Although several treatments are available for hair restoration, the most effective treatment is hair transplantation using patient’s own hair.
What are the indications for hair transplantation? The indications for this procedure are thinning of the hair, hair loss or hair loss due to injury.
What does hair transplantation accomplish? This procedure redistributes the hair from the back of the head to the balding areas.
What is the recovery time associated with this procedure? Typically it takes about one week before one can return to normal work.
Is everyone a candidate for hair transplantation? Most people will be a candidate for hair transplantation, however, several factors need to be considered. These factors include but are not limited to age, pattern of baldness, family history and general health. This can be decided after a consultation with a hair transplant surgeon.
Background: It has long been known that the hair on the scalp that is oriented along a horseshoe pattern responds differently to the genetic factors and hormones that cause balding. As such if these hairs were transplanted over the areas of hair loss, they could retain this property and continue to grow. This is the basis behind hair transplantation procedures.
Procedure: A strip of hair is usually removed from a donor site behind the head where hair cells are resistant to effects of hormones. This area is then closed with sutures. The strip of hair is then cut down to individual one, two or three hair follicular units. This is careful work performed under magnification. These follicular units are then transplanted in the skin of the balding area.
The most important part of the procedure is the planning of the implantation. In order to obtain a natural hairline it is pivotal that the direction of the hairline, number of hairs transplanted and the orientation of the hairs are planned carefully. The actual hairline on the scalp is not a line as one would think. Instead it is a transition zone from the skin of the forehead to the scalp. The hairs grow in a random pattern and become increasingly dense as one moves backwards on the scalp. This natural random pattern and transition zone should be preserved, otherwise, the results would appear as though it was operated or fake.
The procedure is typically done as an outpatient procedure under mild sedation with local anesthesia. The patient is asked to wash their hair the night before the procedure as well as the morning of. Once adequately sedated, the donor hair is obtained as previously stated and the surgical team begins to divide the hair follicles. They are then transplanted in the area of the balding scalp and once done covered with a turbine like dressing. The dressing is changed the morning after surgery.
Recovery: Following the procedure, starting the next day and for the next 10 days the hair can be cleaned using hydrogen peroxide and allowing water to run over the area. Patients are asked to sleep on their backs and with their head elevated for 2 weeks. It is expected that by about 8 weeks after the procedure the newly transplanted hairs would have completely fallen off. This is a normal progression of hair transplantation as the roots of the hairs remain in the scalp and new hair growth begins at about 3-4 months after the procedure. This will continue and the full results are seen at about 6-8 months after the procedure. Hair transplantation can also be performed for scars as the result of injury, surgery or burns and is a great tool for camouflaging unsightly scars over the scalp or eyebrows.
Long Term Results: The transplanted hair will continue to grow similar to normal hair and the results are permanent in most individuals. Depending on the amount of balding, follow up procedures might be necessary to increase the volume. Typically this can be done anytime after 4 months has passed from the previous transplantation. This will allow adequate blood supply to have reached the hair cells that were transplanted.
Scalp Reduction: For those men with class IV, V or even VI balding pattern, scalp reduction can result in significant decrease in the amount of balding. This procedure can either eliminate the balding spot entirely or in a serial fashion, decrease the amount of balding so that fewer hair grafts would be needed to cover the spot and achieve a dense natural look. The procedure is performed under local anesthesia or twilight sedation and superficial layer of the balding skin is removed. The incision is then closed with sutures. Area is cleansed with hydrogen peroxide 4-5 times a day and patients can wash their hair with non-irritating shampoo the next day. Sutures are removed on day 8. Combing or brushing of the area should be avoided in order not to disturb the incision.
Flaps: Flaps are able to improve hair loss by being able to rotate a hair bearing skin over an area of baldness. The process is typically an outpatient procedure under twilight or general sedation. Tissue from hair bearing parts of the scalp is then rotated in such a way not to distort the remaining hair and to fill the bald areas of the scalp. Tissue clips are then used to close the incisions. A drain is placed under the flap. The drain is typically removed the next day and the clips are removed in 8-10 days. Ice packs are applied to the area for 72 hours. Patient sleeps with head elevated for 10-14 days. Incision lines are cleaned with peroxide 4-5 times a day and patient can wash their hair with non-irritating shampoo the day after the procedure. Combing or brushing of the area should be avoided in order not to disturb the incision. Occasionally, a repeat or bilateral procedure is needed to cover the entire balding region.
Artificial Hair Restoration
Artificial Hair Restoration: Artificial hairpieces (aka wigs, toupee) have been around for centuries. The original hairpieces were glued or taped to the scalp resulting in easy dislodgement and embarrassment. Today’s hairpieces utilize other mechanisms to attach to the scalp. Some are connected via surgical wire or hooks. These have increase risk of infection and some have been banned for use due to complications associated with them. Others are connected via weaving of the hairpiece to the remainder of the natural hair that exists on the scalp. This can result in further loss of hair due to tension that is being placed on the existing hair by the weaving process.
Water activities present a unique challenge to artificial hair restoration. Although most hairpieces will remain on the scalp during water activity, exposure to water furthers the wear and tear of the hairpiece and decreases its lifetime. If one is considering artificial hairpieces it is important to take into account the cost of the hairpiece as well as the cost of the maintenance that is associated with it. Most likely two hairpieces would be needed in order to utilize one while the other is being serviced. Essentially the cost of purchasing and maintaining a natural appearing hairpiece can match or by far exceed that of surgical hair restoration procedures.
Medications: Several herbal, over the counter and prescription medications exist for management of hair loss. The herbal or “natural” medications might work in some instances; however, their efficacy and side effect profile is not thoroughly researched, as would be the case with other medications. In most cases the actual results are not similar to the advertised results. FDA approved over the counter and prescription medications are available for medical management of hair loss.
For the most part, individuals who will benefit from these types of treatment are younger individuals who have noticed new onset of balding or thinning of the hair but have not lost any significant amount of their hair. In these cases topical medications can help cease further hair loss while oral medications can cause re-growth of some of the lost hair. These medications do carry limitations. Once on this medication, it must be continued for life or any improvement would quickly dissipate once the medication is terminated. Further more, the oral medications available are not approved for use in females. Males with pregnant partners are asked to refrain from using these oral medications and pregnant females are cautioned against handling of these medications.