Author: Dr. William Rassman

Hi,
Recently (past year) I have noticed that my hair is thinning all over the top of my head, even on the sdies too (less noticable, because of angle to lights). I have been rather stressed recently (working long hours at wierd times), and have also had a knee reconstruction. The hair that remains on the top my head is still fairly dense, and shows no sign of miniturization (colour loss or weakness). Assuming my hair is falling out due to stress, how long do I have to become unstressed before this hair is permanently lost?

If I am going bald, assuming I have 90cm square of bald patch, how many grafts will i need to get to totally cover my scalp when i want my hair about 1-2cms long (dry).?

Also, what would be the theoretical maximum amount of grafts i could put per centimetre of scalp?

If you are a woman and stress is the cause of the hair loss, it may reverse after the hair has gone through a telogen cycle (6-8 months). The surgery you had certainly adds stress. If you are a man, you should not be experiencing hair loss around the back and sides unless you have some disease going on like Diffuse Unpatterned Alopecia (DUPA).

With regard to estimating the need for grafts, all I can say is that the ‘art’ is not mathematical. But if you want numbers, the normal hair density is 1250 hairs per square inch. Generally (depending upon your hair color, characteristics and thickness of the hair shaft) you need less than half of that number to get back a normal ‘appearing’ density (625 hairs per square inch or about 300 follicular units per square inch assuming that your density is normal). People with low contrast hair to skin color (blonde on blonde) get away with less hair to ‘look’ normal, but people with high contrast hair to skin color (black hair on white skin) need to get closer to half of the original density. The maximum number of grafts into an area of the scalp in a single session, could run as high as half of the original density and some doctors claim that they do this, but that is rarely practical or needed in most people and all of the grafts packed together like that rarely grow.

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I am just 15 and i am male. About 3 years ago i got nits and bought some conditioner for it. My scalp reacted with it and i got dandruff. My peers teased me about my dandruff and i started frantically rubbing my hair to get rid of it. When i was 14 it turned into pulling hair from the very centre of my scalp. i didnt want to pull my hair and get bald but i had an urge and got satisfaction out of pulling. i have now got a small circle of baldness on my scalp and have managed to stop pulling from there but now im pulling from the back of my neck and behind my ears and it is thinning out there. I require help and advice and want to know:if i leave it will it grow back to normal?

This condition is called trichotillomania, which is an impulse disorder characterized by the urge of pulling out hair from scalp, eyelashes, eyebrows, beard, nose, pubic area, or any other area in the body. It is most often related to obsessive-compulsive disorders. Surgical treatments for hair restoration are usually not indicated, and the best treatment would be through psychotherapy and behavioral treatment. You should be seen and treated by a psychiatrist. If you can stop pulling hair, it will usually grow back in a few months with no further treatments, but if you have stopped pulling out your hair and the hair does not return, then transplants are a relatively fool proof way of handing it provided that you do not go back to pucking out the hair again and again.

Dr. Richard Shiell wrote the following about this disease: “By far the most common of patients with this disease are children of both sexes and as trichotillomania is an OCD, where stress seems to play a role, most of the kids just “grow out of it” with no lasting problems. Success rate very high (probably over 90 %)

Some do not grow out of it however and a small percentage of the females go on to be chronic pluckers. They associate the plucking with episodes of stress but I do not know if this has been verified scientifically. Most of the cases I see fall into this category and have plucked each hair so many times that the follicles in the patch cease to grow somewhere along the line. In other cases, not so long standing, the hair is short , vellus-like and snowy white in the plucked area. It is this group of women who acknowledge the plucking (past or present) and who are seeking help that you will have some success after transplantation. I cannot give you a figure for success as I have lost contact with all of these patients over the years. Psychologists tell me that medication will assist those members of this group who find it difficult to refrain from plucking.”