Firstly the patient was 39 at the time, his goal was to drop the central apex line a fraction and rebuild the temple points, with a high density.
In respect of future loss, of course this is a possibility at almost any age and he is well aware of this; at 39 there is a good chance aggressive hair loss is behind him. That combined with the fact his hair line was kept relative to his age and facial structure anyway, with the central apex 7.5cm and temple points 9cm above the brow, so it was hardly aggressive. With this in mind he has good hair characteristics and donor density to still treat future hair loss and he is well aware of the pros and cons.
Whether or not he needed is very much dependent on your perception and very personal; a NW4/6 would look at him and say he is greedy, nothing wrong with him, but for him he was not happy with his appearance; and a goal of a hair transplant is generally to make you feel better, and this was achieved here.