Wondering If You Are A Good Candidate For A Hair Transplant?
Hair loss and the journey to stop it or restore it has always been filled with hope, curiosity, and a certain degree of trepidation. Today’s ubiquitous social media hair transplant result pictures can create the impression that surgery is the cure for all hair loss. In reality, the most important element in a successful hair transplant is the patient. The difference between magic and disappointment comes down to one question: are you the right candidate?
Hair transplant candidacy is not a simple equation but a complex balance of biology, artistry, and psychology. It’s not about whether you “want” hair, but about an objective set of factors which take into account the longevity of the outcome as well as its natural appearance. In this article we have taken the approach of putting the marketing claims aside, and drilling down to the essential candidate checklist used by ethical surgeons to determine if a patient is the best fit for surgery.
The Donor Supply: Stable, Ample and Lifelong
Visualize your donor area, the permanent band of hair at the back and sides of the head, as a limited savings account from which the surgeon will be making withdrawals in the form of grafts. The first criterion of candidacy is a healthy and stable savings account.
A good candidate should have a high density of healthy follicles in the donor area. But density isn’t the only qualification, stability is also critical. The surgeon must be confident that those follicles are genetically programmed to be resistant to dihydrotestosterone (DHT), the hormone which causes patterned baldness. This is why those with Diffuse Unpatterned Alopecia (DUPA), a thinning which affects the whole scalp including the donor supply, are poor candidates for transplant. Transplanting follicles that are predestined to fall out is a waste of time and money. The ideal candidate has a well-defined donor area of high caliber follicles which will be present for the rest of their life and from which a substantial number of grafts can be harvested.
The Mindset: Expectations and Planning for the Future
A hair transplant surgeon is an artist, and a strategist. They are not magicians. The most successful candidates understand this, and the best candidates approach the procedure with a realistic vision for the future and a willingness to partner with their doctor to achieve it.
Good expectation checkpoints for a potential candidate include:
Awareness of “Coverage” vs. “Density”: Full coverage is a goal of a hair transplant but the density will not be the same as on a head of hair that has never been thinned by loss. The key is to strategically create the illusion of a full head of hair.
Acceptance of a Mature Hairline: For most men, a gently receded and softer hairline will be far more natural and age appropriate than an artificially low hairline. Good candidates are not demanding the thick low hairline of their teens but a significant natural improvement for their age and facial proportions. Good candidates have realistic expectations and trust their surgeon to provide an appropriate design.
Commitment to the Long Term: Hair loss is a progressive process. A great candidate sees the hair transplant as a part of a long-term hair loss management plan, and is often on medications such as finasteride or minoxidil to preserve existing hair and prevent further loss behind the transplanted area.
The Blueprint: Age and Pattern
There is no legal age to have a hair transplant. However, your stage of hair loss has a major bearing on how the surgeon approaches the surgery.
The Young Patient (20s to Early 30s): Caution is the watchword here. A hairline designed for a 25 year old man will usually appear very isolated and unnatural as balding progresses behind it. The responsible surgeon will first recommend a course of medications to stabilize the loss, then will only be prepared to perform a hair transplant to bolster the existing hairline by a small amount, and will make a comprehensive plan for a larger later surgery in the future.
The Prime Candidate (Mid-30s to 50s): This age range is usually the ideal window. The pattern of loss (Norwood Class III to V) has generally stabilized by this age and will be more predictable for the surgeon to plan for in the future. This allows a long lasting hairline to be designed, and the surgeon can confidently plan graft distribution with a clear idea of the future.
The Older Patient (60+): In general, it is the stability of the donor supply and the pattern of loss which will dictate candidacy here. Many men in their 60’s with a stable Class VI pattern are excellent candidates for a hair transplant, as their pattern of loss has usually stabilized allowing for a comprehensive and final transplant.
The Canvas: Hair Characteristics
It’s not just about the amount of donor hair, but also its quality. Certain hair characteristics can make a huge difference to the perceived results.
Hair Caliber: Thick coarse hair shafts create better coverage than fine thin hair. A patient with fine hair will need more grafts to create the same visual effect as someone with thicker hair.
Hair and Skin Color Contrast: The greater the contrast between hair color and skin color (e.g. black hair and fair skin) the more the scalp is visible through the hair, and more grafts are needed to mask the scalp for coverage. Inversely a low contrast between hair and skin color (e.g. blonde hair and fair skin or grey hair and pale skin) creates the appearance of density and fullness with fewer grafts.
Hair Texture: Curly or wavy hair has a distinct advantage. The curls interlock and create more volume and better scalp coverage than straight hair.
The Green Light: Overall Health
Hair transplant surgery is minimally invasive, but it’s still surgery. Good overall health is a basic qualification for a candidate. Any existing medical condition that could complicate healing or blood circulation such as uncontrolled diabetes, autoimmune disorders like lupus, or a personal history of keloid scarring may make someone a less than ideal candidate. A complete medical review is necessary to ensure a safe surgery and optimal graft take.
Who Are the “Bad Candidates?”
As important as it is to understand who makes a good candidate, it’s also useful to know the other side. These are the people a responsible surgeon would want to strongly encourage not to have surgery:
The “Miracle Seeker”: No surgeon is going to promise 100% density or a perfect result to someone with advanced hair loss.
The Unstable Shedder: Someone who has had a sudden, recent bout of shedding from stress, illness or medication (telogen effluvium) is a no-go until the underlying cause has been remedied.
The Patient with Body Dysmorphic Disorder (BDD): If a person has BDD, a change in their appearance will not solve their psychological issue.
The Patient with an Insufficient Donor Supply: In very advanced baldness (Norwood VII) there may simply not be enough donor hair to create a noticeable or cosmetically significant result. To attempt it in this case is to risk a sparse and unnatural outcome.
The Final Test
The final test of candidacy comes during a frank and detailed consultation with a qualified hair transplant surgeon. This is not a sales pitch. The consultation is a diagnostic and planning session. The surgeon will examine your scalp under magnification, take a medical and family history, review your hair characteristics and most importantly listen to you. They will then present a plan, and a long-term realistic vision.
Hair transplant surgery can be one of the most positive interventions a doctor can provide for his patients. The results can truly help restore confidence and a feeling of self. However the success of the whole process is rooted in the selection of the right candidate. By honestly assessing your donor supply, expectations, biological blueprint, medical health, and partnering with an ethical medical professional, you can answer the all-important question: am I the right candidate?
