Hair shafts occur as small groups called follicular units. During a hair transplant, a follicular unit is removed from the donor area (usually the posterior scalp) and implanted at the recipient area (usually the front of the scalp). A follicular unit may contain one, two or three hair shafts. The number of follicular units transplanted in a procedure depends upon the donor and recipient areas. Male pattern baldness usually requires the transfer of a large number of grafts. This is in contrast to the small numbers required for hair loss associated with small scars.
As mentioned previously, the posterior (back) part of the scalp is usually used as a donor area for hair transplants. Less preferred donor areas include beard and body hair. In certain individuals, the posterior scalp hair may be inadequate as a source for donor grafts. This can be due to the progress of MPB. This is observed as reduced density (hair follicles per square cm) and thinning (miniaturization) of hair follicles. It can also be as a result of a previous harvest of hair follicles during a hair transplant. An individual with a poor donor area also tends to have an advanced stage of MPB.
In spite of these challenges, it is possible to improve upon the appearance of those with a poor donor area. In such a situation we try to achieve improvement with the help of fewer grafts. Frontal forelock occupies the portion behind the central part of the forehead. Many individuals with advanced male pattern baldness tend to retain hair in this region. A relatively full forelock does not give an unnatural look in an individual with advanced hair loss. The forelock helps frame the face when an individual is observed from the front. It would be the part of the scalp that would be visible as a person steps out of an elevator. Increasing the density in the forelock region would require lesser grafts when compared to the rest of the scalp.
In patients without donor deficiency, other areas that are addressed include the hairline and mid-scalp. These occupy the area adjoining the forelock. The crown is given lesser importance when compared to the previously mentioned areas because of the lesser aesthetic significance and the requirement of a large number of grafts.
Salvaging the remaining hair follicles is also important in a person with MPB. MPB is usually a progressive condition and left untreated many can progress to more advanced stages of baldness. This is especially true in the case of younger individuals in whom the hair loss has not stabilized. Preservation of remaining hair follicles is achieved by means of medications. These medications include nutritional therapy, topical Minoxidil, and Finasteride. It is important for individuals to make an informed decision about the use of these medications. They should be taken for long periods for adequate results.
Male pattern baldness with poor donor areas offers some challenges for hair restoration. But often it is possible to improve upon the appearance with the help of medications and a limited hair transplant.
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