Είχα μιλήσει παλιότερα για την retrograde alopecia, η ΑΑ των άκρων (ο tasos33 θα το θυμάται). Υπάρχουν πολλά είδη AA που προσβάλλουν την δότρια περιοχή είτε στα άκρα (πάνω από το σβέρκο, αυτιά - retrograde alopecia) ή πιο βαριές περιπτώσεις όπως η DUPA (διάχυτη αραίωση αλλά
και στην δότρια περιοχή) αλλά και η senile alopecia (που είναι πρακτικά μια ομοιόμορφη αραίωση με thinning και συναντάται στους ηλικιωμένους κυρίως, από εκεί και το όνομα).
Το σημαντικό σε όλες αυτές περιπτώσεις είναι να θυμόμαστε ότι όταν η πλάγια ή πίσω περιοχή έχει τέτοιου είδους αραίωση η περιοχή ΔΕΝ ενδεικνυται για μμ, όχι γιατί θα επιβαρυνθεί ή θα αραιώσει περαιτέρω (που είναι και αυτό ένα πρόβλημα),
αλλά γιατί σε τέτοιες περιπτώσεις τα μοσχεύματα δεν είναι σίγουρα και υπάρχει μεγάλη πιθανότητα να χαθούν. Παραθέτω αυτούσια και την άποψη του Dr. Konior για το θέμα της senile alopecia (όπου με ένα χαρακτηριστικό παράδειγμα δείχνει πως επηρεάζει την λήπτρια).
"Let me clarify that the observation of miniaturized hair within the donor region is not uncommon in many of the patients I examine during consultation; however, the proportion of miniaturized hair versus non-miniaturized hair does vary widely. Unlike pattern loss, where an entire zone will experience progressive miniaturization – thereby leading to the appearance of a balding – miniaturization observed within the donor area tends to be sporadic. The significance of this type of sporadic miniaturization can vary widely from person to person and the occasional detection of donor site miniaturization does not mean cosmetic devastation for every potential or former hair restoration patient. However, this phenomenon must be recognized and appreciated by all potential patients since it can affect the end result. Fortunately, however, the end result will not be adversely affected to any significant degree for the great majority of patients since the “aging” process of individual hairs within the grafts will occur sporadically just as it occurs sporadically within the donor site.
This reminds me of a conversation I had many years ago with one of the all time pioneers of surgical hair restoration. Remember that there was once a time when the primary method of surgical restoration available was “plug” grafting. This particular physician, just like many others during that time period, had his hairline restored with standard 4 mm plugs many years earlier. Despite having what was considered at the time to be a very good result, he still had the distinct appearance of plugginess along his hairline. Years later his hairline appeared to look much better and I asked him if he had undergone any additional procedure to soften the old plugs. He indicated to me that his improved look was a result of sporadic miniaturization within the old plugs – not from additional surgery. He also made it clear that he was experiencing miniaturization in his donor site and he was thankful for it since it helped to soften the contrast of his former too-dense plugs. Because of the randomness of the miniaturization process, both his donor site and his recipient site were thinning in proportion to one another, thereby leading to a balanced appearance between the donor site and the recipient site. This man, a leader of our field with well over 30 year’s experience, was very surprised to discover that the process of miniaturization was a real entity. Once again, although he did experience a density reduction, it was age appropriate and he continued to look natural.
Some members have suggested that this process should be detectable during consultation. However, information obtained during consultation, despite the highest of high-power magnification, is heavily determined by age. I would challenge anyone to examine an entire class of high school seniors and predict with great accuracy the primary factors associated with aging hair, i.e. who will bald, who will go gray and who will develop donor site thinning. However, our ability to predict the future for these parameters of aging hair will increase proportionately as we inspect the same men at their 10, 20, 30 and 40 year high school reunions. Age of presentation makes a huge difference in our ability to forecast the future and thereby recommend a sound surgical treatment plan.
Ultimately it will be the percentage of hairs in the donor area that experience miniaturization which will determine whether or not a cosmetically significant change has occurred. A 10% change will probably be insignificant, but a 40% change can be. It is difficult to definitively predict several decades ahead what may happen with respect to donor site hair miniaturization. My lack of a magical crystal ball for prognostication is why I typically advise young men to delay surgery until a reasonably mature age. I do believe that most patients with the potential to develop donor site miniaturization can be identified by the skilled practitioner. However, some will slip through the cracks as the element of time factors into the unpredictability of hair loss. Keep in mind that every class 7 patient had his day in the sun when no one on the planet could have found any trace of miniaturization in the area that would eventually convert into a virtual sea of baldness. Patient selection, patient examination and patient education are key."
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Dr. Ray Konior