Androgenetic Alopecia (Male pattern Baldness)
Over 95% of men with hair loss are suffering from Androgenetic Alopecia (AGA). Typically some donor hair will be left at the back of the head, making it possible to consider hair transplant. Hair Transplant is the best option to fill-in the front hairline; and to thicken the front half of the scalp.
The scarring can be from injuries or after surgery.
Who are Good Candidate?
Anyone who has experienced permanent hair loss may be a candidate. Patients with light-colored hair and pale skin (as opposed to dark hair and light skin) and those with curly hair may appear to have a denser look, requiring fewer sessions. Expectation must be realistic. While hair transplants look very natural, the end result may not achieve the density or total coverage of that of a teenager. Results can also vary from patient to patient. The patients have to accept that a second procedure may be needed in the future to catch up with progressive loss of existing hairs, and to achieve the desired density.
Hong Kong SAR Department of Health described hair loss as Men's Most Painful. The Public Opinion Programme (POP) has conducted 3 studies in Hong Kong regarding the psychological and social impacts of Men Hair Loss.
Study 1 : The Psychological Effects of Hair Loss in MenDate of Study : June 1999
4420 men with hair loss were recruited into the study. Their ages were between 25 to 54. Their responses to questioning were as follows :
• 77.4% believed they look older than the actual age when without hair
• 48.6% believed that hair loss made them less attractive to the opposite sex
• 25.2% were consequently emotionally disturbed
• 25.0% lost self-confidence from hair loss
• 13.1% believed that hair loss had affect their employment opportunity
Study 2: Opinions of Single Female on Men with Hair LossDate of Study : Feb 2000
545 female were recruited into the study. Their ages were between 18 to 40 and responses to questioning were as follows :
• 91.9% agreed that hair loss can affect the appearance of men
• 84.8% considered men with hair loss look older than their actual ages
• 80.9% considered men appearance an important consideration in their choosing of partners
• 67.6% believed that hair loss will reduce men's attractiveness
• 47.1% claimed that men with hair loss lack confidence
• 37.7% reported that they mind about hair loss when selecting their male partners
Study 3 : Opinions of Employers upon Job Applicants with Hair LossDate of Study : 2005
In order to understand how hair loss can affect job application, Pfizer (US) in 2005 appointed JobsDB.com and POP to conduct 2 studies in Hong Kong. The results confirmed that hair loss has a negative impact upon job applicants. 113 employer in Hong Kong were recruited in the study. Their response to questioning were as follows :
• 80% of employers agreed that applicants with hair loss look older
• 43% of employers would not employ hair loss applicants for frontline customer service
• 35% of employers expressed a negative opinion on applicants with hair loss
• 26% of employers indicated that they will not appoint applicants with hair loss to represent their companies as manager to attend important business meetings
Study 4 : Opinions of Job Applicants Regarding Hair Loss and Job InterviewDate of Study : 2005
500 Hong Kong residents over the age of 25 were recruited in the study. They all had a job interview within the last 3 years and concerned about their hair loss problem. Their response to questioning were as follows :
• 59% indicated that hair loss reduced their competitiveness;
• 56% believed hair loss adversely affected the first impression of the employers
• 47% believed that hair loss adversely affected their confidence during job interview
• 20% had given up the chance of job interview because of their hair loss
The Public Opinion Programme (POP) was established in June 1991 to collect and study public opinion on topics which could be of interest to academics, journalists, policy-makers, and the general public. At present the POP is under the Faculty of Social Sciences in the University of Hong Kong.
Address & Contact: University of Hong Kong - 5/F, Kennedy Town Centre, 23 Belcher's Rd, Kennedy Town, Hong Kong
Hotline: (852) 3921 2703
Surgical Plan & Hairline Design
Norwood Class II
Thinning in area 1 - Relatively easy job and welcomed by many small hair transplant centers as only a few hundreds grafts are needed. We do not recommend for those younger than 25. Further hair loss in area 2 will make the transplanted hair in area 1 stand out like horns, very difficult to repair. Can only be considered if:
• No family history of severe hair loss
• Willing to take medicine to slow down AGA
• Great psychological distress from hair loss
• Prepared to have further transplant to add on density
• Celebrities who must maintain a young look and accept the consequences
Norwood Class III Recommendations
Losing hair in area 1 and 2 - good candidates for hair transplant and with good result. First priority is just to fill in area 2, reserving some donor hair for future. Area 1 can easily be covered with the newly transplanted hair. (Pictures Below)
Norwood Class IV Recommendations
Losing hair in area 1, 2, and 3 - this is the best candidate for hair transplant and with the most obvious improvement. A higher density will be put into area 3 (the forelock) while lower density of 1-hair graft into area 2. The hair in forelock can be combed forward or backward, allows more flexibility in styling. (Pictures Below)
Norwood Class V Recommendations
Losing hair in area 1, 2, 3, and 4 - treatment is similar to Class VI except area 4 is the last priority. This area is only visible on nodding or bending, requiring a lower density, or not at all if not enough donor hair. Further session is optional. (Pictures Below)
Norwood Class VI Recommendations
Losing hair in area 1 to 5 / 5v - usually not enough donor hair to cover the entire area. There are 2 options:
• To fill in area 2, 3, 4 to look good in the front. This is suitable for tall people.
• To fill in area 3, 4, 5, 5v to look good in the top. This is suitable for short people.
• The remaining areas can be left alone or filled in later. (Pictures Below)
Norwood Class VII Recommendations
Losing hair in area 1 to 6 - impossible to fill in all areas. You can still look good by adding some hair into the forelock Area 3. (Pictures Below)
Vertex Variant Recommendations
This group loses hair in the crown (area 5v, 5, 4) and retains the hairline (area 2, 3). Hair can be transplanted into area 4 and 5 to achieve good coverage.(Pictures Below)
The 3 Reasons of Receding Hairline
• Androgenetic Alopecia, also known as Male Pattern baldness
• Born with a high +/- large forehead
• After surgery
The 4 Patterns1. M Shaped - Receding Apex
2. Receding Hairline with Retained Forelock
3. Inverted U
4. Losing the Temporal Hairline As Well
Overall satisfactory rate is above 90% after restoring the empty areas with hair transplant. The number of follicular units required will br governed by the area and the density desired. When planned wisely, just 1,800 t0 2,400 grafts can achieve quite reasonable visual improvement. For those demanding a ver dense look, a second procedure mat be required for touch up. Usually in the second procedure the receded temporal hairlines on both sides are also repaired. Read More ...
Objective 1 : Re-frame the Face
• Your face is like a framed pictures, with the eyes being the focus.
• When you talk, the audience will look at your eyes to show interest and attention.
• With receded hairline, the upper frame is lost.
• Eye contact will unintentionally shift to your empty forehead - quite an embarrassment for both!
• The first priority in hair transplant is therefore to re-frame the faces so that eyes of audience are not drawn toward.
Objective 2 : Re-establishing The Lost Aesthetic Balance
• All the facial features such as eyes, nose, hairline, lips, are related to each other in proportions
• Dr. Marquardt quantified beauty scientifically by developing the "Perfect Face" Mask based on the Phi ratio 1 : 1.618
• The closer various facial features such as length of nose, position of eyes and length of chin correlate to this mask, the more aesthetically pleasing the face is
• This mask has been widely used in cosmetic surgery
• Hairline provides a complementary balance to the other facial structures
• Hair transplant can re-establish the aesthetic balance that was lost in the balding process
Objective 3 : Create an Age-Appropriate or Younger Look
• The loss of hair is associated with old age.
• The apparent loss of vital energy adversely affects employment and social interaction.
• By restoring a hairline and adding on hair to bald scalp, an age-appropriate or even younger look can be achieved.
Objective 4 : To Increase Facial Attractiveness
We judge by pattern recognition. The followings are basic criteria for facial attractiveness. If any one of these features is disturbed, the face will be distorted losing its attractiveness. By properly designing a hairline the following can be restored:
Da Vinci's Golden Rule of Thirds
In Western countries the proportion of beauty is Da Vinci's Golden Rule of Third.
In hairline design the Anterior-most point is set according to this rule. An ideal face should have equal vertical distance from:
• Lower 1/3 - Lowest point of hairline to Glabella
• Middle 1/3 - Glabella to base of nose
• Upper 1/3 - Base of nose to tip of chin
Four Other Rules
There are 4 Other Rules for Designing an Attractive Hairline
• The apex is directly above the outer corner of the eye
• The apex is not rounded
• Hairline when looked at from front is an inverted U
• Hairline when looked at from side is horizontal
Violation of the Golden Rule of Three
From our observation not everyone fits into this rule, especially the Asians. The 3 facial parts as mentioned do not have to be exactly equal to look good. There are still some rules regarding their proportion if to look good.
Example 1 : Smaller chin
• Most Chinese and some Caucasians have a smaller chin.
• A small chin gives an elegant and gentleman look.
• The hairline has to set lower accordingly.
Example 2 : Longer chin
• This type is seen mainly in the Caucasians
• Long chin induces a sporty and adventurous charactesr.
• The hairline has to be set higher accordingly.
Our New Golden Rule
• We have studies hundreds of pictures of "attractive" celebrities.
• After checking and comparing their facial proportions, we have developed a new Golden Rule.
• The result of our study, "the New Landmarks in Hairline Design", was presented in the ISHRS Annual Scientific Meeting (2009 Amsterdam, Netherland).
河童 or "river-child" are legendary creatures, a type of water sprite found in Japanese folklore (source of picture).
Kappa are typically depicted as roughly humanoid in form, and about the size of a child. Their most notable feature is an indentation on the top of their head that holds water; this is regarded as the source of their power. This cavity must be full whenever a kappa is away from the water; if it spills, the kappa will be unable to move (source of information)。
We recommend not to set the hairline too low, especially in young adults. There is always a risk of progressive hair loss extending to the crown. If the patient do not have adequate donor hair to cover the extensive bald area, they will end up with a rim of hair in the front, the appearance of a Kappa.
The primary aim of hair transplant is to good good, not just the transfer of hair from one region to another. Hair tansplant has gained popularity in the last few years. Consequently we are facing with an increasing demand for repairing work. Many patients are not happy with their previous transplant, and want us to do something.
Unfortunately correcting a poorly placed hairline is always impossible. The only remedy is to do it right in the first place. Here we have some of these examples referred to our center for repair.
Example 1 : Position of the hairline was reasonable, but the density was too low. Also the hairline was too rigid and orderly to be natural
Remedy： Randomly add on density in front of and amongst the existing hairs
Example 3 : Not enough grafts to fill in the center behind the hairline, creating the look of a Kappa
Remedy： Simply add on the density
Example 5 : Asymmetry in the hairline - the right side is higher than the left by 2cm.
Remedy： Unable to correct - lower the right by 1cm may improve.
Example 7 : The typical 'Corn Rows" appearance, when minigrafts instead of follicular units were used. The insertion was too orderly.
Remedy ： Put some 1-hair FU in front, and add more grafts in between.
Example 2 : The new apex was too rounded. The transplanted hairs did not match the existing ones in angles and directions.
Remedy： Punch out the unwanted transplanted hairs and recycled, will leave scars.
Example 4 : There was inadequate density of grafts behind the narrow hairline.
Remedy： Add more grafts in the empty area.
Example 6 : Difficult to style the hair as the grafts were inserted perpendicularly. Correct angle should be 35-45°.
Example 8 : Another typical example of the "Corn Rows" appearance. The pattern is more obvious on cutting short the hair.
Remedy ： Add grafts in between inorderly to be more natural looking.