Hair loss occurs in more than 60% of men and in approximately 10% of women. Although a lack of scalp hair can potentially increase the risk of actinic damage and skin cancer, male and female pattern baldness are conditions that are, with few exceptions, treated electively.
Balding is a major concern for many, and surgery to treat hair loss (ie, hair transplantation) is the most common cosmetic surgery procedure performed on men today. Yet, the market for hair transplantation is dwarfed by the immense market for products that treat hair loss without surgery. These products, which include shampoos, hair-care cosmetics, scalp massagers, 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. Exceptions are the two medications the US Food and Drug Administration (FDA) approved: minoxidil (Rogaine, available over the counter in the United States) and finasteride (Propecia, available by prescription only for men), which have limited but definite benefit. Hair transplant
Interest in hair transplantation will probably increase as knowledge that most modern hair-transplantation techniques can create virtually undetectable restoration spreads, as shown below. To this day, hair transplantation remains the treatment of choice for most patients with hair loss.
One of the most rapidly growing segments of hair transplantation is hair transplantation in women. Surgical hair restoration was developed for and has traditionally been used in males. Newer techniques are more adaptable to females.
Hair transplantation is used to treat various forms and degrees of permanent alopecia in both men and women. Intact hair follicles may be harvested from within the safe donor area (SDA) of a patient’s scalp by either follicular unit strip surgery (Hair transplant) or follicular unit extraction (FUE); each harvesting method has unique advantages and disadvantages. The refinement of follicular unit transplanting over the last decade has led to markedly improved hair survival and natural-appearing results (see the image below).
Some say, “A bad hair day is better than a no hair day.” For millions of individuals, hair loss is a major problem associated with loss of self-esteem, insecurity, and even depression. Hair loss can range from early thinning or hairline recession to complete loss of hair along the top and upper sides of the head.
A full head of hair contains approximately 100,000 hairs. (People with red or blonde hair have somewhat more than this.) The loss of up to 30% of the number that was present during the peak of adolescence that occurs by middle age is part of the normal aging process. For thinning to become cosmetically noticeable, at least 50% of the hairs must have fallen out in a particular area. Loss of a smaller percentage than this generally does not result in the cosmetic appearance of hair loss. In addition to the loss of the number of hairs, the hair loss process causes individual hairs to thin, which further contributes to the appearance of hair loss.
The Norwood Classification System recognizes and categorizes the typical sequence of the hair loss process in men. Early in the process (types 1-3), the hairline recedes, typically led by frontotemporal recessions. In the latter stages (types 4-7), progression of hair loss at the vertex (crown)(Hair transplant) gradually meets and joins the progressive hairline recession, resulting in varying sizes (in both coronal and sagittal dimensions) of the confluent vertex with frontotemporal regions of baldness.
For women, the development of androgenic alopecia is classified into three stages. The typical pattern of hair loss in women is progressive diffuse thinning in an oval area along the top of the scalp. Hair loss along the hairline is usually spared.
During the 1990s, leaders in hair transplantation debated several topics. Out of the debates emerged several commonly (though not unanimously) accepted truths.
First is the superiority of hair grafting versus bald-scalp reduction and scalp-flap surgery in almost all situations. Second is the inferiority of lasers to conventional cutting devices to form the recipient site. Third is the acceptance of large-session micrografting, also termed the megasession, in which 2000 or more grafts can be transplanted safely in a single procedure.