Thinning Hair

We are often asked, by men with thinning hair, whether they should proceed with hair transplantation now or whether they should wait until they have lost more hair.

Studies have shown that thinning of hair is not recognized until at least 50% of the original hairs are lost. By the same token, to make a significant recognizable cosmetic improvement in an area of thinning one has to at least double the number of hairs that are already in that area. We find that even the most objective patients will not be satisfied with the knowledge that they have replaced temporary, balding hair with a similar amount of transplanted hair that will last. In order to be happy, after the transplanted hair has fully grown, they need to be able to see an improvement when they look in the mirror.

Occasionally, we will advise someone with very early thinning, especially a younger patient, that they should wait until their hair is thin enough that they will be able to see a significant improvement after hair transplantation.

Usually by the time patients have contacted us about thinning hair, they have already lost enough hair that we can make a visible improvement by hair transplantation.

If there is sufficient space between the existing hairs, we often choose to transplant as many grafts in an area of thinning as we would in a bald area. The transplanted hairs surround the existing hairs without damaging them. This will make a significant cosmetic improvement as soon as the transplanted hair grows back. In the future, after the non-transplanted hair is lost due to natural progression of baldness, there will be enough transplanted hair to look respectable on its own.

In some patients, with early thinning of hair, there is not enough space to do this but we can cover a larger area with the same number of grafts. In this case, we advise patients that they will likely want to increase the density of hair with another session of hair transplantation after they lose more of their preexisting hair.

Sometimes, even when there is enough space to finish an area in one session, patients choose to transplant enough hair for the present and to have a second session, after the non-transplanted hair is lost, to restore the hair density.

There are really only three disadvantages to transplanting hair into thinning areas. The first is that there can be a temporary shedding of some of the preexisting hairs in the area from two to six months after the procedure. This is due to the local shock of surgery and temporary effects on circulation. All but the few hairs that were destined to fall out permanently in the next six months or so will grow back but the hair in the area may look slightly thinner in the mirror before it looks thicker after the transplanted hair and the “shock-lost” hair grows in. The second is that it may require two sessions to achieve final satisfactory density of the transplanted hair. The third is that patients often forget that we warned them that their existing hair would continue to go bald. If they can see their hair getting thinner they worry that they are losing their transplanted hair and will go bald when in fact they are losing their existing hair and will keep their transplanted hair for the rest of their days.

The main advantage of proceeding with proactive hair transplantation when the hair is thinning as opposed to reactive hair transplantation after the scalp is bald is that others never need know that you underwent hair transplantation. In the short term, we can use the existing hair to camouflage the recipient area to allow a speedy cosmetic recovery. In the long term, the hair grows in so gradually that nobody who sees you each day will see your hair improving. After a year, even people who haven’t seen you in years will likely not be able to put their finger on why you look better and younger.

If you barely have any thinning and it really doesn’t bother you, you can postpone hair transplantation. If the thinning hair already bothers you when you look in the mirror, there is no benefit in waiting