hair transplantation in men with advanced degrees of hair loss
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Hair transplantation in men with advanced degrees of hair loss

Hair transplantation in men with advanced degrees of hair loss is a challenging task. Different techniques have been formulated and improvised over the years of which follicular unit transplant is an important one.

Why do men experience hair loss?

Male pattern baldness is genetically inherited. The main factor is the presence of the hormone di-hydro testosterone in higher levels which is seen to affect the hair follicle development eventually leading to follicle death. Hair loss can be prevented to a certain extent by reducing the amount of this hormonal production or by preventing the hair follicle from absorbing it. Most often two pills such as Finasteride and Minoxidil are prescribed to patients to slow hair loss. A significant amount of men are seen to have been benefited by these medications in slowing hair fall while prevention of the same has not been effective.

Hair density patterns in an individual

On an average a healthy individual has approximately 1,00,000 hairs of which 25% is present in the permanent donor region which is the area covering the back of the head. Let us compare and evaluate the difficulties encountered by a hair transplant surgeon in treating baldness. In a Type II baldness pattern, the amount of hair loss is around 10-20%, which means the amount of hair follicles available for transplant is about 12,500. In contrast, in Type VII pattern, the loss is about 70-80% which means that the available follicles are only about 6000-8000. With these available follicles, a hair transplant surgeon has to cover an area which previously harbored about 70,000 follicles. This suggests very clearly that all the hair lost cannot be replaced by transplantation but only partially restored. Hence it is extremely important that maximum possible hair follicles be transplanted without compromising on the aesthetic appearance of the individual with the available limited resources.

Keeping in mind the above condition, it becomes mandatory for the doctor and the patient to have a counseling session in which the doctor can evaluate the balding pattern of the individual and advise him accordingly. By doing so, the doctor gives the patient a clear picture of what he can expect out of the transplant and how effective it would be given his hair loss condition and age.

The next question that follows is ‘how to get maximum benefit out of the relatively decreasing amount of growing hair follicles available?’

Good results of a hair transplant depend on the number of hair follicles transplanted that have the potential to grow. This can be achieved using the follicular unit grafting technique combined with another technique known as single donor strip harvesting. The harvested follicles are dissected using a microscope to get single or in groups of two or four undamaged hair follicles for transplant. The separated follicles are kept moist and chilled to get maximum benefit. Using this method an extra 20% of grafts can be obtained as compared to the traditional methods commonly followed.

Since it is understandable that all hair lost cannot be replaced, an illusion of fullness can however be created by maximizing the appearance of coverage without of course compromising on the natural flow of original hair pattern. One such feasible technique is the coverage of the crown area.

Covering the crown gives an effect of less balding. The surgeon has to hence visualize the pattern of hair transplant based on the facial structure of his patient. Usually hair follicles numbering 600-800 are sufficient to cover the crown. Sometimes a larger number of follicles of upto 2400 are transplanted in a single procedure when the crown region is wider. Better results are obtained when the area around the crown is also transplanted with a few stray hair follicles. Unlike the temporal peak baldness restoration, the crown coverage is mainly with 2 or 4 hair follicles per graft so that higher hair density can be achieved.

When a patient is in Type IV stage of baldness, then the procedure of hair restoration in the crown becomes easier because of the lead obtained by the already present temporal tufts. However, when a Type VII patient has to be treated, most often it is easier to reconstruct the temporal peaks and then take the lead from it to cover the crown region. By doing so, the lock of hair that would have earlier spilled on the forehead can be artistically recreated. The angles at which the hair grafts are transplanted also determine the natural fall pattern of the restored hair. When the angle patterns of hair graft is not taken care of, the restored hair will look artificial.

Using the technique of follicular hair transplant is advantageous –

1. the natural hair follicles are maintained for transplantation.

2. the number of grafts obtained by teasing the hair follicles is about 20% higher than normal hair transplant procedures.

3. since the technique is carried out on small transplant sites, higher hair density can be achieved with minimal scarring.

Recreation of the patient’s natural hairline is however under the discretion of the surgeon. A creative the surgeon produces better the results.


Hair transplantation in men with advanced degrees of hair loss references

  • Epstein JS. Hair transplantation for men with advanced degrees of hair loss.
    Plast Reconstr Surg. 2003 Jan;111(1):414-21; discussion 422-4. PMID: 12496614
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