Approach to Hair Transplantation in Advanced Grade Baldness by Follicular Unit Extraction: A Retrospective Analysis of 820 Cases

BACKGROUND: In advanced grade baldness (Norwood 5–7), hair restoration has been considered difficult due to the donor recipient area mismatch. In this article, we have given a comprehensive methodical approach to manage these cases. OBJECTIVE: To assess the outcome and challenges faced with follicular unit extraction (FUE) and to plan a successful management in advanced grade baldness in 820 cases of androgenic alopecia. MATERIALS AND METHODS: A retrospective analysis of 820 male patients with advanced grade of baldness (grade 5–7) treated by FUE. The patients were divided into five groups based on the extent of scalp coverage, for example, frontal coverage, frontal + mid-front coverage, vertex, full coverage, and frontal forelock only. The results were analyzed at 6, 9, 12, and 24 months. RESULTS: At 12 months, 94% patients were satisfied with the results, whereas 62% wanted another sitting for increasing the coverage area/density. CONCLUSION: Hair transplantation can give natural and aesthetic results even in advanced baldness. Beard and body hairs can be used to augment results in cases with limited donor supply. A mature hairline with an adequate density in a gradient, from front to back helps in achieving a satisfactory response even in extensive cases of advanced baldness.