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Follicle Miniaturisation

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The hair follicle growth cycle consists of three phases: a growth phase (“anagen”), a transitional phase (“catagen”), and a resting phase (“telogen”). In susceptible hair follicles, the hormone dihydrotestosterone (DHT) can,over time, cause the growth phase of the hair cycle to become progressively shorter. As a result, the individual hairs produced by these follicles decrease in size (diameter and length) until they eventually disappear. This process is called “miniaturization.” It is the main mechanism in androgenetic alopecia (genetic balding).

In some areas of the scalp, most or all of the follicular units have the genetic predisposition to be immune to the effects of DHT. As a result, these areas might never become miniaturized. Thus, hair will remain on these parts of the scalp for the person’s entire life. This happens most often in the back and sides of the scalp, aptly known as the “permanent zone,” while the front and top of the scalp are the first areas to experience thinning and baldness.

It is due to this genetic resistance to DHT in the permanent zone that hair transplant surgery can be an effective treatment for hair loss. In a hair transplant, follicular units are removed from the permanent areas of the scalp and implanted into balding areas. Because of a phenomenon known as “donor dominance”, these transplanted follicular units retain their DHT-resistance even when transplanted into an area that was formerly populated by hair affected by genetic thinning. Once transplanted, the follicular units will continue to grow normal, non-miniaturized terminal hairs for the lifetime of the individual. Since hair in the permanent zone provides the donor hairs for use in surgical hair restoration, this region of the scalp is also referred to as the donor area.

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