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Hair transplantation surgery can be performed in any person with androgenetic alopecia (male pattern hair loss) with;

a good donor area,

a good general health status,

reasonable expectations.

Male Pattern Hair Loss (MPHL) is defined as; hair loss at the front, top and/or the crown/vertex of the scalp. The back and sides of the scalp are spared and usually grow hair for life (permanent area or ‘safe’ donor zone). The cause of MPHL is the presence of hormone receptors in the hair roots. No such receptors exist in the permanent area ( the back and sides of the scalp). These receptors attract the male hormone dihydrotestosterone (DHT) which the hair loss process. The number and location of these susceptible hairs is determined by inherited genetics from both or either parents.

The elements that a doctor assesses to determine whether a candidate is a good subject for surgical hair restoration include:

the patient’s general state of health;

the hair’s texture,fine or coarse;

the contrast between the patient’s hair color and skin color;

the density, i.e., the number of hair follicles per square cm of the hair in the donor area;

the size of the area to be covered and of donor area;

whether or not previous grafting procedures have been done;

the patient’s goals and expectations.

Making an accurate diagnosis and making treatment recommendations require an examination by a doctor and a frank discussion of possibilities between the patient and the doctor.

The doctor should also give the patient a realistic estimate of the total cost of the planned procedure or procedures.

The patient must understand that transplantation redistributes existing hair follicles and cannot create new hair follicles.

With the appropriate technique and hair type (caliber, form, color ) , all patients will have natural appearing transplanted hair. Avoiding ''pluggy'' apperance in the frontal hair line is utmost importance.

The key to success is to establish realistic expectations regarding the perceived density from a hair transplant. Normal human scalp contains 60 – 100 hair shafts in cm square. Human scalp containing 40 – 60 hair shafts in cm square, no evident hair loss is detected by naked eye.

Between 25 – 40 hair shaft in cm square, hair loss may be evident to the naked eye, depending on hair thickness, form and color.

Literally, transplanting 25 -40 hair in cm square, will produce an acceptable result; 40 -60 hair in cm square will produce near normal hair density in most of the patients. The numbers and percentages given here is intended to give a clue about the result that should be expected. There are many other factors influencin the result and patient satisfaction post operatively.

Male pattern hair loss is a progressive process which may last up to 45 years of age. It is important to review the ongoing nature of hair loss and the natural recession of temporal and posterior hairlines in the vertex. Transplanted hair must appear natural one year – and twenty years –after the procedure.

Given the progressive nature of hair loss, the surgeon must consider if the supply of donor hair will accommodate the future demands of hair loss in that individual. Before even attempting the first hair-transplant session, the surgeon must envision the feasibility to “finish the painting”, i.e., to paint an ever enlarging canvas (continually balding scalp) with ever diminishing paint supply (dwindling and depleting usable donor hair). The surgeon must be mindful of whether the patient will retain sufficient donor hair to cover the exposed scalp with ongoing loss as the patient ages so as to avoid the appearance of an unnatural hair pattern that does not exist in nature.

The net density from a procedure is equal to the total number of hair follicles transplanted minus the ongoing loss of existing hair. It will be more difficult to create the perception of a net increase for patients with rapidly ongoing hair loss than for patients whose hair loss has slowed, either naturally or from medications.

The patient’s chief cosmetic concern should be delineated, frontal scalp, the vertex, or both. Also defining the location of frontal hair line is very important, patients shouldn't seek the adolescent level, rather more suitable hair line for the present age and future. The frontal two-thirds of the scalp is a long-term, cosmetically ‘‘safe’’ region for transplant. The vertex of the scalp has more long-term cosmetic risk for male patients.

How many operations shall be needed to achieve the goal of the patient should also be discussed. The number of surgeries needed will reflect the rate and extent of future hair loss. The majority of patients can achieve their cosmetic goals with two procedures.

Alternatives to surgery

Not everyone is suitable for a hair transplant procedure or wishes to undergo surgery.

There are topical and oral medications approved for hair loss which can be discussed with your GP or hair loss specialist. They require life-long treatment to maintain their effect.

Camouflage products (colored creams, sprays, and powders) , when applied to the thinning hair, help to camouflage thinning areas, as long as there is still some hair present in the area. They do not treat the hair loss process.

Low level laser might be of benefit in increasing hair growth and hair calibre.

General health and environmental factors can also influence hair growth.

Shampoos and conditioners may improve the quality and health of the hair but will not increase the number of hairs.

Micropigmentation tattooing has been utilised to produce the appearance of hairs either as stubble or strands.

Hair replacement systems, hair pieces and wigs can give the illusion of a full head of hair. Hair pieces are a non-surgical means to restore hair by covering bald areas of the scalp. There is a large variety of means for attaching these. The most common are glue adhesives, “weave” attachment, and clips.