HT and Hair Loss Type Question

[Empty Area]

So most of us know that getting a transplant at a younger age is a very speculated topic. We all know the outcome of such, in the case of losing more hair as you get older.

 

I've read many topics with terms such as "devil horns" and that would be enough to scare me away...if all i had was a receding hair line.

 

So i got to thinking....

 

Let's say someone with a diffuse pattern, with and even ammount of loss over the top portion of the scalp was to get a transplant, where the grafts were evenly distributed, no lowering of the hair line, and no dense packing. Even if the patient was to halt his loss, and maybe lose a little later, what would the outcome be?

 

Seems the more i think about it, they would be back to square one, in a sense, right? While that patient would not be happy, it seems that one would rather that than "devil horns" or dense patches in specific areas, or just a full crown and no hair in the frontal part of the scalp.

 

Could anyone elaborate or give some insight as to whether what i am stating is true, or whether i'm talking out of my behind?

 

 

Sincerely,

Empty Area

[MikeTheDane]

I agree with you completely. There are two factors to consider though, one is that diffuse thinners have a bigger chance of shock loss, and the other is that a thinner will almost always become completely bare in the thin area, while someone with just high temples might never progress.

 

That being said though, a young person with a defined but diffuse NW6 pattern, would in theory be allowed placement of grafts, look great for a decade, then back to how it looked to begin with as he loses more hair (as opposed to completely bald).

 

I've raised the point on occasions, but there are members who have the opposite view. I think it's a valid issue to raise and I think it's time that we have a thorough debate about it.

 

The way I see it, it's way safer to have a HT when you're young as a diffuser, than as someone with a missing hairline.

[Sparky]

Well if the rest of my hair fell out i'd have devils horns, but i'm 34 now with no diffuse thinning so I think i'll be ok, and i'm on Finasteride. Hopefully they will come up with something more permanant before I have problems. If not i'll have another ht at some point filling in the front going back, but not fill the crown in.

[Empty Area]

thanks mikethedane. I just didn't know if i was just thinking too much into it.

 

So it seems to make sense to others as well. Even then though, after waiting ten years or so, hopefully technology can speed up and we won't have the same options in ten years as we do now. I'm hoping that Propecia will halt the loss even longer. I try and stay optimistic :]

 

Any other opinions???

[Megatron]

Let's say someone with a diffuse pattern, with an even ammount of loss over the top portion of the scalp was to get a transplant, where the grafts were evenly distributed, no lowering of the hair line, and no dense packing. Even if the patient was to halt his loss, and maybe lose a little later, what would the outcome be?

 

there are a few issues to consider:

 

#1 - the amt of graphs, the cost and the # of procedures involved in spreading an adequate amount of hairs evenly over the top of the scalp

#2 - hiding the donor scar could be an issue, especially with a large amt of graphs

#3 - keeping the hair long (i.e., to hide the scar) would likely not be a good look for a diffuse thinner

#4 - extracting a sufficient amount of graphs from the donor area could be an issue with a diffuse thinner

#5 - lastly, I think to the trained eye, you'd be able to tell something was awry, because the transplanted hair coming from the donor region is thicker than the hair on the top of a person's head (I believe this is the case even for a diffuse thinner) and therefore, having sporadic thick hairs all over one's scalp looks more odd than sporadic thinner hairs

Edited May 21, 2010 by Megatron

[Empty Area]

sounds like you think its a bad idea overall for a diffuse thinner to get a HT Megatron?

[MikeTheDane]

there are a few issues to consider:

 

#1 - the amt of graphs, the cost and the # of procedures involved in spreading an adequate amount of hairs evenly over the top of the scalp

#2 - hiding the donor scar could be an issue, especially with a large amt of graphs

#3 - keeping the hair long (i.e., to hide the scar) would likely not be a good look for a diffuse thinner

#4 - extracting a sufficient amount of graphs from the donor area could be an issue with a diffuse thinner

#5 - lastly, I think to the trained eye, you'd be able to tell something was awry, because the transplanted hair coming from the donor region is thicker than the hair on the top of a person's head (I believe this is the case even for a diffuse thinner) and therefore, having sporadic thick hairs all over one's scalp looks more odd than sporadic thinner hairs

 

I'm afraid that I don't quiet follow your logic Megatron

 

#1 - Diffuse thinners don't nessesarily require more procedures to achieve coverage. For example, a guy with 100% hairloss on 50% of his head (a very high forehead) versus a guy with 50% hairloss on 100% of his head (diffuse NW6) both would essentially require the same amount of grafts and procedures. Shockloss aside; As the years pass, the diffuser would look thinner but the high forehead would require more grafts to close the gap without hair that has occured.

 

#2 Why is it harder to hide on a diffuser? He does not nessesarily have diffuse thinning on his sides or donor area, only the MPB affected area like everyone else.

 

3# I agree, but I think that goes for both parts

 

#4 Again, I think you misunderstood diffuse as having a diffuse donor area. This is actually not nessesarily the case, as with myself. I'm a diffuser, but I had 85 G/CM2. Though I do agree that in cases where the patient does have low donor area (55 or less) it may not be the best option. The good news is that a diffuser generally looks better buzzed.

 

#5 That may be true, I'm not sure about this. Atleast the trained eye is not the general public, but I see your point.

Edited May 21, 2010 by MikeTheDane

[mahhong]

I think there is a little bit of confusion between Diffuse Patterned Alopecia (DPA) and Diffuse Unpatterned Alopecia (DUPA).

 

DUPA causes hair to thin diffusely over pretty much the whole head, where as DPA causes diffuse thinning but only over the areas susceptible to male pattern baldness.

 

Some of the points raised are good ones that should be taken into consideration. Probably the main issue with DPA is the risk of shockloss if you have a HT . The hairs on pretty much the entire head are somewhat weaker and more susceptible to shockloss so having a HT in and around those hairs does pose a risk that is probably greater than people who aren't diffuse thinners. I think most professionals are of the opinion, however, that as long as they can shave your hair to get a good view of where they will be inserting grafts this risk is not substantial. People with DUPA are generally completely unsuitable for HT because they have no "donor" area as such. This form of thinning is pretty rare in men however,.

 

My understanding is that when it comes to DPA it is best to assume the patient will eventually lose the majority of hair on their head and become something between a Norwood V-VII. As soon as an are begins to thin one must assume the hair will eventually be gone from that area completely, so if you have DPA the areas that are thinning are more than likely to one day be bald.

 

The difference with a non-diffuse type of MPB is that it's in some ways harder to judge if that's the case. Someone with a bit of crown loss and temple recession may find their hairloss tapers off soon after and they don't have much more hairloss. In contrast, some may find everything just keeps receding until they're a VI/VII on the Norwood scale.

 

With DPA I would assume the pattern of balding may becomes a bit clearer a bit earlier. The downside, however, is that you must plan as if you're going to lose all the hair in the thinning areas. Effectively I would assume a doctor will treat you as a Norwood VI (or similar) and thus any HT you have will be fairly liberal in terms of density and hairline planning. That having been said men with DPA can and have made excellent HT candidates so it is not a "problem" when it comes to HT surgery.

 

You will probably find your doctor will want to plan as if one day you will be a Norwood VI or similar. Therefore ideas about dense packing or loading specific areas will have to be tossed out and instead a focus on "building" your hair back almost in layers will have to be the approach taken. A doctor will likely want to start with low density and larger coverage and build up density if and when it is allowable.

 

This is how I imagine DPA is handled anyway. I am a DPA thinner but I have seen lots of success stories. However, where as someone with a different form of MPB might not get beyond a Norwood III/IV, a DPA thinner will probably have to assume they're at least a Norwood V/VI in waiting and approach their hair restoration as such.

[Empty Area]

Great post maahong.

 

That being said though.....

 

are there any diffuse thinners here that care to elaborate? Such as when you got your HT, how long after more hair started to fall out, if it were the right decision, etc?

 

I also remember reading in this forum that Propecia was great for diffuse thinners. Figured i'd throw this into the mix and see if anyone could elaborate on "why" it is great on diffusers?

 

sincerely,

Empty Area

[mahhong]

Great post maahong.

 

That being said though.....

 

are there any diffuse thinners here that care to elaborate? Such as when you got your HT, how long after more hair started to fall out, if it were the right decision, etc?

 

I also remember reading in this forum that Propecia was great for diffuse thinners. Figured i'd throw this into the mix and see if anyone could elaborate on "why" it is great on diffusers?

 

sincerely,

Empty Area

 

I can't offer any help on the first question but on the second question I might be able to (though it's only personal opinion).

 

If it is indeed true that propecia is very useful on diffuse thinners the reason may be as follows. When you have non-diffuse MPB your hair doesn't really "thin" but merely disappears bit by bit, in a way. Most people with non-diffuse MPB might not even notice they have it until a fair bit of their temples and crown have gone. In the early stages, when they're just receding and thinning in the crown a little, they might assume they're not balding or want to wait until that's the definite diagnosis.

 

By contrast diffuse thinners tend to start noticing their whole scalp/hairline getting thinner and more see through (like I did). But, what's more than likely happening is instead of lots of hair follicles actually ceasing to produce hair, instead the vast majority of hair follicles just start producing thinner, weaker hair that creates the thin, see through effect. In short, what I'm trying to say is that there is a good chance diffuse thinners notice their hairloss before a lot of their hair follicles have "died", so to speak, where as non-diffuse will tend to notice and take action when a lot of the follicles in the susceptible areas have already stopped producing hair.

 

So, if a diffuse thinner takes propecia there is a good chance it will start reversing some of the damage done and the hairs from the thinning follicles will begin getting thicker and stronger again. You can imagine that if this happens all over the head you get a fair amount of density back. By contrast a non-diffuse thinner might only start taking propecia when their hair and crown have thinned beyond "average" and to a point where there is clear balding happening. By then a lot of the follicles that have been affected will likely already be "lost", however, and propecia won't work for them. Instead it will only work for the follicles that haven't died or the thinning follicles.

 

I hope that makes sense, and of course it's just a theory. Diffuse thinning is an interesting one because whilst pretty much the whole of the top of my head has thinned, no one area has really become bald. The crown and hairline have thinned the most but a good amount of my temples and crown remain. When I see men non-diffuse MPB often they have thick hairlines in the "centre" but no hair at the temples. By contrast I have much more defined temples but my entire hairline has thinned a bit. However I really know I'm balding where as a lot of those guys may not have noticed as much, or just believe it's a bit of recession and not full-blown MPB. Therefore I think diffuse thinners notice their baldness a bit earlier and when they start on medication there are lots of thinning follicles but relatively few "dead" ones, so they can possibly see strong results because a lot of those thinning follicles can be reversed somewhat and some good density restored.

[MikeTheDane]

Great post Mahdong, and I agree completely with your assessment. This is also how I am picturing it.

 

Maybe if some of the gurus would come to share their knowledge on the subject we could conclude something...

[Megatron]

excellent posts Mahdong. yes, I was assuming diffuse thinner meant thinning in the donor area and that's why I said they're not a good candidate for a HT for several reasons.

 

I never heard of non-diffuse MPB. I thought everyone who experienced MPB had minaturization to some extent.

[mahhong]

excellent posts Mahdong. yes, I was assuming diffuse thinner meant thinning in the donor area and that's why I said they're not a good candidate for a HT for several reasons.

 

I never heard of non-diffuse MPB. I thought everyone who experienced MPB had minaturization to some extent.

 

I think to some extent you're right. My post was a bit misleading since I was making the distinction between diffuse and non-diffuse but everybody is a diffuse thinner to some extent. I think the difference is actual DPA thinners tend to thin at the same rate over near enough their entire bald-susceptible region whereas MPB (non-diffuse) tend to thin in a more gradual, linear way, starting at the temples and crown and expanding into the middle of the head.

 

To post links to two different examples of what I mean:

 

A DPA thinner:

 

http://www.babble.com/CS/blogs/famecrawler/2007/11/23-End/brenden-fraser-hair-wig-mummy-bald.jpg

 

Non-diffuse MPB:

 

http://www.babble.com/CS/blogs/famecrawler/2008/04/16-22/jude-law-balding.jpg

 

 

You can see someone like Jude Law; it's likely where they have gone bald their hair follicles are mostly "dead" and propecia isn't likely to make them start sprouting new hairs. Brendan Fraser, on the other hand, actually has a pretty intact hairline and general covering of hair, but it's thin all over (he's not the best example as it's really thin!). My logic is if Brendan Fraser got on propecia a lot of those thinning hairs or recently "dead" follicles might start producing new or thicker, stronger hair. That overall increase in density would give him a more aesthetically noticeable improvement than Jude Law, who has a pretty thick head of hair except in his temples, where he's pretty much completely bald. Logic says to me he might get a few thicker hairs in his temple region but it's likely his cosmetic improvement would be pretty minimal.

[Bill - Seemiller]

Guys,

 

While I haven't read every post, I wanted to correct a few misunderstandings. Mahong did provide some excellent information however, some of the terminology needs to be corrected.

 

Below is an article I wrote awhile ago regarding the differences between "diffuse alopecia" and genetic baldness with a diffuse thinning pattern.

 

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Diffuse Hair Thinning has been used two ways that I have seen so it's important to define and differentiate them.

 

Diffuse Alopecia:

 

Some people who refer to Diffuse Hair Thinning are referring to Diffuse Alopecia. Diffuse Alopecia is a condition characterized by hair loss over the entire scalp including the sides and back of the head. An example of Diffuse Alopecia is Telogen Effluvium. Diffuse Unpatterned Alopecia is another variation of Diffuse Alopecia. Diffuse Alopecia is not the same as genetic hair loss. Instead it can be caused by a number of other things not related to DHT.

 

Some possible causes include:

 

1. Pregnancy or shortly after can cause temporary diffuse alopecia

2. Hormonal changes in the body (such as thyroid disorders)

3. Iron deficiency can sometimes cause diffuse alopecia

4. Scalp determatitus or other inflamation of the scalp

5. Certain medications (anticoagulants - blood thinning drugs) can cause diffuse alopecia

6. Traumatic Stress (physical or emotional) can sometimes cause diffuse alopecia

7. Severe infections such as pneumonia

 

Treating this type of hair loss depends on the actual hair loss cause. Tests should be performed by a medical doctor to first determine the cause. Tests may include a thyroid gland test to determine it is working properly, and iron levels to ensure they are normal. Certain medications or supplements may be administered to correct the condition. In many cases of diffuse alopecia, no treatment is needed for the hair loss condition in itself and in many cases, the hair regrows. Some people however may continue to experience diffuse alopecia where the scalp hair remains thin. Complete baldness however, is exceptionally rare.

 

Genetic Hair Loss with a Diffuse Pattern:

 

More commonly on our hair restoration discussion forum, many people refer to a “diffuse thinning” pattern as hereditary hair loss with diffiuse thinning on the top of the scalp only. This differs from Diffuse Alopecia that is characterized by hair loss all over the scalp. With diffuse pattern baldness in hereditary hair loss, the sides and back of the head remain unaffected. These hairs will miniaturize and become vellus hairs over a longer period of time. This type of hair loss is still genetic and can be treated with Propecia (finasteride) and/or Rogaine (minoxidil).

 

---

 

While men and women suffering from diffuse alopecia aren't typically good candidates for hair transplant surgery, those with a diffuse thinning pattern of genetic baldness can be. Propecia and Rogaine can help save existing diffuse natural hair while hair carefully transplanted around and between it can add density. Worst case scenerio, even if the remaining natural hair is lost, transplanted hair can often thicken its appearance since these thicker, terminal hairs are ultimately just replacing thinner and weaker looking ones.

 

Obviously, successfully transplanting a diffuse thinner takes consideration and proper planning with a quality hair restoration physician. However, when done right, many of these patients come out with a thicker, fuller looking head of hair.

 

Best wishes,

 

Bill Seemiller

[MikeTheDane]

Thanks Bill, that was exactly the answer I was looking for. I knew I was right!

[Cam Simmons MD ABHRS]

Good question Empty Area.

Thanks for the posts Mahhong and for the clarification Bill.

Using the word “diffuse” is confusing when describing male pattern baldness (Androgenetic Alopecia). A Norwood 6 patient has balding over the front, top, and crown but has healthy donor hair. When someone has thinning over the same areas I describe them as having a “Norwood 6 thinning” pattern. They don’t have diffuse loss; they have patterned loss over a large area. I plan with the expectation that, without medications, thinning areas will go bald and that the area could expand. That is a Norwood 6 thinning patient can go on to become a Norwood 6 or 7 patient.

A young man who has a Norwood 3 pattern can also progress through the stages without medical treatment and end up with as much hair loss in his 50s as a young man who started with a Norwood 6 thinning pattern.

Propecia and Minoxidil work best on thinning hair and don’t help bald areas. If someone has a lot of miniaturized hair in an area that is contributing to the cosmetic effect it is always best to try medical treatment before considering hair transplantation. Miniaturized hair is more prone to shock loss and end-stage miniaturized hair may not come back.

Patients are often surprised how much hair it takes to make a thin area look thicker. Cosmetic improvement depends on perception. Think of the difference you achieve when you add 20 trees to a forest vs. the change you see when you add 20 trees to an empty field.

For these reasons, I will transplant hair into an area when there is enough thinning that I can see at least as much scalp as hair in that area. Then there will be enough space between and around the existing hairs that I can add enough hair to make a visual improvement. If the only 3 people who know you are thinning are you, me, and your girlfriend it is too early for hair transplantation to be worthwhile and we could cause more harm than good.

For someone with a large area of hair loss it is better to have thinner hair over a bigger area but if the hair is spread out too much it can be like painting an entire room with 1 pint of paint i.e. see-through everywhere and not cosmetically appealing. The trick is to balance coverage and density to get the best cosmetic effect. In a second session hair can be added to increase the density in the first area, to expand the transplanted area, or both.

In summary, hair transplantation can be worthwhile for patients who have thinning over a large area as long as they have a stable supply of donor hair, we don’t start too early, and we plan for the long-term.