Patrick Mwamba, MD
Dr. Patrick Mwamba
Dr. Patrick Mwamba is one of the early developers of the follicular unit extraction (FUE) method and is the most experienced body hair transplant surgeon in Brussels, Belgium.
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Diffuse Patterned Alopecia (DPA)
Diffuse Hair Loss and How to Treat It
Unlike male pattern baldness (MPB) and female pattern hair loss (FPHL), which tends to follow one of the hair loss patterns defined by the NorwoodScale and the LudwigScale, Diffuse Patterned Alopecia (DPA) is characterized by diffuse thinning throughout the front, crown and vertex(crown) with no distinct pattern evident. However, like male and female pattern balding,Diffuse Patterned Alopecia patients typically preserve the stable "permanent zone" on the sides and back of the scalp and may sometimes retain a well-defined hairline. DPA is also a type of hereditary balding condition like and rogenetic alopecia (genetic hair loss).
Diffuse Patterned Alopecia (DPA) can be difficult to diagnose and, particularly in its early stages, may be confused with a similar condition known as Diffused Unpatterned Alopecia (DUPA). While both conditions are characterized by diffuse thinning, DUPA sufferers lack the stable permanent zone necessary for surgical hair restoration.
Treatment for Diffuse Patterned Alopecia
DPA often responds well to medical hair loss treatments like Propecia (finasteride) and Rogaine(minoxidil) and, due to the preservation of the permanent donor region, many DPA sufferers are candidates for hairrestoration surgery.
Conclusion
It’s essential that hair loss suffering men and women seeking medical and/or surgical treatment for diffuse thinning consult with a skilled and experienced hair restoration physician. Differentiating between DPA and DUPA is critical because Diffuse Patterned Alopecia patients frequently make good hair transplant candidates, whereas DUPA patients rarely do.
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Dr. Ted Miln
Dr. Ted Miln
Dr. Ted Miln is performing refined follicular unit grafting with incredible density, with results that are undetectable from his patient's native hair. -
Female Hair Loss - Treatment and Restoration
Female hair loss, otherwise known as Female Pattern Baldness (FPB), affects 1 out of every 4 women in the United States. Recent findings have found that the incidence of FPB has been reported to be as low as 8% and as high as 87%. And, it does appear to be as common for women as for men. Most often, menopause is the most frequent time for hair loss in women to become apparent.
For a woman to lose her hair can be even more troubling than for men. A woman with thinning hair is not generally accepted as part of the normal aging process. Society has come to expect a thick, luxurious head of hair as part of the attractiveness in women.
While males and females can both experience thinning hair, they typically do not lose their hair in the same order or appearance.
Women with thinning hair compared to Men
Typically men observe their hair loss earlier, whereas women will first notice it in their late 20's through their early 40's. Female Pattern Baldness (FPB) is often seen during hormonal changes. These include the use of birth control pills, following childbirth, or during or after the time of menopause.
Top view of patient, showing excellent growth of transplanted hair.In addition, men typically have localized areas (patterns) of thinning, whilein women this usually occurs as thinning across the top, or over an even wider area. When women have very diffuse thinning over much of their scalp they are generally not good candidates for hair restoration surgery. However, women with localized hair loss, similar to the typical male pattern baldness, can successfully undergo hair restoration surgery.
Thinning hair in females is also characterized by an increase in the combination of normal thick hairs mixed in with finer, smaller hairs. This results in decreased density, and not total hair loss.
A woman's hair has also been proven to be more sensitive to the effects of stress than men's hair. Stress can result in hair loss in women and men. But this type of loss is not female pattern baldness. Rather, it is known as “telogen effluvium.” This type of hair loss is the shedding of hair in the resting phase when the body senses that it needs to divert its energies elsewhere. Therefore stress can temporarily changes the amount of hair that is shed. But the lost hair is likely to grow back.
The production of the hair loss-inducing androgens is also different among men and women. A woman produces a small quantity of androgens in the adrenal glands and the ovaries. The ovaries also produce pre-hormones, which are then converted to androgens on the outside of the ovaries or adrenal glands.
Generally speaking, a woman with hair loss will probably not experience total balding in a given area. But if there is total hair loss, this is most likely a sign of a previously hidden disease. For this reason, it’s important for females to have their hormone levels checked by a physician if they are experiencing heavy hair loss.
Finally, men and women react differently to various hair loss treatment options. In men, hair loss may be halted or even reversed by finasteride (brand named "Propecia"). However, Propecia is not safe for females or children. Minoxidil (Rogaine) can be effective for both men and women in treating hair loss.
However, for some women the causes of their hair loss are much more complex than the classic "male pattern baldness". Thus proper diagnosis of the underlying cause is vital before any hair loss treatments are attempted.
The following physicians are nationally well known experts in female hair loss. Feel free to contact them.
David Whiting in Dallas, Texas - 214 824-2087
Vera Price in San Francisco, California 415 353-4163
Maria Hordinsky in Minneapolis, Minnesota 612 625-1493
Wilma Bergfeld in Cleveland, Ohio 216 444-5722
For a web community that is dedicated to female hair loss visit HerAlopecia.com -
Nizoral 2% Shampoo (Extra Strength) for Hair Loss
Nizoral 2% is magnificent shampoo and a significant part of what's referred to commonly as the Big 3. The other two are the FDA approved and proven treatments Propecia (finasteride)and Rogaine (minoxidil). To date, Nizoral is the only shampoo on the market that can make the unique claim that it's proven to stop the formation of DHT. Its active ingredient ketoconazoleat 2% concentration has proven to be a moderate DHT inhibitor and has growth stimulating properties about as effective as Rogaine 2%.
This product includes 2%, the highest concentration of the active ingredient ketoconazole. To view the clinical abstract proving the effectiveness of ketoconazole in the treatment of androgenetic alopecia, view "Ketoconazole as a hair loss treatment". There is also a less concentrated 1% of Nizoral. To learn more, visit Nizoral regular shampoo.
We strongly suggest using Nizoral shampoo in addition to other proven treatments. Nizoral should be used 2 or 3 times a week to avoid dry hair and a flakey scalp.
On the off days, you may want to consider rotating Nizoral with other excellent shampoos designed specifically for thinning hair. See the recommended treatments section below for other shampoos we recommend.
Developing Realistic Expectations:
Men and women sometimes suffer from hair loss for different reasons. Thus, diagnosing its cause is necessary to facilitate and promote proper treatment.
Don't expect immediate results. It's recommended to use Nizoral in conjunction with other proven treatments for at least 6 to 12 months before determining its effectiveness. Documenting your progress with bi-monthly photos can help you determine whether or not Nizoral has been successful in helping you maintain existing hair.
To date, only surgical hair restoration is proven to grow hair in completely bald areas. You are invited to have a free virtual consultation with one of our prescreened hair restoration physicians.
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Future Hair Loss Treatments
Some day, perhaps in the distant future, baldness may become a curable aliment. Scientists are currently researching gene therapies to alter a person's genetic vulnerability to hair loss. However, the actual implementation of such hair loss treatments may be decades away.
In the near future, drug treatments which inhibit the balding process seem more promising. The hair loss drug Propecia (finasteride) has been proven successful in slowing and/or stopping hair loss by blocking the conversion of testosterone into dihydrotestosterone (DHT) in the scalp.
Another promising drug that inhibits the development of hair loss causing DHT hormones is Dutasteride.
Like Propecia, it also inhibits the creation of DHT. And based on preliminary clinical studies, dutasteride promises to be even more successful than Propecia in inhibiting the production of DHT.
In addition, Dutasteride inhibits the activities of two types of 5-alpha-reductase enzymes. In contrast, Propecia (Finasteride) only inhibits one type. Dutasteride has been shown to decrease levels of DHT by 90% after only two weeks, making it a more powerful and faster-acting weapon against hair loss than Propecia (Finasteride).
Dutasteride is not yet FDA approved for the treatment of hair loss. However, it is being marketed as Avodart by GlaxoSmithKline as a hair loss treatment. Some hair restoration physicians also prescribe it for the treatment of hair loss. Like Propecia, Avodart is not safe for women and children.
In time, perhaps even more effective hair loss drugs will be developed to inhibit the hair loss process.
Future Hair Transplants - an endless supply of bald resistant donor hairs?
The amount of hair you can transplant is ultimately limited by the amount of hair follicles you can safely relocate from the bald resistant donor area at the back and sides of your head.
Some day it may be possible for physicians to create multiple hair follicles from one original follicle. This process typically called "hair cloning" or more correctly "Hair Multiplication" is currently being investigated by several research scientists and hair restoration physicians.
If and when this process is successfully developed patients would no longer be limited by the finite amount of bald resistant hairs that can be relocated from their donor area. Hair multiplication would result in a virtually limitless supply of hair available for hair transplantation.
This would be especially good news for men or women with extensive baldness and a very limited supply of donor hair. Even those with extensive baldness would theoretically be able achieve thick full heads of hair.
However, experts believe that we are at least ten years away from hair multiplication being available, if even then.
For most men and women, hair loss can be effectively halted or even reversed with current hair loss treatments. But the future holds the promise of even more effective treatments and perhaps some day even a "hair loss cure".
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Dr. David Josephitis
Dr. David Josephitis
Dr. David Josephitis performs ultra refined FUT/strip and FUE with outstanding results along side with Coalition members Drs. Ron and Paul Shapiro. -
Hair transplantation FAQs
Hair transplantation is really about relocating (transplanting) the bald resistant hair follicles from the back of the head to the balding areas on the top of the head.
This process works for a lifetime because the hair follicles taken from the back of the head are genetically resistant to baldness, regardless of where they are relocated to.
Hair transplantation, when done right, can be so natural that even your hair stylist will not know that you've had it done.
But the skill and techniques of hair transplant surgeons does vary widely, as do their results. It's important to choose the right procedure and clinic to assure that you will get completely natural results.
The state of art hair transplantation procedure that we recommend is called "Follicular Unit Hair Transplantation".
To learn more about the leading hair transplantation physicians who perfrom this procedure, visit our recommended physicians page.
A typical session of between 1,500 to 3,000 grafts normally involves a full day of surgery on an out patient basis. Most patients will arrive in the morning and will have their procedure completed by late afternoon.
View a step by step overview of a typical hair transplant procedure.
Patients are given local anesthesia in the donor and recipient areas. Most patients find that once the anesthesia is given that they feel no pain or discomfort during the surgery. Following surgery patients will typically feel some amount of soreness and numbness, with some mild discomfort. Most patients are pleasantly surprised by how minimal the discomfort from the surgical procedure is.
Today hair restoration clinics typically provide free no obligation consultations, with surgical sessions priced either per graft or by the session. Prices typically average around $5 to $6 per graft.
It is normal for the price per graft to drop as the size of the surgical session increases. Many clinics will offer a reduced rate per graft once a certain surgical session size (i.e. 1,000 or 2,000 grafts) is exceeded.
To compare the long term costs of hair transplantation to other hair loss treatments, visit our hair transplant cost section.
The amount of grafts you will need ultimately depends on your degree of hair loss, now and in the future, and on how full you desire your hair to be.
For help estimating the amount of grafts/hairs you may need, click here.
To use our interactive graft calculator, click here
With today’s very refined micro hair transplantation procedure the incisions are very small and less invasive than past procedures. This results in more rapid healing. Most patients feel fine within a day or two following surgery, although some numbness and mild soreness can be expected for several days following surgery.
Immediately following surgery a patient’s recipient area is typically pink with scabs forming around the micro incisions. These hundreds of tiny incisions will heal rapidly within a week to ten days.
During the first few days after the surgery a person’s hair transplants will be noticeable if there is no previous hair to mask these temporary scabs. However, most patients feel comfortable being in public without wearing a hat within 5 to 7 days following surgery.
Once the transplanted hair grows out the results should look entirely natural, even under close examination.
Normally it takes between three to five months following surgery before the transplanted hair follicles begin to grow new hair. The transplanted hair grows in very thin initially and gradually grows thicker and fuller over time. After one year a patient’s transplanted hair will be fully mature and will continue to grow for a life time.
Since the hair follicles that are transplanted to the balding areas are genetically resistant to going bald, they will continue to grow for a life time – just as if they had been left in the bald resistant donor area.
To understand why some hair follicles are genetically resistant to going bald, while other are not, click here.
The most important decision in restoring your hair is the physician you choose. The skill, talent, and experience of hair restoration physicians vary widely, as do the end results. Who you choose will determine how natural and full your new hair will be for the rest of your life.
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Dr. Bessam Farjo
Dr. Bessam Farjo
The Farjo Hair Institute is a family run clinic solely devoted to performing excellent follicular unit hair transplantation in Manchester and London. -
What is Rogaine and how does it work?
Along with Propecia, Rogaine is one of the only proven hair loss medication options approved by the FDA for treating hair loss. Minoxidil, (Rogaine’s active ingredient), was originally created as a drug for treating hypertension (high blood pressure). It was then discovered that one of its side affects was growing hair. Minoxidil was then tested for use a topical application for regrowing hair. The results were sufficiently impressive that the FDA approved it as a treatment for hair loss.
Rogaine works by revitalizing shrunken hair follicles, thus increasing their size. When you use Rogaine every day, your follicles may increase in size, and the growing phase may become longer. This may then produce longer, thicker hairs.
Rogaine is a clear alcohol-based solution and should be applied to a person’s thinning area with its supplied dropper or spray twice a day.
The solution is approved and available in two strengths -- Regular (2%) and Extra Strength (5%). Individual users of Regular strength Rogaine have claimed success rates of 30-40%. Meanwhile, users of Extra Strength Rogaine have claimed success rates of 50-60%. Currently, the average price for a 2oz. bottle of Rogaine is about $20-30 per month. Minoxidil is also available as a generic and can be purchased over the counter without prescription.
It’s important to note that Rogaine (minoxidil) does not cure baldness and scientists have been unable to determine just how it works. What is known is that Rogaine increases the blood flow to the areas of the scalp that surround these balding areas. Currently some researchers believe that Rogaine (minoxidil) works by opening the follicle’s potassium channels located in the cells. It’s theorized that these channels, when opened, may regulate hair growth.
Rogaine can’t grow hair on completely bald scalps or in the frontal hairline areas. It has been found to be somewhat effective in maintaining or growing hair in the crown area (the top back of the head). However, Rogaine is only effective at delaying hair loss. It is also more effective in women than in men. And again, the reasons for this are not understood.
What can I expect with Rogaine?
Rogaine (minoxidil) generally only regrows hair in a minority of men and women. In most cases, the best case scenario for hair growth with these treatments is a thin coverage of thin hair.
The real benefits of Rogaine (minoxidil) is keeping what hair you have or slowing your thinning. Rogaine’s success depends on how advanced your hair loss has become.
You must apply it to your scalp twice a day for life to get and maintain any benefits. Research shows that using Rogaine (minoxidil) only once a day is ineffective. If you stop taking Rogaine (minoxidil) you will loose whatever hair you preserved or regrew within 2 to 4 months. And while Rogaine may stimulate hair growth, it may not prevent the hair follicles from their eventual deterioration.
It's also true that Rogaine's effects may diminish over time. Some doctors believe that patients can build up a tolerance after many years of use. But it's possible to fight this tolerance by taking a week or two off from the treatment every 3-4 months. However, it's not advised to take this break unless you've taken the hair loss medication consistently for at least 12 months.
Are there side effects from Rogaine?
There are only minor side effects with Rogaine. But some users do experience certain problems such as scalp irritation, itching, and dandruff. However, this can be treated with a good shampoo like Nizoral or Neutrogena T-Gel. There may also be an increase in hair shedding at the start of the treatment. You shouldn’t panic, as this may actually be a signal that the treatment is working.
Due to the medication’s alcohol content, some users may develop a contact rash or irritated skin. And with excessive doses, some users may experience dizziness or a rapid heartbeat. However, with normal use these effects are uncommon.
Rogaine users with severe, refractory high blood pressure experienced some problems. One such problem was “hypertrichosis,” hair growth on the face or other bodily areas. This side effect appears in about 3-5 % of women who use the 2% solution, and higher among women using the 5% solution.
Rogaine and Hair Transplants
Some hair restoration physicians have come to consider Rogaine to be instrumental right after surgery. This is especially true when grafts have been placed in and around existing hair.
The shock of surgery can result in temporary hair loss. Rogaine is thought to possibly help prevent this temporary loss of healthy preexisting hair. The 5% solution has been found to be more effective for men and women. However, some physicians believe that the hair loss medication should be stopped a week or two before surgery. They feel that Rogaine may increase bleeding, while dilating blood vessels.
After surgery, most patients wait a week or two before restarting Rogaine. This gives the graft areas time to heal. However, taking Propecia is not interrupted by surgery.