When faced
with thinning hair or hair loss many individuals turn to hair care treatments
like shampoos to help them with their condition. Depending on the type of hair
loss being experienced and the degree of that hair loss, this decision can be an
effective and rewarding one.
Can Shampoos
Reverse Hair Loss
Depending on
the type of shampoo you choose, and the active ingredient of that shampoo, the
short answer can be yes. Certain hair loss shampoos contain botanicals that act
to neutralise the effects of DHT in the hair follicle. DHT, an enzyme that is
produced as a by-product of testosterone, is currently thought to be the leading
cause of hereditary hair loss, also called male pattern baldness.
Another
active ingredient in effective hair loss inhibiting shampoos is thymus peptides.
These also penetrate to work deep within the hair follicle but claim to stop
hair loss through a process of deep cleaning and pore unclogging so that new
hair growth can break free and begin again naturally. These shampoos support
their effectives with the theory that hair loss is caused by an autoimmune
disease where the white blood cells attack foreign matter, such as dirt and
debris, to eliminate it from the pores. This white blood cell concentration
causes interrupted hair growth. However, the deep cleansing of the peptides will
reduce the need for excess white blood cells and allow the follicle to function
properly and produce hair.
What Shampoo
Can Really Do For Hair Loss
If you choose
a shampoo that contains botanicals for DHT neutralisation you can expect to see
a reduction in hair loss within one week of starting treatment. With continued
use you can expect to see new hair growth beginning in as little as four weeks.
If you choose a hair growth enhancing shampoo that contains thymus peptides you
can expect to see a slowing of excess hair loss within 2 weeks and some new hair
growth within three months. However, these types of shampoos are not effective
for everyone who uses them. In clinical studies thymus peptides have failed to
produce new hair growth for 5% of females and 30% of males experiencing hair
loss due to hereditary pattern baldness.
If you are
not looking to experience new hair growth you have a few more options. Some
shampoos, especially those that contain the active ingredient trichogen have
been proven to thicken the hair shaft to provide the appearance of thicker hair
and to stop or reduce hair loss.
Other
shampoos, with a wide variety of active ingredients, aim to thicken hair for
more fullness, cover thinning hair spots with volume boosting capabilities, and
or help nourish existing hair in order to keep it healthy and reduce breakage
and early fall-out.
Effective
Shampoos for Treating Hair Loss
Once you have
decided which type of hair loss condition you want to treat and which active
ingredient sounds the most promising for your condition you need to look at the
most popular shampoos available on the market.
For
individuals who wish to stop hair loss and stimulate new hair growth using a DHT
neutraliser Nisim Cleansing Shampoo is a great choice. This company makes a wide
variety of shampoos for hair loss including once specially formulated for dry,
oily, or combination hair.
For
individuals preferring to use thymus peptides for deep cleansing ThymuSkin
manufactures a variety of hair care products including shampoos.
If you just
need to give the thickness or volume of your hair a healthy boost you can choose
from the hundreds of specially formulated shampoos on the market at your local
drug or grocery store. Many of these shampoos also boast products that can help
make your hair shinier, softer, and more manageable.
No matter
what your needs with a little research and time you are sure to find the shampoo
for hair loss that fits your hair loss condition, your hair type, and your
lifestyle needs. There is an ingredient called Ketoconazole that has been
provent to control dandruff and also grow hair! Regenepure DR contains
Ketoconazole.
Male Pattern
Baldness (MPB)
The general
medical term for all types of hair loss is "alopecia." There are many different
factors that can cause alopecia, including genetics, hormonal influences,
illness, or environmental factors.
"Androgenetic
alopecia" (AGA), also sometimes called "androgenic alopecia," is by far the most
common form of hair loss in both men and women, though the patterns of hair loss
seen with AGA tend to differ across gender lines. Women with AGA tend to show a
diffuse thinning of the hair on all areas of the scalp (this is often termed
"female pattern baldness" or FPB), while men tend to show distinctive patterns
of hair loss around the temples, the crown (the top of the scalp), and/or a
"receding hairline" from the forehead working backward (this is often termed
"male pattern baldness" or MPB). The Norwood Male Pattern Hair Loss Chart (shown
below) shows typical manifestations of MBP.
Hair and hair
growth: the basics
In order to
better understand hair loss, it can be helpful to have a basic understanding of
hair growth patterns and terminology.
Each strand
(or "shaft") of hair is made up of a strong structural protein called "keratin;"
this is the same material that makes up our fingernails and the outer layer of
our skin. Hair that is very fine, short, and usually light in color (such as
"peach fuzz" on the face) is called "vellus hair." Healthy head hair, as well as
beard, armpit, and pubic hair, is called "terminal hair."
A shaft of
hair has three basic layers: the "medulla," the "cortex," and the "cuticle." The
medulla is the innermost core of the hair, and it is only present in thick hairs
such as scalp hair. The cortex is the middle layer which provides strength,
color, texture, and elasticity. The outermost layer is called the cuticle; it is
colorless and forms a tightly-packed layer of overlapping scales to protect the
hair from the environment.
Each shaft of
hair grows out of a small sac within the skin called a "follicle." A follicle is
a like a small canal with a bulbous area at the bottom called the "dermal
papilla," from which the hair fiber is produced. Very small blood vessels
nourish the dermal papilla during hair growth. The follicle is also connected to
a "sebaceous gland" (or oil-producing gland), as well as a tiny bundle of muscle
fibers called the "arrector pilli."
A normal hair
growth cycle can be broken down into three phases: the "anagen phase," the
"catagen phase," and the "telogen phase."
The anagen
phase is a hair's growth phase. Approximately 85-90% of hairs are in the anagen
phase at any given time. For scalp hair, this growth phase can vary from 2 to 6
years, in which the hairs grow approximately 10cm per year.
At the end of
the anagen phase, a hair enters the catagen phase. This is a transitional phase
that lasts about one or two weeks, during which time the hair follicle shrinks
to about 1/6 of its normal length. The lower part of the follicle is destroyed
and the dermal papilla breaks away to rest below the follicle.
After the
catagen phase comes the telogen phase, a resting period. The telogen phase
typically lasts about 5 to 6 weeks. During this time, the hair stays attached to
the follicle but does not grow. Approximately 10-15% of hairs are resting at any
given time. At the end of the telogen phase, the follicle once again begins the
anagen phase. The dermal papilla, which had been resting since the the end of
the catagen phase, rejoins the base of the follicle and a new hair begins to
form. If the old hair has not already shed, the new hair will push it
out.
Each hair
will pass through these phases independent of other hairs nearby. The average
scalp contains about 100,000 hairs, and it is typical to shed between 50 to 100
hairs from the head each day.
Male pattern
hair loss, defined further below, is caused by the body's failure to produce new
hairs on certain areas of the scalp. Therefore, the onset of male pattern
baldness is a gradual process, and not typically marked by sudden or excessive
hair loss.
Causes of
AGA/MPB: DHT and Heredity
While the
causes of androgenetic alopecia are not fully understood, two major factors that
appear to be involved in AGA are:
1. the
presence and action of dihydrotestosterone (DHT), a potent androgen, in the hair
follicles, and
2. a seemingly inherited sensitivity to DHT in the affected
hair follicles.
"Dihydrotestosterone"
(DHT) is a naturally occurring hormone and a potent derivative of testosterone
(T). It is recognized that DHT plays an important role in the development of the
male fetus, as well in male pubescent development. DHT is able to bind to the
same cellular androgen receptors that T does. While it is known that both T and
DHT play important roles in various biological functions in the human male, it
has not yet been possible to determine which of the two hormones is the primary
or sole initiator of certain biological responses.
Regarding the
topic of hair loss, one thing that seems certain is that DHT appears to play a
major role in the process of androgenetic alopecia.
In the body,
T is converted into DHT with the aid of an enzyme called "5-alpha reductase"
(5aR). Due to a slight variance in its chemical structure, there are two types
of 5-alpha reductase enzymes, aptly named "type I 5-alpha reductase" and "type
II 5-alpha reductase." Type I 5aR has been found in various parts of the body
including the sebaceous glands, the sweat glands, the skin, and the hair
follicles. Type II 5aR has been found in the sebaceous ducts, the hair
follicles, the prostate, the liver, and the testicles. Both types of 5aR can
combine with T to form DHT.
In the hair
follicles, 5-alpha reductase combines with testosterone to produce DHT. DHT then
goes on to bind to androgen receptors in the follicle itself.
The DHT
production and binding process described above occurs even in men who are not
losing their hair. Though the exact causation is not fully understood, problems
with male pattern hair loss seem to arise if the follicles themselves have a
predisposed sensitivity (probably inherited) to certain levels of DHT over
time.
If certain
follicles are indeed sensitive to DHT, they will undergo a gradual shrinking
process. Through each new cycle of hair growth, the follicle will continue to
degrade, becoming shorter and thinner than in the previous cycle. As a result,
the hair that grows from the follicle will become progressively finer and more
wispy, until the follicle has miniaturized to the point where it can no longer
grow a viable hair.
The hairs
that tend to be most sensitive to this degradation process in men are the hairs
around the temples, forehead, and crown (as shown previously in the Norwood
Chart). The hair on the back and sides of the head seems to be less prone to
AGA; thus the familiar "horseshoe" pattern of hair around the head seen in many
men who are balding.
The
degradation process in the affected follicles that is seen in AGA typically
takes place fairly slowly, over a course of years. Hair loss that occurs rapidly
or in patches, that involves the breaking of hair shafts, diffuse shedding, or
is associated with redness, scaling, or pain could be caused by conditions other
than AGA and should be checked with a dermatologist in order to be treated
properly.
Treatments
for MPB
The most
effective treatment options for male pattern hair loss to date have focused on
interrupting the production of DHT in the scalp, and/or stimulating the growth
process in the hair follicle itself.
There are
currently only two FDA-approved drug treatments for hair loss. (The FDA is the
U.S. Food and Drug Administration, a governmental organization responsible for
assuring the safety, efficacy, and security of drugs, biological products,
medical devices, our nation’s food supply, cosmetics, and products that emit
radiation.) Those two treatments are Finasteride and Minoxidil, and they are
further described below. A third promising hair loss treatment called
Dutasteride is currently being tested for the treatment of hair loss, and thus
it is often included in hair loss information resources. It is also described
below.
Though there
are only two FDA-approved treatments for hair loss to date, there are numerous
hair loss products on the market, including a large number of herbal and vitamin
treatments. Consumers should beware that many products claiming to stop hair
loss or regrow hair have not been proven to work in clinical settings, and
indeed don't work. When in doubt about any particular product, be sure to check
the list of active ingredients and discuss them with an impartial doctor or
dermatologist.
Male pattern
hair loss tends to happen over the course of years. If you do choose to try to
treat your hair loss, it is a good idea to start early, in order to slow or
prevent as much loss as possible. At the first signs of hair loss, speak to your
doctor or dermatologist to discuss your options.
Acceptance
The least
expensive and easiest "treatment" for male pattern baldness is acceptance! And
those who accept their hair loss will certainly be in good company-- by age 35,
about two-thirds of American men will experience some appreciable degree of hair
loss, and by age 50 over three-quarters of men will have significantly thinning
hair.
Your
hairstyle will probably need to change as your hairline changes. Many guys with
significant hair loss opt for very short styles, including shaved or nearly
shaved heads. Wearing facial hair can also augment the looks of a man with MPB.
You should speak to your barber about the styling options that will look best
with your hairline, head/face shape, and facial hair.
Finasteride/Propecia:
5-Alpha Reductase Inhibitor
The drug
Finasteride was initially prescribed to men in the United States under the drug
name "Proscar" to treat enlarged prostate glands. A side effect of the
medication was that it caused hair growth in a significant number of the
patients. It is now marketed in the U.S. as "Propecia" to treat mild to moderate
hair loss in men. It is widely considered the most effective treatment for male
pattern hair loss available to date, and it is FDA-approved for that
purpose.
Finasteride
is a type II 5-alpha reductase inhibitor. Type II 5-alpha reductase (type II
5aR) is an enzyme that is responsible for converting testosterone into DHT.
Finasteride blocks the action of type II 5aR, thereby inhibiting DHT production
in the hair follicles. A daily dose of 1mg can effectively lower DHT levels by
as much as 60%.
86% of men
who take Finasteride see a stop to the progression of hair loss, and 65% of men
who take it experience hair growth in the crown area. It has been shown to
effectively treat hair loss on the vertex (top of the head) and the anterior
mid-scalp area. There is evidence that Finasteride works in treating receding
hair lines at the temples, but it seems to be less effective in that area.
The typical
dose for treatment of hair loss is 1mg/day. It may take from 3 to 6 months for
the patient to see an effect. In order to retain the benefits of the medication,
it must be taken indefinitely. If a patient stops taking Finasteride, DHT levels
will rise in the hair follicles, and hair loss is likely to resume. It is only
available by a prescription from your doctor.
Precautions
Finasteride
should not be taken by women who are pregnant or who may become pregnant, nor
should women handle broken tablets of this medication, as it can be absorbed
through the skin. The reason for this precaution is that Finasteride is known to
cause birth defects in developing male fetuses (recall that DHT plays an
important role in male fetal development).
Unless a
trans man has a chance of being pregnant or makes the decision to go off of
testosterone in order to become pregnant, Finasteride can be taken daily for the
treatment and prevention of male pattern hair loss.
Possible side
effects
Possible
side effects of Finasteride include decreased libido, breast tissue tenderness
or enlargement, skin rash, swelling in the lips, tongue, or face, abdominal
pain, back pain, diarrhea, dizziness, or headache. For men born with a
functional penis and testes, Finasteride can also cause difficulty in getting or
maintaining an erection.
Dutasteride:
5-Alpha Reductase Inhibitor
Dutasteride
is similar to Finasteride in that it is also a 5-alpha reductase inhibitor. It
is effective in inhibiting both type I and type II 5-alpha reductase, though it
is unclear if this provides additional benefits in the treatment of male pattern
hair loss.
Dutasteride
is FDA-approved to treat enlarged prostate glands in men, but it is not yet
marketed or approved for treatment of hair loss. Dutasteride is currently being
tested for the treatment of MPB, and thus it is often included in hair loss
information resources. It is only available by a prescription from your
doctor.
Precautions
Dutasteride
should not be taken by women who are pregnant or who may become pregnant, nor
should women handle broken tablets of this medication, as it can be absorbed
through the skin. The reason for this precaution is that Dutasteride is known to
cause birth defects in developing male fetuses (recall that DHT plays an
important role in male fetal development).
Possible side
effects
Possible
side effects of Dutasteride include decreased libido, decreased amount of semen
released during ejaculation, or breast tissue tenderness or enlargement. For men
born with a functional penis and testes, Dutasteride can also cause difficulty
in getting or maintaining an erection.
Minoxidil/Rogaine
Minoxidil was
first used in tablet form as the drug "Loniten," an antihypertensive, to treat
high blood pressure. An unexpected side effect of Loniten was that some patients
experienced excessive hair growth.
As a result,
a topical solution of Minoxidil was developed for application directly on the
scalp to stimulate hair growth. This product is marketed in the United States as
"Rogaine," though it can also be obtained under other names and as a generic. It
typically comes in 2% and 5% solution, usually in a lotion form. Minoxidil works
best at the back of the head; it is not shown to work quite as well at the front
of the head or on the temples, though some users have shown improvement in those
areas in clinical trials.
The exact
process by which Minoxidil causes its results is not fully understood, but it
appears to help slow or reverse the shrinking process of the hair follicles,
thus slowing loss and causing some regrowth in some patients. It requires
twice-a-day application, and it may take from 3 to 6 months for the patient to
see an effect. Topical minoxidil does not require a prescription; it can be
purchased over the counter in many drugstores.
Minoxidil is
generally not considered as effective as Finasteride in slowing or preventing
hair loss due to male pattern baldness. Some men use a combination of both
Finasteride and Minoxidil to treat their hair loss.
Possible side
effects
Common
side effects of Minoxidil include including skin irritation, itch, contact
dermatitis, hives, swelling, and sensitivity. Rare side effects include blurred
vision, chest pain, decreased libido, difficulty in maintaining an erection,
fast or irregular heartbeat, flushing, headache, lightheadedness, numbness or
tingling of the hands, feet, or face, or rapid weight gain.
A note about
androgen receptor inhibitors/anti-androgens
Drugs or
supplements that have anti-androgenic activity are sometimes used for the
treatment of hair loss in women, but due to unwanted side effects they are
typically not used for hair loss treatment in men. Depending on the
drug/supplement in question, they may act to block the binding of DHT to
androgen receptors, or may cause a reduction/suppression in overall production
of testosterone. Drugs in this category include cyproterone acetate,
aldactone/spironolactone, and nizoral/ketoconazole.
For men, the
trouble with most hair loss drugs that block the binding of DHT (and T) to
cellular receptors is that this effect is usually not localized only to the hair
follicles. Thus, the drugs can act as anti-androgens throughout the body, often
causing unwanted feminizing effects.
A note about
herbal/vitamin treatments
As noted
earlier, there are numerous herbal/vitamin hair loss products on the market
today; whether and to what extent those products are effective in treating MPB
is difficult to say. This is not to imply that vitamin or herbal remedies cannot
be effective in treating hair loss-- indeed, some people have had success with
such treatments, and some studies exist that indicate successful results for
certain substances. However, there is very little regulation around the
marketing and sale of herbal and vitamin products, and as such it can be
difficult to find accurate, unbiased information about various treatments and
their effectiveness.
The reason
that herbal/vitamin treatments are regulated more loosely is largely due to the
fact that they are considered by the FDA to be "dietary supplements" rather than
"drugs."
According to
the FDA, a "drug" is an article that is intended to diagnose, cure, mitigate,
treat, or prevent diseases (drugs can be derived from natural/plant sources).
Drugs must undergo clinical studies to determine their effectiveness, safety,
possible interactions with other substances, and appropriate dosages. The FDA
must review these data and authorize a drug's use before it can be marketed. In
other words, drug manufacturers must obtain FDA approval by providing convincing
evidence that a drug is both safe and effective.
"Dietary
supplements" are substances that exist in nature, and include vitamins and
minerals; herbs, botanicals, and other plant-derived substances; amino acids;
and concentrates, metabolites, constituents and extracts of these substances.
The FDA does not authorize or test dietary supplements, nor does it require the
companies that sell such supplements to provide evidence that they are safe and
effective.
By the FDA's
reasoning, when a company creates a non-natural substance for ingestion (such as
a drug), the burden of proof is on them to prove it is safe because the
existence of that substance is attributable specifically to that company.
Dietary supplements, however, exist in nature, and their origin cannot be
attributed to a specific company. Therefore, the burden of proof is not on the
companies selling the supplements, any more than the burden of proof is on a
food distributor for proving that potatoes or beans are safe.
Furthermore,
drugs are patentable substances, while natural substances are not patentable.
The research costs for testing any substance in a clinical setting are
incredibly high. Drug companies are able to recoup these costs by their ability
to patent the drugs they are testing. Because dietary supplements are not
patentable (you cannot patent a substance that already exists in nature), the
costs for the research and clinical testing of that substance that are required
for FDA approval cannot easily be recouped. Therefore, dietary supplements are
rarely given the same kind of rigorous clinical testing that is required for
drugs before marketing-- it is simply not cost effective.
Because of
this situation, a potential consumer of herbal/vitamin hair loss treatments
would be wise to conduct their own research on the product(s) in question before
buying. It is best to find the active ingredients in a hair loss remedy and find
independent, reputable clinical research and unbiased consumer testimony about
the efficacy of those ingredients. It is best to find out how those active
ingredients produce their effects (i.e., are they 5-aR inhibitors, are they
anti-androgens, etc.), bearing in mind potential side effects of such
treatments. You may also wish to discuss the use of supplements with your
doctor, as some herbal remedies can have negative drug interactions with other
medications or supplements you may already be taking.
Hair
restoration surgery
For men who
don't get satisfactory results from available drug treatments, who have some
money to spare, and who are good surgical candidates, hair restoration surgery
may be a viable option.
There have
been significant advances in the area of surgical hair restoration since the
1990s. New micro-grafting techniques, in the hands of a skilled surgeon, can
create virtually undetectable new hair lines in men who have varying degrees of
hair loss. While this is good news for those considering hair transplant
surgery, it is important to note that in order to get optimal results, one must
find a surgeon who is proficient in the latest techniques, equipment, and
artistry required to create a good hairline.
Finding the
right surgeon can be a daunting task, as the field of hair restoration is
completely unregulated both within the medical community and the government. Any
licensed physician in the U.S. can legally perform hair transplant surgery
without any prior surgical training or accreditation of any kind. Anyone
considering hair restoration surgery should understand that though there are
some highly skilled and highly trained surgeons who specialize in hair
transplantation, there are many who are not skilled or trained in the latest
techniques. Thus it is important to do your homework as you look for a quality
surgeon.
Tips for
finding a good surgeon
1. Learn all
you can about hair restoration surgery
Before
approaching any surgeons, learn as much as you can on the current types of hair
restoration surgery available. Learn the basic techniques involved in each type
of surgery so that when you begin to speak to potential surgeons, you are able
to ask probing and informed questions. Find out which surgeries have become
outmoded since the advent of newer surgical techniques, and avoid surgeons who
still practice outdated techniques. (Basic descriptions of various surgical
procedures, both current and outmoded, are provided below.)
2. Find a
surgeon who will provide multiple references and before and after
photos
Make sure
the surgeon(s) you are considering can provide you with at least 10 sets of
clear before and after photos taken with the same angle, background, and
lighting. Ask to see photos of donor area scars. Request at least six patient
references (names and phone numbers) whom you can contact to discuss their
experience with the surgeon in question.
3. Check the
state medical board
Contact
your state medical board to see if any complaints have been filed against the
surgeon(s) you are considering.
4. Ask about
the technology, team, and skills being used
If the
surgeon practices some variant of "follicular unit transplants" (FUT, further
described below), ask him or her questions about the procedure. Specifically,
find out how many technicians on the team will work on dissecting follicular
units from the donor area, how many of them will be using stereo-microscopes,
how much experience the surgical team has with dissecting follicular units, and
how long the dissection process will take (i.e., how long will the donor area be
handled before the units are grated back into the skin).
5. Have a
direct consultation with the surgeon who will be performing the
transplant
Some of
the more splashy hair transplant offices will have you see a "medical
consultant," rather than the surgeon, during your consultation. The role of
these consultants is often to sell you on the procedure; be wary of such
approaches.
6. Avoid
flashy marketing, "infomercials", "bargain" pricing, and unrealistic
promises
Be wary
of a surgeon who promises major results in only one session. Depending on your
degree of hair loss, you may need more than one session for optimal results.
Similarly, don't choose a surgeon based on price or marketing alone.
Follicular
Unit Transplant (FUT) Surgery
All types
of hair restoration surgery share the same goal: to move or transplant hair from
DHT-resistant areas of the scalp (such as the back or sides of the head) to the
areas of loss, creating a new or improved hairline. The recently developed
technique of "follicular
unit transplant (FUT)" surgery,
however, results in vastly improved results than older surgical methods can
provide. Indeed, the advent and development of FUT surgery has rendered a number
of older surgical methods nearly obsolete, as they typically are more traumatic
to the patient's scalp and produce far less natural-looking results. (A number
of older surgical techniques are described below so that the buyer may beware
when researching hair restoration surgeons.)
What is
follicular unit transplant (FUT) surgery?
In order
to understand FUT surgery, it is necessary to start by defining a "follicular
unit." A follicular unit is a natural grouping of hair(s) that grow together in
the scalp and share the same blood supply. Follicular units typically occur in
groups of one, two, or three (and, occasionally, four) hair follicles; the
average follicular unit contains about 2.4 hairs.
A follicular
unit transplant involves the redistribution of these naturally occurring
follicular groupings to the area of hair loss. Currently, there are two methods
for transplanting follicular units: "follicular
unit transplantation (FUT)" (sometimes
also called "follicular unit grafting" or "FUG") and "follicular
unit extraction (FUE)." Both
methods transplant hairs in follicular unit groupings from a donor area to an
area of loss. The difference between the two is the method used to remove the
units themselves.
How does
FUT/FUE work?
In the
method typically called follicular unit transplantation (FUT), a thin strip of
hair is removed from the back and/or sides of the scalp (the donor area). The
donor area is sewn closed, leaving a small scar that is usually masked by the
hair growth above it.
The donor
strip is then carefully dissected beneath a binocular stereoscope (a
high-powered microscope) into follicular unit grafts of 1-, 2-, 3-, or 4-hair
groupings. Excess skin from around each follicular unit is cut away, leaving the
smallest possible graft (thus resulting in minimal scarring upon
transplantation). The dissection process is usually handled by a surgical team
of several people, each working with a stereoscope, so that the donor
hair/tissue is kept out of the body for the least amount of time possible. The
grafts are stored in a special holding solution and refrigerated while awaiting
placement in the balding part of the scalp (the recipient area).
Once the
follicular units have been dissected from the donor strip, they are then
re-implanted into the recipient area. Recipient sites (tiny incisions) are made
in the scalp where the grafts are to be placed. Placement of the grafts requires
skill; the depth, angle, and distribution of these recipient sites are a
critical aspect if the results of the procedure are to look natural.
In the
follicular unit extraction (FUE) method, a large area in the back and sides of
the scalp is shaved to approximately 1mm in length. Instead of removing a single
donor strip, as is done in the FUT method, a tiny circular incision (about 1mm
in diameter) is made around each follicular unit. The follicular units are
extracted, one-by-one, directly from the scalp. The tiny wounds are small enough
to be left open and heal on their own, which takes about a week. The extracted
follicular units are then transplanted into the recipient area in much the same
way as the FUT method described above.
FUE is a bit
more demanding and time-consuming, as each individual follicular unit is removed
by the surgeon rather than by a team of technicians who are able to work from a
donor strip simultaneously. The donor-strip method of FUT tends to be the more
common of the two procedures to date.
How many
hairs are transplanted and how long does it take?
Depending
on the extent of hair loss, a patient may require more than one session in order
to achieve the desired result. Anywhere from as few as 100 to as many as 3,000
follicular grafts may be transplanted in a single procedure which usually lasts
several hours. Generally, if a patient needs more than 2,500-3,000 grafts, the
surgeon will opt for more than one surgical session.
The majority
of patients have the procedure performed under local anesthesia with a mild
sedative. There are no bandages on the scalp after the surgery. Antibiotics,
painkillers, and medicine to reduce swelling are often prescribed for the first
few days after the procedure. There may be a follow-up visit to the surgeon's
office for scalp washing or other maintenance. Regular activities can usually be
resumed a day or two after the procedure, while heavy exercise, swimming, and
heavy lifting can be usually resumed after the donor site stitches have been
removed (usually about a week). Of course, specific directions may vary
depending on the surgeon.
The
transplanted hair begins to grow in two to three months.
Benefits of
FUT
Because
properly-dissected follicular unit grafts are very small, there is minimal
scarring in the area of the transplants; the only scarring that remains is the
single, linear scar from the closed donor-strip area, or the small, round, 1mm
scars that are left in an FUE procedure. The small scars from an FUE procedure
are often barely visible, and both types of scars are usually masked by the hair
growing around them. With a skilled surgical team working to quickly and
accurately dissect the follicular unit grafts, very few hairs die in the process
of transplantation, and hair growth after the procedure is typically as high as
90% or greater. Healing is also fairly speedy (typically one to two weeks), and
the end result of an artfully done FUT will look quite natural.
Costs of
FUT
Hair
transplant prices typically range from about $3 to $8 per graft, with $5 to $6
per graft being about average. The price per graft usually drops as the size of
the surgical session increases. Some surgeons do not charge on a strictly "per
graft" basis, but rather give a price quotation upon assessing the patient's
particular situation and needs.
Who is a good
candidate for FUT?
Because
male pattern hair loss is a problem that progresses over time, it is important
to assess the degree of loss-- and the likely continued pattern of loss-- before
considering surgery. It is important to have realistic expectations, to consider
medication to slow loss, and to understand that hair loss might continue to
progress even after such treatments. Having a transplant procedure too early on
in the progression of hair loss may require additional surgeries at a later date
to avoid awkward islands of hair as the loss continues.
A reputable
and conscientious surgeon will help a patient consider these factors before
moving forward with a surgical plan. Again, be sure to choose a surgeon who has
your best interests in mind, and ask numerous questions about the procedure that
are specific to your current degree of hair loss. (See also "Tips for finding a
good surgeon," above).
Buyer
beware:
Older/outmoded
surgical procedures in hair restoration
With
recent advancements in follicular unit transplantation (FUT) techniques (to
date, this is the preferred method of hair transplantation), a number of older
surgical hair restoration techniques have become outdated and should be avoided
as they are often less safe and produce less-than-natural-looking
results.
Many
physicians still perform outdated hair restoration techniques such as "hair
flaps," "scalp reductions/hair lifts," "round/square grafts," "strip grafts," or
"scalp expanders." Even though such techniques are not nearly as effective as
newer follicular unit transplant techniques, and are far more traumatic and
dangerous to the patient, they are still performed with some regularity. This is
mainly done because performing the newer surgical techniques requires additional
skills, equipment, facility space, and trained staff, which in turn requires a
significant investment of money and time. Also, the workday time needed to
perform a good follicular unit transplant can take anywhere from 5 to 10 hours,
while the older methods take less time. Some surgeons are not willing to invest
the necessary money and time in the new techniques.
Various
outmoded techniques are described briefly below, along with a summary of their
potential pitfalls. The generally should be avoided in favor of newer follicular
unit transplant techniques.
Hair
Flap
A flap of
hair-bearing skin (typically about an inch wide by three to seven inches long)
is moved from the side of the scalp to the front hairline by cutting it on three
sides and twisting it around toward the front. The flap is surgically stitched
into the balding area. Because one edge of the flap is left connected to the
scalp before grafting into place (thus not separating it from it’s blood supply)
it has to be twisted so that the hair bearing side ends up facing outward. A
unsightly “knot” will form where the flap has to be twisted. Other potential
problems of the hair flap procedure include: the possibility of partial or
complete tissue death on the flap, poor positioning of the flap, hair growth in
the opposite direction of a normal hair line, infection, extreme scarring in the
donor area, loosened skin in the forehead area, and/or the front hairline scar
must be re-grafted.
A variation
of the flap technique described above is the free-form flap, created when all
four sides are cut and the flap is completely removed from the donor area so
that it’s new position in the balding area can be set in a direction of natural
growth. It is a procedure recommended only for patients such as burn or accident
victims.
Hair flap
techniques should be avoided in favor of newer follicular unit transplant
techniques, described above.
Round or
Square Grafts
When
people talk about "hair plugs," this is the type of surgical technique they are
referring to. In this procedure, 3-5mm grafts are made with a hole punch devise,
resulting in a "plug" of hair about the size of a pencil eraser. These plugs are
then transplanted into the scalp, often creating a a "doll hair" effect. Because
the grafts are large and therefore compromise the blood supply, hair in the
middle of the graft often does not grow, leaving the patient with a doughnut
effect.
Some surgeons
offer a slightly modified version of the graft technique, using smaller grafts
(often called "mini" or "micro" grafts), but even this doesn't naturally produce
a good-looking result. These graft techniques should not be confused with
follicular unit transplantation (FUT), which is described in detail above.
Round or
square grafting techniques should be avoided in favor of newer follicular unit
transplant techniques, described above.
Linear
Grafts
A 3-4mm
linear strip of donor hair is removed from the side or back of the head, and
either the entire strip or large parts of it are transplanted to form a new
hairline. Since this type of graft is quite large, a "trench" must be surgically
cut into the bald area and the large graft is placed into the trench. As the
hair grows, it usually creates a less-than-natural looking hairline.
It should be
noted that during follicular unit transplantation (FUT), a linear strip of
hair-bearing scalp is often removed from the side or back of the head in order
to obtain donor hair. However, in FUT that linear strip is then divided into
many tiny follicular units, and those units are transplanted one by one to
create a new hair line. Thus, a linear graft should not be confused with FUT,
which is an entirely different procedure.
Linear
grafting techniques should be avoided in favor of newer follicular unit
transplant techniques, described above.
Scalp
reduction/hair lift
This
procedure is sometimes also called "alopecia reduction," "galeoplasty," or "male
pattern reduction (MPR)." Performed in the doctor’s office under local
anesthesia, the bald part of the scalp at the top or crown of the head is cut
away, and the edges of the nearby hair bearing skin are sewn together, bringing
the hair-bearing scalp from either side to meet in the middle. The "hair lift"
is a more radical form of scalp reduction, in which dissection or loosening of
the scalp skin is done at a level below the major arteries of the scalp. To
avoid damaging these blood vessels, the nerves are cut and tied, leaving the
head permanently numb. This is major surgery, which requires hospitalization and
general anesthesia.
There are
numerous problems with scalp reductions and hair lifts, including: major
scarring, accelerated hair loss, thinning of the scalp itself, hemorrhaging and
hematoma, infection, and unnatural appearance of the scalp. In most scalp
reduction surgeries the skin on the scalp eventually stretches back, leaving a
visible scarred and bald area.
Scalp
reductions and hair lifts should be avoided in favor of newer follicular unit
transplant techniques, described above.
Scalp
Expanders
Scalp
expanders are silicone balloons inserted between the inside of your scalp and
your skull in order to stretch the skin for future scalp reductions, hair flaps,
or hair lift surgery. Once inserted in the scalp, the balloons are gradually
inflated with a series of saline solution injections. The skin on the head is
blown up to much larger than its normal size, which is both drastic as well as
awkward-looking. It is a procedure that is only recommended in trauma cases such
as burn victims.
Scalp
expanders should be avoided in favor of newer follicular unit transplant
techniques, described above.
www.americanhairloss.org
The American
Hair Loss Association is a national, non-profit membership organization
dedicated to educating the public, healthcare professionals, main stream media
and legislators about hair loss.
www.regrowth.com
The Regrowth
Network is a consumer hair loss information site focused on treatments that are
backed by clinical evidence. They are not corporately owned.
www.aad.org/public/DermatologyA-Z/Index.htm
The American
Academy of Dermatology has developed a "Dermatology A to Z" resource based on
common dermatological conditions, treatments and terminology. It includes
definitions of dermatology terms, explanation of common dermatological
conditions and procedures, links to AAD press releases and pamphlets, articles
in Dermatology Insights, AAD Guidelines of Care, and links to other
associations.
www.webmd.com
Search WebMD
for information about hair loss and treatments (including drug information about
finasteride and minoxidil).
www.iahrs.org
The
International Alliance of Hair restoration Surgeons (IAHRS) is an organization
whose membership is limited exclusively to state-of-the-art hair restoration
surgeons.