Are young men with extensive hair loss more suitable for follicular unit extraction (FUE) due to the lack of a linear scar? After all, I can always just shave my head later right?
This hair loss question was answered by Dr. Cam Simmons of Toronto, Canada, who is one of our recommended hair restoration physicians.

I am concerned that some people may validate follicular unit extraction (FUE) as a viable option right now. I think you need to be just as cautious about starting FUE hair transplantation as you would be of starting follicular unit transplantation (FUT) by strip.
FUE is still a relatively new technique and it is too early to know all of the long term consequences. There are not a lot of hair transplant photos of patients who have had thousands of FUE grafts transplanted. I have not seen one photo of a class 7 patient on the Norwood scale of hair loss treated by scalp FUE alone. I have been quite disappointed by the results I have seen on-line and in conferences of extensive body hair transplant FUE.
More and more I hear the notion that it may be OK for someone to have FUE transplantation into their hairline then shave the head later if they lose their hair and dont want or cant do more surgical hair restoration. I believe that this is wishful thinking that has no basis in reality. Has anyone seen any good photos of anyone who has actually done this?
FUE scars are small but not invisible. If a patient comes in with medium or long hair I can always find the FUE or trichophytic scars with back-combing and careful examination. I can always see the scars from either method if someone has shaved their head. I have seen patients who had lots of FUE with grafts taken from well outside the safe donor area. I have also seen the start of a moth-eaten look in the donor area after extensive FUE. This is not to overlook the effects of strip surgery but just to state that FUE is not perfect either.
If you had a hair transplant then went quite bald and buzzed your head or shaved it slick, you would still have a five oclock shadow in an unnatural pattern. The texture of the skin in the recipient area may be better than it would have been in the old days of the bigger graft but it wont be perfect.
To make a good decision it is important to have realistic expectations. FUE transplantation requires just as careful planning as strip transplantation especially for someone who could lose a lot of hair.
I believe that hair transplantation of any kind should be considered a permanent step with long-lasting benefits and long-lasting consequences. You cannot undo any surgical hair replacement. The trade-off for having more hair on top is that the donor area will have some hair missing and some scarring. This can be minimized but not eliminated. Not everyone can get the coverage or density they would like but with careful planning they can have natural looking hair in a natural pattern that is better than they would have had without hair transplantation.
Generally speaking, men in their early 20s have a more unpredictable future and higher expectations to look like their peers. You seem to have a good understanding of how much hair you could lose. In my experience, intellectual understanding does not equate to emotional satisfaction. A conservative approach for someone who already has a class 7 pattern on the Norwood scale makes a noticeable difference and can be quite satisfying. The same approach for someone who is headed toward a Norwood 7 pattern will have less visual impact and will be much less satisfying. Decisions must be made on an individual basis but I would encourage you to explore every other option instead of hair transplantation right now.
Cam Simmons MD ABHRS
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Bill Seemiller – aka Falceros
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