Hair Loss Cure 2020

I will update this post with more body hair transplant (BHT) megasession results as I get feedback. However, before you consider body hair transplants to the scalp, you need to be aware of their major limitations.

Body Hair Transplant Limitations

The growth rate of transplanted body hair on the scalp is very unreliable. You should go in with the expectation that a lot of grafts will be wasted and never take.
Other than beard hair, most body hair is far thinner than scalp hair.
The cost of a body hair transplant procedure is significantly higher than the cost of a FUE or FUT hair transplant. The body hair extraction process is more labor intensive and is susceptible to higher transection rates.
You can get some scarring in the body area from where the grafts are removed. Especially if the surgeon is inexperienced. Minor hyperpigmentation or hypopigmentation is always possible.
The body hair may stand out from your scalp hair in terms of curliness, length and overall texture. The growth cycle of body hair also differs significantly from scalp hair.

Having said all the above, I have seen a large number of impressive body hair transplant before and after results over the years. I have long wanted to present a few successful megasession BHT cases, but delayed till now.

I was reminded of this subject when on a recent BTT show chat, a person named “Robert Hellner” proclaimed that he was delighted with his 6,500 graft BHT procedure. All of his grafts came from his beard.

Body Hair Type and Anagen Duration

Different types of body hair have different anagen growth phase duration. Healthy scalp hair has an anagen phase that lasts from 2-6 years. Most types of body hair have a significantly shorter duration anagen phase. The below table and image are from the following paper.

Body Hair Type	Anagen Duration	Anagen Percentage	Telogen Duration
Scalp	2-6 years	85	3-4 months
Beard	1 year	70	10 weeks
Mustache	16 weeks	65	6 weeks
Trunk	16 weeks	30	12 weeks
Axillae	16 weeks	30	12 weeks
Pubic	16 weeks	30	12 weeks
Legs	16 weeks	20	24 weeks

Body Hair Transplant Result — Body hair transplants can lead to curlier hair.

Background

I covered the subject of body hair transplants a few times in the early years of this blog. When BHT became popular around 15 years ago, I was very excited. Like a lot of balding men, I have an excessive amount of body hair. At one point, I even thought that this is almost a hair loss cure for many men with excessive body hair.

However, later on, it became evident that for a majority of people, the results were not always guaranteed. According to most surgeons, only beard hair and chest hair represent suitable donor zones for body hair.

Some surgeons such as Dr. John Cole only recommend beard hair as good and reliable enough to transplant in sizable quantity. At the other extreme, some surgeons go all out and use almost all types of body hair (including armpit, back, pubic and thigh hair). Perhaps hoping that at least a portion of it grows with some kind of regularity? There are nowadays 100s of surgeons who perform body hair transplants.

On a humorous note, did you know that Jeff Bezos’ grandfather grew his butt hair on his thumb after a skin graft procedure? And the transplanted butt hair kept growing till he died. It even had to be shaved off the thumb regularly.

If a patient with insufficient scalp donor hair wants to also use body hair, most surgeons combine the two types of hair during a hair transplant procedure. The body hair usually acts as a filler, and is never implanted in the front of the scalp.

Body Hair Transplant Megasessions

In this post, I will try to collect some before and after photos and videos of patients who received BHT megasessions of close to 10,000 grafts (or more). Note that there are between 90,000 to 150,000 hairs on a human head.

The number varies depending on hair color and genetics. The permanent donor region of the scalp only has around 12,500 hairs (6,000 folliclar units) that are transplantable. One human scalp hair follicular unit (graft) can contain 1, 2, 3 or 4 hair follicles, with 2 being the most common. Most body hair grafts contain just one follicle.

Dr. Arvind Poswal

The global leader in BHT hair transplant procedures is probably Dr. Arvind Poswal of India. He has been performing them for almost 20 years. I previously covered his vast body hair transplant experience. Also see his year 2007 thread on BHT on Hairsite.

Dr. Poswal benefits from India’s vast 1.4 billion population, which includes a lot of men with excessive body hair. A number of other Indian hair transplant surgeons have become body hair transplant experts in recent years.

The same cannot be said when it comes to similarly populous neighboring China, where body hair transplants are not as common. Chest hair and back hair is extremely rare in East Asian men, while beard hair is often minimal. However, do note that even amongst East Asian genotypes, there are rare exceptions.

On Hairsite’s archives, you can see 200 before and after results of Dr. Poswal’s patients covering the years 2004-2009. Around one-third of these include some body hair. On his own website, Dr. Poswal’s before and after photos and videos are even more extensive:

Dr. Poswal’s patient photo gallery.
Dr. Poswal’s patient video gallery.

In all of his large cases where body hair is moved, the hair transplant involves a combination of both scalp hair and body hair. This is the norm for all surgeons. Dr. Poswal recently told me that he has even done some rare 10,000 graft BHT procedures across several separate sessions. If he sends me photos of any such megasession body hair transplants, I will add them here.

You can check out Dr. A’s Hair Restoration YouTube channel for more recent results.

Impressive BHT Results of 5,000-10,000 Grafts

An interesting 2013 case presentation from Dr. Venkataraman Mysore of India entailed 8,900 body hair grafts, of which none were beard hair. Moreover, the patient was 63 years old when he started, and he underwent 10 total BHT procedures! These included chest, abdomen, thigh, arm and back hairs in order of quantity.
Eugenix Hair Sciences of India seems to have become a world leading clinic when it comes to performing body hair to head hair transplants. One of their recent patients got 8,000 beard hair grafts moved to the scalp. See one of their lead surgeon Dr. Arika Bansal’s video overview of BHT below:

Watch this video on YouTube

Perhaps the earliest documented case of a BHT patient was Australian FUE pioneer Dr. Ray Woods’ patient “Roman”. Between 1998 and 2000, he received: 2000 donor head hair; 1500 beard hair; and 4,500 chest plus abdomen plus back hair. For a net total of 8,000 single follicular units, of which 6,000 were body hair.
Dr. Sanusi Umar of the US is among the world’s most experienced surgeons when it comes to BHT. On his YouTube channel, you can find cases going as far back as 2008, His latest body hair transplant cases involved over 6,000 grafts, including 4,500 from the beard. See his report from 2016 that analyzed 122 cases of body hair to scalp transplants that he performed from 2005-2011.
In my post on US-based Dr. Jeffrey Epstein, I showed a video of a patient with 3,000 back hairs moved to the scalp. It is worth watching in its entirety. Unfortunately, Dr. Epstein has recently become a bit less optimistic about the success rate of body hair transplants.

I originally wrote this post on the arrector pili muscle (APM) in 2017, with an update in 2020.

Recently, I discovered a 2021 video in which the semi-retired dermatologist Dr. Andrew Messenger of the UK makes some important claims. He thinks that current hair loss treatments mainly impact the hair cycle. They do not reverse miniaturization, and he presents proof of this phenomenon.

Moreover, he theorizes that the structural changes in miniaturized hair follicles are perhaps more profound that previously foreseen. In particular, the irreversible destruction of the arrector pili muscle and subsequent fat infiltration. He presents an image from Dr. Rodney Sinclair’s 2014 paper on this subject, which I discussed in one of my past updates further below.

However, I am skeptical about the irreversibility of hair regrowth once the APM is beyond repair. It seems like Dr. Ralf Paus in the second half of the above video is also optimistic about the potential reversal of miniaturized hairs via a number of treatments.

I am especially curious as to how hair transplants on people with extensive Norwood 5-6 level balding work so well (since arrector pili muscles throughout their scalp are destroyed). Even body hair to scalp transplants often work well (especially beard hair). Can body hair follicles that are moved to the scalp help reinvigorate dead arrector pili muscles? Or can you actually move arrector pili muscles from the body to the scalp?

Also of interest, there are quite a few spectacular male-to-female transition hair growth results that are solely credited to medications such as Dutasteride, Spironolactone and Estrogen.

Please see the section titled “My Points of Contention” at the bottom of this post, where I elaborate further on these arguments. I have e-mailed both doctors to see if they have any further feedback.

Update: August 7, 2020

Goosebumps, the Sympathetic Nervous System and Hair Growth

Yesterday, Taiwanese and US researchers published an important paper titled: “Cell Types Promoting Goosebumps Form a Niche to Regulate Hair Follicle Stem Cells.” The work was led by Dr. Sung-Jan Lin of National Taiwan University, in collaboration with researchers from Harvard University (US).

Arrector Pili Muscle and Goosebumps — Goosebumps, Arrector Pili Muscle and Hair Growth.

The scientists made some important discoveries in relation to the arrector pili muscle (APM), and the sympathetic nervous system. The APM maintains sympathetic innervation to hair follicle stem cells. (HFSCs) The sympathetic nerve activates HFSCs via synapse-like contacts and norepinephrine. An important quote:

“APMs are often lost in the scalp skin of people with androgenetic alopecia. It is possible that in such skin, loss of APMs leads to the loss of sympathetic nerves, making HFSCs more difficult to activate. Our results also suggest the potential of using selective β2 agonists to promote HFSC activation.”

Lin’s team found that the biological mechanism behind baldness in men is closely connected to the sympathetic nervous system. Hair follicle stem cells activate after receiving signals via what are known as ADRB2 receptors. Based on these findings, the researchers hope to develop small molecule drugs that can activate ADRB2 receptors as a means of regenerating hair.

Goose bumps are a sympathetic nerve response involving the contraction of tiny muscles all over our bodies. These arrector pili muscles causes hair to stand up straight on the skin when we are fearful and under threat. The scientists aim to ultimately control the muscle-nerve system that drives hair regeneration. A video of these findings is embedded below. It is quite something to see Dr. Lin Sung-jan being mobbed by the media.

Watch this video on YouTube

Jan 10, 2017

Androgenetic Alopecia: New insights into the role of the Arrector Pili Muscle

Several weeks ago, the arrector pili muscle got significant coverage in a few newspapers around the world. Famed Australian dermatologist Dr. Rodney Sinclair co-authored an important paper titled “The arrector pili muscle, the bridge between the follicular stem cell niche and the interfollicular epidermis” that was just published this month.

Dr. Sinclair has been involved in this area of hair loss research for a few years. See his 2014 paper titled: Beyond goosebumps: Does the arrector pili muscle have a role in hair loss? Also see the very interesting new insights on the APM section of his website. Australian newspapers were especially interested in this latest study and its findings as evidenced by articles such as this one and this one.

The Arrector Pili Muscle

Arrector pili muscles are small muscles attached to individual human hair follicles on both the scalp as well as body (so we have millions of these muscles throughout our bodies). Contraction of these muscles causes hairs to stand up, a phenomenon that is known as goosebumps. Therefore, the musculus arrector pili is often referred to as the goosebump muscle.

Every hair root is connected to the arrector pili. This smooth muscle contracts in response to signals from the “fight or flight” sympathetic nervous system.

Arrector Pili Muscle Degeneration and Hair Loss

In recent years, a few studies have come out that suggest a possible connection between the arrector pili muscle degenerating (where it gets replaced by fat) and hair loss due to the subsequent disconnection between various hair follicle stem cell populations. It is possible that an intact arrector pili muscle plays a crucial role in the maintenance of follicular integrity and stability.

However, there are many uncertainties about this theory that I discuss in the next section. It seems that while in alopecia areata (AA) patients the arrector pili muscle remains intact, this is not true in androgenetic alopecia (AGA) patients. Unfortunately, over 95 percent of balding men suffer from AGA. So this could be why it is much easier to grow back hair for people with AA compared to people with AGA.

However, the rate at which the arrector pili muscle degenerates and gets replaced by fat varies substantially between patients and between individual hairs on the same scalp. Some miniaturized vellus hairs in balding regions might even never lose most of their arrector pili muscle connection.

My Points of Contention

According to Dr. Sinclair’s own quote from a past paper, “It remains unclear whether arrector pili muscle regression is a cause or effect of permanent follicle miniaturization“. I think this is the crux of the issue surrounding this theory/hypothesis.
I am curious why hair that is transplanted from the back of a person’s scalp to the front grows so well if the arrector pili muscles in front have been destroyed? Surely the transplanted hair cannot just automatically regenerate the arrector pili muscle?
Related to the above, an important Japanese study from 2012 concludes that correctly transplanted hair can re-enable “connectivity and cooperation” with the arrector pili muscle and nerve system. In effect, it might be very possible to reactivate or regenerate the APM.
In Dr. Tsuji and his team’s groundbreaking technology “the transplanted primordium also forms connections with surrounding tissues (arrector pili muscle and nerves) and repeats normal hair cycles”.
There are 100s of online anecdotal reports with before and after photos of people regrowing long-lost hair in bald scalps. Miracle results are especially common in people undergoing male-to-female transition regimens. You can also find many reports of surprising hair regrowth in many old men who recently started taking dutasteride for enlarged prostate issues. And the Reddit result logs from people taking oral minoxidil are sometimes spectacular. Maybe they regenerated their arrector pili muscles; or maybe those muscles always remained intact in spite of severe AGA; or maybe one can regenerate hair without the need for having any intact arrector pili muscles?
It is unclear when exactly we have a point of no return where the arrector pili muscle is largely or entirely replaced by fat and hair stops growing (either as a cause or effect). It seems like there is significant variation depending on person and hair follicle. In many cases, the arrector pili might not be entirely degenerated and replaced by adipose tissue even in areas of the scalp where one has been bald for several decades. In such cases, subsequent hair and muscle regeneration could then be possible via something like dutasteride or finasteride.

Body Hair Transplants of 10,000 Grafts