Being situated in the Sikh heartland my practice is geographically favourable to receiving the largest number of cases of traction alopecia due to tying a tight top knot mostly seen in Sikh boys and men and referred to as Sikh pattern traction alopecia.
I get a lot of people with androgenetic alopecia comparing their results, timelines and long term preservation of hair transplant result with or without medication to that with Sikh pattern traction alopecia on my youtube channel.
One must remember, that the causation, the quality of donor hair, the quality of the recipient area, the effect of DHT on both forms of baldness, the differing aims and objectives of each entity individually, are worlds apart.
So what sets this group of baldness apart?
1. It is due to mechanical forces and not due to genetic predisposition or change in hormonal equilibrium.
2. There is an abrupt transition between normal hair and the bald area which can be linear and dramatic unlike in androgenetic alopecia where it is gradual, feathered and often inconspicuous.
3. In traction alopecia, there is a variable degree of scarring in the dermis and some in the sub-dermal region as well.
4. The scalp donor may be involved in traction alopecia and this may restrict availability of good quality grafts and hence coverage may not be optimal even for a small area, making it a tough proposition to produce a happy outcome.
5. The scalp donor may have a change in hair direction due to constant pull which may lead to technical difficulty in harvesting of grafts. This is never seen in androgenic alopecia.
6. Since DHT is not incriminated in the causation, DHT blockers like oral Finasteride and Dutasteride are not needed unless ofcourse there is co-existing androgenetic alopecia.
7. When thinning starts due to traction alopecia, it can very rarely be reversed.
Traction alopecia has only one cure to achieve a natural hairline when a bald patch sets in- surgical hair restoration or a hair transplant in lay terms.
8. Traction alopecia occurs in young Sikh men and in women of African descent.
Both have very high expectations which can be irrational at times. They contrast planted density with native density which is very high. There is absolutely no thinning of other hair not involved in traction alopecia. So their reference point is of a high quality. This is also true of some early cases of androgenetic alopecia but when we talk of extensive baldness, the goals are pretty much watered down and this group is rational and realistic about density of coverage possible. The hair density that may satisfy this coterie may be too low for a person with Sikh pattern traction alopecia. What you can deliver and what is expected by the client can be aligned through a minor touch up after 6 months of the first procedure so there is no waste of time and the patient achieves his full result at the 12 month mark on the timeline.
9. Pure traction alopecia will not progress in time, unlike androgenetic alopecia.
That is unless there is no concomitant androgenetic alopecia co-existing or developing later in age.
10. Very high densities can be given in pure traction alopecia in one or 2 sessions since there is no fear of progression of baldness and no need to preserve grafts for future use.