Thank you for your question. You submitted two photos of the top of your head and you're
asking about whether or not 2000 grafts will be adequate for the areas of concern that
you presented in the front of your hairline, but you do mention in your question that you
have some bald spots in the middle, and you've got an estimated one point of 600 grafts,
so you're looking for some clarity on what to do.
Well I can certainly help you with this question. I'm a Board-certified cosmetic surgeon. I've
been performing hair transplant surgery for over 20 years. I'm a Fellowship-trained oculofacial
plastic surgeon and I’m also the founder of Trichostem Hair Regeneration centers, a
non-surgical alternative to a hair transplant for people with thinning hair for both men
and women.
So I will give you some perspectives on how we discuss options with patients who look
like yourself when they come to our practice. So to begin with, let's just start with this
question about transplants and numbers of grafts. When you think about hair transplantation,
some of you have to really be very mindful of what kind of volume can you get from the
surgery. Numbers like 600 and 2000 sound like a lot, but when you think about it, when you
have the most hair you had over a hundred thousand hairs, and when people noticed hair
loss they've already lost fifty percent of their hair.
So these numbers are relatively small and when you think about these small numbers,
you have to think strategically of where you would place grafts. Now both male and female
pattern hair loss the majority of it is genetic, and microscopically, they appear the same.
In other words, the hair does not just disappear, it goes through a thinning process—that’s
where the term hair thinning is used. Every time a hair grows and reaches the end of its
growth cycle, it sheds, after sheds it goes through a very late phase of not growing and
then it grows again. Well when hair is thinning it grows back thinner and eventually it grows
until it stops growing at all.
So there is a progression of both male and female pattern hair loss and it's also important
to factor in in making your decision about transplant. And what's most important about
that is understanding that your donor area, which is in the back of the head, where if
you look at either the Norwood scale for men or the Ludwig scale for women, at the very
end when there's no more hair to loose, there's a narrow band of hair, that's the area that's
called genetically resistant and this is the hair that is transplanted. So you have to
understand, there's not an endless supply. Now there's also a big difference between
men and women in terms of the type of transplant that is done. For men, the ideal transplant
candidate is typically a man who has frontal hair loss, where the hairline recedes and
the area becomes smooth, but they still had hair in the back and some in the middle. So
what we usually do is we'll place hair in the center so that it creates a balance and
it doesn't look like the man is bald.
With women the expectation is much higher, you expect to have a lot more hair, and the
challenge is that women have more of a diffuse hair loss and because it's diffuse hair loss,
it means that there's a lot of existing hair. Now when you think about this whole problem,
you also have to understand that we're trying to aim for coverage. So when a hair transplant
is done—let’s use the number two thousand—if you get 2000 hair grafts, that means you have
to have 2000 stabs made into the top of the scalp where little openings have to be made.
Now no matter what, there will be a lot of existing hair that happens to be in the path
of the blade, as well as adjacent hairs that will also be traumatized. What ends up happening
for women is a lot of hair gets lost and that hair does not come back. So when you transplant
hair that may be somewhat thicker than the hair that is native to that area, your net
effect is not as good as you would have expected. This is a very common experience that a lot
of hair transplant doctors would agree with.
In our practice, we actually have found an alternative to this, because what else is
also an issue is you still keep losing hair so the transplant also has a certain effect
of shelf life in terms of the number years before you need another transplant. What we
do is something called Hair Regeneration, and this was a method and a technique of using
an injection, which is not a surgery for an injection, combining platelet-rich plasma
with extracellular matrix. It was originally intended to help hair transplants heal better,
to help the donor area as well as the grafts heal better, and a serendipitous discovery
was that the thinning hair also became thicker.
So we've developed a system, a process of customizing this material and injecting it
in a way so that we're able to successfully improve the appearance of 99% of men who come
to us and more than 80% of women who come to us. I would say that with the women, we're
actually seeing more improvement and higher numbers as we are more selective about who
we agree to treat. We treat patients from around the world and this has been such a
successful alternative to hair transplants that we’ve actually seen that one treatment
in the right candidate can actually result in better coverage of the scalp than not just
one but two hair transplants.
So I would say that this is something that is worth learning about is learning about
technology like what we've developed called Hair Regeneration, because what we're doing
is we're stabilizing or stopping the progression of hair loss and we're reversing the thinning
so that we get more thick hair. If you think about it, the hair is already there, especially
for women, but if those hairs would thicken even a little bit you get a lot more coverage.
Mathematically speaking, up to a certain point, if you double the diameter of a hair you can
actually quadruple its volume, which means that you get a lot more coverage and fullness.
So with that being said, I would say that be cautious about what to expect with a hair
transplant. Discuss these concerns about collateral hair loss and realistic expectations and the
limit of transplantation. Learn about Hair Regeneration and similar treatments and then
make a decision about what you want to do.
So I hope that was helpful I wish you the best of luck. And thank you for your question.