Man: I was told I'm not currently a good candidate for hair transplant. When will I be a suitable candidate? I consulted a hair transplant surgeon and was told I'm not a candidate. I have gaps of thinning hair rather than bald spots and incisions would risk damaging the existing follicles. I'm currently taking finasteride for two months now. When will I be a suitable candidate for the procedure? Is it possible to transplant hair to the thinning areas? Should I consult another surgeon? I do not have any hair loss at the the temples or front.

Dr. Amiya Prasad: Thank you for your question. You submitted a photo and in your question you state that had gone for a consultation and you were advised that you are not a good hair transplant candidate, you're on finasteride for a couple of months and you want to get some guidance. Well, I'm actually very pleased to know that someone who you saw decided that you weren't a good candidate for transplantation. It requires a little bit of understanding as to why you're not a good candidate. First, let's understand what is a hair transplant? A hair transplant is the strategic movement or literal transplantation of hairs from the area in the back of the scalp that we refer to as the genetically resistant area or the donor area. Now this is a narrow space and it is limited. When you look at a male who has very advanced hair loss where they just have the horse shoe kind of pattern that hair is permanent. It's not going to fall out and the scientific idea is that since it's permanent those hairs can be cut out and then placed in another area strategically.

Now, when we look at the space on the back of the scalp and this area we refer to as the crown. The surface area of the crown is fairly large and it is very common for men to come in and say I want to cover the bald spot, but the problem is, is the amount of area to cover requires a large number of grafts and unfortunately the donor area is fairly limited. The next reason that you need to also understand is your hair is thinning but you may not have bald areas, which means that if you were to look at your scalp with a microscope there's a good chance that there's a lot of existing hair and that it would be not to your benefit to then place grafts and literally destroy those viable hair follicles. I think that the strategy that your doctor may have suggested was the finasteride to see if the finasteride can reverse the hair thinning.

Let's just understand finasteride for a moment. Finasteride is a drug that is taken once a day, it's one milligram and it is used to inhibit an enzyme called 5-alpha reductase. The 5-alpha reductase converts testosterone to dihydrotestosterone. Now this dihydrotestosterone can cause susceptible hair follicles to thin and to eventually disappear. Many men particularly men with crown hair loss will respond to finasteride so I think you're on the right track. At this time unfortunately a lot of men don't want to take finasteride especially in their 20's and 30's because when they're doing research they're seeing concerns about long term sexual side effects. In fact so many people come to us for one of our unique treatment that we call hair regeneration, I'll discuss in a moment, because they don't want to take finasteride and they're having progressive hair loss.

The understanding now that might help you is a concept that we've been in a leadership position with and this is the method that we call hair regeneration. It was discovered several years ago after the introduction of a material called extracellular matrix and this type derived from pig bladder that helps wound healing using adult stem cells, which means your own body's stem cells to heal by duplication of tissue that is native to a given area where the extracellular matrix is applied. When it's applied to muscle, you are able to regenerate muscle. When we apply it to skin you regenerate skin. Well, although hair is an organ that you can't regenerate or duplicate hairs or clone hairs, which has been the holy grail of hair restoration. We can restore the cells in signals necessary for hair growth. Now, this is something that we have developed a formulation, a method, a delivery system and we do these injections several times a week for people who come to us from all over the world, and this might be an option that you can investigate. What is unique is that it's a one time treatment and once you have this treatment, the hair that is thinning will come back thicker.


What to Do If You're Not a Good Candidate For a Hair Transplant

Has a doctor told you that you aren't a good candidate for a hair transplant? Dr. Amiya Prasad discusses why this is, and what options you have at your disposal.