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Diffuse Unpatterned Alopecia (DUPA)
What Is DUPA?

Diffuse Unpatterned Alopecia (DUPA) is a form of genetic hair loss characterized by diffuse thinning over the entire scalp. Unlike Diffuse Patterned Alopecia (DPA), DUPA lacks the stable permanent zone associated with other forms of alopecia.

Dr. O'tar Norwood defined DUPA in his 1975 seminole publication "Male Pattern Baldness: Classification and Incidence" as:

Diffuse, Unpatterened Alopecia (DUPA). In this type, there is a general decrease in the density of hair without any definite pattern, although it is usually more marked over the top and front. This type is common in women.

Identifying DUPA

Diffuse Unpatterned Alopecia patients have a similar pattern of hair loss to DPA patients but the balding tends to occur more rapidly. DUPA patients are also more likely to achieve the “horseshoe” pattern commonly associated with Norwood class VII baldness. However, unlike other forms of alopecia hair loss, the DUPA “horseshoe” takes on a thin and transparent appearance.

It is important that patients suffering from diffuse hair loss are properly diagnosed. While DPA patients are often good candidates for surgical hair restoration, DUPA patients typically make poor hair transplant patients due to the lack of a stable zone in which to harvest donor grafts.

Treatment for Diffuse Unpatterned Alopecia

Not a lot is known about the cause and treatment of DUPA. However, about half of males who suffer from this form of balding benefit from Propecia (finasteride). Unfortunately, DUPA is about 10 times more common in females for whom Propecia is not a treatment option.

Conclusion

Anyone suffering from diffuse hair loss should consult with a dermatologist or hair restoration physician for a proper diagnosis. This is especially true for balding men and women considering hair transplant surgery.
- Read more about Diffuse Unpatterned Alopecia (DUPA)
Follicular Unit Hair Transplantation - Step by Step
We believe that patients have a right to full disclosure and a complete understanding of exactly what hair restoration surgery involves.

This step by step presentation shows how today’s state of the art follicular unit hair transplant procedure is typically performed.

Patient is prepared for surgery

During surgery hair follicles from the back of the head that are genetically resistant to going bald will be removed and relocated (transplanted) to the balding areas.

Donor area is trimmed

Prior to surgery, the hair in donor area that will be surgically removed is trimmed.

Donor area is prepared for surgery

Once the donor area has been prepared it is given local anesthesia.

Donor tissue is removed

The donor tissue containing the bald resistant hair follicles is then surgically removed.

Donor area is sutured

The donor tissue containing the bald resistant hair follicles is then surgically removed.

Hair combed over sutures

When patient’s hair is combed over the donor area the sutures are not visible. These sutures are typically removed approximately ten days after surgery.

Donor tissue is trimmed into follicular unit grafts

Surgical technicians then use microscopes to view the donor tissue in order to dissect and prepare follicular units hair grafts.

Bald recipient area is prepared

After being given local anesthesia, the balding recipient area is ready for surgery. No trimming or shaving of hair is needed in the top recipient area.

Incisions are made in the balding areas

Tiny incisions are made in the recipient areas in irregular patterns that mimic nature. The follicular unit grafts will then be placed carefully into these tiny incisions.

Grafts are placed into the incisions

Follicular unit grafts are gently placed into the recipient incisions.

Grafts are placed in varying densities

Typically the smallest one and two hair grafts are placed in the very front of the hairline, with three and four hair grafts placed behind them.

Patient immediately following surgery

Following surgery a patient will have hundreds of tiny incisions with short hair stubble showing from the new grafts.

Close up of recipient area after surgery

The tiny graft incisions heal rapidly. The redness and scabbing in the recipient area normally clears up within about one week.
- Read more about Follicular Unit Hair Transplantation - Step by Step
Dr. Christian Bisanga

Dr. Christian Bisanga

Dr. Christian Bisanga performs world class FUT and FUE hair transplants with excellent results exclusively at his clinic Brussels, Belgium
FUE – a new way of doing Follicular Unit Hair Transplantation
Follicular unit extraction is a minimally invasive procedure for performing follicular unit hair transplantation. However, unlike the predominant follicular unit transplant procedure, in which a strip of donor tissue is removed and dissected under magnification, the FUE procedure uses a small punch to extract each follicular unit one by one.

Both the strip excision and FUE procedures create 1, 2, 3, and 4 hair follicular unit grafts that are then transplanted into the balding area in the same manner. The primary difference between these two procedures is the technique used to harvest the follicular unit grafts.

Comparing the Strip Excision procedure to the Extraction (FUE) procedure

The common strip excision method of performing follicular unit hair transplantation involves surgically excising a thin horizontal strip of bald resistant skin from the donor area.

Strip Excision Procedure

Donor strip being excised

Incision sutured together

Hair combed down after suturing

This donor area is then sutured together. These sutures (either stitches or staples) are then typically removed about ten days after surgery. Some physicians use dissolvable sutures so that no removal is needed.

Patient’s donor area 2 months after surgery

Once this linear incision is fully healed the patient is left with a thin horizontal scar in the back of the head. This scar is typically hard to detect since the surrounding hair conceals it, even when the hair is cut short.

To view a video of an actual strip excision surgery.

How the FUE Procedure is performed

With the Follicular Unit Extraction or FUE procedure 1, 2, 3, and 4 hair follicular unit grafts are carefully extracted one at a time using a tiny punch of one millimeter or less. Often the surgeon requires the patient to buzz cut a portion of their donor area so that they are able to see the patient’s scalp.

The follicular units are extracted

The follicular units are extracted by placing the punch around a single follicular unit and cutting a small circle through the skin around that follicular unit. The follicular unit is then gently pulled up and away from the loose tissue underneath the skin.

The small hole left behind after the follicle is extracted then heals over the following week. Normally this small round incision contracts as it heals making the resulting round scar smaller than the size of the 1mm punch that made the incision. The FUE patient ultimately ends up with hundreds of small round white scars, which are normally not detectable once the patient’s hair grows out.View a video of an actual FUE surgery.

To Extract or to Excise, that is the question.

Advocates for the relatively new FUE procedure claim that this procedure produces less noticeable scarring and no tightness or numbness in the donor area since no donor tissue has been pulled together and sutured. Many patients and physicians find the claim that FUE produces less visible scarring to be debatable.

Some physicians and patients also have concerns about the relatively new FUE procedure, such as the lack of formal studies regarding the percentage of follicles that may or may not be transected during the sight unseen extraction process.

In addition, since the physician must personally extract all follicles, one by one, the FUE procedure is very physician dependent and thus very expensive. The FUE procedure also requires considerably more time in surgery to move a given amount of hair to the balding area.

The standard strip excision procedure has the advantage of utilizing a collaborative team to carefully create the grafts once the donor tissue is removed in a strip. This collaborative approach enables a well trained staff to do sessions of 2,000 to 3,000 all follicular unit grafts in a single day. This team approach enables a patient to get a much larger number of grafts/hairs in one sitting at a much lower cost per hair than with the FUE procedure.

However, some believe that despite being relatively costly the FUE procedure may be appropriate for patients who have very limited elasticity in their donor area or who only need a small number of grafts.
- Read more about FUE – a new way of doing Follicular Unit Hair Transplantation
Concealers - Disguising Hair Loss Remedy for Adding Fullness
There are a variety of hair loss remedy "concealer" products that are applied to the scalp and/or hair in the thinning areas to mask a person's baldness and increase the look of fullness of thinning hairs. These products such as Toppik, Couvré, and Prothik can work surprisingly well at creating the illusion of fuller hair.

Some of our member physicians advise their hair restoration patients to use such hair loss remedy products to enhance the look of fullness in their transplanted areas. These products can also be used post operatively to hide the immediate surgery.

Toppik - Toppik is an effective, safe, and easy-to-use product that completely covers up the scalp's thinning areas.

Couvre - COUVRe is safe for men and women, easy to use, and is totally undetectable to the world's toughest critics.

Caboki - Caboki is comprised of a series of charged microfibers that, when applied to the scalp, tightly bind hair shafts and create a denser, fuller appearance.

DermMatch - DermMatch is a safe and easy way to cover-up thinning areas and instantly provides the appearance of a natural looking head of hair.

Nanogen - Nanogen is one of the fastest, easiest ways to conceal thinning hair and hair loss.

Prothik - Prothik does an exceptional job of adding thickness and fullness to thinning hair while reducing the contrast between thinning hair and the scalp.
- Read more about Concealers - Disguising Hair Loss Remedy for Adding Fullness
Menopause and Female Hair Loss
Many cases of female hair lossare caused by hormonal fluctuations or changes in the body including those who have PCOS (polycystic ovarian syndrome), birth control pillside effects, a recent pregnancy,postmenopausal trauma, or menopause. Women with hair loss experience varying balding patterns These patterns can help determine the type of alopecia you have along with a thorough examination by a physician.

Because of an imbalance between estrogen and testosterone due to declining estrogen levels, thinning hair and accelerated hair loss is common in women during menopause. Hair on certain areas of the head that is more sensitive to androgen hormones like DHT(associated with male pattern baldness) may thin or fall out. Similarly, declining estrogen levels may result in unwanted facial hair growth.

In some cases, polycystic ovarian syndrome(PCOS), may accompany menopause and hair loss.

Be sure to speak with your doctor on the most effective ways to cope with menopause and minimize hair loss during this transitional time.
- Read more about Menopause and Female Hair Loss
Spectral.DNC by DS Laboratories: A Breakthrough Hair Loss Treatment?
As the field of medical hair restoration continues advancing and evolving, hair loss sufferers look toward new, cutting edge clinics and corporations for faster, more effective, and less invasive hair loss treatments. In various but not all cases, the breakthroughs achieved through oral medications and topical solutions (seen in proven hair loss treatments like Rogaine (minoxidil) and Propecia (finasteride) are fantastic. Thus, hair restoration entities continue striving to create the next advancement and bring the world closer to a “hair loss cure.” However, for each hair restoration treatment that’s proven safe, effective, and efficient, it seems as if a dozen others are rejected for being unproven, inefficient, or unsafe.

For this reason, it’s always advantageous to thoroughly research the newest hair loss solutions and determine whether they are safe and effective, or if they fail to live up to the high expectations set by the current gold standard treatments such as proven solutions Propecia and Rogaine. Below, we evaluate whether Spectral.DNC, a topical solution created by Divine Skin Laboratories (DS Laboratories) can help stop hair loss and regrow hair.

Spectral.DNC is a topical treatment formulated by DS Laboratories which claims its “the world’s most effective topical hair loss treatment.” But can Spectral.DNC live up to these lofty claims and offer a more effective solution, or will it suffer the fate of many therapies before it and fail to gain the approval of the hair restoration patient community?

According to DS Laboratories, Spectral.DNC is applied (as an atomized mist or liquid) to the balding scalp twice daily, once in the morning and once at night. Along with a series of vitamins and herbal supplements (herbal extracts, copper peptides, and a vitamin complex), the active ingredients in Spectral. DNC are 5% minoxidil, Aminexil (SP94), and Retinol. Since minoxidil is also the proven, active ingredient in topical Rogaine, Divine Skin utilizes a frequently asked questions feature on its website to explain how Spectral.DNC is different and more effective than minoxidil. According to Divine Skin, it’s the two other active ingredients – Aminexil and Retinol that make Spectral.DNC more effective than Rogaine.

Aminexil (or Aminexil SP94) is a compound currently featured as an active ingredient in a line of healthy hair shampoos by L’Oreal. Aminexil is allegedly helpful in the treatment of perifollicular fibrosis – a pre-mature aging of hair shafts caused by inflammation and an overproduction of collagen proteins. It’s worth noting that while some reputable sources have researched its connection to perifollicular fibrosis, it hasn’t been conclusively linked to hair loss (especially androgenic alopecia hair loss), nor is Aminexil proven to treat perifollicular fibrosis. Furthermore, Aminexil is not recognized or approved by the United States Food and Drug Administration (FDA) as a treatment for any type of hair loss.

DS Laboratories indirectly counters these statements by sharing the results of a “worldwide” study which demonstrated an 8% increase in hair growth and a 6% increase in hair shaft diameter in hair loss sufferers using Aminexil (compared to a placebo group). This study however, is not without its limitations. This study was conducted in 1994, only contained 130 participants, lasted for 42 days, and doesn’t appear to be published in any sort of peer reviewed publication. Because of this, it’s difficult to evaluate whether or not the addition of Aminexil as an improvement over simple 5% minoxidil. But what about the Retinol?

Retinol (and its derivatives) is a form of Vitamin A, often used in medical dermatology for maintaining healthy skin and treating specific types of acne. Allegedly, certain forms of Retinol act as hair restoration drugs (after periods of long term usage) by preventing hair loss hormones from binding to target receptors and killing healthy hair follicles. While evidence of these claims was difficult to find, many Retinol users claim that the drug is harsh on skin and utilizing it in the scalp would cause irritation and require small, likely ineffective dosages. Much like Aminexil, there’s no solid evidence to suggest that Retinol makes Spectral.DNC a more effective hair loss solution than Rogaine or other minoxidil related products. Interestingly enough, while copper peptidesare listed as in inactive ingredient, research supports that copper peptides may play a role in transforming thin vellus hairs into thicker terminal hairs, increasing follicular size, and regenerating healthy scalp skin. However, because copper peptides aren’t listed as an official “active ingredient” by DS Laboratories nor do we know its concentration, it’s difficult to gauge its efficacy within Spectral.DNC.

The only proven and FDA approved ingredient in Spectral.DNC is 5% minoxidil. While minoxidil is safe and efficient, it’s unclear what the additional ingredients in Spectral.DNC may actually accomplish. Furthermore, the cost of Spectral.DNC runs between $35.00 and $45.00 for a month supply, compared to around $ 25.00 for a three month supply of generic 5% minoxidil. According to DS Laboratories, the only known side effects revolve around minoxidil (which are no different than those associated with Rogaine). Although minoxidil is relatively safe and effective, it’s been used as a hair loss treatment for decades.

Those hair loss sufferers considering using Spectral.DNC as a treatment for thinning hair can feel confident knowing that they will, at the very least, obtain similar results to using minoxidil 5%. Until the other active ingredients are peer reviewed, whether or not Spectral.DNC is more effective than Rogaine 5% is mostly conjecture.
- Read more about Spectral.DNC by DS Laboratories: A Breakthrough Hair Loss Treatment?
Setting the Highest Standards in Hair Restoration
Why the Coalition?

With hair loss treatments often being marketed without regulation or accountability, hair loss sufferers need credible information about legitimate treatments and the ethical physicians who provide them.

The Coalition of Independent Hair Restoration Physicians is a carefully selected group of skilled and ethical physicians who are united in providing patients with outstanding education and results.

Physician Accountability

Membership in the Coalition requires members to maintain a high degree of patient satisfaction. Members care for their patients knowing that their patients are free to post their experiences on the popular Hair Restoration Discussion Forum. On this open forum patients are free to critique physicians and to hold them accountable for their actions. This forum is run and moderated by hair restoration patients.

In such a transparent environment our members are held publicly accountable for their actions and results. Members who fail to meet the high technical and ethical membership standards set by the Coalition are removed from the group.

However, we ask that patients first give their physician the opportunity to satisfy their concerns privately before posting any public criticisms on the discussion forum.

If the issue is not resolved to the patient’s satisfaction they are encouraged to contact the Coalition by email to service at hairtransplantnetwork dot com

Member clinics also agree to open their clinics up to inspection. Many of these inspections have been reported on the Hair Restoration Discussion Forum. View some of these clinic visits.

Membership Standards

The skill, technique and talent of hair restoration physicians vary widely, as do the end results. Only a minority of leading physicians provide truly state of the art hair restoration.

Coalition members are carefully reviewed and granted membership based strictly on their high level of integrity, skill, experience and ability to perform ultra refined follicular unit transplantation.

All Coalition members have made the investment in time and resources to perform a highly refined and difficult to perform state of the art procedure called “Ultra Refined Follicular Unit Hair Transplantation”.

While many surgeons now perform standard follicular unit grafting, only a minority have risen to the challenge of using very tiny incisions and grafts to achieve ultra refined results. This ultra refined procedure, while very demanding on the physician and staff, produces excellent results for the patient with optimal density and rapid healing. It also allows the patient to achieve their goal for fullness and density with a minimal number of surgical sessions.

To learn more about Ultra Refined Follicular Unit Hair Transplantation

Membership Criteria

A physician must meet the following requirements before being granted membership in the Coalition of Independent Hair Restoration Physicians:
- A demonstrated capability to successfully perform large sessions of ultra refined follicular unit grafting using tiny incisions and grafts that are microscopically prepared.
- The ability to dense pack tiny follicular unit grafts in a given area when appropriate.
- Mastery and control of the orientation and direction of the transplanted grafts to achieve a completely natural appearance.
- Dedication to doing state of the art hair restoration exclusively or at least as the main specialty of the clinic.
- Excellent patient results demonstrating a high level of artistry and naturalness throughout, as well as excellent growth rates.
- An excellent reputation of the physician amongst colleagues and former patients.
- Several years experience in performing hair restoration surgery.
- Medical training, depth of background, board certifications, honors, credentials, lectures, and published articles and books.
Note - All members contribute dues to support our joint educational resources and services.

We are open to reviewing experienced surgeons for possible membership. Apply for membership as a physician.

Membership Selection Process

Physicians with a proven track record of providing excellent ultra refined follicular unit hair transplantation and who meet the Coalition’s membership criteria will be considered for membership.

In addition to reviewing the applicant physician’s credentials, technique and results, input from patients and current members of the Coalition will be considered prior to membership being granted.
- Read more about Setting the Highest Standards in Hair Restoration
Hair transplants - Are they right for you?
Most hair loss sufferers can benefit from hair transplants. However, some are better candidates than others and will achieve more dramatic results.

Different Patients Achieve Different End Results

Two Hair Transplant Sessions one totaling 1860 grafts the other 2995 grafts

It is important to have realistic expectations and to find a hair transplant surgeon who can meet or exceed your expectations.

Surgical hair restoration is largely a matter of "Supply and Demand".

The look you can and will achieve with hair transplants is determined by several factors. But the most critical factor is really a question of "supply and demand".

The supply of hair is how much viable bald resistant donor hair you have. The demand is how much bald area you want to cover and to what degree of thickness.

Your “Donor Hair” determines what you can achieve.

For virtually all hair loss sufferers, even those with severe baldness, there is typically hair that grows for life on the sides and back of the head. This is because the hair in this "donor area" is genetically different from the hair on the top of the head in people who go bald.

The hair follicles in the "donor area" are genetically resistant to the effects of such baldness causing hormones as (DHT) dihydrotestosterone. That's why they continue to grow, while the hair on the top (in the male pattern baldness area) thins and goes bald over time.

How much viable donor hair you have will largely determine how much you can accomplish with hair transplants. Most people have enough viable donor hair to do at least one or two hair transplant procedures.
- Read more about Hair transplants - Are they right for you?
Non Surgical Hair Replacement Systems
Hair Replacement systems, also known as hairpieces, hair replacements, hair systems or toupees, have improved over the past decade. Quality hair replacement systems are now refined in construction and light weight. For those with extensive baldness who require a full head of hair to be satisfied they offer a quick and nearly instant solution.

Hair systems are constructed of human hair or synthetic fiber. Recent advances have made the synthetic hair much more natural in appearance and texture.

A quality hair replacement system is specially constructed for an individual recipient. These systems are made of real hair, synthetic, or both. They're designed to attach to the head for an extended period ranging from 3-6 weeks, without ever being taken off. Visit Farrell Hair Systems for more information.

Hair systems can work for both men and women. In fact, more and more women are opting for hair systems over wigs, as they can be more comfortable and look more natural.

The process of getting a Hair Replacement System

Typically clients first visit a hair salon for an evaluation. The extent of their hair loss is measured. They are given information including prices, maintenance, and future schedules. Usually, it takes several days for the system to be prepared, based on the client’s preferences.

While a person can get virtually any type of look, you are generally guided towards an option that looks more undetectable and realistic. These studios employ their own hair stylists to achieve ideal looks. Clients can visit these stylists for monthly haircuts or touch-ups.

With these hair systems, a fine mesh foundation is placed on the scalp's balding area and precisely cut to these dimensions. Later, real or synthetic hairs will be inserted into a foundation to create the "Hair System" or hair piece.

The foundations of the past were actually designed to be thicker and more durable. Fortunately, today's foundations are much thinner to make them undetectable. However, this thinness comes at a price, literally. The thinner a system the more delicate it will be and thus it will require being replaced more often.

Once completed, the hair system is attached to the client scalp using clips, weaving, and/or adhesive. The hair system is then styled to match your existing hair.

Maintaining a Hair Replacement System

The stylist in the studios also remove the systems about once a month for maintenance, cleaning, and styling. During these adjustments a person can expect to have their hair system removed, their scalp thoroughly shampooed, and their hair cut. The hair system may also be touched up and or colored if needed.

It's crucial to carefully groom the hair system to maintain a natural appearance. With a quality system, a person can expect to continue doing all normal activities such as running, bicycling, and weightlifting.

However, hair systems typically require time, money, and effort to keep them looking their best. And some clients may feel some discomfort, as well as some insecurity that their hair system may be detected.

Various Methods of Attaching a Hair System

Hair replacement systems can be attached in a variety of ways. They can adhere to the skin, hair, or a combination of both.

When attached to existing hair this method can provide an extra sense of security for clients who enjoy active lifestyles. This type of attachment goes by names such as fusion, weaves, cabling, beading and bonding. Because this type of attachment depends on the rate of the hair's growth, the system must be reattached periodically.

Hair replacement systems can also be applied to bare skin. This can be performed in a variety of ways, such as waterproof and biologically safe glues as well as two-sided tape. However, while these glues and tapes are generally safe for the skin, it's possible to have an adverse reaction. For that reason you should tell the studio stylist of any discomfort.

It's also possible to have a hair system applied surgically. In this case, small skin grafts, known as "tunnel grafts", are taken from a donor site. These tunnel grafts are then formed into tiny loops and placed in the balding areas where the outer edges of the hair system will be attached. The edge of the hair system is then attached to these loops once they have grown into the scalp. Since the hair system is now attached to the scalp, rather than the existing hair that grows out over time, the hair system does not get progressively looser over time.

However, this method of attachment is not recommended due to possible complications such as skin infections.

Finding a Quality Hair Replacement System

If you're considering a hair attachment, you need to be aware of just how to locate the nearest studio, as well as what to look for in one.

Of course you can use the Yellow Pages or the Internet to locate a qualified studio. However, once you do locate one, it may be a good idea to check with the local Better Business Bureau for complaints against the company. It's usually only a problem if there have been multiple complaints against the company.

It's best to consider a hair attachment studio that specializes in non-surgical hair replacement systems. And once you do find an appropriate office, it's best to bring along a photograph showing your ideal look. Plus, try to meet with other clients who are wearing the hair system you may be considering.

It's also important to find out how a company handles potential client problems and complaints. Do they have money-back guarantees or trial periods? These are important questions to ask.

You may also want to check around with the American Hair Loss Council (AHLC), one of the leading groups governing hair loss. The AHLC can't endorse any individual firm. However, this organization supplies clients with a list of local AHLC specialists, known as the American Hair Loss Council Source Book. The specialist and studios on this list are all required to sign a statement that says they honor the group's code of ethics. This code is designed to protect consumers.
- Read more about Non Surgical Hair Replacement Systems