Choosing to have hair restoration
surgery (HRS) is a major decision for most people. HRS will permanently
change your appearance to a more youthful look. A balding man rarely
conjures up the image of youth and vitality and that is what most
modern men are striving for today. For men who have not lost their
hair, this information will be of little value. But for those men
suffering from hair loss who want their hair restored, HRS is the
only permanent solution available for men today. HRS will restore
hair that will grow naturally and require styling and haircuts,
just like men who do not suffer from hair loss.
The first consultation with your hair restoration surgeon is critical
to success. A frank discussion of goals and treatment plans goes
a long way to achieving satisfying results.
The surgical treatment of hair loss can be broadly divided into
three main areas: hair transplantation, scalp reduction and scalp
flaps.
Hair transplantation is an
operation which takes hair from the
back of the head and moves it to the area of hair loss. The fringe
(back and sides) of hair on a balding scalp is known as donor dominant
hair which is the hair that will continue to grow throughout the
life of most men. The transplantation of this hair to a bald area
does not change its ability to grow. Donor dominance is the scientific
basis for the success of hair transplantation.
Candidates for HRS are those individuals with hair loss that have
sufficient donor hair from the fringe of the scalp to transplant
to the balding area. In the past, many bald patients were not suitable
candidates for HRS but modern techniques have advanced the art of
HRS so that many more men are candidates.
Hair transplantation surgery has improved
by leaps and bounds over
the past decade. The days of the "plugs and corn rows"
are gone and the age of single hair, micro and mini-grafting
has arrived. Through the use of the these variable-sized hair grafts,
along with new and improved instrumentation, the accomplished hair
transplantation surgeons can create a natural hair appearance that
is appropriate for each individual patient. Single-hair grafts have
the finest and softest appearance. Although they do not provide
much density, they do provide the critical soft hairline that is
the transition to thicker hair. Reconstructing a new hairline is
a skill requiring surgical as well as artistic skill. It is critically
important to get it right the first time and thus requires considerable
forethought and planning. Examining the hairline of a non-balding
person will show the presence of numerous single hairs in the very
frontal hairline. Micro-grafts are small grafts containing two to
three hairs
that are placed behind the hairline to provide a gradually increasing
hair density. Lastly, mini-grafts contain four or more hairs and are placed
well behind the hairline so that the single hair and micro-grafts
can blend naturally into the density provided by these larger grafts.
There is different terminology and techniques used by many surgeons.
New techniques naturally give rise to new terms. Although there
are variations in the techniques of individual surgeons, the combination
use of these grafting techniques provides the most natural and pleasing
results.
The side effects of hair transplantation surgery are relatively
minor consisting of mild pain and discomfort after the operation,
swelling which may move down to the eyes, and the formation of scabs
over the grafts which take approximately one week to resolve. Serious
problems of bleeding, scarring, and infection are rare. Modern hair
transplantation surgery is comfortable, predictable, and the results
are pleasing to most patients.
Hair loss, however, is a life-long
process. Most men will develop
male pattern baldness (due to male hormones) until approximately
40-45 years of age. After that, the aging process thins the entire
head of hair. Progressive hair loss, or the desire for more density,
will require more transplant procedures. Modern techniques, however,
allow HRS specialists to transplant larger number of grafts, greatly
reducing the number of procedures needed to complete the result.
Though humans no longer make use of hair for protection, heat retention,
or camouflage, it still remains a very important means by which
individuals display and are recognized. Appropriate appearance and
grooming are still very important in social organizations and in human relationships.
The human body contains approximately five million hair follicles
while the scalp (prior to any kind of hair loss) contains 100,000-150,000
hair follicles. Blondes have the greatest number of scalp follicles,
followed by brunettes. Those individuals with red hair have the fewest number
of scalp follicles. The normal growth rate of scalp hair is one-fourth
to one-half inch per month.
It is important to understand the normal hair growth cycle to understand
why hair loss occurs. The hair follicle is an anatomical structure
which evolved to produce and extrude (push out) a hair shaft. Hair
is made up of proteins called keratins. Human hair grows in a continuous
cyclic pattern of growth and rest known as the "hair growth
cycle." Three phases of the cycle exist: Anagen: growth phase;
Catagen: degradation phase; Telogen: resting phase. Periods of growth
(anagen) between two and eight years are followed by a brief period,
two to four weeks, in which the follicle is almost totally degraded
(catagen). The resting phase (telogen) then begins and lasts two
to four months. Shedding of the hair occurs only after the next
growth cycle (anagen) begins and a new hair shaft begins to emerge.
On average, 50-100 telogen hairs are shed every day. This is normal
hair loss and accounts for the hair loss seen every day in the shower
and with hair combing. These hairs will regrow. Not more than ten percent of the follicles are in the resting phase (telogen) at any
time. A variety of factors can affect the hair growth cycle and
cause temporary or permanent hair loss (alopecia) including medication,
radiation, chemotherapy, exposure to chemicals, hormonal and nutritional
factors, thyroid disease, generalized or local skin disease, and
stress.
Androgens (testosterone, dihydrotestosterone) are the most important
control factors of human hair growth. Androgens must be present
for the growth of beard, axillary (underarm), and pubic hair. Growth
of scalp hair is NOT androgen-dependent but androgens are necessary
for the development of male and female pattern hair loss.
It is estimated that 35 million men in the United States are affected
by androgenetic alopecia. "Andro" refers to the androgens
(testosterone, dihydrotestosterone) necessary to produce male
pattern
hair loss (MPHL). "Genetic" refers to the inherited gene
necessary for MPHL to occur. In men who develop MPHL the hair loss
may begin any time after puberty when blood levels of androgens
rise. The first change is usually recession in the temporal areas,
which is seen in 96 percent of mature Caucasian males, including
those men not destined to progress to further hair loss. Although
the density of hair in a given pattern of loss tends to diminish
with age, there is no way to predict what pattern of hair loss a
young man with early MPHL will eventually assume. In general, those
who begin losing hair in the second decade are those in whom the
hair loss will be the most severe. In some men, initial male
pattern
hair loss may be delayed until the late third to fourth decade.
It is generally recognized that men in their 20’s have a 20
percent incidence of MPHL, in their 30’s a 30 percent incidence
of MPHL, in their 40’s a 40 percent incidence of MPLH, etc.
Using these numbers one can see that a male in his 90’s has
a 90 percent chance of having some degree of MPHL.
Androgens (testosterone, dihydrotestosterone) are necessary for
the development of MPHL. The amount of androgens present does not
need to be greater than normal for MPHL to occur. If androgens are
present in normal amounts and the gene for hair loss is present,
male pattern hair loss will occur. Axillary (under arm) and pubic
hair are dependent on testosterone for growth. Beard growth and
male pattern hair loss are dependent on dihydrotestosterone (DHT).
Testosterone is converted to DHT by the enzyme, 5-reductase. Finasteride
(Propecia®) acts by blocking this enzyme and decreasing the
amount of DHT. Receptors exist on cells that bind androgens. These
receptors have the greatest affinity for DHT followed by testosterone,
estrogen, and progesterone. After binding to the receptor, DHT goes
into the cell and interacts with the nucleus of the cell altering
the production of protein by the DNA in the nucleus of the cell.
Ultimately, growth of the hair follicle ceases.
The hair growth cycle is affected in that the percentage of hairs
in the growth phase (anagen) and the duration of the growth phase
diminish resulting in shorter hairs. More hairs are in the resting
state (telogen) and these hairs are much more subject to loss with
the daily trauma of combing and washing. The hair shafts in MPHL
become progressively miniaturized (smaller in diameter and length)
with time. In men with MPHL all the hairs in an affected area may
eventually (but not necessarily) become involved in the process
and may, with time, cover the region with fine (vellus) hair. Pigment
(color) production is also terminated with miniaturization so the
fine hair becomes lighter in color. The lighter-colored miniaturized
hairs cause the area to first appear thin. Involved areas in men
can completely lose all follicles over time. MPHL is an inherited
condition and the gene can be inherited from either the mother or
father’s side. There is a common myth that inheritance is
only from the mother’s side. This is not true.
In summary, male pattern hair loss (Androgenetic Alopecia) is an
inherited condition manifested when androgens are present in normal
amounts. The gene can be inherited from the mother or father’s
side. The onset, rate, and severity of hair loss are unpredictable.
The severity increases with age and if the condition is present
it will be progressive and relentless.
If you are a woman with loss of
scalp hair, you should seek professional advice from a physician
hair restoration specialist.
In most cases, female hair loss
can be effectively treated.
If you are a woman who has started
to lose scalp hair, you are not alone if:
1. You are unpleasantly surprised
by the hair loss, and
2. You don’t understand why you are losing hair.
The patterns of hair loss in women
are not as easily recognizable as those in men.
Hair loss in men is likely to occur
primarily between late teenage years and age 40-50 in a generally
recognizable "male pattern" baldness known as androgenetic alopecia.
Men with male pattern hair loss may have an expectation of hair loss
if they have male relatives who lost hair in a recognizably male
pattern.
Unlike hair loss in men, female
scalp hair loss may commonly begin at any age through 50 or later,
may not have any obvious hereditary association, and may not occur
in a recognizable "female pattern alopecia" of diffuse thinning over
the top of the scalp. A woman who notices the beginning of hair loss
may not be sure if the loss is going to be temporary or permanent:
For example, if there has been a recent event such as
pregnancy or illness that may be associated with temporary hair
thinning. If you are a woman who is worried about loss of scalp hair, you
should consult a physician hair restoration specialist for an
evaluation and diagnosis.
Self-diagnosis is often
ineffective. Women tend to have less obvious patterns of hair loss
than men, and non-pattern types of hair loss are more frequent in
women than in men. Diagnosis of hair loss in a woman should be made
by a trained and experienced physician.
In women, as in men, the most likely
cause of scalp hair loss is androgenetic alopecia, an inherited
sensitivity to the effects of androgens (male hormones) on scalp
hair follicles. However, women with hair loss due to this cause
usually do not develop true baldness in the patterns that occur in
men. For example, women rarely develop the "cue-ball" appearance
often seen in male-pattern androgenetic alopecia.
Patterns of female androgenetic
alopecia can vary considerably in appearance.
Patterns that may occur include:
Diffuse thinning of hair over
the entire scalp, often with more noticeable thinning toward the
back of the scalp.
Diffuse thinning over the entire
scalp, with more noticeable thinning toward the front of the
scalp but not involving the frontal hairline.
Diffuse thinning over the entire
scalp, with more noticeable thinning toward the front of the
scalp, involving and sometimes breaching the frontal hairline.
Unlike the case for men, thinning
scalp hair in women due to androgenetic alopecia does not uniformly
grow smaller in diameter (miniaturize). Women with hair loss due to
androgenetic alopecia tend to have miniaturizing hairs of variable
diameter over all affected areas of the scalp. While miniaturizing
hairs are a feature of androgenetic alopecia, miniaturization may
also be associated with other causes and is not in itself a
diagnostic feature of androgenetic alopecia. In post-menopausal
women, for example, hair may begin to miniaturize and become
difficult to style. The precise diagnosis should be made by a
physician hair restoration specialist.
It is important to note that female
pattern hair loss can begin as early as the late teens to early 20s
in women who have experienced early puberty. If left untreated, this
hair loss associated with early puberty can progress to more
advanced hair loss.
In women, more often than in men, hair loss may be due to conditions
other than androgenetic alopecia. Some of the most common of these
causes are:
Trichotillomania — compulsive hair pulling.
Hair loss due to trichotillomania is typically patchy, as compulsive
hair pullers tend to concentrate the pulling in selected areas.
Hair loss due to this cause cannot be treated effectively until
the psychological or emotional reasons for trichotillomania are
effectively addressed.
Alopecia areata — a possibly autoimmune
disorder that causes patchy hair loss that can ranges from diffuse
thinning to extensive areas of baldness with "islands"
of retained hair. Medical examination is necessary to establish
a diagnosis.
Triangular alopecia — loss of hair in
the temporal areas that sometimes begins in childhood. Hair loss
may be complete, or a few fine, thin-diameter hairs may remain.
The cause of triangular alopecia is not known, but the condition
can be treated medically or surgically.
Scarring alopecia —hair loss due to scarring
of the scalp area. Scarring alopecia typically involves the top
of the scalp and occurs predominantly in women. The condition
frequently occurs in African-American women and is believed to
be associated with persistent tight braiding or "corn-rowing"
of scalp hair. A form of scarring alopecia also may occur in post-menopausal
women, associated with inflammation of hair follicles and subsequent
scarring.
Telogen effluvium — a common type of hair
loss caused when a large percentage of scalp hairs are shifted
into "shedding" phase. The causes of telogen effluvium
may be hormonal, nutritional, drug-associated, or stress-associated.
Loose-anagen syndrome — a condition occurring
primarily in fair-haired persons in which scalp hair sits loosely
in hair follicles and is easily extracted by combing or pulling.
The condition may appear in childhood, and may improve as the
person ages.
Only two hair restoration medications have been approved by the
FDA after testing for safety and efficacy in clinical trials. These
are the topical medication minoxidil (Rogaine®) and the orally
administered prescription medication finasteride (Propecia®).
Safety and efficacy information for these medications is clearly
stated, as required by the FDA in product information provided
with the product. Neither product “guarantees” to stop
hair loss or stimulate growth of new hair because hair loss can
be due to many causes that may or may not be treatable by the medications.
Finasteride (Propecia®) is available only by prescription from
a physician. While minoxidil (Rogaine®) is available as an over-the-counter
topical medication, both finasteride and minoxidil are most effective
when used as recommended by a physician hair restoration
specialist
after the cause of hair loss is correctly diagnosed.
Click here for more information on Cosmetic Surgery
Dr. Vincent
specializes in plastic and cosmetic surgery and his practice is located in
Ogden, Utah. Patients from the following cities and areas of Salt Lake City, West
Valley City, Provo, Sandy, Park City, Orem, Layton, Taylorsville, St. George,
Utah (UT) and Twin Falls, Idaho (ID) can conveniently schedule an appointment
with our Ogden, Utah office.
