Hair Transplantation
SURGERY FOR HAIR BALDNESS
The surgical technique for hair baldness has seen major advances in recent years. The era of "plugs" or tufts of hairs transplanted with an average of 10 to 15 hair follicles per hole created is long gone and cosmetic results have improved quite significantly.
Unlike what some think, hair follicles do not grow one by one, but within groups of 1, 2, 3 and even 4-follicles called follicular units.
The greatest technological advance in Hair Transplantation has been our ability to microscopically surgically separate these units of 1, 2, 3 and 4 follicles and transplant them into the bald or thinning areas as they were in the donor area including all its attachments, glands, erector pili muscle, etc.
Today, Hair Transplant surgery is performed under local anesthesia with mild sedation and takes approximately 3 hours. The patient is discharged home 1-2 hours after the procedure with a head bandage. He/She returns in 24-48 hours post-operatively to remove the dressings. From there, the patient is free to perform their normal activities with post-operative instructions to avoid damaging the transplanted micro grafts.
15-30 days post operatively 80% of the transplanted hair follicles fall out, losing the follicles but leaving the roots. At this stage there is also a relative decrease of natural hair growth due to the surgical stress of the procedure. It is important to know that all natural hairs that fall out after surgery will grow back. From the new roots (transplanted hairs) new follicles will grow. These new follicles begin to fill the transplanted regions of the scalp in about 3 months after the procedure. After this period, they will grow an average of 1 cm per month, with the final result appearing around 12-18 months after the procedure.
Since the transplanted hair does not contain the genetic code for baldness, they will never fall out. This resulting in hair transplants for life.
However, the natural hair (not transplanted), which contains the genetic code for baldness will continue to fall out. Hence, the possible need for a second and third transplant session. This need is directly proportional to the speed of the loss of hair follicles and baldness advances.
Actual patients depicted.
HOW DOES HAIR LOSS OCCUR
There are hair follicles with a genetic predisposition for baldness and hair follicles that do not carry the genetic code for baldness.
Both hair follicles tend to fall. The difference between the two is follicles not genetically predisposed only fall when they turn their life cycle and are still thick. When it occurs, they are immediately replaced by other hair follicles of the same thickness.
The hair follicles which carry the genetic code for baldness suffer a loss process altogether, because they do not fall as thick ordinary hair follicles.
The hair follicles that have the genetic code for baldness, have in their roots, receptors for a hormone called dihydrotestosterone, commonly known as DHT. This hormone causes the follicles to undergo a process of gradual atrophy or miniaturization. It binds to receptors causing the hair follicle to weaken and shrink becoming a fuzz invisible to the naked eye. This hair follicle is not replaced when it falls, setting baldness.
Microscopic image of the scalp (up 50xx)
Note the process of atrophy of the hair follicles in the same area. Do not worry about the thick hair that you see fall out every day with those who clog the drain, fill the brush, as these will be replaced. Worry about with those you do not see fall. Just look at the hairbrush of a woman with a full head of hair and notice that despite being full of hair, she is not bald.
Myths:
Frequent use of caps, washing your head, stress, etc, does not make anyone bald! These factors may accelerate the process on a person with genetic predisposition for hair . Ultimately, this person will have the same baldness pattern with or without these factors.
Finally, there is no medicine or therapy capable of making hair grow! Medical treatments can slow down or even stop the balding process but will not change the final result.
FEMALE BALDNESS
The loss of hair among women is much more common than you think, and contrary to popular belief, baldness is not a problem for men only. Research indicates that 1 in 5 women can present with thin and fine hair.
If you are a woman who notices a quick drastic loss of hair, with or without thinning, is surprised, upset and worried about hair loss or does not understand why you are losing hair, you are not alone. Many women experience the same problem.
The good news is that the vast majority of cases can be treated by an expert. In some cases, only medical treatment can work, but in others the need for Hair Transplantation combined to medical therapy is necessary.
Female pattern baldness is more subtle than men and women can disguise it with their hairstyles. Baldness in women can affect only the frontal region or the entire scalp. Only a minority of women seek Hair Transplant surgery because they think this procedure is exclusive to men.
Unlike what occurs in men, where almost all cases of baldness are genetic in origin, female baldness is more complex. Menstruation, pregnancy the use of birth control and the frequency of diets in women can greatly influence hair growth. Even worse, stress can cause hair loss. A well balanced life of work and leisure plus exercise is healthy not only for overall health but for the hair as well. Diet is also a key component for healthy hair. B vitamins, trace elements, Zinc, Copper and Iron are also very important. The main component of hair is Keratin, which is a protein therefore low-protein diets can affect the vitality of hair.
The most common cause of baldness in women is more diffuse and less obvious than in men. Because there are often other associated disorders in female baldness initial diagnosis is typically incorrect or correctly diagnosed too late. In women, hormonal changes have a huge impact on their hair. In addition to the sex hormones that change during pregnancy or contraceptive use, other hormones such as thyroid or adrenal glands can influence hair loss. These other hormones can lead to diffuse hair loss generically called diffuse alopecia in women. These two absolutely distinct entities should be differentiated both by history, clinical examination and by laboratory tests.
Female pattern baldness can be classified in three grades:
- Grade I - Slight thinning, more visible in the midline axis of the scalp
- Grade II - Transparency that allows viewing of the scalp
- Grade III - Advanced baldness is already present
Treatment for the different grades of baldness:
- Grade I, early baldness - If alopecia is part of the disease, clinical treatment should suffice
- Grade II, intermediate baldness - If alopecia is part of the disease, clinical treatment combined to Hair Transplantation
- Grade III, advanced baldness – Hair Transplantation
CAUSES
The causes of female baldness, unlike men where 99% of cases are genetic, can be many and not always easy and simple to be detected and treated.
The most common causes are:
- Androgenic, a genetic cause which accounts for approximately 70% of all female baldness. This form is also present in other women in the family including mother, aunts, grandparents, etc. The only treatment for this type of baldness is surgery such as Hair Transplantation.
- Telogen Effluvium, a common type of hair loss in women occurs when a large percentage of hairs in the telogen phase fall out. This loss of hair is due to hormonal disorders, nutritional deficiencies, stress, etc. and usually begins in young adulthood or adolescence and improves with medical treatment only.
- Trichotillomania, an act of compulsive hair plucking. This issue cannot be treated surgically or medically. The patient must treat the underlying emotional or psychological issue causing the compulsion.
- Alopecia Areata, an autoimmune disease that causes localized loss of hair. Medical examination is needed to establish accurate diagnosis and treatment.
- Cicatricial Alopecia, hair loss which can be caused by excessive traction of the hair. For example, black women tightly pulling back the hair to keep a high forehead. This type of hair loss may also be caused by burns, plastic surgery, facial radiotherapy, etc. In such cases, the only solution is Hair Transplantation.
Systemic causes include:
- Increased hormone levels. Investigation into the cause of hormone elevation, which may result from simple things like ovarian cysts or benign adrenal gland tumors, must be explored.
MEDICAL TREATMENT
It is important to clarify that if the cause of female baldness is genetic, no medical treatment will bring back the hair follicles. At most, progression of baldness can be slowed down by medical treatment. In some cases, there is a thickening of the follicles, giving the false impression there is new hair growth.
- Minoxidil improves the local blood supply which in theory may slow down hair loss.
- Finasteride acts by blocking the action of DHT in the hair bulb and therefore slows hair baldness. Finasteride has a greater effect and efficacy in men and should never be used orally in women. Depending on the stage of hair baldness, the affected area and the patient's age, Finasteride may improve baldness by reversing the process, thickening the follicles providing dense coverage and the impression there is new hair growth.
- Lasecomb (Laser) is the latest technology in terms of clinical treatment. In theory the laser stimulates the local circulation, slows down hair loss and increases the thickness of the hair follicles.
- Other treatments include the use of shampoos to decrease hair loss and have been very popular with very limited results.
In summary, when the cause of baldness is genetic as the vast majority of cases are, clinical treatments are ineffective. Most assume the problem is due to poor blood circulation and nutrition of the scalp. This is directly demystified by Hair Transplantation where follicular units transplanted in these regions grow and develop normally; proving that baldness in these areas has nothing to do with poor blood supply.
SURGICAL TREATMENT
The ultimate solution for cases of thinning hair is surgical Hair Transplantation using a micro-implant technique.
Many women do not seek this procedure due to pure lack of information or because they think the procedure is indicated only for men. Today, 10% of surgical Hair Transplantation is performed on women providing excellent cosmetic results and restoration of patients self esteem.
