Androgenetic alopecia care with customized technique allows optimal outcomes

Key Points

New York - With regard to the surgical treatment of androgenetic alopecia, strip harvesting and follicular unit extraction (FUE) techniques can work very well, but each technique must be used appropriately and for the appropriate patients to ensure optimal outcomes, says Walter Unger, M.D.

Dr. Unger, a hair transplant specialist with offices in Toronto and New York and clinical professor in the department of dermatology at Mount Sinai School of Medicine, says that hair transplant techniques and the instrumentation used have evolved, but neither strip harvesting nor FUE are optimal for the harvesting of donor hair for the treatment of male pattern baldness (MPB) or female pattern hair loss (FPHL).

Moreover, Dr. Unger stresses that a tempered enthusiasm is warranted with regard to new and medical therapeutic approaches for these conditions.

It has been well-established that dihydrotestosterone is the key hormone involved in MPB, and in many cases, FPHL, Dr. Unger says. However, a definitive treatment counteracting that hormone that is consistently effective in all patients remains elusive.

"Nevertheless, some of the best minds in medicine are working on stem cell therapy for different tissues including heart, spinal column, pancreas, as well as hair follicles. I am confident that we will succeed in finding a consistently effective stem cell therapy for androgenetic alopecia in the future. It is just a matter of time," he says.

Proper selection

Until a definitive medical treatment for androgenetic alopecia is found, Dr. Unger says, currently used surgical techniques need to be used in the right patient population in order to optimize outcomes. The type of surgical technique chosen for patients with androgenetic alopecia very much depends on the age of the patient and the present, as well as probable eventual, severity of hair loss, he explains.

In more severe forms of MPB, including Norwood types VI and VII, Dr. Unger says that the patient will typically have a large balding area and a relatively small fringe of more permanent hair from which one could collect potential hair follicles for grafting.

Most men who have MPB have a fringe of different widths, Dr. Unger says, but the fringe invariably becomes narrower with age, and the area with the densest hair within the remaining fringe contains the largest percentage of permanent hairs. This is thus the most ideal area from which to take potential hair grafts.