About Hair Loss

The beginning of hair transplantation in the 1950s was also the beginning of "plugs". These plugs of hair had approximately 20 hairs. They were harvested with a tool somewhat like an apple core that left a small hairless spots in an area of hairbearing skin. Recipient sites were made with the good intention of removing non-hairbearing skin and replacing it with the plugs. Unfortunately these plugs had to be placed far enough apart that they would survive. The net effect was good density of the plugs themselves with large spaces in between that gave hair transplantation a bad name for decades. To their credit, their goal was not as much a natural appearing hairline as much as just getting hair to be transplanted and survive.

Grafting techniques have advanced. Grafts have become progressively smaller. At first, grafts were divided from the plugs. Later, grafts became progressively smaller reaching the size of single micrographs and 3 or 4 hair minigrafts.

Donor sites have improved from harvesting via a tool which left a noticeable bald spot at each donor site to a technique which is performed by harvesting a strip of hairbearing scalp and closing the donor site primarily to minimize the nonhairbearing skin that remains. The hair is then divided into sheets called slivers. The slivers are then divided into follicular units or the natural groupings of the hairs in either groups of 1 or 2 micrographs or 3 or 4 minigrafts which provide more natural transplantation results than the plugs of early hair restoration.

Placement techniques have improved allowing more density and more grafts in fewer sessions. Micrographs are placed in the most visible areas of the frontal hairline, and minigrafts are placed just behind to give more density with a more natural appearance than the old style plugs.

Most people use the Norwood classification system to describe hair loss.

Hair Loss - Norwood Chart

How does this classification system help us?

It helps us because not every patient at every age is a good candidate for hair restoration.  To understand this, consider Norwood VI and VII patients.  As their hairline recedes lower and lower, they have less donor site availability.  There simply is not enough hair to take from the fringe to transplant effectively with such a large area of nonhairbearing skin.  It is possible in some cases to create a small tuft, but in general it is easy to see that these are less favorable candidates for hair restoration.

The hard part is that patients who have come to see us are somewhere in the process of their hair loss, and we have to predict what type of treatment will be effective for them now, and later in life.  If we transplanted somebody who is a Norwood classification IV, and they developed into a Norwood classification VII,  you can imagine that the graft placement pattern will look unnatural.  If we transplanted a Norwood classification II and filled in the small temporal recessions, and he developed into a Norwood classification IV, his grafts would also look out of place, isolated and unnatural.

In short this means that patients who are older, with a classification of hair loss at an older age of less hair loss, are our best candidates.  Patients who are likely to have more hair at an older age are likely to have donor hair that will provide more coverage.  We use the classification system, and your history of hair loss, and your family history of hair loss, to help us predict the best treatment plan specifically for you, not only now, but also in the future.



Before Hair Restoration    


5 Months after Restoration 


Before Hair Restoration

5 Months After Restoration

Women with hair loss tend to have thinning hair in similar areas to baldness in men. Instead of temporal recessions, there tends to be a generalized thinning of hair across the top of the scalp from temporal recession to temporal recession and posteriorly to the area where men typically have bald spots.  Thinning hair in this area makes it more difficult to style.  This can be particularly disconcerting to some women and make group activities like swimming uncomfortable.  As many as 30-40% of hair loss patients can be women.

Ludwig Hair Loss

One of the more favorable characteristics of hair restoration in women, is that larger grafts with more hair can be placed and appear more natural and provide more density faster, due to the camouflage of surrounding hair.  More hair with your hair, faster.  More hairs per graft mean more hair for less money, and in less time.