What class are you now? Having retrograde alopecia with limited hair loss is unusual. We see it most commonly in individuals, who are headed to an NW6 or greater. Usually, we this retrograde alopecia when someone is already showing evidence that they are advancing to an NW6 or higher.
Retrograde alopecia is an interesting phenomenon. When a child is born, they usually have vellus hair all over their head. Most of the hair later turns into terminal hair everywhere except the lower part of the donor area, where we see retrograde alopecia. Often, only when a child advances beyond age 5 or 6 does this hair in the lower part of the donor area begin to change into terminal hair. Typically, this bottom part of the donor area is where we see retrograde alopecia occur. In other words, this region seems to be different physiologically or genetically than the other parts of the donor area. Anatomically in adult life retrograde alopecia will occur 2 or 3 cm below the location of the occipital protuberance and below.
The question is whether hair transplants happen in those experiencing retrograde alopecia. It happens all the time, but most commonly because the physician does not see retrograde alopecia on the horizon. Incidentally, the best predictor is to harvest from this area with FUE to look for a higher percentage of telogen hair. The hair in this area is already miniaturized compared to higher regions of the donor area, so miniaturization alone is not a great predictor. Only later in the hair loss process does this hair in the bottom of the donor area become markedly miniaturized. Thus, the next best predictor is to evaluate the recipient area to look for signs that a patient is advancing to an NW6. If the patient is progressing to an NW6, it is much safer to avoid harvesting from this region. The only reason to avoid this area in harvesting is that the patient will lose the grafts from this zone later in life because transplantation does not protect these follicles from their destiny, which is to fall out.
In strip surgery, it is inadvisable to harvest in this region because the area is highly prone to very wide scars, which do not respond favorably to scar revision. Only one clinic in the world commonly harvested here over the decades to obtain finer hair for the hairline. Their commercials run incessantly on TV and of course, they made many bad decisions over the years. All of these bad decisions led to a bad global reputation from which they will never recover. Whenever I saw a strip scar in this region, I could always predict the clinic source.
I call this part of the donor area, the "Minor Region". On average, there are 3062 follicular units (I prefer the term follicular groups) in the Minor Region. There are 12,333 follicular groups in the Major Region above the minor region. We should be able to take one-half of these groups for transplantation.
I prefer to leave the Minor Region until later in the transplant process. The rationale is straightforward and three-fold. First, this area is prone to retrograde alopecia. Second, this area is more likely to show white doting because many FUE patients prefer a "fade" shorter hair style in the donor area. Of course, we can solve any white doting with Scalp Micropigmentation (SMP). Third, the hair is finer in this region and will not provide as much hair volume or coverage because the volume is exponentially a function of hair diameter. If you double the hair diameter, you quadruple the hair volume.
Thus, you are a candidate for hair restoration provided you have the following:
1. Realistic goals
2. your family history does not predict an advanced degree of loss that will not allow you to meet your long-term goals
3. The remainder of you donor area has an acceptable density (average or higher than average density are preferable)
4. Your donor area cross sectional trichometery (CST) is average or greater. The CST is a measure of density and diameter
