Hair Density – Maintaining and Maximising
Maintaining and maximising hair density is achieved by taking medical treatment and this allows the patient to be on the front-foot by controlling the AGA (androgenetic alopecia) process. The mainstay of medical treatment remains 5-alpha reductase inhibitors that reduce the formation of DHT with less binding of DHT to Androgen Receptors (AR) and reversal of the miniaturisation process of follicle units. This can only be achieved by taking the medications long term and continuously. If follicles with Androgen Receptors allow to miniaturise beyond a certain critical point, the Arrector Pilli muscle detaches and this is the point of “no return” for a follicle unit. The reason for this is that Epidermal Stem Cells are delivered to the Bulge Area of a hair follicle via the blood supply of the Arrector Pilli muscle (Sinclair et al), so once the Arrector Pilli muscle has detached from the miniaturised follicle it can no longer be salvaged or “turned around” and that follicle unit is lost forever. Without medical treatment those who undergo hair transplant surgery merely “tread water” because existing follicles with AR will continue to miniaturise and disappear over time despite adding new hair follicles devoid of AR from the SDA (safe donor area) – new follicles are added but existing old follicles are disappearing.
Effects of not taking medical treatment
It is important to understand that hair loss needs to be treated. Even if an individual chooses to undergo hair transplant surgery he/she will still need to take a set of treatments post-op. The total Hair Mass Index (HMI) or hair volume will increase after the surgery but return to what it was before or even worse if medication is not taken as the miniaturization process continues with regard to non-transplanted hair. The aesthetic effect will not be as good as it would otherwise should the patient not take medical treatment long term.
In addition to 5-alpha reductase inhibitors, products such as ketoconazole shampoo, derma-roller, low level light therapy, Vitamins, Serenoa repens (Saw Palmetto), minoxidil will further amplify the effect of increased Hair Mass Index (hair mass volume). For a list of non-surgical treatments click here.
Importance of Hair Shaft Calibre
Essentially the medical treatment net effect in the end is to maximize hair shaft calibre of hairs affected by AGA. This is mostly achieved by lengthening the Anagen (Growth) Phase of hair follicles. Hair shaft calibre is the most critical factor in increasing or decreasing hair mass index (HMI). For every 10 microns that a hair shaft increases or decrease in diameter, there is a 36% volume effect either way. So, in the end it is not about the “number” of hair follicles or hairs but the average calibre of hair shafts. The cumulative effect of an increase or decrease in hair shaft calibre (hair mass index) is enormous and makes the difference between hair with volume that provides good scalp cover versus hair with poor volume (low calibre hair shafts) that does not adequately cover the scalp allowing the reflection of light to be seen from the scalp creating the appearance of thinning hair cover or balding areas.