Retrograde alopecia is more common than possibly realised; it can be minor and inconsequential to aggressive and progressive over time. The area retrograde alopecia is most common around the ear and down the sides of the neck, then across the nape of the neck; common sign is finer, wispy hair and a lower density to the hair above. It is common as we age, especially the nape of the neck shows greater signs of retrograde alopecia as the quality of hair deteriorates as it rises up from the nape into the back of the head.
If the retrograde alopecia rises to far into the traditional hair transplant donor safe zone it can create a problem when the doctor is looking to harvest the donor hair from the area. Retrograde Alopecia does not necessarily reject someone from being a hair transplant candidate but it will place limitations on the traditional donor area and the number of hairs available.
The FUT hair transplant technique is less affected by retrograde alopecia because the extraction zone is localised to a relatively thin strip around the sides and back known as the occipital bone. But the FUE technique relies on a wider zone to remove the follicular units from, as the zone is only limited by where the hair around the back and sides ceases it is important to calculate the real safe zone.
Removing potentially weak hair to reach the required graft numbers to treat the hair loss surface area could result in a poor result, either with the hair not regrowing or falling out at a later date. Shaving the donor area and inspecting under magnification before performing the hair transplant can identify the level of miniaturisation and how far in to the donor area retrograde alopecia has progressed.
Hair should not be removed directly adjacent to the area of miniaturisation just in case the alopecia progresses; good donor management is vital to a successful hair transplant result. When accessing the donor safe zone and calculating the potential total number of grafts that are available, then it can be assessed against the surface to treat now and as the surface expands whether a hair transplant is suitable.