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  • Most patients undergoing surgical procedures for hair loss have either male pattern baldness (MPB) or female pattern hair loss (FPHL).

  • Surgical techniques used to treat hair loss include hair transplantation, alopecia reduction, and transposition flaps. The latter 2 techniques are rarely used currently.

  • Follicular units (FUs) are the building blocks of modern hair transplantation (follicular unit transplanting [FUT]).

  • The 2 main methods of donor harvest are strip harvesting and follicular unit excision (FUE). The latter may be achieved using a variety of techniques and devices.

  • Minoxidil or finasteride may arrest or partially reverse MPB and FPHL, so a trial of treatment is often appropriate prior to surgery, or concurrent with surgery.

  • Additional innovations of potential benefit include bio-enhanced storage solutions and platelet-rich plasma (PRP)


Hamilton and Norwood described the degrees of severity of male pattern baldness (MPB) from a mild Type I to a severe Type VII1-3 (Fig. 217-1). Fortunately, a large majority of male patients do not progress past Types VI: Norwood found that at age 79 only 11% of men have Type VII MPB (Table 217-1), and Unger found that among 328 men older than 65 only 13.7% have Type VII MPB4 (Table 217-2). Thus, if one treats all or most patients as if they will develop Type VI MPB, one is being reasonably cautious. Exceptions are individuals with earlier than usual onset of significant degrees of MPB or Diffuse Unpatterned Alopecia especially if there is a family history of Type VII MPB, in which case it is wiser to plan on an evolution to Type VII MPB.

Figure 217-1

A, The Hamilton-Norwood classification of MPB. B, The Norwood classification for Type A variant MPB. C, Ludwig pattern of hair loss in females.

Table 217-1Hamilton Study of Incidence of MPB (Norwood-Hamilton Scale) by Age

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