Thank you for your question.

You submitted your question with several photos mostly focused in the area of your hair part.

And you are asking are you a good candidate for a hair transplant followed by you’re

asking the number of grafts. You state also in your question that you started having hair

thinning about 3 years prior but you never had thick hair and that you had a more intense

hair loss 6 months ago.

Well, I can certainly share with you how I discuss the options for treating hair loss

patients like yourself in my practice. A little bit of background, I’m a Board-certified

cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I have

been in practice in Manhattan and Long Island for over 20 years. I am also the founder of

TrichoStem™ Hair Regeneration Centers. This is a system we developed as a non-surgical

treatment for male and female pattern hair loss. And it has turned out to be a significant

way to help manage particularly female pattern hair loss where there was only essentially

minoxidil as the only method to treat progression before someone would be a candidate for hair

transplant.

So to begin with, it is important to have a proper diagnosis before you undergo any

intervention. The point of that is understanding that simply transplant is not a treatment

for hair progression or hair loss progression. Hair transplant is a way to put hair where

there isn't hair. And I think that, just to get to your main question, if you look at

your scalp, you will notice that the density of your hair is still significant enough that

I think that it is unlikely that any hair transplant surgeon will feel comfortable about

doing a transplant where there is so much existing hair. There are several reasons for

that but one of which is something basically called collateral hair loss. If you have existing

hairs, when the placement of hair is done, it can potentially cause trauma to the existing

hair resulting in significant loss which will not be very productive.

But more importantly, it comes down to what is the diagnosis. Now statistically speaking,

95% of hair loss is a genetic pattern hair loss known as androgenetic alopecia. However,

when it comes to the practical workup of hair loss in women, I generally defer first to

having my patients having hormone levels checked either by their gynecologist or dermatologist

or endocrinologist just to get a certain sense of any issues related to hormonal levels as

being a source.

Further, I would say that the way you phrased your question where you stated that you’ve

been losing hair for 3 years and it became more intense 6 months ago, my follow-up question

would be does that mean you’ve been experiencing a lot of hair shedding? Hair shedding is generally

not quite a characteristic of genetic pattern hair loss. It’s more a characteristic of

telogen effluvium. Telogen effluvium, it can be defined as either hair shedding related

to a stressor event such as something significant whether a life event or family crisis, medical

condition, general anesthesia that is preceded like 2-5 months prior before there is a significant

amount of hair shedding. There is also a subgroup of patients who have something called chronic

telogen effluvium. And very typically, they are women who will state that they are constantly

shedding hair.

The distinction between a chronic telogen effluvium and an androgenetic alopecia patient

is that even though the patient is shedding a lot of hair, generally speaking, they don’t

appear to be progressively thinner. The challenge we often have is we sometimes have to deal

with a mixed picture where by microscopy, we can see that there is miniaturization or

thinning of a lot of hair. The patient is also challenged by chronic hair shedding.

And there is very little that is really understood about this condition and there have been some

theories presented about variable fluctuations of hormone levels that might be relevant in

a situation like yours if you’ve had hair shedding.

Now speaking about the management of female pattern hair loss, let’s say you’re not

dealing with telogen effluvium, well in our practice, we typically treat our patients

with a treatment called Hair Regeneration. And what Hair Regeneration evolved from was

an accidental discovery that thinning hairs became thicker when we were doing hair transplant

and we were using a wound healing material to help improve the survivability of hair

grafts as well as the donor area where the hairs are harvested from. From that evolved

a challenge to see if we can get that effect to be consistent.

Well, much has been learned over the course of 7 plus years since we initiated this and

I developed a system that also characterizes specific subgroups. And these subgroups are

defined essentially by age, gender, age of onset of hair loss, degree of hair loss, rate

of progression of hair loss and other medical conditions so that we have essentially categories

to assign patients and not just put everybody under the broad category of androgenetic alopecia.

The reason for this is that the treatments that we do are customized to those particular

categories. And so the goal is essentially managing hair loss.

I always tell my patients that this condition, if it’s androgenetic alopecia and there

are no other contributing variables, then you are dealing with something that is hardwired

in your DNA. And so hair loss treatment is really hair loss management. Essentially,

even though there’s going to be progression, what we try to do medically is to maximize

the quality of the hair through these injection treatments which reactivates hair growth of

hair that isn't currently growing which is essentially a prolonged resting phase, thickening

of thinning hairs and prolonging the lifespan of the hair growth cycle and timing our treatments

in a way to maximize the length of benefit of each of these injections. And generally

speaking, our injections are timed for many of our female patients from one injection

followed by 18-24 months later, another injection. And so we developed treatment strategies depending

on those variables and the evaluation. This may be something that is worthwhile considering

before you decide to have hair transplant.

I think first, it’s important to be confident about your diagnosis. I tell our patients

that although we can help the quality and longevity of the hair growth and really do

well with androgenetic alopecia, and as I said earlier it has made a very big impact

in the treatment of female pattern hair loss such that many people are embracing this strategy

that further, if someone has at the same time telogen effluvium, well that can get pretty

frustrating. And nonetheless, it is still management and all of this has to be hopefully

clearly understood before you undergo any kind of treatment options.

So I think it’s important that you learn more about the non-surgical options that you

have, a proper work-up necessary for any woman dealing with hair loss and then choose what

you think is most appropriate for you.

So I hope that was helpful, I wish you the best of luck and thank you for your question.