Dear Dr. Rassman,
I am a 27 year old male who experienced extensive hair loss following the use of Accutane about 6 years ago. The hair loss stopped after about 18 months, but the original volume never recovered. I’ve been using Rogaine and Propecia for about 5 years. While my hair loss seems to have slowed (it’s been very gradually thinning ever since), the crown remains very thin to the point where it appears as an obvious bald spot, and my hair color (dark brown) exacerbates the problem.
I’ve attached some photos. I had a hair transplant evaluation two years ago by a dermatologist who specializes in hair science- he told me that while I have a thin crown, it wasn’t thin/bald enough to justify a hair transplant because the transplant would likely damage/destroy too many of my remaining crown hairs for there to be marginal gains in density. At the time of the evaluation, I had mistakenly left some hair thickening product in which may have influenced that evaluation.
My question is as follows: at what point in the balding process would most reputable doctors determine that the marginal gains of a hair transplant to the crown justify any damage/loss to whats left of the original hair in that area? Is there a certain metric that’s used (ie hairs per centimeter in the area)? Furthermore, I was just curious about the typical number of grafts required to restore a natural crown, given that the crown is very thin but not completely bald? Thanks!
Generally, men your age will respond to finasteride (Propecia) with regrowth in the crown, but clearly from your email, this was not your case. A good doctor should work with you through the specific logic and goals in your case. Treatment options may include Scalp MicroPigmentation / SMP (as long as you have hair there, this is a good option) or a hair transplant with between 1500-2000 grafts. The higher number is for individuals with fine hair.
Without an examination, it’s difficult for me to tell just how thin your crown is or what appropriate action you could take. There’s no exact metric to determine when the right time to transplant is. Everyone is different. Since it has been 2 years since your last evaluation with a physician, you should consider seeing a doctor again to find out if your options have changed.