Hair Thinning: Can Fine Hairs Be Revived Before Transplant?

The hair follicles on the scalp are present, but most of them only produce fine hair?

Hello Dr.
Huang,
I am currently a postdoctoral researcher at National Chiao Tung University and I understand that you are an attending physician at Hsinchu Hospital.
I would like to consult you regarding my hair loss issue.
Based on the area affected, I believe I am at stage 5 or 6 of hair loss.
I have visited a hair transplant clinic, but the doctor mentioned that the area is too large to be completely covered and the cost would be around 180,000 TWD.
However, when I look at my scalp from a distance, it appears bald, but up close, I can see many fine hairs.
They are not thick enough to create coverage, and the hair follicles have not yet closed.
I am wondering if these fine hairs or the still-open follicles can be salvaged.
If so, the results might be much better than a hair transplant.
I am also concerned that a hair transplant might damage these follicles.
Do you think that using medications like Minoxidil in combination with Finasteride could help recover these fine hairs, or are they fundamentally different from the existing hair? Would it be more practical to proceed with a hair transplant? Honestly, I am quite apprehensive about visiting hair transplant clinics, as they tend to recommend hair transplants, and then dermatologists suggest Minoxidil...
I am unsure who to trust in this situation.
This issue, which seems not to be a medical condition, is really frustrating.
Thank you for your response.

KC, 30~39 year old female. Ask Date: 2006/11/18

Dr. Huang Ruiyun reply Dermatology

The logic behind this issue is actually quite simple; the difficulty lies in the decision you make for yourself.
Pathway 1: Male pattern baldness is not a disease; it is merely a common genetic trait, where one increasingly resembles a certain ancestor.
Bruce Willis and Sean Connery both have this trait and remain confident and charismatic.
Pathway 2: Currently, there are three recognized treatments for male pattern baldness: Finasteride, Minoxidil, and hair transplantation.
Please use Finasteride and Minoxidil consistently for one year, and then: 2.1: If effective, the genetic predisposition will not change, so continue lifelong use; otherwise, revert to Pathway 1.
2.2: If somewhat effective but not satisfactory, consider adding hair transplantation.
Continue lifelong use of Finasteride and Minoxidil; otherwise, the transplanted hair from the back of the head will not be affected by male pattern baldness, and the originally balding area will continue to expand, resulting in an odd hairstyle.
2.3: If ineffective, please revert to Pathway 1.
Achieve enlightenment and let go of the so-called "three thousand worries." It turns out to be quite liberating.

Reply Date: 2006/11/18

More Info

Understanding hair thinning and the potential for revival of fine hairs before considering a hair transplant is a complex issue that involves various factors, including the underlying cause of hair loss, the health of the hair follicles, and the effectiveness of available treatments.

From your description, it seems that you are experiencing significant hair thinning, potentially classified as Norwood scale stages 5 or 6, which indicates advanced male pattern baldness. However, you also mention the presence of fine hairs that are not coarse enough to provide adequate coverage. This is a crucial detail because it suggests that your hair follicles may still be active, albeit producing thinner hair strands.

In cases of androgenetic alopecia (male pattern baldness), the hair follicles gradually shrink due to the effects of dihydrotestosterone (DHT), a derivative of testosterone. This process leads to the production of finer, shorter hairs, often referred to as "vellus" hairs, which may not provide the same aesthetic coverage as thicker terminal hairs. The good news is that if these follicles are still alive and not completely miniaturized or scarred, there is a possibility of revitalizing them.

Medications like Minoxidil (often referred to by brand names such as Rogaine) and Finasteride (Propecia) are commonly used to treat hair loss. Minoxidil works by increasing blood flow to the hair follicles, potentially revitalizing dormant follicles and promoting hair regrowth. Finasteride, on the other hand, works by inhibiting the conversion of testosterone to DHT, thereby reducing its harmful effects on hair follicles. The combination of these treatments can be effective in stimulating hair growth and improving the density of existing fine hairs.

Regarding your concern about hair transplant surgery, it is essential to understand that hair transplants involve relocating healthy hair follicles from a donor site (usually the back of the head) to the balding areas. If your existing follicles are still viable, it may be beneficial to explore non-surgical options first, as these treatments could potentially improve the density of your hair without the need for invasive procedures.
However, if you are considering a hair transplant, it is crucial to consult with a qualified dermatologist or a hair restoration specialist who can assess your specific situation. They can evaluate the health of your hair follicles and determine whether you are a suitable candidate for a transplant. If the follicles are too damaged or if there is insufficient donor hair, the transplant may not yield the desired results.

In summary, before proceeding with a hair transplant, it would be wise to explore medical treatments that could help revive your fine hairs. Utilizing Minoxidil and possibly Finasteride could improve your hair density and overall appearance. If after a reasonable period of treatment you do not see satisfactory results, then discussing hair transplant options with a specialist would be the next step. Always ensure that you are receiving advice from certified professionals in dermatology or hair restoration to make informed decisions about your hair loss treatment.

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