Can you use a hair transplant to treat radiation-induced permanent hair loss in pediatric patients?

Q: Can you use a hair transplant to treat radiation-induced permanent hair loss in pediatric patients?

A: Yes, but there are a number of things to consider:

1. As in adults, if the hair loss from radiation is extensive, or involves the permanent zone of the scalp, there would not be enough donor hair to make the procedure worthwhile.
2. Depending on the nature of the scarring, it may not take grafts well and always will require multiple procedures to achieve adequate density.
3. Hair transplant procedures (both FUT and FUE) leave scarring, so future treatments for tumor recurrences that cause hair loss (radiation or chemo) may expose these scars and be an additional cosmetic problem.
4. There is a concern that the younger patient may eventually develop androgenetic alopecia and this would be a problem if extensive and occurring early. Family history, of course, is important, but there is no way to tell with certainty the prognosis of AGA in a young person.
5. For those that might develop AGA, finasteride is not indicated in males under 18 and there is no way to tell in advance if the person can tolerate this medication.
6. The hair transplant procedure is long, so local rather than general anesthesia is used. That said, 12 y/o is generally the minimum age that a patient can tolerate the procedure and a 12 y/o needs to be mature and motivated. Certainly, waiting until the patient is older makes it easier surgically.