Hair transplant surgery in the young patient can be dangerous. We do not have a crystal ball and we cannot predict your future. If you begin surgery when you are young, you may find your hair loss exceeds your donor capacity. At this point, you may wish that you had not begun doing surgery and simply desire to return to your natural state of baldness. Unfortunately, I find many individuals present to my office with this very complaint. They simply want to return to a natural, bald state.
The younger you are when you first experience hair loss, the more hair loss you can expect to occur over the remainder of your life. Like it or not, hair loss is a lifelong process that will not cease until you die or we discover a medical cure for hair loss. We cannot predict when we will see a cure for hair loss. If you are already an advanced degree of hair loss in your early twenties, I would recommend against hair transplant surgery. If your degree of loss is less, and you have excellent hair characteristics, we might consider hair transplant surgical solution at some point.
I do not believe that any young individual should begin surgery in his early twenties without first trying medical treatment. Most medical treatments such as minoxidil, propecia, avodart, and topical spironolactone do not grow a significant amount of hair in most individuals. What they do often though, is slow or even stop hair loss. This is very important to you. You are buying time until we have a better solution and perhaps limiting the amount of hair restoration you will require over the course of your lifetime. This may ultimately save you money and preserve you coverage for a longer period of time. You may also slow your hair loss until such time that you become more comfortable with your degree of hair loss. This means that if your donor supplies will allow us to give you a full look in the front, but a thin or bare look in the back, vertex, you may be happy with this result at age 50, but very disappointed at age 23. In other words, people tend to become more comfortable with their hair loss as they age. This is not an absolute rule though. I have seen many men in their 50s, 60s, 70s, and 80s who were not happy with their hair loss and sought treatment.
If you do consider surgery at a young age, I recommend CIT. This is the only true stand-alone procedure. In other words, you can elect to shave your head down the road and still appear natural because you will not have a linear strip scar in your donor region. You must realize that this is a new procedure though, and there are many things about it that we are still unravelling. We know that in due course we are simply going to get better and that the results should continuously improve. This does not mean that we are disappointed with the results to date. Rather, we find the results are fantastic. We do expect major improvements over time and a better definition of the complications.
I do not recommend strip incisions in the young patient and feel that it is important for any physician to disclose the potential benefits of CIT/FUE and the linear scar complication to any young male seeking hair restoration surgery.
CIT also allows you to pursue the "less is more" illusion of coverage. Here the hair is cut very short in a crew cut fashion. The balding or thinning areas are restored so that they appear thin but natural. We do not attempt to restore the density you were born with but give you a thin look. When the hair is cut short, we find the illusion is such that you appear to have better coverage than you really do. In other words, less coverage gives you a more full illusion.
Typically, I recommend that any person delay hair restoration surgery until they are 23 years of age. I would consider CIT placed in a conservative fashion in a younger male though, but only if they were fully educated and had been counselled by those who experienced hair transplant surgery at a young age, but now spend a large portion of their time educating others about their unfortunate mistakes.
The longer you can delay your procedure, the better when you are in your early twenties.