Trichotillomania is an impulse control disorder sometimes linked/worsen by other issue like depression or stress. It is first improtant to make sure this habit is not going to happen again.
The chances of having permanent hair loss is high given that the hair has stayed thin now at the age of 28 when the pulling occured during teenage years. If the pulling of hair has only been stopped recently, there may be a small chance some of the hair pulled out may still grow back. Pulling of each hair may result in the actual hair bud (where the growth center is) being pulled out in which it is permanent.
Sometimes, the bud is not being pulled out if the shaft is broken. However if the trichotillomania is chronic, it is likely you would have lost some amount of hair permenantly. Given a year and if the hair doesnt grow back much, it is likely this is what you are going to have.
Permanent hair loss can be treated through hair transplant where we take the hair from the back of your scalp and transplant it in the thinned area. However, trichotillomania is absolutely contraindicted to hair transplant and you must be sure you have the issue under control. If not all the transplanted hair will be wasted and there may not be any point doing it.
Otherwise hair transplant would usually be very highly successful in the rate of 97-98% here in the absence of any other medical illnesses and scalp diseases.
At the end of the day, you will have to seek the right doctor and someone who have years of experience dealing with hair and will give you the right advise. Hope that helps.
