There are many possible causes of hair loss, however most hair loss is normal and part of each individual’s genetic makeup. We hope the following information will help you better understand your hair loss and options for treatment.
We all lose hair everyday. Hair grows for a period of time, usually 2 to 6 years, and then the follicles shed the hair and go into a rest stage for approximately 3 months, then a new hair growth cycle begins. It is normal to lose between 50 to 150 hairs per day from normal shedding.
Androgenetic alopecia is the scientific name for the genetic predisposition in both men and women for pattern baldness. Pattern hair loss in men is often referred to as Male Pattern Baldness (MPB). Androgenetic alopecia is the cause of over 95% of all pattern hair loss, including baldness in men and thinning hair in women. Pattern hair loss occurs in somewhat predictable stages, and is relentlessly progressive. Usually the earlier in life pattern hair loss begins the more advanced the pattern will ultimately become. Studies have shown that pattern loss is increasingly evident and advanced as people age.
In MPB, the hairs on the top of the scalp have a genetic sensitivity to the male hormone testosterone (DHT). The hairs on the sides and back of the scalp do not possess this genetic trait so are unaffected. For this reason, hairs removed from the sides and the back (Donor Area) will maintain their genetic predisposition when transplanted and continue to grow when moved to the top of the scalp where hair loss occurred.
How Many Grafts Will I Need?
I am a male in my early 20′s and live in Texas. I know I’m young, but I do not have a history of baldness on either my father or mothers side. I have had a high hairline (I believe it’s a NW3) my whole life. I’m looking to get FUE transplant this summer. My two questions are these: How many grafts, based on my pictures, do you think I will need? Secondly, I am not looking to spend all of my money at once, but was wondering if I could do it two or maybe even three sessions? Best Regards.
Thank you for your question.
You are in your 20′s and you submitted some very good photos to help me asses the degree of your hairloss. You stated that you’re planning to get a few week grafts and you want to know how many grafts you’ll need and the questions you’re asking are all very reasonable. Now I’m probably going to help you a lot by educating something that we do a lot in our practice that’s a little bit different than the usual answers you will get from a hair restoration specialist. So let’s begin first by defining what your situation is.
You are dealing with unfortunately with a young age with male pattern hairloss. Male pattern hairloss traditionally has been based on a genetic pattern such that different decades of our lives most men will have some time of male pattern hairloss. Now it’s kind of rule of decades in your 20′s 20% of your contemporaries will have hairloss that means at 80% of your contemporaries have lots of hairs when you hit you 40′s and 50′s its starts to even out. 50% have significant hairloss, 50% have mild or moderate but some degree a lot of men by the 4th or 5th decade of life will have some degree of hairloss.
In the 90′s, specifically in 1997, when drug Finasteride was introduced, we had an understanding with male pattern hairloss based on something called dihydrotestosterone or DHT. And the concept is at a certain point of your life, a protective mechanism turns soft and then dihydrotestosterone literally chokes the hair follicles and causes thinning. Many men mistakenly believe that they have too much testosterone although that is wish full thinking. It’s not true. Most men have normal testosterone depending on whatever age range they’re at but it’s the conversion of testosterone to dihydrotestosterone. And dihydrotestosterone is what causes the hair follicle to shrink. So a drug like finasteride diminishes DHT or dihydrotestosterone.
Now moving the clock forward and in 2011, a research was done in the University of Pennsylvania and it showed that there are certain adult stem cells that are responsible for the hair growth process that suddenly stops working. And they noticed that in the scalps of bald men, the hair follicles are present but the hairs did not continue to grow.
So essentially, with dealing inactive follicles, in our practice the past 2 years, we have had the remarkable opportunity to develop and injection using a wound healing model to stimulate and reverse thinning hair. If you will imagine that these adult stem cells are responsible for the protection of the hair follicle from DHT or dihydrotestosterone. Imagine that we have applied a material that causes healing in a cellular level that protects the hair follicles. We refer to this as progenitor cells as was referredto in the University of Pennsylvania studies. These progenitor cells, think of it as protecting the hair follicles. So essentially, what we are able to do is literally create a wall in conceptual way because this is a test to proven in a laboratory studies but conceptually this is what appears to be the case. And by doing this, thinning hair is being reversed in our practice with this injection and this is a very important point particularly to somebody in their 20′s. And when you’re in your 20′s and you could imagine by the time you’re in your 30s 40s, your hairloss will otherwise progress. And even if you take DHT blocker like finasteride, you can still progress.
So traditionally in hair transplant, we were always hesitant to perform transplant on a 20 yr old because somebody who are in their 20′s continuously loss their hair while the transplanted hair the genetically resisted hair would stay and it would force them to keep doing more and more so my suggestions for you is to actually consider this kind of hair regeneration technology. And if in our practice, just to give you perspective of what we do when we use hair regenerative technology we’ll do that first. We’ll do the injection first then after a year and see how much re-growth you had. We then decided if you want more hair. We can then do a transplant and even with the transplant we can use this regenerative healing technology that allows are donor area to heal beautifully and our hair grafts to take very well.
So to answer the question about the number of grafts, that’s very straight forward. The number of grafts depends on the area that you want to cover. And in typically the hair transplants zone are frontal middle and back. And generally in a given transplant we will transplant anywhere from 15hundred to two thousand hairs and we’ll do that usually towards the front because the hair frames the face and if you want to frame the face, you want to do it towards the front. Now that may not be adequate to cover as much as you desire that were additional transplantation may be recommended but in summary, before you consider a transplant, think about investigating both of the DHT blocker although currently finasteride does have a lot of controversy about long term side effects. And in addition, that’s new hair regenartive technology that we have been fore front of and then consider a transplant. So I know that’s a lot to learn and i hope that was helpful and thank you for your question.
Hair Fall After Six Months of Hair Transplant?
I did my hair transplant six months ago in India. The hair growth till now was good and I still see some new hairs growing. But along with new hairs growing, I am having a very high rate of hair fall from the transplanted area. This is the first time I am having such hair fall post surgery. I consulted my surgeon and he had suggested me to have Biotin capsules along with Finasteride tablets and 5% Minoxidil. I would like to know if this is normal or a serious issue.
Thank you for your question!
It has now been several months since your transplant and you’re noticing a fair amount of hair falling out despite having had the transplant. Now, your physician did prescribe for you a combination of Biotin, Finasteride and Minoxidil. So essentially, your physician is trying to restore hair that is actively thinning. So let’s understand what exactly is going on.
First of all, the procedure of hair transplantation where hair is placed in between existing hair, can cause a situation called shock loss where combination of swelling and trauma can put hairs in an advanced stage of called the telogen phase. Where essentially the follicles are not the actively growing phase and actually get shocked. When they are shocked, they fall out and after several months, they start to re-grow.
The other thing to be mindful of, it’s not likely necessarily be the case because with the addition of finasteride, minoxidil, essentially, your doctor is thinking about managing your natural progression of hairloss. That means of course, even with a transplant, male or female pattern hairloss will still continue. When talking about genetically susceptible hairs, continue to fall out.
Now the degree of fallout that you’ve had would be unusual for progression in such a short period so I think that maybe more of a shock loss aspect to your situation but it is certainly reasonable to add medical therapy to help bring back your hairs a little bit faster.
Something to learn about that we’ve been in a leadership position in is the use of a material called extracellular matrix combined with platelet-rich plasma that we are doing to treat both male and female pattern hairloss in our practice. And this material has helped a lot of our patients who come to use from around the world, not only treat the progression of hairloss, but reverse the hair thinning. So what many of our patients do whom come to us with hair thinning before even going a transplant will do this injection treatment and see how much of their hair actually comes back and thickens. It is very gratifying to be able to see people who are progressing particularly young people, younger males who are in their 30’s and 40’s and progressively loosing hair on the course of a few years suddenly stop and reverse to a point where a significant amount of their hair that looked like it was gone has come back.
Now routinely, what we will then do is then say to our patients about a year afterwards: Are you satisfied or do you want to have more hair? And when they say they want or in cases they want more hair, we offer the option of hair transplantation. And during that time, when we do hair transplantation,we use this material extra cellular matrix for advance healing from the donor area so that after I do the harvesting of the strip and the closure, I also apply this material and we get beautiful results in terms of the incision 99% of the time as well as in helping hair follicles that are transplanted flourish.
It’s no secret that although you can move hundred hairs from the back to the front, for many hairs transplant practices patients can lose up to 50% of those hairs. We’ve had patients who come to us from other practices where they lost practically 100% of their hairs and has to do with a lot of factors including surgical technique and the time the hair follicle is outside the body and numerous factors that this is not the necessary right time to discuss. However, what you can anticipate now is a waiting period and a waiting period because it takes several months to see significant hair growth when there is shock loss dormant period or when the hair follicles that were transplanted are to grow. Hair grows about a centimeter a month so allowing some time to let this hair grow back is pretty much the only choice you have at this point.
The medical intervention would probably be helpful to increase or shorten the period or should I say where some of this hair follicles starts to come back especially the ones that are being affected by DHT such that this hairs would probably flourish and come back based on that concept so in an additional thing or information that you’ve learned hopefully from our discussion is that there is this new technology that we are employing using extra cellular matrix that maybe something to consider in the future beyond once your hair transplant has settled in. So basically my advice is to hang in there, continue communicating with your physician and see how your hair grows and see where you at proximately in a year. So I hope that was helpful and thank you for your question.
Alopecia areata is an immune system disorder which causes hair follicles to stop producing hairs. Sudden loss of hair from small patches on the head is a common symptom. Advanced forms of the disorder include alopecia totalis, where all hair on the head is lost, and alopecia universalis, which results in the absence of all body hair.
Traction alopecia is the loss of hair from constant pulling, often the result of tightly braided hairstyles and hair weaves.
Delayed Loss from Stress
Telogen effluvium is a slowing of new hair growth resulting from sudden and severe stress, followed by a delayed shedding of hair. Sudden and severe stress induces a high proportion of follicles to enter the resting stage, and a few months after the stressful event, all of the resting follicles begin to shed hairs at about the same time.
Is Hair Transplant Suitable for my Case?
I’m 32, having hair loss problem and it is quite serious at the top of my head. I’ve never been pregnant before and planning to get married & get pregnant next year. Am I a good candidate for hair transplant?
Thank you for your question.
You submitted a photo that shows something called the whitening of the part and you’re asking about whether or not you a candidate for hair transplant. And you shared that you’re never been pregnant and you’re planning to be married and get pregnant in the upcoming year or so. And so the question is then it doesn’t make sense to get a transplant.
Well let’s begin by answering the question by diagnosing the problem. When a woman submits a photo and comes to our office and complain of hair loss, the most common cause called female pattern hair loss. Now there are 2 different scales we refer to when we talk about hair loss. One is the Norwood-Hamilton scale for men and the other is Ludwig scale for women. When women have hair loss, there is a defused thinning of the entire scalp and the front hair line tends to stay intact. Now that’s a contrast in male pattern hair loss where there is recession in the temples and thinning of the crown. So with female pattern hair loss, that widening of the part is a reflection of diminishing overall density of the hair and sometimes very often we refer to it as a Christmas tree pattern because the part gets wider and it looks like a Christmas tree from the top view.
So something to learn about hair transplant versus other options, well, for women until recently, the only option hair loss treatment was minoxidil and then a lot of dermatologist who treat female pattern hair loss with corticosteroid steroid injections. Now that is based on a belief that female pattern hair loss has an inflammatory component. Many of our female patients come to us that they have itching and that’s a sign not seen typically in men. And you will notice that there is some type of tingling and we believe that there some inflammatory component in female pattern hair loss. The problem is this time we don’t know what the cause is.
Now if you were to come into my practice in New York and I can tell you that we had an amazing opportunity to develop a non-surgical injection treatment that we have been very successful with for both male and female pattern hair loss and it’s based on the concept of wound healing such that the hair follicles are being protected. The background of this is based on studies coming in the University of Pennsylvania which determine that there are cells called progenitor cells that are like adult stem cells that protect the hair follicles, almost like a shield effect. And so when they stop being functional that the hair thins. And what that means, as the hair grows cycle continues, new hair growth comes back thinner than previous growth. That’s what they call it thinning hair. It goes from being thick like an oak tree and gets smaller and smaller becoming sapling and eventually just shutting off.
So we have been able to use a material called extracellular matrix that I use as a surgeon in some other areas for advanced would healing such as face lifting surgeries and other areas that I do cosmetic surgery as well as reconstruction surgery. We use that combined with platelet-rich plasma and injectit in the scalp and do a certain specific protocol that I develop and we have been able to help a lot of women with hair loss. And when we talk about the percentage of success at this time, 99% males have success measured by a clear improvement and hair quality and density thickness and 70% of our female patients notice a similar level of improvement. And it just usually takes a little bit longer, usually most of our female patients notice improvement at about 9 months.
Now in terms of hair loss that women experience, there is a phenomenon called telogen effluvium and that it is referred to stress hair loss and the hair growth stage there is a percent of hairs. About 8% to 10% of hairs for about 3-4 months are in sleeping stage called telogen stage. Well when there is stress called telogen effluvium and a lot of women will say I have severe stress and my hair kept on falling out and it comes in a panic and try to figure out what’s happening. Now pregnancy sometimes help thicken hair and a lot of times women will lose a lot of hair whether during their pregnancy or after. So I’m actually discouraging from doing hair transplant prior to your plans for your pregnancy.
And in addition, because there are limited options for treating female pattern hair loss from a surgical perspective, I try to discourage women from getting transplants because their progression can still go on and since they don’t have the option of using like a drug called finasteride that men can do to prevent further loss, the choices are limited. And that’s really why I am very excited about our injection in so many ways. The injection is both a vaccination in other words it prevents progression and can turn around and re-thicken hair so it’s a very exciting time to be in. This is what I feel is an emerging field of regenerative medicine and in our practice specifically hair regenerative medicine. And so if you’re going to do something at all, I would consider that as an option as a way to prevent the progression of your hair loss because you can’t predict what actually is going to happen related to your pregnancy. Now if you’re nervous about that, so just hold off on anything or everything all together because I don’t think a transplant will do to you what you want and if you were to lose more hair, then the benefit of a transplant will be too limited to appreciate. And the time and energy put in to do it may not be worth the investments. So consider learning some more regarding this hair regenerative technology and figure that in the context of the information I provided about hair transplant. So I wish you the best of luck and I hope that was helpful and thank you for your question
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