A 31-year-old man thinks that he lost the hair in his crown area. He wants to know if it can be restored with a hair transplant.

Dr. Amiya Prasad, a hair restoration specialist, explains that male pattern hair loss affects the whole scalp but it is often expressed variably. Sometimes it is frontal recession or temporal peaks then of course, the crown area thinning out. However, when someone looks closely, they notice that they didn’t really lose a lot of hair. The problem is that the hair has been progressively thinning. In every growth cycle, as the hair sheds, the hair comes back thinner.

The challenge is the area that needs to be covered. There’s only a limited amount of hair available from the donor area. The donor area is the band of hair that is genetically resistant to hair loss and this is where the hair transplants are harvested from. With the popularity of follicular unit extractions (FUEs), hair is harvested from outside of that donor area, meaning those hairs are at risk of being lost. Reality is, there’s a mismatch as someone needs thousands of grafts in order to be able to fill the crown area, but the average hair transplant is no more than about 2000 grafts.

Some hair transplant doctors generally don’t talk about collateral loss. To take the hairs that are to be transplanted, the surgeon has to make multiple incisions or stabs. Whether they use a tiny needle or blade, they’re by design traumatizing existing hair that can cause them to shed out and disappear. To achieve density, one needs more than one transplant.

To deal with hair loss progression, Dr. Prasad suggests that he first explore medical options. The medical options for hair loss treatment include minoxidil which is topically applied. Minoxidil doesn’t really stop hair thinning progression; it stops the shedding of hair or prolongs the growth cycle of thinning hair so it looks like someone has more hair than they have. The other drug is finasteride which is well known because it has been a significant treatment for hair loss since the late 90s. Finasteride inhibits the enzyme responsible for the conversion of testosterone to dihydrotestosterone or DHT. Certain people with male pattern hair loss have DHT-sensitive hair follicles. If they reduce the DHT, they can get reversal of that thinning process and the hairs can come back thicker. Unfortunately, some men are not taking finasteride because of the risk of long-term sexual side effects.

In Dr. Prasad’s practice, he has developed an alternative called Hair Regeneration. Hair Regeneration is a method of using a material called extracellular matrix (ECM)combined with platelet-rich plasma (PRP). Platelet-rich plasma is derived from the patient’s own blood. He has developed a formulation and a method of delivery that is customized to every patient. Through the use of ECM which is an advanced stem cell-based wound healing material, he has been able to successfully reverse hair thinning and it has been extremely effective in the crown area. When people have existing thinning hair, he gets really excited because he doesn’t talk about transplants, but about medical therapy and Hair Regeneration. With this treatment, he has 3-5 years of data and has been able to help close to 100% of male pattern hair loss patients who come from all over the world.

Dr. Prasad would advise against transplantation in the crown area. He is advocating very aggressively that people come when they still have existing hair. There is certainly a lot of proven benefit from the hundreds to thousands of patients that he has treated from all over the world. The earlier he gets somebody when they are thinning, the more volume they are able to get back. This treatment has been stable and doesn’t require re-injection at least for the 3-years in the majority of patients. Dr. Prasad has been doing some secondary injections to try to enhance people with more advanced hair loss. It has become such a great option that it even exceeds the results of any hair transplant.

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