the risk of failure high – graft survival rates are usually less than 50% – but the procedure can also exacerbate the condition. 

Before considering surgical hair restoration, patients with inactive scarring alopecias must undergo an evaluation by a hair transplant surgeon. This will help determine if they are a suitable candidate for an FUE hair transplant.

Patient age

While there are no age restrictions for hair transplants, an ideal candidate is over 25 years old. According to the ISHRS 2017 practice consensus, the majority of male hair transplant patients were aged 30–39. Individuals under 25 should consider other treatment options, such as medical hair loss therapy.

Dealing with hair loss at a young age can be distressing. However, getting a hair transplant too early is not a good idea. Male pattern hair loss is a progressive condition that worsens over time, meaning early hair transplantation will only offer temporary relief.

Men who lose their hair at a very young age are more likely to suffer from extensive hair loss later in life. In such cases, patients will be chasing hair transplants for the next 10–15 years. Eventually, they won’t have enough healthy hair left to keep up with the hair loss and may end up with isolated patches of hair on a bald head.

bad hair transplant candidate depleted donor area
Male patient with depleted donor area after several failed hair transplants

Additionally, a hair transplant surgeon cannot safely determine the actual donor area limit in very young patients. They, therefore, risk transplanting follicles that are not androgen-resistant and will later fall out. 

You can only properly consider hair transplantation after hair loss has been stabilised with medication and the pattern of balding is known. Our Glasgow clinic advises patients under 25 to stay on medical treatments for at least 2–3 years before contemplating hair transplant surgery.

There is no upper age limit for a hair transplant procedure. As long as a patient is healthy, they can undergo a minimally invasive FUE hair transplant. It is important to note that patients over 68 tend to have thin hair. This can make surgical hair restoration less effective. However, this is not true for all patients, and is best approached on a case-by-case basis.

General health

In order to be a good candidate for a hair transplant, you need to be in good general health. This will help you recover quickly and prevent complications.

Although hair transplantation is a simple procedure, there are a few contraindications for the surgery. These include:

  • Active autoimmune disease 
  • Uncontrolled diabetes
  • Uncontrolled hypertension
  • Patients allergic to local anaesthetic
  • Certain skin conditions, such as keloids and pemphigus 
  • Severe systemic and scalp infections 

Patients with contraindications to hair transplant surgery may experience poor hair growth and other suboptimal results. In some cases, they may even experience worse hair density due to a flare-up of an underlying hair disease.

Childbirth

Recent childbirth is another contraindication to hair transplantation. Approximately 90% of new mothers suffer some degree of temporary hair loss between three and six months after giving birth. While hair transplants are a safe, proven, and effective method of treating hair loss in women, the procedure should not be undertaken for at least a year postpartum.

Mental health

Patients with body dysmorphic disorder (BDD) are excessively preoccupied with non-existent or minimal appearance flaws involving several parts of their bodies. While hair loss is their second most common concern, BDD patients will usually present with trivial defects that are not even apparent to hair loss experts. Patients with BDD are at a high risk of being dissatisfied with transplant results, seeking ever-more corrective surgeries.

Trichotillomania is also a contraindication to hair loss surgery. This obsessive-compulsive disorder involves incessant hair pulling and plucking. Before undergoing treatment for their hair loss, patients with trichotillomania should seek psychological support.

Medication

Before undergoing hair transplant surgery, it is crucial to ensure that your surgeon is fully aware of any medication you take and any long-term health conditions you have.

Several medications, including immunosuppressants, can affect your hair growth. Others, such as antiplatelet and anticoagulation medications, should be stopped before surgery to reduce your risk of bleeding. 

Hair loss stability

The stability of your hair loss is always assessed during your initial consultation with Dr Bonaros. It is safe to proceed with surgery if your hair loss has not changed or accelerated recently, and if the recipient area has not undergone extensive miniaturisation. 

In cases where hair loss has been rapid, and the recipient area has a high degree of miniaturisation, Dr Bonaros will advise you to undergo medical therapy for 6 to 12 months. This will help stabilise your condition before you proceed with surgery.

Hair characteristics

Hair calibre, hair colour, and hair texture are three important cosmetic features for transplant patients. In general, patients with thicker hair should be able to achieve better results than those with thinner hair. This is because balding appears when light penetrates past the hair and is reflected off the scalp.

Thicker hair will be able to block more of the light from reflecting off your scalp, resulting in a more pleasing cosmetic result. In addition, people with thick hair may need fewer hair follicles to achieve the same cosmetic effect as those with thinner hair.

The colour of your hair, especially in relation to your skin colour, is also very important. This is because your hair colour blends in with your skin. High contrast stands out, so the less contrast between your hair and scalp colour, the better. 

The texture of your hair also plays a key role in the final outcome of your hair transplant. The more your hair curls or waves, the greater the level of coverage it provides.

Hair density

When determining whether a person will be a good candidate for a hair transplant, the density of donor hair is one of the most important factors. Patients with high donor hair density are generally good candidates for hair transplantation. 

For example, a patient with a donor area that contains at least 80 grafts per square centimetre is an excellent candidate. On the other hand, patients with donor hair density less than 40 grafts per square centimetre are poor candidates.

Good and bad donor area for hair transplant candidates
Rich vs poor donor hair density

Hair transplant expectations

When performed by trained physicians, today’s FUE hair transplants can safely and effectively creates natural-looking, permanent results with virtually undetectable scarring. However, this is not always the case. When having a hair transplant, realistic expectations and a good understanding of the procedure are essential. 

The donor area contains a limited number of hair follicles that are genetically resistant to hair loss. Sometimes, there may not be enough hair to cover a patient’s bald spots. Furthermore, although transplanted hair can permanently restore thinning areas, it does not stop the progression of hair loss. Additional hair transplants may be required to address continued balding.

Hair transplant before after photos Dr Bonaros Glasgow
An example of a hair transplant by Dr Bonaros. The donor area has been well-managed and looks untouched.

At our Glasgow hair loss clinic, we ensure patients understand the potential limitations of hair restoration surgery and set realistic expectations. During your consultation, Dr Bonaros will explain the exact hair transplant procedure, as well as the timelines for healing and hair growth and the results you can expect.

Dr Bonaros: Glasgow’s leading hair restoration specialist 

Based at his established hair loss clinic in Glasgow, Dr Bonaros is a leading hair restoration specialist. Not only is he a full member of the British Association of Hair Restoration Surgery (BAHRS), but he is also Scotland’s only full member of the International Society of Hair Restoration (ISHRS). 

When you choose our clinic, you can rest assured that you will receive compassionate and professional care. Dr Bonaros offers various hair loss solutions, including FUE transplants and prescription medication. During your consultation, he will provide you with tailored treatment plans to address your unique situation and concerns. 

If you are experiencing hair loss, schedule a consultation with Dr Bonaros to discuss your options, including whether you are a good candidate for hair transplant surgery.

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