Q: At what level of thinning should the hair transplant be done?

A: A hair transplant should be considered in an area of thinning when:

• The area has not responded to medical therapy (finasteride 1mg a day orally and minoxidil 5% topically for one year).
• The thinning is significant enough that it can’t be disguised with simple grooming (i.e. is a cosmetic problem even when the hair is combed well).

Other factors that are important include:

• the age of the patient
• the donor supply
• whether the thinning is in the front of the scalp or in the crown

Q: Could you accept easing of the very strict definition of FUT, which you published about 15 years ago? Could you agree to use mixture of single FU and double FU under the name of FUT?

A: One would never want grafts larger than the largest original follicular units or the results will not look natural. The artificially large grafts will stand out in relatively thin surroundings. If one were to try to fix this by transplanting the doubled FUs very close together (over one or more sessions) one risks running out of grafts for other areas of the scalp. In other words, you can’t fool mother nature.

Q: Can the crown be transplanted first instead of frontal area? Why is the crown the last choice? Any reasons behind it?

A: The crown can be transplanted first in patients who have very good donor reserves (i.e., high density and good scalp laxity). Otherwise, after a hair restoration procedure to the crown you may not be left with enough hair to complete the front and top if those areas were to bald.

Cosmetically, the front and top are much more important to restore than the back. A careful examination by a trained hair restoration surgeon can tell how much donor hair there is available for a hair transplant.

Q: Have there been any studies showing the difference between men and women in their response to laser treatments for hair loss?

A: In the International Journal of Cosmetic Surgery and Aesthetic Dermatology (Vol. 5, Number 2; 2003), a study on low level laser therapy (LLLT) was conducted which indicated that there was a 55% increase of growth (hair count) in the temporal area as well as 64% in the vertex of the female subjects who were treated with LLLT for hair loss. The study also indicated a 74% increase in the hair counts of the male subjects in the temporal area and 120% in the vertex region. These results would initially indicate that LLLT works better in men than in women, but there were four times as many men in this study so the results might be different in a larger test group.

Q: I am having hair thinning and retreating from the front part of the scalp. According to Norwood’s classification I rank a category III. From what I see on the Rogaine pack it is used in hereditary hair loss on the (vertex) on top of the scalp. Any recommendations? A: Minoxidil does work on the [...]