Hello Dr. Rassman
In one of your latest replies you suggested that transplanting grafts just to thicken the regions close to hair line is not advisable as it can damage existing original hairs. Also you said you have applied this to some actors. Didn’t their existing hairs get damaged as you said? Could you supply us some further information?
There are judgments that are made based upon experience. If a hairline is eroded or eroding and the person is on finasteride (Propecia), I would treat the hairline that has hair present in it, provided that the patient understands the nature of progressive hair loss. In the young man, the erosion of the hairline is just the beginning of the balding process, so keeping a fuller hairline with transplants and following the loss as it goes back is not unreasonable.
What I avoid is someone who has miniaturization in and behind the hairline, but the hairline is still normal. Getting to know the patient has a lot to do with what I do and I tend to be more conservative than most doctors are protecting the patient from unnecessary surgery.
From time to time, I see a person with a Norwood Class 2 pattern that received 3000+ grafts in the frontal hairline. As a Class 2 patient, unless the hairline is eroded I do not usually transplant these patients… but if I do, just a few hundred grafts usually work. To give these patient 3000+ grafts means that the doctor is money hungry, pushing aside ethics to get as much of the patient’s cash as possible.