Before considering a transplant, the type, cause, and stability of hair loss must be established. Surgery performed on a misdiagnosis can be both ineffective and harmful.

Assessment Steps

  • History: Family history, onset and speed of loss, medication use, diet, chronic conditions.
  • Physical exam: Pattern of loss (localized vs. diffuse), hairline status, signs of scalp inflammation or redness.
  • Trichoscopy (dermoscopy): Examination for microscopic signs like follicular miniaturization, yellow dots, and broken hairs.
  • Pull test: Used to gauge the severity of active shedding.
  • Blood work: May be ordered to rule out correctable causes such as thyroid dysfunction, low ferritin/iron, or vitamin D/B12 deficiency.
  • Biopsy: May be necessary in ambiguous or rare cases — particularly when scarring alopecia is suspected — for a definitive diagnosis.
Bottom line: Only stable, androgenetic cases with an adequate donor supply are good surgical candidates. Active autoimmune or inflammatory processes must be treated or controlled first.