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Are you a good candidate for hair transplant surgery?

This article discusses the factors that determine whether you will be a good or a bad candidate for hair transplant surgery.

If you are considering hair restoration surgery, it is important to be well-informed throughout your experience. A hair transplant can have life-changing effects on those who are eligible. The advancements in medical science have made hair transplant procedures more precise and natural in appearance than ever before, giving men and women more options when it comes to dealing with hair loss.

 Unfortunately, not everyone is suitable for the procedure. Here are some key factors that we look into during your consultation in order to determine whether you will make a good candidate for hair transplant surgery.

Hair transplant Dr Bonaros Glasgow, Scotland

Hair loss diagnosis

When considering hair restoration surgery, it is essential to find a surgeon with the appropriate training, experience, and certification. Hair loss can have many causes, and not all can or should be treated with hair transplantation. Male and female pattern baldness is the primary indication for hair restoration surgery. Scars from accidents, burns, complications from prior cosmetic surgery and traction alopecia can also be safely treated. The diagnostic evaluation and consultation of patients presenting with hair loss should only be performed by licenced physicians and trichologists.

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

Male and female pattern baldness usually affects hair follicles on the front and top of the head. In contrast, those on the sides and back of the head remain largely unaffected and may be transplanted successfully where the hair is thinning.

Diffused Unpatterned Alopecia -DUPA-, on the other hand, lacks a stable donor zone considered safe for surgical transplantation.

With DUPA, hair thins not only in the front and top of the scalp but also in the sides and back, and the majority of hairs on the scalp are or will eventually become miniaturized. It is crucial to recognize DUPA due to the fact that hair transplantation is not an 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, the donor area may appear severely depleted.

DUPA can only be treated with medical treatment – minoxidil, finasteride, and low-level laser therapy. DUPA is relatively uncommon, affecting only 2-6% of men with hair loss.

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, also known as spot baldness, is an autoimmune condition in which hair is lost from some or all areas of the body. In some cases, it causes a few 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 area affected by alopecia areata is small and has not changed for several years, and there is no evidence of inflammation below the scalp in a scalp biopsy. However, this would require a very detailed discussion with an expert physician, as patients need to be aware and accept the risk that the transplanted hair is susceptible to falling out again, at any time. 

Scarring alopecia, otherwise known as cicatricial alopecia, refers to irreversible inflammatory follicular damage that results in scarring and hair loss, and it is more common in women between 30 and 50 years. Primary scarring alopecias include lichen planopilaris, frontal fibrosing alopecia, central centrifugal cicatricial alopecia and others.

lichen planopilaris, frontal fibrosing alopecia patients are bad candidates for hair transplant surgery
Lichen planopilaris and frontal fibrosing alopecia patients are bad candidates for hair transplant surgery.

A common characteristic among scarring alopecias is the permanent damage of the stem cells of hair follicles by the immune system. Hair transplantation is not recommended for patients with active cicatricial alopecia, as not only is the risk of failure high – graft survival rates are usually less than 50% – but the procedure can also exacerbate the condition. 

Patients with inactive scarring alopecias must be evaluated before considering surgical hair restoration.

Age

According to the ISHRS 2017 practice consensus, the majority of male hair transplant patients were aged 30-39.

Even though there are no age restrictions for hair transplants, an ideal candidate is over 25 years of age.

Individuals under 25 should consider other options, primarily medical therapy for hair loss. Even though dealing with hair loss at such a young age can be distressing, getting a hair transplant too early is rarely a good idea. Male pattern hair loss is a progressive condition that worsens over time, and while hair transplantation may offer temporary relief, one may regret it in a few years.

Men who lose their hair so early are more likely to suffer from extensive hair loss later in life. And If that is the case, patients will be chasing hair transplants for the next 10-15 years. Eventually, they won’t have enough donor hair 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, the hair transplant surgeon cannot safely determine the actual limit of the donor area right now and risks transplanting follicles that are not androgen-resistant and will later fall out. It is only after hair loss has been stabilized by using medication and the pattern of balding is known that we can look at hair transplantation.

Our Glasgow clinic advises patients under 25 to stay on medical treatments for at least 2-3 years before considering a hair transplant.

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. Patients over 68 tend to have thin hair, making surgical hair restoration less effective. Nevertheless, this is not always the case, so we deal with it 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 done under local anaesthesia, there are a few contraindications for the procedure such as:

  • 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 surgery may experience poor growth and suboptimal results from surgery, and in some cases may even experience worse hair density due to a flare-up of underlying hair disease.

Recent childbirth is also a 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 before the child’s first birthday.

With body dysmorphic disorder (BDD), patients are excessively preoccupied with non-existent or minimal appearance flaws involving several parts of their bodies, and hair loss is their second most common concern.  The patient with BDD will present with very trivial defects that are not even apparent to the hair loss expert. Hair transplantation might not the right solution in these cases. They are at a high risk of dissatisfaction, seeking ever-more corrective surgeries.

Trichotillomania, an obsessive-compulsive disorder of incessant hair pulling and plucking is also a contraindication to surgery. Before undergoing treatment for hair loss, patients should seek psychological support first.

Finally, several medications, including immunosuppressants, may affect hair growth, while others, such as antiplatelet and anticoagulation medications should be stopped to reduce bleeding risk. Ensure that your surgeon is fully aware of any medication you take and any long-term health conditions you may have.

Hair loss stability

The stability of the patient’s hair loss is always assessed during the initial consultation with Dr Bonaros. In cases where hair loss has not changed or accelerated recently, and if the recipient area has not undergone extensive miniaturization, it is safe to proceed with surgery. In cases where hair loss has been rapid, and the recipient area has a high degree of miniaturization, we believe it is in the patient’s best interest to begin medical therapy for 6 to 12 months in order to stabilize the condition before proceeding with surgery.

Hair characteristics

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

Those with thicker hair will be able to block more of the light from reflecting off the 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. Low contrast between your hair and skin colour is an excellent cosmetic characteristic. This is because hair colour blends in with skin colour. High contrast stands out, so the less contrast between hair and scalp colour, the better. Finally, we consider the degree of curl. The more curl or wave there is in the hair, the greater the level of coverage the hair provides.

Hair density

When determining whether or not 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 a high donor hair density are generally good candidates for hair transplantation.

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

A patient with a donor area that contains at least 80 grafts per cm2 is an excellent candidate. On the other hand, patients with donor hair density less than 40 grafts/cm2 are poor candidates for hair restoration, and we must set realistic expectations for them.

Expectations

Realistic expectations and a good understanding of the hair transplant procedure are essential.

The donor area contains a limited number of hairs genetically resistant to hair loss, and sometimes they may not be enough to cover bald spots patients desire to cover. Furthermore, hair restoration surgery may permanently restore thinning areas, but it does not stop the progression of hair loss.

Even though transplanted hair is permanent, additional hair transplants may be required due to continued hair loss.

At our Glasgow clinic, we always make sure our patients understand the limitations of hair restoration surgery.

During your consultation, Dr Bonaros will explain exactly what will be happening to your head during the hair transplant procedure, the timelines for healing and hair growth and the results you can expect.

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.

Several factors determine whether or not a patient is a good, excellent or poor candidate for hair transplant surgery.

We consider all these factors together when determining whether someone is a good candidate or not. While someone might have a low density of hair follicles in the donor areas, they may have other favourable hair characteristics that offset the disadvantage of the hair density.

When performed by trained physicians, today’s hair restoration surgery safely and effectively creates natural-looking, permanent results that are virtually undetectable.

If you are experiencing hair loss and want to learn more about your options, including whether you will make a suitable candidate for hair transplant surgery, schedule a consultation with Dr Bonaros.