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Hair Transplants for Hairline Lowering?
What is better for me, surgery or transplants? Pros and cons of a transplant? I have curly
hair, am I a good candidate? How long before they are "bangs/fringe" length? I am trying
to ask as many questions as I can before making an appointment. Thank you.
Thank you for your question.
You're young and you're unfortunately affected by female pattern hair loss. And you're asking
about hairline lowering and you're also asking about options in terms of transplants and
surgery.
Well, it just so happens I am a board certified facial surgeon and a hair restoration specialist
so I think I can give you some perspective on how to take an approach that will work
for you. First of all, let's understand a couple of things. One is there are two types
of hair loss that affects 95% of people, male pattern hair loss in men and female pattern
hair loss in women.
Now, female pattern hair loss tends to be more defused type of hair loss as supposed
to male pattern which is more where the temples go up and they get a receding hairline and
the crown gets larger. With women, it's much more defused. Interestingly, in women there
is even in a more progressed female pattern hair loss patients there is still some preservation
of frontal hairline.
Now, your concern is that your hairline is high and so how do you approach this in terms
of lowering your hairline. Well, I'm going to answer this question a little bit differently
than what you are probably used to hearing from other hair restoration specialist in
terms of surgery. In my practice, in the past several years, I've developed a way to treat
female pattern and male pattern hair loss using regenerative technology. And before
we get to that, let's understand a little bit about what causes hair loss.
We'll, let's talk about this standard more common patterns of hair loss. Essentially,
there are some factors that is choking the life out of the follicle. In men, we know
that the DHT, dihydrotestosterone. In women, it's an unknown cause but we believe that
there is some inflammation basis for that loss. In addition, based on recent studies
have demonstrated that there are stem cells that are turned on normally with normal hair
growth than in people who are losing hair stop working. Now, these stem cells are also
referred to as progenitor cell and that's a very important word, progenitor, which means
from out purposes protect and basically the progenitor cells protect the hair follicles
from the attacks.
So what I have been doing in my practice, as a normal part of non-surgical treatment
of hair loss, is an injection combining this material called extracellular matrix with
something called Platelet-rich plasma . Platelet-rich plasma is drawn from your own blood and it
contains the active growth factors that are also part of the healing process. When we
heal, we activate the body's adult stem cells. And so what we believed is the basis of our
success is the restoration of the progenitor cells which have stopped functioning and protecting
the hair follicle from the attack of either the DHT, dihydrotestosterone or from the yet
to be determined cause of female pattern hair loss. What we typically see in female hair
loss is improvement around 6-9 months closer to 9 months as a general rule because women
have longer hair. It takes a little bit longer to see the result.
A very important factor here is that this injection treatment helps stop not only re-grow
hair that is thinning but it stops and prevent the progression of this hair loss process.
And it is very important when you consider surgery, think about a simple concept think
of a treadmill. If you're getting transplants for example and then the hair continues to
thin, it's like you're taking one step forward and then 2 steps back. And many female patients
who have gone hair restoration surgery are very dissatisfied because of that. And unfortunately,
unlike men who have option of taking Finasteride and oral drugs that blocks dihydrotestosterone,
there is no equivalent for women. So if you were to come into my practice, one of the
first things I will recommend is the injection.
So now let's talk about the surgical option because you wanted have a lower hairline.
This is one of the most common things that people come to us for in terms of hair restoration.
They very often say I want my hairline very much lower but we have to understand a couple
of things when it comes to hairline lowering. You're looking at a choice between hair transplantation
which is moving hair follicles that are genetically resistant to loss from the back and moving
them forward or doing some kind of incisional surgery which tries to bring the hairline
downward. I can tell I would want to persuade you from not doing the incisional surgery.
Unfortunately, the chance of seeing visible scars especially the way you wear your hair
may not probably make it worth it. In addition the elasticity of the skin and the skin heals
maybe the problematic and become a greater challenge. And of course, one of the risk
of doing incisional surgery where you're taking out and make a strip of skin and try shorten
the length of the forehead to the hairline is that you can have hair loss as a matter
of process intention. So I almost never really recommend that unless someone has a lot of
redundant skin on their forehead and usually that's in women who are much older and part
brow lifting procedure.
So I would recommend considering doing a hair transplant procedure as part of your goal
now the way I approach lowering a hairline is on a more conservative approach and the
reason is this when you look at your own hair, you'll see how closely the hair follicles
are. During transplantation, we can try and pack the hair as close as possible, 20, 40
hairs per square centimeters. Some people on the hair transplant surgeons make all kinds
of claim that 80 to a 100 hair per square centimeters but there is a critical factor
and that is the blood supply and survivability. So we adjust and we don't try to do the same
procedures on everyone.
As a surgeon I understand that tissue as a different level then a lot of the hair transplant
doctors who don't actually perform any other kinds of surgery but are limited only working
on hair. And so I would say that it is possible to do a good job with hairline lowering but
I would be conservative in terms of process. And the reason is that if you start your hairline
low and you diffusely fill the area that you want to fill, it may look good initially because
you seal the hairs looking relatively close together. But as it heals, it may look like
there is too much space between the hair follicles and that's a give away or something is wrong.
So what I like to do is work from the back of the hairline forward and try to place as
many hairs as I can in a way so that it feathers in and it blends with the hairlines so it
looks natural even as it is healing, it looks very natural. It is important to be realistic
about how low we can make the hairline and how dense we can make the hairline invariably
more than one session in order to be able to do a reasonable job in getting the density
.
Regardless of how many grafts we place, we can improve the survivability using the same
technology we use in our injection but we have to be realistic that the hairs are going
to be further apart than the way they appear naturally in nature . Now we can put single
hairs in the front like we typically do and 2, 3, 4 grafts behind. But still it's my recommendation
to all of our patients men or women that hairline lowering be done from the back towards the
front in a very meticulous way so that the person doesn't look like they have transplants.
Unfortunately, hair transplants are very commonly seen and as unnatural and pluggy because too
many doctors try to be over ambitious and create unnaturally appearing hairline.
So in summary, I would suggest considering the regenerative technology that we have introduced
and it has been very successful in my practice using the extracellular matrix and Platelet-rich
plasma to vaccinate and so that it prevents further loss, restores hair that is thinning
and become more thicker and then surgical hair transplantation perform in a realistic
way where you don't go to low, to early and see that gaps as you are healing and have
it subconscious about that. So I know I have introduced something different to you and
I hope that was helpful and thank you for your question.