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March 23, 2020

Is hair transplant necessary in the beginning stages of hair loss?

Hair loss is a very common condition that increases with age. However, due to the various factors in modern society, there seems to be an increase in hair loss amongst the population. And patients are losing hair earlier in life. This could be due in part to genetics, pollution, cigarette smoking, high stress levels associated with city living. Hair loss affects men more than women and the pattern of hair loss is different between the two genders. Hair loss is graded according to severity and it is important to grade the hair loss condition accurately for more targeted treatments, and also to monitor progression or improvement of hair loss.

How Hair Loss For Men Starts

In men, we use the Norwood-Hamilton classification system of hair. We consider grades 1 to 2 to be the early stages of hair loss, where either the hairline is receding slightly upwards or backwards, creating a wider forehead, or just above the temple area, leaving a M-shaped hairline.  It can be very subtle and insidious at first. Very often only the patient himself notices the changes in his hairline.

Further back, the crown area may start to show a bit more scalp so there is a round area of balding just beginning to be noticed. It is usually more noticeable when the hair is wet and limp, or under bright lighting.

How Hair Loss For Women Differs

In women, the Ludwig-Savin classification system of hair loss is used. Women tend to lose hair in a different pattern than men. Often, the hair loss is in a central zone at the top of the scalp, so when one parts the hair, the gaps get wider. In early hair loss, we commonly see women in the 1-2 to 1-3 stage.

Seek Treatment For Mild Hair Loss Early

In mild hair loss, it is important to get diagnosed accurately and early. It is also important to ensure that we rule out medical conditions or nutritional deficiencies and even hormonal imbalance that could lead to hair thinning or hair breakage. Hence, seek treatment early with medical professionals who have special interests in hair.

Once we have ruled out underlying medical conditions that may cause hair loss. We can focus on the reasons for the hair loss. The most common reason in men is  androgenetic alopecia, (AGA), which is caused by an excess of the hormone dihydrotestosterone (DHT). DHT is converted from testosterone by the enzyme 5-alpha reductase. Too much DHT causes hair to thin in the characteristic pattern, known as male pattern hair loss.

Hair Transplant Is Not The Only Option

In men, early hair loss should be treated early to avoid it getting worse. A hair transplant is not the treatment option if hair loss is very mild, contrary to popular belief. Instead, we advocate the use of the oral medication finasteride. The original trade name is Propecia. This is the most effective way to prevent worsening of hair loss, especially at the crown and mid-scalp area. One can expect about 20 to 30% improvement to the thinning areas, if treatment is started early enough. Usually, as long as there are fine hairs left in that area, there is a strong chance it will improve with finasteride. If the area is completely bald, smooth and shiny, chances are it is too late to start finasteride. It does not work so well at the hairline in front. But it can prevent the hairline from receding further back. We see this as a maintenance approach to balding.

Another established treatment is the use of minoxidil. Minoxidil is a blood pressure medication but it has been used on the scalp to stimulate hair growth.  The exact mechanism how this works is not fully understood but scientists believe it works by a combination of increasing blood flow and also directly stimulating hair growth via prostaglandin mediated pathways. Minoxidil was approved for androgenic hair loss by the US FDA in 1996 and since 2014, is the only US FDA approved topical treatment for androgenic hair loss.

Other Alternatives To Treat Mild Hair Loss

Other treatments for mild or early hair loss include the Low Level Laser Therapy. This utilizes low energy light at 670nm to stimulate hair growth and has to be used consistently for the best results. Some commercially available treatments include Revage clinic laser, Hairmax home device or iGrow laser home device.

There are supplements that claim to improve hair loss, but there is very little scientific evidence for it. Some of these supplements include Pantogar, Saw palmetto, etc.

When Is A Good Time To Consider A Hair Transplant?

This is one of the most often asked million-dollar question in our clinic.

  • Am I a good candidate for a hair transplant?
  • Is it too early or too late for a hair transplant?

Who Are The Best Candidates For A Hair Transplant Procedure?

Generally, a hair transplant should be considered when one has lost a significant amount of hair to the point that the non-hair transplant treatments are unlikely to bring about a reasonably satisfactory improvement. In very broad terms, someone with stable Norwood 3 to 5 would make the ideal hair transplant patient. Stable means that the patient is not losing hair rapidly and his hair has been stable or very slowly progressing over a few years. This group of patients make the best candidates for a hair transplant.

Not Everyone Should Undergo A Hair Transplant

For very advanced hair loss patients with Norwood grade 6 to 7, we really need to look at the balding area involved and the remaining donor hair at the sides and back of the scalp to determine if we have enough donor hairs to meaningfully cover the thinning areas.

If the balding area is too large, and there are not enough donor hairs to cover the area, it may not be wise to proceed with a hair transplant. We have seen such disasters of hair tranplants attempted on a Norwood 6 patient, but with such a sparse result, that the patient often looks worse, even sickly, with the hair transplant and would have been better off not doing it in the first place.

Scalp Micro-Pigmentation (SMP) - An Alternative For Severe Hair Loss

In such cases where a hair transplant will not benefit the patient, we might discuss the possibility of a scalp micropigmentation (SMP) procedure.

The scalp needs to be examined carefully to be sure if there are sufficient gaps to plant new hairs, and also to see if the donor hairs at the back and sides of the scalp are healthy. We make it a point to discuss expected results and the patient’s personal goals, before deciding whether or not to proceed with a hair transplant.

Think Hair, Think Dr. Harold