Hair Loss

Facts about normal hair growth:
About 90 percent of hair on the scalp grows continually. The other 10 percent of scalp hair is in a resting phase that lasts two to three months. At the end of the resting stage, this hair is shed.

Shedding 50 to 100 hairs a day is normal. When a hair is shed, it is replaced by a new hair from the same follicle and the growing cycle starts again. Scalp hair grows about one-half inch a month.

As people age, the rate of hair growth slows.

What causes hair loss?
Hair loss is believed to be primarily caused by a combination of:

aging
change in hormones
illness
family history of baldness
burns
trauma

Generally, the earlier hair loss begins, the more severe the baldness will become.

Hair loss is not caused by:

poor circulation to the scalp
vitamin deficiencies
dandruff
excessive hat-wearing
a gene passed on from an individual's maternal grandfather

What is hair replacement surgery?
The interest in hair replacement has significantly increased over the past ten years. Two out of every three men and one in five women suffer from hair loss. For men, the main cause of a diminishing hairline is heredity. Hormonal changes such as menopause can cause both thinning and hair loss in women.

There are a number of hair replacement techniques that are available, although hair replacement surgery can not help those who suffer from total baldness. Candidates for hair replacement must have a healthy growth of hair at the back and sides of the head. The hair on the back and sides of the head will serve as hair donor areas where grafts and flaps will be taken.

There are four primary different types of hair replacement methods, including:

hair transplantation - during hair transplantation the surgeon removes small pieces of hair-bearing scalp grafts from the back or sides of the head. These grafts are then relocated to a bald or thinning area.

tissue expansion - in this procedure, a device called a tissue expander is placed underneath a hair-bearing area that is located next to a bald area. After several weeks, the tissue expander causes the skin to grow new skin cells. Another operation is then required placing the newly expanded skin over the adjacent bald spot.

flap surgery - flap surgery is ideal for covering large balding areas. During this procedure a portion of the bald area is removed and a flap of the hair-bearing skin is placed on to the bald area while still attached at one end to its original blood supply.

scalp reduction - scalp reduction is done in order to cover the bald areas at the top and back of the head. This technique involves the removal of the bald scalp with sections of the hair-bearing scalp pulled together filling in the bald area.

Possible complications associated with hair transplantation procedures:

patchy hair growth
Sometimes the growth of newly placed hair has a patchy look especially if it is placed next to a thinning area. This can often be corrected by additional surgery.

bleeding and/or wide scars
Tension on the scalp from some of the scalp reduction techniques can result in wide scars and/or bleeding.

grafts not taking
Occasionally there is a chance that the graft may not "take". If this is the case, surgery must be repeated.

infection
As in any surgical procedure there is the risk of infection.

About the procedure:

Location options include:

surgeon's office-based surgical facility

outpatient surgery center

hospital outpatient

hospital inpatient

Anesthetic options include:

general anesthesia

local anesthesia, combined with a sedative (allows the patient to remain awake but relaxed) for adults

Probable length of procedure: Several surgical sessions are usually needed to achieve satisfactory fullness, with a healing interval of several months recommended between each session. It may take up to two years before seeing the final result with a full transplant series.

Recovery period:
Plugged or grafted hair falls out within a month or two after surgery, which is normal and almost always temporary. After hair falls out, it generally takes another month or more before hair growth resumes. A surgical touch-up procedure may be needed to create more natural-looking results after the initial incisions have healed. This may involve blending, a filling-in of the hairline using a combination of mini-grafts, micro-grafts, or slit grafts.

Non-surgical hair replacement with medication:

Finasteride (Propecia™)
Finasteride, produced by Merck and Company under the name Propecia, was approved by the FDA in December 1997, as a treatment for male pattern baldness. It is the first drug available in pill form for the treatment of baldness.

In men with mild to moderate hair loss, clinical trials showed that 83 percent of the male patients had kept their hair or grown more after one year of treatment. Propecia (finasteride) works by blocking an enzyme called 5-alpha reductase, which is responsible for the formation of dihydrotestosterone in a man's body. The enzyme converts testosterone to DHT (dihydrotestosterone). It is believed that DHT is a key factor in male pattern hair loss, and finasteride decreases the concentration of DHT in a man's scalp.

Finasteride is available by prescription only.

minoxidil (Rogaine™)
Minoxidil, a drug produced by Upjohn under the name of Rogaine, has been available since 1988 for the treatment of hair loss. It is currently available as an over-the-counter drug.

Minoxidil is topical solution that must be applied by applicator or fingers to the balding area twice a day, every day. Decreasing the dosage to once a day results in some hair loss, and discontinuing application causes regression to pretreatment baldness.

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