Posts Tagged: Norwood Hair Loss Classification

Which Gives More Donor Hair in Hair Transplant, Follicular Unit Transplantation or Follicular Unit Extraction?

May 11th, 2006

Q: I am Norwood Class 6 and have read about both Follicular Unit Extraction (FUE) and Follicular Unit Transplantation (FUT). Which will give me more hair?

A: In general, FUT will give you more hair since, in FUT, the best hair from the mid-portion of the permanent zone of the scalp (also called the “sweet spot”) can be utilized in the hair transplant.

With FUE, since only the hair follicles are extracted and not the surrounding bald skin, if too much hair is removed, the donor area will begin to look thin as hair is removed. This will limit the amount of hair that can be harvested.

Although in FUE additional areas of the scalp can be utilized to some degree, this will generally not compensate for the inability to access all of the hair in the mid-permanent zone and the total amount available for the hair restoration will be less.

Topic: FUE & FUT

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Posted by Robert M. Bernstein M.D. at 9:07 am

Before Hair Transplant, How Long Should One Use Propecia Hair Loss Medication?

April 14th, 2006

Q: I am 28 years old and was told that I have early Norwood Class 3 hair loss. I want to have a hair transplant but my doctor told me to use Propecia for 6 months and then come back to discuss surgery. I don’t want to wait that long, what should I do?

A: Actually, you should wait a full year.

If you are an Early Norwood Class 3, the Propecia can work so well (in actually growing hair back) that you may not even need a hair transplant.

The important point is that Propecia only starts working at 3-6 months and during this time there may actually be some shedding as the new growing hair literally pushes out the old.

A hair transplant performed at 6 months may not only be unnecessary, but growth from the medication may be attributed to the hair restoration surgery. I suggest to wait and see what the medication can do before going for hair restoration surgery.

Topic: Drugs & Medications

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Posted by Robert M. Bernstein M.D. at 1:10 pm

Hair Transplant Starting with Crown?

October 5th, 2005

Q: What are your thoughts on performing a hair transplant to the crown first?

A: It depends upon the person’s age, how bald he is likely to become, and the donor supply.

As a general rule, the crown should not be transplanted in a younger person (under 30) as the extent of his balding is hard to predict and crown thinning at this age often suggests that the person will become at least a Norwood 6.

If a person has enough donor hair (i.e. good donor density) and scalp laxity, so that coverage of the entire bald area can be accomplished if the patient becomes a Norwood class 6 (and it is unlikely that he will become a Class 7), then transplanting the crown before the front is reasonable.

If a person has a family history of baldness limited to the crown, even at an advanced age, and the person in question is following this pattern, then earlier treatment of the crown may be considered.

Lastly, if you do treat the crown in a younger person, or one with whom the extent of hair loss is uncertain, the crown should be transplanted with light coverage only. That way a limited amount of hair will be used up in this area and there will be enough left over for the more cosmetically significant top and front of the scalp.

For a complete review of this topic please read: Follicular Transplantation: Patient Evaluation and Surgical Planning. Dermatol Surg 1997; 23: 771-84. A copy in PDF format, and other hair transplant publications, can be downloaded at the Bernstein Medical – Center for Hair Restoration Medical Publications page.

Topic: Crown (Vertex)

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Posted by Robert M. Bernstein M.D. at 1:43 pm

Does Propecia Hair Loss Medication Reverse Early Hair Loss or Thinning in Frontal Scalp?

September 27th, 2005

Q: I have early frontal thinning and was told that I am a Norwood Class 4A. I have been taking Propecia for several years. I recently went to see a doctor who told me go off Propecia and consider a hair transplant, since there is “no scientific evidence that Propecia works in the front of the scalp.” What should I do?

A: We have seen many patients who have had early thinning in the frontal scalp and who have re-grown hair (as evidenced by visual thickening) using Propecia. The indication for Propecia does include treatment of frontal hair loss. There are published data by Leyden et. al. in the JAAD in 1999 demonstrating improvement in a controlled clinical trial of men with frontal hair loss.

The fact that DHT causes frontal hair loss and that Propecia blocks DHT gives a logical explanation for these effects. Of course, if there is no hair in the area at all, the medication is not going to work.

Topic: Drugs & Medications

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Posted by Robert M. Bernstein M.D. at 1:04 pm

What is Recommended Treatment of Early Hair Loss?

July 1st, 2005

Q: I am 27 years old and have a Class 3 degree of hair loss. Should I should do a hair transplant or consider non-surgical methods of hair restoration?

A: At age 27 with early hair loss, you should consider non-surgical options first.

Propecia is the most important medication, but you need to be on it for one year at the full dose of 1mg a day to assess its benefits.

If you have done this and other parameters are OK for a hair transplant, such as adequate donor hair density and scalp laxity and you have little evidence that you will become extensively bald (i.e. no donor miniaturization and no family history of extensive baldness), then hair transplantation can be considered.

Topic: Age

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Posted by Robert M. Bernstein M.D. at 12:17 pm



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