With the decrease in age at which people now experience hair thinning or hair loss or baldness, we now see a lot more young people in grade 6 or 7 of androgenetic alopecia.
Hair loss now starts as early as 16 years of age, progresses rapidly and is also becoming resistant to minoxidil, finasteride and other therapies such as prp/gfc
This is the reason why more and more people are now coming to us in grade 6 or 7 asking for hair transplant.
So let us now understand the maths.
A full head of hair has roughly 40000 grafts or 1 lac hair. When one looses the entire top area hair ie as in grade 7, we can assume that he has lost 20000 grafts or follicular units.
We know that in order for thinning to be visible in an area, 50% of the hair has to be lost. ie thinning is not visible until we loose 50% of hair in an area. Hence in order to cover a bald area so that thinning is not visible, we don’t need to replace 100% of original hair no. Replacing 50% of hair is enough. Hence in an area where there were 20000 follicular units previously, like in grade 7, we need to put in 10000 grafts.
Now the questions is:
From where will these 10000 grafts come ie what is the donor area
Can it be done in one session
Is this hair going to be permanent.
Do all grade 7 baldness candidates need 10000 grafts?
So how do we proceed?
To answer Q1, we need to examine the donor area through trichoscopy. This is an extremely crucial step without which a hair transplant in Delhi simply cannot be planned. If the person has a dense scalp donor area, he would be able to give 5000 to 6000 grafts over multiple sessions. If he has a good beard, another 4000 can be taken from the lower part of the jawline. So this completes 10,000 grafts. If, however, his donor areas are weak, then we can look for alternate donor areas like chest or body hair. If we still feel that the donor is not sufficient, then we can perform a hair transplant in Delhi for some part of his hair loss area, for example, the front half. Alternatively, we can start minoxidil and finasteride for the patient and wait for 6 months for his donor area to improve in density and then attempt a hair transplant.
10000 grafts can definitely not be done in a single sitting unless we are using multiple donor areas, in such cases we can do 10000 grafts over 4 to 5 consecutive days. If however we plan to use only scalp and beard donor, the best way is to split the procedure over 2 to 3 sittings, each 2 months apart.
Transplanted hair can thin out over time. Hence we need to protect it by using minoxidil and finasteride and improving our diet and lifestyle. In grade 7, where we have already used majority donor area and aren’t left with much for future hair transplant, using these medications becomes all the more important. Despite using medication, let us remember that transplanted hair can still thin out over time.
A lot of grade 7 hairloss patients come in with extreme hair thinning, but its not lost all together. In such cases, putting in a lower no like 6000 or 7000 could also be sufficient assuming that the medications will make existing hair thicker. Add to that the transplanted hair and we will have full coverage. Therefore tricoscopic analysis of the bald area is also important to understand how much capacity is there in the existing hair to become thicker, as that will decide how much we need to transplant.
SO to sum it up, covering grade 7 baldness with hair transplant is possible if we carefully assess the donor area, predict future hair loss and plan our surgery meticulously, along with counselling patient about future haircare.
