A 24-year-old gentleman has hair loss and wants to get his hair back to normal. He wants to know if he is a candidate for hair transplantation.
Dr. Amiya Prasad is a board certified cosmetic surgeon and specializes in hair restoration over the last 20 years. At 24-years-old, he explains that this gentleman is at the minority of men who are losing hair. In hair loss, there is a Rule of Decades: In someone’s 20s, only 20% of their contemporaries have any kind of hair loss while more than 80% have a lot of hair, in the 30s, 30% of men have hair loss. This gentleman’s family history is probably the cause. There are 11 chromosomal locations including the X chromosome where hair loss genes are passed down in families.
With the photo he submitted, Dr. Prasad would classify this as severe hair loss. With this much hair loss, there is no hair transplant that would replace the volume of hair that he has lost. The permanent zone of hair that is used for transplantation is a very narrow band with limited number of hairs at the back of the scalp. Hair transplantation has become such an industry that it has become more about the sale of transplant surgeries than it is about finding solutions for patients. The International Society of Hair Restoration Surgery in the United States has actually compiled data from its members and found that 65% of patients desired more density after they had hair transplant surgery.
If he was in his 40s, a hair transplant done in a more limited way would probably be more acceptable because at this age, more than 40-50% of men in this age group have hair loss, so having more hair in the center would be a more acceptable result. Patients who had transplants in their 20s didn’t understand that hair loss was going to continue, and by their 40s all they have left are grafts.
Dr. Prasad says that there are two drugs that are used in the United States that are indicated for hair loss: finasteride and minoxidil. Finasteride is an oral drug by prescription and minoxidil is a topical drug available over the counter. Finasteride may or may not be helpful for him, and many young men are concerned with the drug’s potential for long-term sexual side effects. Minoxidil won’t stop the progression of hair loss nor will it provide enough volume to create the appearance of no hair loss.
In Dr. Prasad’s practice, he developed a treatment called Hair Regeneration. This is the application of a material called extracellular matrix (ECM) that was originally used for treatment of wound healing in facial and body cosmetic surgery, and also for the hair grafts in the donor area in hair transplant surgery. It was discovered that the hairs that were thinning actually became thicker. For hair loss, he combines a material from the patient’s own blood called platelet-rich plasma (PRP) with extracellular matrix and injects it to the scalp. The results of this treatment actually far exceed the results for hair transplantation. During hair transplantation, existing thinning hairs become traumatized from the placement of incisions in to the scalp to place the grafts which cause collateral hair loss. Through this injection, it is stopping the progression of hair thinning and making hair thicker, thereby creating more volume.
Hair thinning is a progression where thick hairs become thinner with every subsequent growth cycle. With thinning hairs more numerous than hair transplants becoming thicker, the coverage is very dramatic. Dr. Prasad explains that he can save the dying but he can’t bring back the dead. The hairs that are thinning and those that are dormant will respond and grow, but hair that is completely gone can’t be brought back.
However, Dr. Prasad adds that it doesn’t mean hair transplant is out of the questionThe limits are based on the numbers of hairs that are at the back of the scalp. There are many doctors who promote various types of devices, but none of these change the physiologic limitations of the donor area. A lot of people are knowingly taking hair grafts outside of the donor area in follicular unit extraction transplants above and even below that area to create volume hoping probably that maybe there will be some type of way to prevent those hairs from falling out in the future. In Dr. Prasad’s practice, he encourages people who have had FUEs or FUTs done elsewhere to come in and have the injection because he found that he can help the healing process of the grafts. He can also help the healing process of the donor area and the thickening of the existing thinning hair so that the overall result looks better.
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