why is Hair fall seen only in the top area of the head and not on the sides?

Concept of Donor area.

why is Hair fall seen only in the top area of the head and not on the sides? 

Answer to this question is very fundamental in understanding why hair transplant is a successful strategy to get your hair back. Let’s talk about anatomy and a little bit of pharmacology.If we do a microscopic and pharmacologic analysis of hair root We find that there are DHT receptors which are present alongside every hair root. Distribution of DHT receptor is determined genetically and varies from individual to individual. DHT receptor is present in high concentrations on the roots present on top of the head as compared to the concentration we find on the sides and back of the scalp. The affinity of the receptors to circulating DHT also varies from person to person according to the genes. Circulating testosterone is converted to dihydrotestosterone which is more potent in its action as compared to Testosterone. Dihydrotestosterone when comes in contact with DHT receptors leads to the destruction of vessels surrounding the hair root. This chronic contraction of blood vessels leads to decrease in blood supply to the concerned hair root further leading to its miniaturization over time. Miniaturized hair follicles eventually Stop growing and it leads to permanent baldness in the concerned area. As explained earlier DHT receptor is present in a lesser number and is less potent in the back and sides of the head.
So we have concluded so far that the problem lies with the roots and not with the skin. Henceforth when we transfer hair follicles from the back of the head to the front bald area, these hair follicles behave in the same way as they were in their original site i.e donor area. Answer to this question is very fundamental in understanding why hair transplant is a successful strategy to get your hair back. Let’s talk about anatomy and a little bit of pharmacology.If we do a microscopic and pharmacologic analysis of hair root We find that there are DHT receptors which are present alongside every hair root. Distribution of  DHT receptor is determined genetically and varies from individual to individual. DHT receptor is present in high concentrations on the roots present on top of the head as compared to the concentration we find on the sides and back of the scalp. The affinity of the receptors to circulating DHT also varies from person to person according to the genes. Circulating testosterone is converted to dihydrotestosterone which is more potent in its action as compared to Testosterone. Dihydrotestosterone when comes in contact with DHT receptors leads to the destruction of vessels surrounding the hair root. This chronic contraction of blood vessels leads to decrease in blood supply to the concerned hair root further leading to its miniaturization over time. Miniaturized hair follicles eventually Stop growing and it leads to permanent baldness in the concerned area. As explained earlier DHT receptor is present in a lesser number and is less potent in the back and sides of the head.

So we have concluded so far that the problem lies with the roots and not with the skin. Henceforth in hair transplant  when we transfer hair follicles from the back of the head to the front bald area, these hair follicles behave in the same way as they were in their original site i.e donor area. 

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