Retrograde Alopecia and Hair Transplant

Dear reader, if you find yourself reading this post, you are probably interested in learning more about a specific hair loss and how to find a solution for it. We are not going to talk about the well-known androgenic alopecia (AGA) but about a specific kind of alopecia, the retrograde alopecia, which differs from the previous one due to a different pattern.

The why and the how of hair loss are well-known. We are familiar with the fact that hair loss occurs in both sexes differently since we are not only genetically different but we also produce different types and quantities of hormones. In men the hormone that causes the alopecia is testosterone, even if the real cause is to be found in the relevance of this with the 5-alpha-reductase enzyme. When this enzyme binds with free testosterone, it creates the Dihydrotestosterone (DHT) hormone, which tends to weaken the hair until it miniaturizes it.

We speak, in fact, generally of androgenic alopecia, yet it takes different names according to the patients’ sexes and this affects them differently regarding the areas concerned.

What is retrogade alopecia?

The retrograde alopecia is perhaps one of the lesser known forms of androgenetic alopecia, probably because it interests only 5-10% of the people affected by AGA.

This form of alopecia is less known since it has less impact both visually and aesthetically if you are affected only by it. What characterizes this type of alopecia are the areas that are affected by it: the lower occipital area of ​​the scalp and the two parietal areas over the ears and sometimes even the sideburns.

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    What differs the retrograde alopecia from the aga?

    The substantial difference between retrograde alopecia and “classic” androgenetic alopecia (AGA) is given by the areas where the hair is miniaturized. This phenomenon, and the consequent shedding, starts from the base of the neck, proceeding upwards (for this reason, sometimes also called “vertical alopecia”) and/or in the two parietal areas around the ears. This mapping differs from that of AGA, where the fall starts from the front of the scalp, with the receding of the hairline and with the hair loss in the central part of the scalp up to the crown area.

    How to identity if you are affected by retrograde alopecia?

    Obviously this type of thinning is not as visible as that of the classic male pattern baldness: when we look in the mirror we are usually led to look at what is presented to us and above all to any thinning problems regarding the hairline. Unless someone else points out this back thinning, it is very difficult for us to pay attention to this eventuality.

    If we are particularly attentive to our hair both for personal and image reasons, and we always want to be sure of our appearance, it is advisable to periodically consult a dermatologist or a trichologist (a dermatologist  who had the opportunity to specifically study hair and all the problems connected to it) .

    The doctor in question, through a specific examination, trichoscopy, is able to examine the scalp in detail and look for miniaturized hairs in the different parts of the scalp.

    What to do if you have been diagnosed with retrograde alopecia

    The treatments to combat and, therefore, block this type of insidious alopecia, are exactly the same to combat and block the shedding in the upper part of the scalp, namely finasteride, dutasteride, minoxidil, LLLT(Low-level laser therapy) and PRP (Platelet-Rich Plasma).

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      Although these treatments would only give the possibility to halt the fall in those areas, also improving the visual appearance, they don’t represent a definitive cure (is a treatment not a cure). As it is well known, these types of treatments are temporary, and the benefits associated with them remain as long as they are used and end when we decide to suspend them: unfortunately we are not fighting against a virus, but against something which is rooted in us, genetically speaking, and for which there is no definitive cure.

      What are the problems of retrograde alopecia in the view of a transplant?

      Obviously, as happens for other forms of androgenic alopecia, the visual impact depends on the aggressiveness with which it affects the aforementioned areas. Nevertheless the big problem that retrograde alopecia brings with it in the patients, who want to undergo a hair transplant, is that it reduces the surface of the donor area ( the follicular units in this area are almost totally free from aga and, once transplanted, they carry this property with them).

      Should be clear that both zones involved in the retrograde alopecia are at the same time 2 very important zones of the donor area:

      1. the nape is the place where normally are harvested the biggest amount of the grafts to implant in the bold areas;
      2. the sides of the scalp, forward of the ears in the lateral temporal region, are normally used to rebuild the hairline (in these 2 parietal zones it’s possible to find the highest amount of single hair grafts).

      For what has been said so far when analyzing the scalp of a patient who intends to undergo a hair transplant, it is not enough to focus on the study of the front part of the scalp, the middle scalp, or the hair to get an idea of how alopecia itself could evolve.

      Analyzing also the miniaturization in the lower part of the neck is to be highlighted, this could be a clear sign of the beginning of retrograde alopecia, making the patient risk not being a good candidate for a possible transplant.

      We have also to consider that if someone is affected by retrograde alopecia and even if technically the transplant could be possible, in practice the patient would have no positive effect since the implanted hair would also be subject to loss, thus negating the result of the transplant itself.

      Strip or fue techniques for graft harvesting in a patient affected by retrograde alopecia?

      Since we now know what the characteristics of retrograde alopecia are, the way in which it affects the scalp and therefore what are the signals that characterise it and the possible treatments, we just have to analyze what could be the best way to intervene thinking about a possible transplant.

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        Since as we know the transplant is essentially composed of 2 parts, the extraction of the follicular units and the grafting of these in order to cover the bald areas, we could ask ourselves which is the best technique for the extraction of the follicular units: FUE or STRIP?

        The STRIP technique, even if we hear less and less of it, is still widely used because especially in very young people it is an excellent solution: extremely elastic skin, maximum number of follicular units removable from the cut skin flap and, with current techniques of plastic surgery, the scar is increasingly invisible.

        As we have said, the safe zone of the donor area represents that narrow part of the nape where the follicles tend to be less subject to AGA and, therefore, the area that, almost certainly, retrograde alopecia will never reach. For what has been said above, the STRIP technique would seem the best technique for extracting the follicular units in patients suffering from retrograde alopecia. If the FUE technique is used only and exclusively in the safe zone, the risk would be to have an overharvested area, that could be extremely visible and anesthetic, once the hair has grown back


        In general once you decide to undergo a hair transplant, before contacting a clinic it’s recommended to always contact an expert (dermatologist or trichologist) to find out if you are suffering from particular pathologies and be advised in the best way possible, on the opportunities offered by both treatments and surgery. These kinds of doctors can guide you in the right direction, avoiding subjecting you to home treatments or rumors, because every person is different and so are the treatments and reactions. Talking about the retrograde alopecia it’s advisable.

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