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Hair Transplantation and Alopecia Reduction at a Glance
  • 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 (AR) and transposition flaps.
  • Follicular units (FU) are the building blocks of modern hair transplantation [follicular unit transplanting (FUT)] (Fig. 256-1).
  • The major advantage of FUT over older punch-grafting techniques is that the results appear natural after a single surgery.
  • Minoxidil or finasteride may arrest or partially reverse MPB and FPHL so a trial of treatment is appropriate prior to surgery, or concurrent with surgery.1,2
Figure 256-1

A relatively small number of single hairs emerge from the scalp. Most often, hairs grow in small groupings of two to five hairs, as shown in the above photo. These groupings are referred to as follicular units.

Hamilton and Norwood described the degrees of severity of MPB from a mild Type I to a severe Type VII3,4 (Fig. 256-2). 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 256-1), and Unger found that among men older than 65 only 13.7% have Type VII MPB5 (Table 256-2). Thus, if one treats all or most patients as if they will develop Type VI MPB, one is being reasonably cautious. An exception is for cases with a family history of Type VII MPB, in which case it is wiser to assume an evolution to Type VII MPB.

Figure 256-2

A. The Hamilton-Norwood classification of MPB.   B. The Norwood classification for Type A variant MPB.

Table 256-1 Hamilton Study of Incidence of MPB (Norwood-Hamilton Scale) by Age

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