Hair Loss

The available medical options for reversing hair loss hair in people suffering from hereditary forms of baldness are limited to relatively few products with most of them being effective only in the early stages of baldness. Once you have lost a big portion of hair due to hereditary factors or an accident, such as a burn, the only remaining option is to replace the missing hair. Your options can be either of a temporary nature, such as the use of hair pieces and hair loss concealers, or a permanent surgical solution. Hair transplantation happens to be the most effective way of surgical hair replacement and the only permanent solution that offers satisfactory results.

Hair transplantation consists in transplanting patient’s own hair from the back of his scalp to the frontal, balding area. The main limiting factor of hair transplantation is the shortage of donor hair and, therefore, many patients do not make a good candidate. The suitable hair transplant candidate should have a high hair density in the back of the scalp, his hair should be thick and wavy, his scalp flexible and the contrast between the colour of his hair and scalp should not be too great, and he must be in good physical condition. Women largely suffer from a diffuse form of hair loss and, therefore, do not make very good hair transplant candidates. Hair transplantation also cannot be performed on patients suffering from unpredictable forms of hair loss such as alopecia areata.

Given the limited supply of donor hair, the hair transplant surgeon must be able to utilise the little hair he can use to create the optical illusion of a full head of hair. This represents the biggest risk in hair transplantation, as it can sometimes happen that the patient does not like the final result. Although you can usually arrange for another hair transplant procedure, some damage can be irreparable. Other risks and side effects occurring during and after hair transplant surgery include excessive bleeding and scarring, the lengthy healing of wounds, the transaction and eventual death of many implanted hair follicles, post transplant shock hair loss, which, though only temporary, can affect your newly-implanted hair as well the hair in the donor area, scalp numbness and tension and the further progression of hair loss post surgery, which can lead to unnatural patterns of baldness. In one recent study, which examined the experiences of 425 hair transplant patients who had undergone 533 hair transplant procedures in total, it was determined that about 5% of the patients experienced complications either during or after surgery.

Hair transplantation can cost more than ten thousand dollars, depending on the technique used, the location and reputation of the clinic, the extent of hair loss and the number of hair transplant sessions needed to achieve the desired change in density. However, sometimes it is impossible to estimate the final cost, which represents another risk you take when deciding on hair transplant surgery. Given the pain, time and cost involved, it pays to educate oneself prior to signing up for hair transplant surgery. The hair transplant industry is a fast-growing area and the quality and affordability of hair surgeries are improving, so do not let anybody push you into hasty uninformed decisions.

Conquering baldness and restoring lost hair is to many of us a distant dream. However, there are existing options for replacing lost hair and some of them may seem surprisingly effective even to the most sceptical hair loss sufferer. The three principal methods of hair restoration include surgical hair restoration, non-surgical hair replacement and therapies for regrowing hair using pills and topicals. The main technique of surgical hair restoration today is hair transplantation, whereas wigs, hairpieces, hair thickeners and hair loss concealers are the most popular aids used to replace the lost hair by non-surgical means. The non-surgical cover-up is obviously the quickest and the least expensive method of replacing lost hair, though not tremendously popular, as many people believe that wigs and concealers cannot withstand rain and wind and do not look natural. In spite of this common belief, some of them are extremely resistant to external influences and can appear very authentic. Wigs and concealers are usually the only option of restoring lost hair for people suffering from non-hereditary forms of hair loss such as unpredictable alopecia areata.

Surgical hair restoration is the most expensive method of restoring lost hair but also the most elegant solution. It can only be used in people suffering from hereditary forms of baldness and burn patients. Candidates are required to have sufficient hair density at the back of their scalp and many women suffering from female form of hair loss with its typical diffuse balding pattern do not meet this condition. Hair restoration surgery has made great strides in the past twenty years with the introduction of the two main techniques used today - follicular unit transplantation and, more recently, follicular unit extraction. These advances in hair transplantation techniques enable the grouping of hairs very close together, which gives modern hair transplants an entirely natural look. The main weakness of hair transplant surgery, besides the cost and the pain involved, is the limited supply of donor hair and the need for multiple surgeries to achieve the final improvement. Furthermore, patients have to commit themselves to the use of finasteride or any other adequate medicinal hair loss therapy for the rest of their lives to prevent further loss of hair.

Hair loss pills and topicals do not, despite significant scientific advances and the discoveries of recent years, provide satisfactory hair restoration results yet. The two most frequently prescribed hair loss drugs, finasteride and topical minoxidil, can be effectively used to reduce hair loss but their ability to regrow lost hair is relatively poor. Their effectiveness typically declines sharply in the later stages of the balding process. There is no existing medicinal or natural hair loss remedy that can deliver adequate visual results comparable to either hair transplantation or non-surgical hair replacements such as wigs and hair loss concealers. Although there are some promising medicinal hair loss drugs currently being developed, especially in the area of genetic research, the ultimate pill for baldness is not expected to become commercially available within the next fifteen years. Other advances in hair science, such as hair cloning or the generation of new hair follicles in wounds, also hold out some promise but it appears that hair transplant surgery will in the next ten to fifteen years remain the most complete method of hair restoration.

The first hair transplants were conducted in Japan back in the 1930s. In the old days of hair transplant surgery relatively large strips of skin of four millimetres in diameter, the so called punch grafts, were transplanted from the back of the scalp to the frontal balding area. Hair transplantation techniques have evolved enormously since then and today’s hair transplants can give you a very natural look. This is due to the miniaturisation of hair transplants, which now contain only one hair follicle (holding between one and four hairs) and are less than one millimetre in diameter. These tiny, single follicular unit grafts are then implanted into the needle-made incisions in the balding area. Today’s technology enables dense packing of hair follicles, which gives you a completely natural-looking frontal hairline. Gone are the days of pluggy grafts that made you resemble a toothbrush.

The two main hair transplantation technologies that are used today are called Follicular Unit Transplantation (FUT) and Follicular Unit Extraction (FUE). The main difference between them is in harvesting hair follicles. The FUT is the older method, using the so-called strip harvesting, when a linear strip of skin of up to 20 centimetres long and 1.5 centimetres wide is extracted from the back of the scalp and the opening is then sewn closed. This strip is then placed under series of microscopes and dissected into small grafts, containing just one follicular unit each and measuring max one millimetre in diameter. Such follicular grafts are then implanted into the balding area. The advantage of this method is its high yield, measured as a percentage of the follicles that are successfully transplanted into the bald area. This yield is around 98%. The greatest weakness is that it leaves the patient with a linear scar at the back of his head. The FUT is less expensive than the FUE and is used when a large area needs to be filled with transplanted hair in one single session.

The FUE method uses a micro-extraction technology to harvest individual hair follicles that can be directly implanted into the small needle poke holes in the bald area. The FUE technique is the latest technology, introduced in 2002. Its greatest benefit is the fact that it leaves the patient with only tiny scars at the back of the head, which are visible only after very close inspection, and the healing time is much shorter than with the FUT, due to the small size of the wounds. However, this method is not suitable for covering large areas in one session and it is more expensive. Additionally, its yield is significantly lower, due to the transaction of many follicles, and since the supply of donor hair is limited, it cannot be used in patients whose hair loss has progressed above NW4 level.

Potential future surgical hair restoration technologies, such as hair multiplication and the generation of new hairs in wounds, should solve the problem with the limited amount of donor hair. It seems that hair implantation will in the long future only be used for creating frontal hairlines and, therefore, the follicular harvesting should manage to provide a sufficient number of hair implants. However, none of the aforementioned potential future techniques is expected to become commercially available before 2012. Therefore, the immediate future probably lies in improving the harvesting techniques of the FUE technique in order to improve its yields and make it financially more affordable. The FUT with its strip harvesting, which sparked a revolution in the hair transplant industry less than two decades ago, may become history in the not too distant future.