In a previous issue of the Forum, I reviewed Dr. Norman Orentreich’s original article which established the concept of “donor dominance” in androgenetic alopecia1. The finding that scalp autografts maintained their hair growth characteristics independent of the scalp recipient site has been the cornerstone of modern hair transplant surgery.
I highly recommend as a fascinating read Dr. Orentreich’s original article (Orentreich, N. Autografts in Alopecias and Other selected Dermatologic Conditions. Ann. N.Y. Acad. ScI; 83: 463-479, 1959).
If one performs enough hair transplant consultations, patients with alopecias of different etiologies will be encountered. The primary requirement in that first visit is to make a correct diagnosis. This is accomplished by taking a directed history, performing a scalp examination using specific clinical assessments and, in selected cases, performing microscopic analysis of hair and/or scalp biopsy.
The primary requirement in a hair transplant consultation is to make the correct diagnosis. The scalp examination usually begins by looking for a recognizable pattern. Generally recognizable patterns are seen in male or female pattern alopecia, traction alopecia, post-facelift alopecia, etc.
Scalp Pathology for the Hair Restoration Surgeon: Differentiating Chronic Telogen Effluvium from Female Pattern Hair Loss
I think that we can all agree that hair loss diagnosis in women presents a more formidable challenge than in their male counterparts. Since hair transplantation is contraindicated for certain alopecias, we need to approach the female candidate with a greater degree of awareness regarding the entire range of differential diagnostic possibilities.
SCALP DERMATOLOGY FOR THE HAIR TRANSPLANT SURGEON: Recognition and Management of Different Alopecias
With increasing consumer awareness regarding hair transplantation, patients with alopecias of different etiologies will present to the hair transplant surgeon rather than to dermatologists or general practitioners. Some of these conditions, if transplanted, can result in failure. A guide for recognition and management of these patients is presented.
As hair restoration surgeons we are all aware of the role of DHT in miniaturization of the hair follicle and of finasteride’s effect in prevention and reversal of this process.