Some people have stated that they believe that younger patients who are experiencing “aggressive hair loss” would be advised to avoid follicular unit extraction (FUE) and opt for follicular unit strip surgery (FUSS) instead, with the idea of having greater yield.
I am currently 28 and I am now deep within a level 3 on the Norwood Scale (with the vortex increasingly thinning). As such, while I am not 24 and at a NW5, I was wondering what people thought regarding what qualifies as “young” and “aggressive”. I know that this is all very subjective, but I was looking for some consensus.
Difficult question to answer simply because androgenic alopecia (“AGA,” “male pattern baldness – aka MPB,” etc) is unpredictable.
You may be a young NW III now, but that doesn’t necessarily mean you won’t be an “old” NW III 20 years down the road. It also doesn’t mean you won’t be a young NW V – VI in a few years either (though there are certain things to look for in these instances). I’ve seen it go both ways, and unfortunately it is difficult to predict and provide accurate estimates of what may happen down the road.
As far as the FUE versus strip debate for young patients, I agree with your initial assessment. However, it is a bit more complicated than this. Allow me to explain: young patients with aggressive hair loss MUST do all they can to maximize their donor capacity. This means not wasting any grafts, and it also means minimizing donor damage and leaving as much virgin tissue for future hair restoration surgeries as possible. This is precisely where FUSS shines. You get the most grafts, the best yield, and leave the most tissue for future strip surgeries and non-strip procedures down the road. However, keep in mind that this is a pretty committed and long-term approach. It’s what is best for younger and more aggressive-patterned patients, but it is long-term plan.
If you think that any sort of scarring in the donor may be an issue down the road because you might just opt for “shaving it all off,” I usually recommend doing a “shave trial” now to see how you like it. Any incision and extraction (aka surgery) in the back of the scalp leaves scarring. So if this is something that could be a problem if you commit yourself to surgery, it’s likely best to give it a try now and see if you like it. If so, you’ve saved yourself a lot of time and money, and truly still have the option to “buzz down”.
Getting back to the original question …
I wouldn’t consider a 28 year old NW III “too young” or “too aggressive.” You may very well be a good surgical candidate at this point in time. However, it sounds like you would benefit from a scalp examination to determine your candidacy and how your hair loss may progress.
Hope this helps! Best of luck.
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