Hair restoration procedures and treatments can reverse
the appearance of aging associated with hair loss and restore a more youthful
look—for women, men and people of all racial and ethnic backgrounds.
Dermatologists and dermatologic surgeons can help each patient with hair loss
select an appropriate hair restoration treatment.
Reasons for Hair Loss
By far the
most common reason for loss of scalp hair is androgenetic alopecia. About 50
million men in the U.S. have scalp hair loss due to male-pattern androgenetic
alopecia (male-pattern baldness). More than 30 million women in the U.S. have
scalp hair loss due to female-pattern baldness. Androgenetic alopecia is an
inherited condition—that is, it "runs in the family."
Male and Female Patterns of Hair Loss
The typical hair-loss patterns of male-pattern and female-pattern
androgenetic alopecia are somewhat different. In men the initial hair
loss—perhaps as early as age 20 to 30—may be in the frontal and temple areas of
the scalp. When hair loss begins early it tends to continue and become more
severe—the "cue ball" pattern shown in this photo:
Severe male-pattern androgenetic
alopecia.
(Photos in this
discussion are used with permission of the American Academy of
Dermatology
National Library of Dermatologic Teaching Slides)
Female-pattern androgenetic alopecia often appears a bit later in life
than male-pattern androgenetic alopecia—age 25 to 45. About one in four women
experience female-pattern androgenetic alopecia. A woman may notice increased
hair loss in association with events that influence hormonal patterns: use of
birth control pills, menstruation, pregnancy, and menopause. The hair-loss
pattern of female-pattern androgenetic alopecia tends to be thinning of hair
rather than complete loss of hair. Female hair loss is likely to begin in the
center of the scalp rather than at the front and temples as seen in men. A
typical pattern of hair loss in female-pattern androgenetic alopecia is shown in
this photo:
Female-pattern androgenetic alopecia;
thinning hair in the central part of the scalp.
The
"cue ball" complete loss of hair that occurs in many men rarely occurs in
women.
Male-pattern and female-pattern androgenetic alopecia are not only very
common, they are very treatable. Both surgical and medical treatments have high
rates of success. The medical treatments are more effective in treating crown
hair loss than frontal hair loss.
Other Reasons for Hair Loss
Other
causes of hair loss are not necessarily associated with aging but are rather due
to disease and scalp injury. While they are much less common than androgenetic
alopecia it may be important to know about them if your hair loss may be due to
a cause other than androgenetic alopecia. Causes include various acute and
chronic diseases, nutritional deficiency, medications, radiation, and improper
hair treatments.
The
common and most of the less common causes of hair loss can be treated
successfully by a variety of hair restoration procedures.
Surgical Hair Restoration
Hair Transplantation
Hair
transplantation is the best known method of surgical hair restoration and also
the method of surgical hair restoration most often used to treat hair loss due
to androgenetic alopecia. Sometimes hair transplantation is combined with other
surgical techniques or medical treatment when deemed appropriate by the
dermatologic surgeon.
Great
refinements continue to be made in the techniques of hair transplantation. The
emphasis of hair transplantation is on creating the most natural appearance
possible by using techniques of single-hair grafts and micro- or mini-grafts
that contain two to four hairs. With such techniques it is possible to create a
hair density pattern and hairline that looks completely natural. The hair
transplant "plugs" of multiple hairs are rarely if ever used today.
Donor
hair for transplantation is taken from sites that have hair of the appropriate
color and texture, such as hair found at the back of the neck. Transplanting is
typically done in a series of sessions over a period of several months. The
areas to be treated and the anticipated outcome are discussed between the
patient and dermatologic surgeon before transplanting begins. Transplantation
also is preceded by a medical and physical examination, and examination of the
scalp to determine the cause of hair loss. While androgenetic alopecia is the
most common cause, other causes need to be ruled out by scalp examination. Hair
loss due to other causes may be treatable by transplantation, but the surgical
approach may be somewhat varied.
Hair
transplantation is effective in treating androgenetic alopecia in men and women
of all racial and ethnic backgrounds. Some differences in hair color, texture
and curl may require slight variations in transplantation technique or in
placement of grafts. For example, East Asians have hair of lower overall density
but greater individual hair thickness than Caucasians; although hair density is
less than in Caucasians, the greater thickness of individual hairs in East
Asians gives an appearance of luxuriantly dense hair growth. African-Americans
have hair with more curl than the hair of Caucasians; as in the case of East
Asians, the hair with more curl gives an appearance of greater hair density.
Placement of grafts in hair transplantation takes these esthetic features into
account.
Postoperative effects of hair transplantation are usually limited to mild
to moderate discomfort, swelling and scab formation over graft sites.
Hair
transplantation may have to be repeated later in life if there is progressive
loss of hair due to androgenetic alopecia. This possibility may be discussed
with the dermatologic surgeon during the initial consultation and examination.
Scalp Reduction
Scalp reduction is
a procedure that surgically removes bald scalp and pulls up adjacent areas of
full hair. It may be done prior to hair transplantation to reduce the size of
the area to receive hair grafts. Scalp reduction is a surgical procedure that
requires a trained and experienced dermatologic surgeon.
Scalp Flaps
Scalp flaps are
surgically created to move a hair-bearing segment of scalp to a place where hair
is needed. When a flap is moved from the donor site to the recipient area it is
left attached to its nerve and blood supply until the graft "takes" in its new
site. A flap grafting procedure can be an all-in-one operation—for example, in a
single procedure it brings hair from a donor site on the scalp to recreate a
hairline on a bald frontal scalp. Not everyone is a candidate for a scalp flap
procedure. Patients are carefully selected and the procedure should be performed
by a trained and experienced dermatologic surgeon.
References:
• Unger WP (ed.).
Hair Transplantation, 3rd ed. New York: Marcel Dekker, Inc.;
1995.
• Stough DB, Haber RS (eds.). Hair Replacement. Surgical and Medical.
St. Louis: Mosby; 1996.