Many surgeons nowadays want to sell hair transplant surgery without considering the long-term consequences of the procedure and they also do not discuss the strategies for the management of hair loss. Many transplant surgeons think of it as a continuous process where they transplant hair but as the patient’s hair loss progresses, they do more transplantation. Unfortunately, the donor area or the area at the back of the neck which is genetically resistant to the effects of dihydrotestosterone (DHT), are limited. When the person’s hair loss continuous despite taking finasteride, they lose their native hair around the transplanted hair. Losing native hair around the transplanted hair leads to a "pluggy" look. A surgeon must be very strategic in using the donor hairs especially if there is only a few amount of hair available for transplantation.In our practice, we do several things as part of an initial evaluation. First, we want to know what age they started losing hair. The reality is when people start losing hair when they're younger, it tends to be a rapidly progressing process. Often in people who have male pattern hair loss, they often don’t respond very well to medical treatments such as minoxidil or finasteride. Finasteride goes by the trade name Propecia inhibits the enzyme that converts testosterone to dihydrotestosterone (DHT). A common myth is that men who are losing hair have too much testosterone, which isn't true. Hair can be genetically susceptible to the effects of DHT. Sadly, finasteride has long term side-effects.Fortunately, in our practice, we offer a procedure called Hair Regeneration that uses a material called extracellular matrix (ECM). ECM is derived from pig’s bladder which is used for wound healing. It recruits adult stem cells called progenitor cells. Progenitor cells are proven to be deficient in those suffering from male and female pattern hair loss, are restored and they activate the process of hair growth. Hair Regeneration uses ECM in combination with platelet-rich plasma (PRP) in a specific way customized to an individual’s pattern of hair loss. With the Hair Regeneration treatment, we have been able to reverse thinning hair, stop male and female pattern hair loss and even restore the cells and signals that appear to be disrupted when a person has thinning hair. In addition, we are also able to help patients who have alopecia areata and systemic lupus.However, there are limitations. We are not able to restore hair that is lost, but there is a remarkable difference with people with progressive thinning hair treated with Hair Regeneration. What I do is perform the Hair Regeneration treatment, then observe them for a year to a year and half. After that, we can a hair transplant if the patient needs more hair. The difference is that we can now be more strategic with the use and placement of hair to get more coverage. I hope that was helpful to you, and thank you for your question.