Treatment Guideline Chart

Alopecia is an involuntary loss of hair usually in the scalp that may occur anywhere over the body.
Scarring alopecia is severe inflammation of the hair follicle result in irreversible damage.
Non-scarring alopecias are reversible.
Alopecia may  be abrupt or gradual in onset.
Most common causes include androgenic alopecia (male & female pattern baldness) & alopecia areata.
History should be reviewed for medications, severe diet restriction, vitamin A supplementation, thyroid symptoms, concomitant illness & stress factor.

Surgical Intervention

Hair Transplantation
  • Surgical option for androgenic alopecia and androgenic alopecia where hairs from the back and sides of the scalp are transplanted to balding areas in the front
    • Usually need 2-4 sessions depending on the number of grafts transplanted per session
    • Success depends on the viability of grafts harvested and inserted into areas with hair loss
    • Mini-grafts and micro-grafts with 2-4 follicles allows for a more natural looking result
  • Follicular unit transplantation (FUT) which is the standard technique in hair transplantation,  may be considered for both males and females with androgenic alopecia with sufficient donor hair
    • FUT may be combined with Finasteride to achieve a better clinical outcome
    • Indicated in patients with androgenic alopecia:
      • With fine or light hair
      • Who do not want to shave their head as needed while taking FU grafts
      • Who do not mind covering the linear scar with longer adjacent hair
      • For maximum donor yield without visible thinning of the donor area
  • Follicular unit extraction (FUE) involves removal of individual follicular units, one by one from the occipital area
    • Indicated for smaller graft numbers, in patients with thick hair, patients who want to wear a short occipital haircut or patients who do not want a linear scar, and in cases of tight occipital scalp elasticity
    • Associated with greater risk of follicle injury and impairment of graft viability
  • Can permanently improve androgenic alopecia by up to 3 stages on Norwood-Hamilton scale when performed by a skilled surgeon in suitable candidates with a good donor hair supply
  • Best long-term results are seen in patients with medically-controlled or spontaneously stabilized androgenic alopecia
  • Has limited aesthetic benefit for MPHL with Norwood/Hamilton stages I-II
  • Not optimal surgical candidate for FPHL with Ludwig I stage; best candidate are patients with Ludwig stage II with sufficient permanent donor hair available and no overlying diffuse telogen effluvium
Scalp Reduction (Alopecia Reduction Surgery)
  • Treatment option for male patients with hair loss at the back of the scalp
  • Area with hair loss is surgically removed and hair-bearing scalp is stretched to fill in the void left by the excised scalp
  • May be performed with hair transplantation or scalp expansion
  • Has limited aesthetic benefit for MPHL with Norwood/Hamilton stages I-III because of potential for scarring
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