Fundamentals of Artistic Hair Restoration: The Donor / Demand Ratio By Bernard Arocha, MD on March 17, 2015

When a patient first meets with Dr. Bernardino Arocha for a consultation at Arocha Hair Restoration, it is typical for the Dr. to spend time assessing not only how much hair loss has occurred but also how much hair remains on the scalp. If an artistic hair transplant is determined to be the best hair restoration approach for the patient, the healthy hair becomes very important.

Let's back up a little. The vast majority of hair loss in men is caused by male pattern baldness, also referred to as androgenic alopecia. Therefore, most hair loss in men can be blamed on heredity -- although we can't discount the many other possible reasons people lose their hair, including serious disease, reaction to certain medications and, in rare cases, stress and anxiety.

Those who experience male pattern baldness inherited hair follicles that are sensitive to Dihydrotestosterone (DHT), which is a derivative of testosterone. While the entire genetic process of male pattern baldness is still being studied, scientists do know that hair follicles that are sensitive to DHT must be exposed to the hormone for a prolonged period of time in order for the affected follicle to complete the miniaturization process. Likewise, when DHT is suppressed, hair follicles continue to thrive.

With proper intervention, this process can be slowed or even stopped if caught early enough. For instance, Finasteride, which is marketed as Propecia, has been shown to block the conversion of testosterone to DHT.

Without intervention, these hair follicles begin to miniaturize at a certain age (how old depends on genetics). Miniaturization shortens the lifespan of each hair follicle affected. Eventually, these affected follicles stop producing cosmetically acceptable hair.

But even on the scalps of those who experience male pattern baldness, not all hair follicles are sensitive to DHT. The hair on the sides and back of the scalp is not susceptible to DHT and these hair follicles can be transplanted to balding areas and remain for a lifetime.

As Dr. Arocha describes in the video posted below, the term used to describe the remaining hair follicles is "donor," and the term used that describes the area where the follicles are needed is "demand." Every patient has a donor / demand ratio, but it can be somewhat cruel. After all, the more follicles you need (demand), the fewer follicles you have the spare (donor).

"We look at how much miniaturization, or hair loss, has already occured and anticipate how much is likely to occur in the future," said Dr. Arocha. "Then we examine the donor area to check if there is any miniaturization taking place. If there is miniaturization in the donor area, we can anticipate that these donors may be susceptible to hair loss in the future and look elsewhere for donor follicles."

The onset of a receding hairline, including the temples and mid-anterior scalp, and thinning crown are signals that your hair may be sensitive to DHT and are beginning to experience male pattern baldness. Join the club -- you have something in common with about 50 percent of men!

You can expect that this pattern of hair loss may eventually progress into more apparent baldness throughout the entire top of the scalp. In the more advanced stages of male pattern baldness, a person will be left with a rim or "horseshoe" pattern of hair.

Anticipating this progression is an important element in planning an artistic hair restoration plan.

"We assess and develop a short-term and a long-term plan that takes into account how a patient's hair loss is likely to evolve over time," said Dr. Arocha. It is an important part of the planning process and should be considered along with other characteristics, such as density, coarseness, curl and donor/skin contrast."

To schedule a consultation with Dr. Arocha, call 888-723-4247.

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Arocha Hair Restoration

Since 2002, Bernardino A. Arocha, M.D. has been transforming lives through the power of hair restoration. With an artistic approach and a variety of procedures available, Arocha Hair Restoration has a track record of providing stunning results. Dr. Arocha is affiliated with prominent organizations with memberships that include:

  • Diplomate, American Board of Hair Restoration Surgery (ABHRS)
  • Fellow, International Society of Hair Restoration Surgery (ISHRS)
  • American Society of Hair Restoration Surgery (ASHRS)
  • American Academy of Cosmetic Surgery (AACS)

If you're ready for a full head of hair, we invite you to contact us with our form or call us at (713) 526-4247.

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