Hair loss stages are categorised in a useful guide to help diagnose the extent of hair loss, for both men and women.
The Norwood Scale is a classification of MPB for men, from remedial thinning to progressive hair loss; this makes it easier to understand the present grouping and determine the potential future loss. The Scale starts at 1 at its most minor up to 7 as the most aggressive form of hair loss, also staging the loss between hairline and the crown.
The female version is known as The Ludwig Scale and works in a very similar way to categorise a stage of thinning. The pattern of loss is generally different but again gives a broad overview as to the condition of a person‟s situation.
As there are so many causes of hair loss, some systemic, traumatic, chemical it is important before any treatment is administered a proper consultation assessment is required.
Blonde or Brown, Hair Characteristics Makes A Difference
It also has to be understood that hairline placement, density and thickness can vary from ethnic origin and genetic background and hair characteristics.
Hair characteristics can range from hair colour, calibre or diameter of the hair, fine or thick, if the hair is curly or straight to the contrast of the hair against the skin complexion. All these aspects carry an important role for the doctor when planning your hair transplant procedure, and will be an important aspect in determining the density and the maximum coverage achievable whilst maintaining a natural looking result and blend with your existing hair.
Planning for further hair loss also becomes easier, as the hair calibre allows for wider coverage whilst maintaining a good density. Ideal hair characteristics include a thick hair shaft, curly or wavy hair, a lax scalp and a low contrast between your skin colour and your hair colour. That is why a hair transplant works and can give a man even in Class 5 and 6 the appearance of coverage and density (donor permitting) without matching hair for hair on the head.
Good and Bad Hair Transplant Candidates
Part of the consultation process is to look into the future and assess whether the goals set out today will work with the potential for hair loss in the future. Your goals may be achievable today but if your objectives change or your hair loss progresses in the future these aspects must be anticipated as after each operation the donor capacity is diminished and be insufficient to meet the demands thus limiting the ability of the doctor to complete your goals.
This will include an assessment of your hair loss stage, technically either the Norwood scale for men or the Ludwig scales for female pattern baldness; then a measure of the donor hair density against surface area to cover in the recipient, hairline design if required and the doctor´s assessment of which technique would be best suitable to treat the level of hair loss.
Supply And Demand – Hair Loss Pattern vs Hair Characteristics
The areas of hair loss can be divided into three regions: the front, the mid-scalp, and the crown or vertex.
The total area of hair loss may vary from 5 to 250 square centimetres, this is an approximate measurement to make a guide easier to understand as the scalp is not flat but contoured and measured in volume. The potential size of the crown can create an insatiable demand for donor hair, which, as we have seen, is limited. The crown can vary widely in size, but in Class 6 or 7 patients can be as large as 175 cm2.
Even if we transplant a minimal density (15 FU) to a fully bald crown (175 cm2) we have used roughly 2600 FU. If we transplant a higher density, 40 FU, then we have used 7000 grafts, this is more than the average person has available in their donor area and this is just in the crown.
It is impossible to place like for like density when the man had a full head of hair; the effects of trying to reach the same density can result in trauma to the skin and a poor yield from the placed grafts; or by placing two hair units in the frontal line will create the thickness of the adolescent hairline but look “pluggy” at closer inspection.
The Art Of Creating Hair Coverage To Advanced Hair Loss Stages
Much of the art is to give the cosmetic effect that the density is the same, this is most obvious when the hair is longer because it blocks the reflection of light on to the scalp. But when the hair is short or shaved this effect is lessened because there appears to be less density; although this is obviously not true.
This is possible because the signs of thinning are first apparent when light reflects through the hair and back off the scalp, showing areas of thinning. If we had to place like for like this would make anything like total restoration impossible, but by blocking the reflection of light makes a hair transplant a viable option in regaining the look of regaining a good head of hair simply because a lower density can be placed and give a realistic effect of fullness.
Some will have to be satisfied with less coverage but a natural looking hair density rather than spreading the hair over the entire recipient area and having a low density, which may look unnatural or not reach the expectations of the patient.
Do I Need More Than One Surgery & How Many Are Needed?
The potential number of grafts on an average scalp that can be harvested can be around 7000, dependent on the techniques used, to harvest these numbers in one procedure is generally impossible unless the aim is to simply take as much as possible with no care.
More procedures can be carried out at a later date if hair loss advances, and with careful donor management allows the sensible and ethical distribution of hair to gain the maximum result for the patient.
With the use of both FUT and FUE techniques, it is now possible to widen the harvest area and increase the overall graft number potential.
There are many aspects to consider when deciding which hair transplant technique to use; some, for example, maybe not wanting a linear scar, money, hairstyle, the extent of your hair thinning to name a few.
Another aspect to consider, more from a technical side is your starting donor hair density and any limitations this may bring in treating your hair loss, be it in this procedure or in the long term.
FUE or Follicular Unit Extraction removes the hair units one-by-one so every hair removed lowers your hair density around the back and sides of your head. As long as the hair removal is spread carefully and not too much is taken over one or multiple procedures your hair appears on the surface to look normal, but too much removed it can start to look patchy with areas of high and low hair density areas. Because of this, FUE becomes harder the larger the area to treat without taking too much and causing problems in the future.
The Strip or Follicular Unit Transplant technique is less preferred today but that does not mean it is less effective as a hair transplant technique. For larger sessions and high NW cases when maybe FUE cannot safely reach the numbers in one session or even multiple sessions. Strip can give the person much greater coverage quick, it will leave a linear scar but then a hair transplant does have limitations. Strip with the Trichophytic Closure has the benefit over FUE in that the area the hair is removed does not greatly effect donor hair density.
There has been many debates over techniques each having pros and cons; it really depends on what you need and what your donor can afford, of course with long-term planning always in mind. This long-term planning from the first op is critical with you and the doctor ensuring you are on the same page with the same goals.
Most patients today elect to have the mixed grafting technique performed, either initially or as their hair loss progresses. This enables them to enjoy the benefits of both techniques and gain the optimum graft numbers over time.
Improvements in Surgical Hair Restoration Can Be a Solution for Many
Advances in hair transplant surgical hair restoration techniques are well suited to treat both men and women; today´s technology enables high density and natural hairline designs. For those that are suitable candidates, the latest follicular unit grafting hair transplant methods present an ideal solution.
