Hair loss in men almost always is due to the androgenic pattern baldness which is usually referred to as male pattern baldness. Although the exact cause of pattern balding is not clear, the trait is transmitted by means of a polygenic type of inheritance. Anecdotal reports indicate a stronger link to men on the maternal side of the family than on the paternal side. Male pattern baldness is a progressive process that continues for rest of the individual's lifetime. The eventual degree of hair loss is typically more advanced with a younger age of onset.
In women, most of the hair loss is also genetic although women have an increased incidence of hair loss caused by numerous sources such as hypothyroidism, various medications, systemic disorders, trauma (surgical trauma, burn alopecia) and infections. There is more speculation concerning the more frequent occurrence of this problem among premenopausal women, but the answer remains obscure. As with male pattern baldness, female pattern hair loss is progressive.. Hair loss in men can be socially acceptable, and in fact in certain situations deemed attractive or alluring. Conversely society has generally less acceptance of thinning of hair or baldness in women, Women with hair loss often find it more difficult to share their feelings about hair loss with loved ones or friends or even with the doctor.
Balding is a major concern for many and surgery to treat the hair loss (i,e hair transplantation) is the most common cosmetic surgery procedure performed on men today. Yet the market for hair transplantation is affected by the immense market for products that treat hair loss without surgery. These products which include shampoos, hair care cosmetics, scalp massages, laser combs, and many more have no proven efficacy except for their ability to temporarily increase the volume of existing hair, resulting in a denser appearance than before. Interest in hair transplantation will increase as the knowledge and awareness that most modern hair transplantation techniques can create virtually undetectable restoration spreads among the people suffering from baldness. Surgical hair restoration was developed for and has traditionally been used in males; However, the newer techniques are more adaptable to females. Hair transplantation also known as hair restoration surgery, used to treat various forms and degrees of permanent alopecia, has evolved into a scientifically based cosmetic surgical discipline over the last half century. There had been unlimited efforts to restore hair or natural looks which lead to manufacturing wigs etc., from the very old times. The only success was seen when hair transplant started in the form of punch grafting and reaching to most advanced technique in hair restoration surgery.
There are several different options for hair transplant today each having its own limitations. The most important limitation has to do with the source of hair graft referred to as donor area. This area in both men and women is genetically resistant to hair loss. In this minimally invasive procedure graft containing hair follicles that are genetically resistant to balding (like back of the head) are transplanted to bald scalp. If donor hair numbers from the back of the head are insufficient, it is possible to perform Body Hair Transplantation (BHT) on appropriate candidates who have available donor hair on the chest, back, shoulders, torso and/or legs. Body Hair Transplant Surgery can only be performed by the FUE harvesting method and, so, requires the skills of an experienced FUE Surgeon. However, there are several factors for a potential BHT candidate to consider prior to surgery. These include understanding the natural difference in textural characteristics between body hair and scalp hair, growth rates, and having realistic expectations about the results of BHT surgery
Since hair naturally grows in groupings of 1to 4 hairs most advanced techniques harvest and transplant these naturally occurring hair follicle units in their natural groupings. Thus modern hair transplantation can achieve a natural appearance by mimicking nature hair for hair. This hair transplant procedure is called follicular unit transplantation (FUT). Donor hair can be harvested in two different ways: strip harvesting and follicular unit extraction (FUE).
Strip harvesting is the most common technique for removing hair and follicles from a donor site. The surgeon harvests a strip of skin from the posterior scalp, in an area of good hair growth. Each incision is planned so that intact hair follicles are removed.
Strip harvesting will leave a "pencil thin" linear scar in the donor area, which is typically covered by a patient's hair even at relatively short lengths. The recovery period is around 2 weeks, With Follicular Unit Extraction or FUE harvesting, individual follicular units containing 1 to 4 hairs are removed under local anesthesia; this micro removal typically uses tiny punches of between 0.6mm and 1.0 mm in diameter. The surgeon then uses very small micro blades or fine needles to puncture the sites for receiving the grafts, placing them in a predetermined density and pattern, and angling the wounds in a consistent fashion to promote a realistic hair pattern.
FUE can give very natural results. The advantage over strip harvesting is that FUE harvesting negates the need for large areas of scalp tissue to be harvested, so there is no linear incision on the back of the head and it doesn't leave a linear scar. Because individual follicles are removed, only small, punctuate scars remain which are virtually not visible and any post-surgical pain and discomfort is minimized. Recovery from micro grafting FUE is less than 7 days. Disadvantages include increased surgical times and higher cost to the patient. It is challenging for new surgeons because the procedure is physically demanding and the learning curve to acquire the skills necessary is lengthy and tough.
Transplant operations are performed on an outpatient basis, with mild sedation (optional) and injected local anesthesia, which typically last about six hours. The scalp is shampooed and then treated with an antibacterial agent prior to the donor scalp being harvested. Regardless of which donor harvesting technique is employed, proper extraction of the hair follicle is paramount to ensure the viability of the transplanted hair and avoid transection, the cutting of the hair shaft from the hair follicle. Hair follicles grow at a slight angle to the skin's surface, which means that regardless of technique transplant tissue must be removed with a corresponding angle and not perpendicular to the surface.
The transplanted hair follicles typically appear to grow in the immediate postoperative period. Within a month the graft follicles enter the telogen phase and all are shed. Hair regrowth then takes about four months, but the hair continues to improve in quality and quantity over the subsequent 2-4 months. Growth stabilizes at about one year and reports have indicated graft survival rate of over 95 percent in experienced hand.
Advances in wound care allow for semi-permeable dressing, which allow seepage of blood and tissue fluid, to be applied and changed at least daily. The vulnerable recipient area must be shielded from the sun, and shampooing is started two days after the surgery. Some surgeons will have the patient shampoo the day after surgery. Shampooing is important to prevent scabs from forming around the hair shaft. Scabs adhere to the hair shaft and increase the risk of losing newly transplanted hair follicles during the first 7 to 10 days post-op.
During the first ten days, virtually all of the transplanted hairs, inevitably traumatized by their relocation, will fall out. This is referred to as "shock loss". After two to three months new hair will begin to grow from the moved follicles. The patient's hair will grow normally, and continue to thicken through the next six to nine months. Any subsequent hair loss is likely to be only from untreated areas. Some patients elect to use medications to retard such loss, while others plan a subsequent transplant procedure to deal with this eventuality.
Hair thinning, known as "shock loss", is a common side effect that is usually temporary. Bald patches are also common, as fifty to a hundred hairs can be lost each day. Post-operative hiccups have also been seen in around 5% of transplant patients.
When performed properly the results of hair transplantation are virtually undetectable. However, complications can arise from errors of technique, poor planning and unpredictable patient factors.
As with any other surgery hair transplantation poses possible risks. Excessive bleeding due to undiagnosed coagulation disorders or secondary to medication can be bothersome at the least and (in rare cases) life threatening at the worst. Infections and anesthesia problems are two other potential although unlikely complications.
Complications more unique to the hair transplantation procedure are rare but can occur. Scarring of the donor site can include hypertrophic scar formation due to excessive tension and perhaps even a tendency towards keloid formation. Alopecic scar formation can result from excessive tight suture placement. Scarring of the recipient site was more common when large graft transplantation was performed.
Poor hair growth can occur and probably is largely dependent on technique. Graft desiccation, rough handling of the graft and faulty graft preparation can result in limited growth. Lack of growth must be distinguished from delayed hair growth because transplanted hair occasionally requires as long as 12 months to grow.
Errors of technique and poor planning are preventable but occur all too often. The most common of these technical errors which results in a transplanted appearance is the use of excessively large grafts and unaesthetic hairline design.
Research and future techniques
The future of hair restoration is exciting primarily because of medical advances. Improved effectiveness of control of hair loss coupled with minimization of adverse effects. In addition gene therapy may have future application in hair loss treatment. The genes that cause alopecia can be located and potentially replaced with genetic sequences not associated with hair loss.
Hair cloning (technically cell multiplication) may offer the surgeons a virtually unlimited supply of donor hairs. By cloning multiple copies of a few donor hairs, patients with even extensive hair loss can expect complete scalp coverage. Most likely, follicle stem cells will be multiplied then injected into areas of thinning to initiate the regrowth of hairs. Candidates for hair cloning include those with advanced hair loss and those with scarring or poor supplies of potential donor hairs because of burn injury.
Mechanization of the hair transplantation is perhaps the only way to improve the process of follicular unit transplantation . Instruments capable of rapidly and accurately dissecting the grafts and automatically placing the grafts will speed the process and reduce reliance upon assistants. However, hair transplantation will remain an aesthetic procedure that requires a skilled surgeon to create natural- appearing results. Robotic Hair Restoration is one such innovative device in the field of hair restoration. The robot allows detection of the follicular units and its topography with several cameras. The images from the cameras can detect the location, distribution, and the angulation of the follicular grafts. The robotic arm has been able to increase the speed of graft extraction and minimize the exhaustion of the surgeon during an FUE transplant. Despite the advantages of robotic hair restoration systems, there are still some disadvantages such as the size of the punches being relatively large in comparison to what is used in other methods of FUE and the high price of the device.