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