Baldness afflicts millions of men and women. Although some individuals do not find this to be a distressing condition, there are a great number of people who do. Sometimes, the use of wigs or hair styling serves to adequately cover the bald areas. In other cases, patients choose to have surgical correction in an attempt to achieve a more permanent improvement. There are basically three types of surgical procedures used to correct baldness.
In hair transplantation, it’s this non-miniaturized hair on the back and sides that are surgically moved to the top of the head in the form of a tiny skin graft. Because the hair on the permanent horseshoe is genetically programmed to grow a lifetime, it will continue to grow even though it’s been transplanted to a different site. This is medical fact, and has been repeatedly proven for more than thirty five years.
For some patients, a hairline may need recreation; for others, more extensive hair replacement may be required. A few patients may want to add density to existing transplants, and others might want to correct a transplanted hairline with which they are dissatisfied. Some patients want to correct sparse eyebrows or scars on the scalp. All these individuals, both men and women, are good candidates for the procedure.
Results of the surgery:
The transplanted hair grows normally and the stigma of being called a bald person is over. The transplanted hairs however lack the thick density, as the donor area at the back is not sufficient to cover the entire head.
Hair loss and Hair fall are two separate things. Hair fall is a natural daily occurrence. Human head contains over 100,000 hairs and one normally sheds 100 to 150 hairs a day, every hair is genetically programmed. In general 85% of the hair on your head grow approximately 1 centimetre per month for about 2 to 6 years and then fall off. Hair loss is primarily caused by a combination of ageing, a change in hormones and a family history (genetic) of baldness. As a rule, the earlier hair loss begins, the more severe the baldness will become.
Hair loss can also be caused by burns or trauma, in which case hair replacement is considered a restoration treatment. However, hairs on back of your head are genetically programmed and scheduled to last long. Approximately, 30 percent Indian men will show signs of male pattern baldness by the age of 20. The incidence of male pattern baldness increases 10 percent per decade through a man’s life. The causes of female loss range often from iron deficiency to thyroid abnormalities to childbirth. For both sexes, hair loss causes diminished self-esteem, stress, anxiety, depression and feelings of social inadequacy.
Baldness is often blamed on poor circulation to the scalp, vitamin deficiencies, dandruff excessive hat-wearing. All of these theories have been disproved. If hair is a symbol of a person’s youth, the loss of it can act as a reminder of approaching old age for men entering their forties.
How is the procedure performed?
Under local anaesthesia, the donor hair grafts are harvested from a strip of skin taken from area between two ears. The strip is divided into small units of skin (grafts), each containing one to three hairs – the follicular units. Then recipient sites are created in the area of hair loss by making small slits in the bald skin. Each site is no bigger than the opening created by the needle used when blood is drawn from your arm. Then each of the grafts is carefully placed into each recipient site. The donor site in the back of the head is not visible. Three to four months later, the transplanted hair begins to grow and continues to grow a half inch per month for the rest of your life.
Why do some Hair Transplants look “more natural” than others?
Although hair transplantation has been performed for almost 35 years, it’s never become as popular as you might expect. With good reason it sometimes looks conspicuous and unnatural! One reason is that old fashioned grafts were simply too big. They contained 10 to 20 hairs, and when they grew, tufted doll’s head resulted However, if the grafts are made very, very small, with only one follicular unit per graft, the density of the hair can be more evenly distributed and exactly approximate nature’s way. This is the basic principle that’s used in what’s commonly called follicular unit grafting.
What’s the advantage of trimming a follicular unit graft?
When many technicians prepare follicular unit grafts, they usually don’t trim away the intervening skin between each follicular unit. So, the untrimmed graft is moved to the bald area with more skin than is necessary. To remove the excess skin (and not damage the oil gland and tiny adjacent telogen hairs) is a very time consuming process and requires both high magnification and experience. However it’s worth it. Trimmed grafts can be more densely packed, and the occasional light skin color that surrounds each hair is eliminated. “Trimmed follicular unit grafts” are the gold standard for hair transplantation. They are rarely performed because the task is simply too time consuming and expensive. When hairlines are created with trimmed follicular unit grafts, the results are astonishing.
What’s the difference between a micrograft and a follicular unit graft?
Micro and Follicular unit grafts are often confused. Micrografts are simply grafts which contain either one or two hairs. They are cut randomly from the donor strip with no attention paid to the follicular unit groupings. Follicular unit grafts are actual isolated follicular units that naturally grew in groupings of one, two, or three hairs. In other words, one three haired follicular unit graft could be divided into 3 one haired micrografts.
How is the perfect frontal hairline created?
We use only single grafts in the front hairline, often 100 to 200 of them. Single hair follicular unit grafts are placed in the front rows, and behind them two hair grafts, and behind them the three haired grafts – thus attempting to duplicate the subtle feathered look of a natural thinning hairline. The grafts are delicately handled, refrigerated and submerged in nutrient solution throughout the entire process.
How much pain should I expect? Are there any complications?
Essentially there is no pain. Most patients describe the session as easier than a visit to the dentist. Complications rarely occur, but occasionally numbness in the donor site may persist for two or three months after the procedure.
What happens after hair transplant surgery?
For the first twelve hours [overnight], there will be a bandage around the head & it will be removed next day morning. If you have the surgery done on the hairline, the small scabs will remain for seven to ten days. Some patients may want to cover the area with a cap at work if they desire. If you have partial hair, it is much easier to cover up the area, or you can use a camouflage product. When the small scabs fall off after seven to ten days, the freshly implanted grafts will be pink, slightly shiny skin which is usually a similar color to the surrounding normal skin and is minimally obvious at first. After approximately two weeks, the areas where the grafts were transplanted are barely visible. Pre-existing hair around or adjacent to the transplanted grafts may shed, giving a thinner look, but will begin to grow back within a few months. This temporary thinning of pre-existing hair is called Telogen Effluvium. Unfortunately there is a time lag between this increased thinning of pre-existing hair and re-growth of transplanted hair, so do not be alarmed if this happens.
Patient can resume light work from third day onwards. Sutures on back of head are removed after 7 days. However patient should not do any exercise for three weeks or shun any activity which will increase pressure in transplanted area. Mild swelling on forehead is possible which disappears after day or two. You can have head bath 4th day onwards. Crusts, scabs and effluvium fall off in next 4 weeks. No special care, medicines or frequent visits to doctor are required. The hairs will fall out of the newly transplanted follicles within two to six weeks after the procedure – this is normal.
How many sessions of surgery will I need?
If you have a completely bald area, it may take two to three surgeries to cover. If you have an area partially covered with hair, it may take only one surgery to fill in the area. Our goal is to restore about twenty-five percent of the donor’s original density in each surgery. After two surgeries, the density is at about fifty percent which is often adequate coverage to satisfy the patient. The time between each session is usually four to six months in order to see how the hair is growing out and to provide more equal distribution. Correct evaluation & estimation is possible after personal consultation.
How long does it take the transplanted hair to grow out enough to fill in the balding area?
Usually it takes three to four months for the hair to grow out, and after that it will grow about half an inch per month which is the same rate as the donor hair. Initial hair quality is usually very thin, softer in texture like baby hair and then it becomes coarser over time. Sometimes the initial hair is curlier, later they straighten in about one year. The color of the initial hair may also be darker. It may be lightened by the sun later.
How long will the transplanted hair continue to grow?
The transplanted hair is the hair from the back of the head, so even though it is transplanted, it will still have the same life span. Normally a hair follicle sheds every three to six years and then grows back from the same root. Thus, the transplanted hair continues the same life cycle.
Can hair transplantation affect the rest of my hair?
Hair roots are very tough and can tolerate surgery or any irritation to the scalp. We know this because we can see how difficult it is for people to remove unwanted hair. A hair can be plucked out hundreds of times and just keeps growing back. The actual physical trauma of cutting the scalp, when inserting the donor grafts, can cut the shafts and/or damage some hair follicles. But more significant is the interruption to the pre-existing hair’s blood supply which is enough to cause the shedding of this pre-existing hair. It is temporary as most lost hair will grow back after a few months.
Are hair transplantation results permanent?
Since the hair used in hair restoration surgery comes from the donor area, which is not sensitive to the balding process, it will be permanent. This hair will retain its genetic characteristics even after relocation. It will grow and continue to grow for the rest of your life.
Why are so few physicians performing all micro follicular unit hair transplantation?
It’s known that using small follicular unit grafts of 1 to 4 hairs and large sessions of 1200-2000 grafts is the ideal procedure for a patient who wants to achieve the most natural result with the least number of sessions.
As beneficial as it is for the patient, it is equally unappealing for the physician performing the hair transplantation procedure. This procedure requires the physician to be more detailed and exact, both in the cutting and placing of the graft. It is more labour intensive and takes longer.
How much Hair Transplantation will I need?
How much work you will need depends on various factors – such as, how much hair loss you have now, the amount of hair loss you will have in time, and your goals and expectations – or how thick you need it to be. This can only be determined through a consultation session.
What about medical treatment?
While Propecia and Rogaine have been proven to re-grow hair, they will not grow all your hair back. Both products have not been proven to grow any significant hair in the frontal temple area, which is the main area of concern for most people. Their greatest benefit seems to be in slowing down hair loss.
What about hair cloning?
Perhaps some day hair transplantation physicians will be able to clone hair follicles from a patient’s donor area. This could potentially allow a patient a virtually unlimited supply of balding resistant donor hair. This would be of particular value to patients who have very little donor hair available for hair transplanting. Although this potential advancement is exciting, it is currently only in the early test stages.
Will my hair require special care after hair transplantation?
Your newly restored hair will grow and require the same maintenance as your original head of hair. It’s your hair and can be washed, coloured, and trimmed any way you choose.
What are the side effects or complications?
There are some minor, temporary complications.
Bleeding – Some bleeding is normal and will stop with simple pressure. Persistent bleeding occurs in about one in a few hundred cases. Additional stitching is rarely required.
Pain – Pain is usually fairly minimal and lasts only a few days. 50 % of our patients do not require any pain relievers.
Numbness – Some transient numbness is inevitable, and usually lasts from three to eighteen weeks. It is rarely bothersome or long-lasting.
Hiccups – Hiccups may occur after surgery. The cause is not well known, but hiccups seem to occur more frequently after hair transplantation than scalp reduction. The incidence of this complication is about 5%. It usually lasts several hours to several days. If left untreated, the hiccups may interfere when you eat and sleep, but there is a medication that the doctor can prescribe to ease the hiccups.
Itching – Some itching commonly occurs but is rarely troublesome and lasts only a few days. Shampooing the hair daily will help the discomfort.
Swelling – There is some swelling in nearly all cases. It affects the forehead and the area around the eyes and lasts two to five days, being maximal on the fourth day. However, it does little harm and lasts no more than a week. We can prescribe you some medication to reduce the swelling.
Infection – This happens in one in several thousand cases and is easily cured with antibiotics. We will provide you antibiotics prior and after the procedure to prevent it from happening.
Scarring – Keloid scarring occurs only in pre-disposed individuals, and even more rarely (1/1000 cases) has this keloid scarring been hypertrophy to the point of “ridging.”
Cysts – One or more cysts may occur in the recipient area when many mini-grafts have been inserted. They usually disappear by themselves after a few weeks or immediately with various simple treatments. They are not usually more than 2 or 3 mm in diameter, i.e., the size of small pimples.
Neuralgia- When a medium-sized nerve, such as the occipital nerve, is either cut or bruised, patients can get either numbness, tingling or “pins and needles” sensations, sometimes even “shooting pains” and hypersensitivity of skin in that part of the scalp. Once in a while someone reports varying combinations of the above, usually lasting for one to four weeks. Very rarely have patients had neuralgia last a longer time period. Prolonged or severe symptoms are exceedingly rare and virtually always disappear within a few months.
WHAT CAUSES HAIR LOSS?
There are many causes of hair loss in men and women, including disease, nutritional deficiency, hormone imbalance, and stress. However, by far the most common cause is what is called androgenetic alopecia. Alopecia is simply the medical term for hair loss. Androgenetic refers to the fact that both a genetic predisposition to balding and the influence of androgens or male hormones play a part in this type of hair loss.
In fact, there is a third factor, which is the passage of time, or aging.
Genetics is not always simple, and such is the case with balding. Just the presence or absence of balding in one’s parents or grandparents, on either the mother’s or father’s side, is not necessarily predictive of one’s likelihood of balding. Certainly, if a man’s father is completely bald, and this man begins to rapidly lose hair in his early twenties, it’s a safe bet that he will develop extensive balding at some point. In short, it’s very hard to accurately predict who will go bald and how rapidly.
All normal men and women produce “male” hormones. The most common of these are testosterone, androsteinedione, and dihydrotestosterone (DHT). Androgens are produced by the testicles and adrenals in men and by the ovaries and adrenal glands in women. These hormones are quite important in both sexes, but occur in different concentrations, being much more predominant in males than in females. This, in part, is responsible for the typical differences between the genders.
It is the exposure of the hair follicles to DHT, in a genetically susceptible person, over a period of time, which leads to androgenetic alopecia, or male and female pattern baldness.
How does this exposure to DHT occur?
In certain cells of the hair follicle, and in the sebaceous glands, there are high levels of an enzyme called 5-alpha-reductase. What this enzyme does is to convert testosterone, which is delivered to these areas by the blood, into DHT. This is important not only in understanding the mechanisms of balding, but also one medical treatment now available, finasteride. What finasteride does is inhibit, or limit the activity of, this 5-alpha-reductase enzyme. Therefore, there is less conversion of testosterone to DHT, and lower levels of DHT are found in the follicle. In later sections, we will discuss this and other medical treatments in much greater detail.
There is no set age at which balding occurs. It is a process, and this is a simple, but often ignored fact. Like any process, it can be rapid or slow, it can begin toward the end of life or in the late teens, and it can progress in a predictably inexorable fashion, or it can stop and start, seemingly stabilize, and then begin again. Once we understand and accept this as a dynamic process, then we can better plan for the present and for the future in terms of how we treat it. This quest for understanding, which you have begun just by opening this book, will do more than all the despairing thoughts, hand-wringing, and self-pity, toward allowing a clear-eyed, rational, long term approach to the problem of hair loss.
So we now have looked at these three interdependent factors that play into the common types of balding. Again, they are: hormones, genetics, and Father Time. So what exactly does happen to the hair? Let’s take a look.
Assuming we have a genetically predisposed person, then as the follicles are continuously exposed to DHT, an interesting phenomenon occurs. Remember the anagen phase, or active growth phase of the hair? This phase becomes gradually briefer and briefer, and eventually the hair becomes finer and shorter, and less deeply colored. We call this “miniaturization” of hairs. This is also the point at which hair loss tends to first be noticed. It’s not that there are fewer hairs on the head, but that their calibre (cross-sectional area), colour and length are so diminished that they no longer provide “coverage” for the scalp beneath. Light penetrates through to the shiny scalp, and this is perceived by the observer as “thinning” or balding.
Also, the ratio between hairs in the anagen phase and those in the telogen, or resting phase, is increased. This simply means that, at any given time, an increased number of hairs are in the telogen phase. These extra numbers of telogen hairs will be found in the susceptible zone for common balding, which is the front, top, and crown of the head. The so-called “permanent” zone, the familiar horseshoe-shaped wreath of hair around the back and sides, is unaffected by these changes. The telogen hairs are easily dislodged during washing, drying, or combing, and this is the second sign of balding: in addition to the apparent thinning seen with miniaturization, we begin to see larger numbers of hairs on the comb, the towel, the pillowcase, or in the bathroom drain. This can be quite traumatic, especially for the younger man or for women. In the next section, we will discuss the natural history of balding, that is, the way it first presents or appears, the different ways it progresses, and how it affects the different regions of the head.
For the sake of completeness, let’s briefly mention some of the other patterns of hair loss, if only to distinguish them from androgenetic alopecia (male and female pattern baldness). There is alopecia areata, where discrete patches of scalp go bald; triangular alopecia, which tend to occur in a triangular pattern in the temporal area; alopecia universalis, in which the entire body may be affected; and various “toxic” alopecia, including those following a severe illness, sometimes with high fever, or following pregnancy. Toxic alopecia may also occur with low thyroid and / or pituitary gland function, or following chemotherapy. The cicatricial (scarring) alopecia occur following tissue destruction and inflammation.
Also seen are the so-called diffuse alopecia (patterned and unpatterned), in which there is widespread thinning that may affect the “permanent” zone as well as the areas vulnerable to balding. In any or all of these less common types of balding above, it may be necessary to have a complete physical and laboratory workup, possibly including scalp biopsy.
So again, the common types of balding are directly related to the presence of male hormones in a genetically predisposed person over time. This can occur in both men and women. The process involves progressive miniaturization of the terminal hairs, and diminished length of the active hair growth cycle. Now, let’s take a look at how this microscopic, cellular process is manifested on the head; we can call this the natural history of balding.
WHAT IS FEMALE HAIR LOSS?
Most of what I have written for male patients applies to women also, but important differences do exist. For those reading this and who are primarily concerned with women’s hair loss and replacement, reading what has been written in the prior sections will be imperative to fully understanding what follows.
A significant number of women suffer from forms of hair loss other than female pattern baldness. These other forms of hair loss must be ruled out before a definitive diagnosis of female pattern baldness can be made. Of these others, telogen effluvium is the most common. Classically, telogen effluvium is that shedding of hair that occurs several months after childbirth. Typically, the woman will notice large amounts of hair suddenly coming out one to six months after a significant stress in her life such as a surgery, a serious illness, or a social or psychological stress. The bad news is that there is no treatment for this type of hair loss. The good news is that the patient does not require any treatment. The hair should return on its own after a dormant phase.
Less commonly, I will see women with traction hair loss. This is found most commonly in women who wear their hair tightly pulled back or in tight braids for long periods of time. The slow, chronic pull on the hair root eventually kills the follicular root system so that no hair will grow in these areas. This form of hair loss may be amenable to hair transplantation if the hairstyle is changed.
True female pattern baldness is much more common than most people realize. It tends to be underestimated because women go to great lengths to hide it. In a study authored by Norwood, M.D. it was noted that the incidence increases from 3% of women in their twenties to 30% of women in their eighties. By the time women are in their fifties, approximately one quarter are affected.
Ludwig scale of balding for women
The pattern of female pattern baldness tends to be different from men’s. Typically, women will notice diffuse hair loss throughout the mid scalp but retain the majority of their hairline. Although this form of hair loss has been assumed to be related to male pattern baldness, Dr. Norwood and I published a paper, which brought this belief into question. If we are correct, perhaps this should not be simply considered the same disease just in different sexes. Some of the pertinent points of the paper include?
Male pattern baldness begins with the recession of the hairline and results in complete hair loss across the top of the scalp. Female pattern baldness causes diffuse thinning behind the hairline but there is no recession of the hairline.
Male pattern baldness begins in the late teens and early twenties when the testosterone levels are high. Female pattern hair loss tends to begin in the late thirties and reaches its peak after fifty when testosterone levels are falling.
Male pattern hair loss affects up to 70% of all males. Female pattern hair loss affects up to 30% percent of women.
Females with a predisposition for male pattern hair loss rapidly develop typical male pattern baldness if given high doses of testosterone.
There has been a report describing a young women with hypopituitarism who presented with clinical and histological features of female pattern baldness in the absence of detectable levels of circulating androgens (testosterone and other male hormones) showing this pattern of hair loss is not androgen dependent.
Treatment with finasteride, a medication that blocks the conversion of testosterone to 5-DHT, certainly helps male pattern hair loss, but has no effect on female pattern hair loss.
As just mentioned, finasteride appears to be largely ineffective for women’s hair loss. If a woman has more of a male pattern hair loss and has elevated androgenetic hormones confirmed with a laboratory evaluation, finasteride can be helpful. I would stress, however, that this is not a common occurrence. Rogaine is effective at halting further loss, but if there is regrowth, it tends to only be short and fuzzy hair. I urge my female patents to consider the use of 5% Rogaine labelled “For Men Only” rather than the 2% for women. It is a more effective concentration and, in my opinion, poses no serious threats. Side effects, specifically developing an itchy red scalp, may be more common with the 5% formulation. It is my understanding that the F.D.A. is considering approval of the 5% Rogaine for women in the near future. In other countries, various androgen blocking medications are available to women, but in the U.S. we resort to spironolactone (Aldactone). This heart medicine has been found to block some of the activity of the circulating androgens. Since some forms of female pattern baldness do not seem to be driven by androgens, this might be useful only in a percentage of patients. Patients must not become pregnant while using spironolactone. Side effects may include breast tenderness, irregular menses and mood swings. Both Rogaine and spironolactone must be continued indefinitely to remain effective.
Important differences do exist between transplantations in men and women. If I give a man any hair, he is happy. He may wish for full thickness, but he understands that most men have some hair loss and anything he can get back into the balding areas helps. A woman, on the other hand, frequently will not be happy unless she has the appearance of full thickness after a transplant. To most women, getting some hair back to give a thinning look is still unacceptable. If a woman’s hair loss is even moderately advanced, hair transplants may not be able to deliver the thickness she desires. I turn many more female than male patients away after consultation for this very reason.
If a woman’s hair loss is not too advanced, and she is willing to use Rogaine indefinitely, frequently we can come to a compromise. If the patient will settle on a particular hairstyle, often I will be able to concentrate the follicular units in the area where they are most needed. The most common example of this occurs with Ludwig type I and II patients. If I can convince the patient not to wear bangs, but instead let the hair remaining in the hairline grow long and then use that hair pulled back over the balding area in a style that keeps it in place, I will then concentrate the follicular units in a zone directly behind the hairline to give the hair being pulled back more fullness. Just like with men, if they will either colour or not colour their hair so as to decrease the colour contrast between their hair and scalps, they will discover their hair loss is much less noticeable. If they are willing to use the remaining hair in specific styles to help cover the areas of hair loss, then I will recommend increasing the length and curl of the hair to add volume. Women typically have a remarkable ability to style their remaining hair and conceal their hair loss. If women who understand these issues can even get a little extra hair, they are very grateful.
If a woman now has, or potentially will have significant hair loss, the transplant will possibly need to be concentrated in specific areas and combined with specific hair styles. In most cases the transplant is concentrated in the front behind the hairline and the patient will then let the hair in front grow long and use it pulled back over the thinning area.
Another big difference between men and women is in telogen hair loss (loss of pre existing hair due to the shock of surgery) in the transplanted areas. As noted before, in men this loss is unusual, occurring in perhaps 5 to 10% of cases. In women, however, I see it, to some degree, in perhaps 25 to 50% of cases. I stress to the patient that if it is healthy hair that is lost, it will return, albeit in four to eight months. If it was hair that had miniaturized, it might not return at all. I emphasize that if this telogen loss occurs, the scalp will look even more bald for three to five months then before the operation. After that, the transplanted hair begins to grow. The other hair that fell out slowly begins to return soon thereafter. I further explain that there is no way to determine in whom this will occur. I have transplanted some women in whom it occurred one time and not the other. It is a risk that the female patient must assume. If it occurs, and the woman was made aware of this possibility before hand, she will be much more understanding than if she were not warned of it at all.
I will often use 2 and 3 follicular unit grafts in women for this reason. I feel that with the larger multi-unit follicular unit grafts and the reduction in the number of needle sticks necessary to plant them by 50% or more, there is less risk of a telogen phenomenon occurring. I do stress to the patient that there could be some plugginess with this technique if she loses much additional hair in the future. Most women tell me they are willing to assume this risk because if they lose much more hair anyway, they plan on wearing a wig. If they do decide to have me transplant the larger multi-unit follicular unit grafts, I still utilize single follicular units for any hairline work.
One final disadvantage women must accept is the possibility of having a more limited donor area. Men typically have good hair remaining on the sides of their scalps above their ears. Unfortunately, many women will have thin hair in this area making it unsuitable for transplantation. Otherwise, women can be great candidates. Just like with men, it depends on the degree of hair loss, the quality of remaining hair, and their expectations.
HAIR LOSS & DANDRUFF / MEDICAL MANAGEMENT
Alopecia also known as hair loss, includes a set of disorders which involve lacking hair where it would normally grow, especially on the head. The most common form of alopecia is a progressive hair thinning condition called androgenic alopecia or “male pattern baldness” that occurs in adult human males and even some primate species. The severity and nature of alopecia can vary greatly. It ranges from male and female pattern alopecia, alopecia areata, which involves the loss of some of the hair from the head, alopecia totalis, which involves the loss of all head hair, and the most extreme form, alopecia universalis, which involves the loss of all hair from the head and body.
Male pattern baldness is estimated to occur in about 66% of adult males to some varying degree, at some point of their lives. It is characterized by hair receding from the sides of the forehead, commonly known as a “receding hairline”. An additional patch of lost hair may be present on the very top of the head as well. The trigger for this type of hair loss is DHT, a powerful sex hormone. In those vulnerable to male pattern baldness, DHT initiates a process of follicular miniaturization, in which the hair shaft is slowly narrowed until the hair on the scalp resembles peach fuzz or becomes non-existent. Female pattern baldness, in which the midline parting of the hair appears to broaden, is a less common occurrence. It is believed to result from a decrease in estrogen, a hormone that normally counteracts the balding effect of testosterone. Onset of hair loss can begin as early as the end of puberty, and is mostly a genetic condition.
There are several other kinds of baldness conditions. Traction alopecia is found in people who wear their hair in ponytails or cornrows with the hair being held back with excessive force. Traumas such as chemotherapy, childbirth, major surgeries, poisoning, and sever stress may cause a hair loss condition known as telogen effluvium.
When it comes to treating alopecia, it is far easier to prevent the aging and falling out of follicles than to regrow hair from dormant follicles. Finasteride and minoxidil have shown some success in partially reversing hair loss, but are generally ineffective at treating extreme cases. Topical application of ketoconazole, which is an anti-fungal and potent 5-alpha reductase (a hormone responsible for hair loss) inhibitor, is often used as a supplement to other approaches. Saw Palmetto is an herbal DHT inhibitor that is reported to have fewer side effects than finasteride and dutasteride. Unlike other products, Saw Palmetto does not interfere with the production of necessary hormones. It has also been seen to inhibit the production of both forms of 5-alpha reductase unlike finasteride which only stops one form. One of the more drastic routes is the use of flutamide, in a topical solution. Flutamide blocks the action of androgens, like testosterone, and is potent enough to have a feminizing effect in men, including breast development.
Dandruff is a problem that is uncomfortable, annoying, and embarrassing. There are many people who have this disorder, which is characterized by itching and flaking of the scalp. Fortunately, dandruff isn’t contagious and dandruff control and treatment is fairly easily.
Dandruff is thought to be caused by a fungus called malassezia, a fat-eating fungus, which lives on the scalp of most healthy adults. While it does not cause problems for most people, malassezia can sometimes grow out of control and begin feeding on the oil on your scalp. The result is increased cell turnover and a large number of dead skin cells. These cells, combined with dirt and oil from your hair and scalp, form flaky white scales.
The common symptoms of dandruff include itching and white, oily flakes. That said, there are several conditions, including psoriasis, dry skin, seborrheic dermatitis, or contact dermatitis, which present similar symptoms. Before beginning treatment for dandruff, it is important to consult your dermatologist to make sure you’re treating the right condition.
While controllable, dandruff can be persistent and requires consistent treatment. There are several types of over-the-counter shampoos available for treating dandruff. If you try one and it doesn’t have the desired effect, move on to the next. Following are four common types of dandruff shampoos:
Zinc pyrithione shampoos, such as Head & Shoulders, contain an antibacterial and antifungal agent (zinc pyrithione) which has been shown to fight the fungus that causes dandruff.
Selenium sulphide shampoos, such as Selsun Blue, can prevent cell turnover and may help control the malassezia fungus. These types of shampoos may discolour blond or gray hair and can cause significant discoloration in chemically treated hair, so follow the directions carefully and rinse well.
Ketoconazole shampoo, like Nizoral, contains a broad antifungal agent.
Tar-based shampoos, such as Neutrogena T/Gel, contain coal tar, which slows cell turnover and reduces the formation of dandruff’s scaly flakes.
Use of these shampoos above is recommended daily until dandruff is controlled. Once the dandruff is under control, dandruff shampoo should be used two or three times a week, alternating with a good moisturizing shampoo. If the dandruff shampoo loses its effectiveness, switch to another type of shampoo or try alternating between types. Be sure to follow directions carefully.
In addition to using the proper shampoo, other steps can be taken to control dandruff, including: eating right, exfoliating the scalp with a massage, managing stress, and reducing the amount of styling products used. Consistently following a dandruff control routine should keep your hair and scalp looking healthy and flake free.
FOLLICULAR UNIT EXTRACTION
Rather than removing a strip from the donor area to obtain hair grafts, very fine holes (1 to 1.25mm) are made in the back and side of the scalp that don’t exceed 1mm in diameter. While this method will produce far more scarring than the standard strip technique, this additional scarring is far less visible and is therefore more attractive to many patients.
FUE can be used solely as means to recreate hairlines and cover bald skin, or it can be used in conjunction with the standard strip procedure to increase the number of grafts obtainable during a single surgery without increasing the size of the strip scar. FUE may also be used as a means to repair scarring from older obsolete hair transplant surgeries.
Follicular Unit Extraction is a minimally invasive surgical procedure that can benefit a limited subset of patients in a hair restoration practice. The Procedure involves the direct extraction of the follicular units from a patient’s donor area using a small 1mm punch. At this time, approximately 60% of patients are candidates for this procedure, and the procedure itself is practical in individuals who require less than 600 grafts at a sitting. Healing is quick, scarring is virtually nonexistent, and discomfort in the donor area has been virtually eliminated.
BODY HAIR TRANSPLANT
The follicular isolation technique is a process of removing one follicular unit at a time from the donor region. A special instrument is used to extract the individual follicular units.
This instrument must cut into the dermis to a point just deep to the arrector pili muscle. Once this structure is cut, the graft can be extracted intact. Grafts ranging from one to 5 hairs each have been extracted. Our technique has allowed the largest single session of graft removal in a single day. We successfully removed 500 intact follicular units in a single day. We also have the largest successive sessions in a five day span on the same patient. Currently, we are able to move almost 2000 grafts in a two day time using our follicular isolation technique.
EYEBROW & EYELASH HAIR RESTORATION SURGERY
Eyebrows and eyelashes make an important contribution to facial symmetry and presentation of self to others. A person without eyebrows and/or eyelashes may feel very self-conscious about his/her appearance. Transplantation or reconstructive surgery can often restore eyebrows and eyelashes. Eyebrows and eyelashes are lost in a variety of ways:
Physical trauma e.g., auto accident, thermal, chemical or electrical burns
Systemic or local disease that causes loss of eyebrow and/or eyelashes
Congenital inability to grow eyebrows and/or eyelashes
Plucking (to reshape the eyebrow) that results in permanent loss of eyebrows
Self-inflicted obsessive plucking or eyebrows and/or eyelashes (trichotillomania)
Medical or surgical treatments that result in eyebrow or eyelash loss e.g. radiation therapy, chemotherapy and surgical removal of tumor
The cause of eyebrow/eyelash loss is evaluated in medical history and examination prior to consideration of hair restoration:
Systemic or local disease that causes hair loss must be under control to assure that hair restoration can succeed.
Obsessive-compulsive plucking (trichotillomania) must be treated to assure that restored hair will not be plucked out.
Trauma, burns or surgery may have resulted in formation of scar tissue; reconstructive surgery may be necessary before eyebrow/eyelash restoration. The degree of eyebrow loss may vary from complete to partial; the degree of loss may be a consideration in selection of the restoration procedure.
Some patients have no eyebrow/eyelash loss, but seek eyebrow/ eyelash enhancement for cosmetic reasons.
A number of procedures are available for restoration of all or part of the eyebrow.
Transplantation of micrografts or single hairs from a donor area to the eyebrow and A reconstructive flap or graft procedure that brings a strip of hair from another site to the eyebrow.
The patient and surgeon must agree on the procedure best suited to the needs of the patient. Eyebrow and eyelash restoration procedures are usually performed in an outpatient setting. Postoperative complications are usually limited to minor pain and swelling.
Reconstruction of the Eyebrow Using Flaps or Grafts
Reconstructive surgery has been used for many years to restore missing eyebrows or to repair partially missing eyebrows. Technical considerations and the needs of the patient determine which reconstructive procedure is used.
Transplants – A strip of hair-bearing skin and subcutaneous tissue is removed from a donor area on the scalp and grafted into the surgically-prepared eyebrow site. The transplant procedure is performed by selecting a hair-bearing area of scalp with hair that is of appropriate texture and orientation to serve as eyebrow hair. Micrografts of one to two hairs placed into incisions should be used for eyebrow reconstruction.
Scalp – to – eyebrow pedicle flaps – (Less commonly used) A strip of hair-bearing skin and subcutaneous tissue is raised from the temple area just in front of the ear, with its blood supply (a branch of the superficial temporal artery and vein) attached. This type of donor graft attached to a blood supply is called a pedicle flap. After the pedicle flap is raised, the recipient area (the eyebrow) is prepared to receive the flap. A subcutaneous “tunnel” is created from the base of the pedicle flap to the eyebrow recipient site; the flap is pulled through the tunnel and secured to the recipient site with stitches. The pedicle flap’s blood supply nourishes the grafted tissue until the grafted tissue develops its own blood supply from surrounding tissue. Hairs grown from grafts and pedicles may have to be “trained” with gel or wax to lay flat to the skin like eyebrow hair; grafted hair also may have to be trimmed occasionally.
Transplantation to Correct Eyebrow Loss – A purpose of transplantation of hair to the eyebrow is to recreate the eyebrow in a natural contour. Patient and physician must work together to outline the eyebrow area to conform to the natural symmetry of the patient’s face. Depending on the size of the area to be transplanted, more than one transplant session may be required.
Donor hair for the transplant is taken from a site that furnishes finer rather than coarser hair; finer hair is a better “match” for eyebrow hair. Donor hair is transplanted as micrografts of one to two hairs. Each graft is placed into an incision prepared for it. The use of single hairs or micrografts permits meticulous adherence to the eyebrow contour for a natural appearance.
As the transplanted hairs grow in their new position they may require occasional trimming as well as “training” with gel or wax.
Transplantation is the only procedure used to restore eyelash hair. This is a very specialized procedure that is performed by just a few surgeons. As is the case for eyebrows, donor hair for transplantation must be finer rather than coarser. All grafts are single hairs meticulously placed into the lid. As few as six hairs per lid may be adequate to create a natural effect.
Itching is a common and troublesome postoperative complication. If the patient gives in to temptation and scratches, there is risk for dislodging the hair grafts and initiating infection. Eyeglasses may be worn to deter scratching. The dermatologist can prescribe medications to relieve itching.
Training of transplanted hairs into eyelash conformation is accomplished by use of lash oil
INSTRUCTIONS FOR HAIR TRANSPLANT
PRE OP. INSTRUCTIONS:
1. Wash face and hair with liquid Betadine surgical scrub soap on the night before surgery and on the morning of the surgery.
2. Do not use any hair oil, cosmetics or makeup after the hair wash.
3. Please take medicines according to the instructions given in your prescription.
4. Please have a full meal 2 hours before the surgery.
POST OP. INSTRUCTIONS:
1. Regular diet.
2. See the doctor as advised in 3-5 days after the surgery.
3. You will be advised to wear a headband after the surgery for 3-5 days.
4. You may use a loose cap for few days, if you like.
5. Take medicines according to the instructions given in the prescription.
6. Keep head elevated at all times (use 1-2 pillows while lying down) for three weeks from the day of the surgery.
7. Do not get the head wet for 5 days from the day of surgery.
8. Use Johnson’s baby shampoo from the 5th day to wash the hair. You may use any shampoo after 21 days.
9. You can travel 36 hours after the operation.
10. Do not undertake any strenuous activities or exercises for three weeks after the surgery.
11. Hair oil, Hair sprays etc. should not be used for three weeks after the surgery.
12. Helmet should not be used for three weeks after the surgery.