About Face

Procedures Menu

About Face

Chapter Ten Hair Transplants Types of Male Pattern Baldness Surgery Punch Grafting Flaps Scalp Reduction Scalp Expansion

Types of Male Pattern Baldness

There are three stages to the development of male pattern baldness, each more pronounced than the last. The first stage is known as “frontal temporal recession,” when the hairline recedes from the temples at either side of the forehead. This stage actually appears in all men as a natural part of the aging process. However, if it becomes apparent in a young man in his twenties, chances are good that he’ll continue on to the next two stages.

Stage two of male pattern baldness is when “frontal temporal recession” is combined with thinning hair on the crown of “vertex” of the head (its highest point). If a man enters stage two in his thirties, it is highly probable that he’ll go on to the third stage. But if he develops this pattern of baldness later in life, say in his fifties, it’s unlikely that it will become any more noticeable. These men might not progress beyond crown baldness.

The third stage of male pattern baldness occurs when the “frontal temporal recession” has advanced to the point that it joins with what has become a completely bald crown. The pattern is complete in stage three, and the man is left with a fringe of hair around the sides and back of his head. Some religious orders of monks, or friars, adopted the fringe as a standard of grooming in days gone by, though it’s interesting to speculate what came first: the style, or the prevalence of male pattern baldness in certain influential monasteries.

Today, there are a number of different approaches to minimizing the problem of male pattern baldness through plastic surgery. But before I explain what they are, let me caution that not all balding men are good candidates for surgery.

As with every other procedure in plastic surgery, it is important that the patient understand its limitations. The surgery for baldness is not designed to restore a man’s youth - he’ll never have the hairline he had as a young man in his late teens or early twenties. In fact, to give him such a low, full hairline would be a disservice; it would look phony, as though he were wearing a badly fitted hairpiece. The idea is to camouflage a man’s baldness, to create a hairline that is natural-looking (maybe even slightly thin and receded) in harmony with his naturally aging face. Once again, a patient with unrealistic expectations is not a good candidate for plastic surgery.

Neither is the man with very fine blond hair a good candidate. This is unfortunate, in my opinion, because I don’t like to see any willing patient of plastic surgery turned down because he is the wrong “type” for it. But fine blond hair presents two problems nearly impossible to overcome. First, there is a certain amount of scarring involved with procedures to correct baldness, and fine hair will not conceal scars to the scalp. Second, fine hair means that, technically, there are not many hair follicles per square inch on the scalp, and this presents a problem - particularly if the surgical approach is a hair transplant. The “donor site” on the patient’s head, as it is called, might not yield enough hair for adequate camouflage. However, patients with coarse blond hair are excellent candidates for surgery.

Timing can also affect the suitability of a candidate: if a patient seeks out plastic surgery too early in his evolution toward male pattern baldness, it might backfire later. This would be the case if a surgeon were to harvest hair for transplant from a “donor site” on the scalp that was destined to become bald later in life. The result, a few years after surgery, would be scars where the hairs had been harvested, and scars on the scalp where it had been transplanted - but no hair. In The Face Book, published by the American Academy of Facial Plastic and Reconstructive Surgery, a surgeon from California recounts his experience: “I’ve seen patients who wanted me to repair damage done by early, poorly done transplant procedures. Some have had all their donor hair used up and are left with visible scars or abnormal patterns of baldness. These men are almost tearful when I tell them nothing can be done. They would take their natural baldness back in an instant, but it is already too late.”

[previous page] [next page]