Hair Loss and Hair Transplants

Reviewed by Robert V. Mandraccia, MD

Hair loss... It's the bane of many an aging man's existence. One out of every two men in the United States experiences some degree of hair loss by age 50. By age 70, approximately four out of five Caucasian men have some balding and two out of five Caucasian women have noticeably thinning hair.

Hair loss can make any man feel self-conscious. Many men opt for hair loss treatment so they can feel better about themselves. In fact, hair transplants are consistently among the top five most popular cosmetic procedures among men in the United States. In 2008, there were 18,062 hair transplants performed on men, according to statistics compiled by the American Society for Aesthetic Plastic Surgery. These numbers will likely increase as the economic downturn continues and growing numbers of men are forced to compete for jobs against men half their age.

Done correctly, hair transplants can boost self-esteem and help men appear markedly younger.

Male hair loss is usually a result of genetics, but hormones and aging can also play a role. Male pattern baldness refers to the onset of a receding hairline and thinning crown, while female pattern baldness affects the whole top of the head.

Hair Today, Gone Tomorrow

There are many different types of hair transplantation procedures available today. One of the newer and more popular procedures is known as micro-hair transplantation. Gone are bulky hair plugs. In their place are individual hair micrografts. This newer procedure is similar to more traditional hair transplantation, but surgeons now use individual hair follicles as opposed to clumps.

The newer micrografts result in a more natural looking head of hair. This is possible with the use of follicular unit extraction and follicular unit transplantation. A follicular unit is a small bundle consisting of one to four hair follicles and the oil glands, muscles and connecting tissue that surround and support them. Follicular unit extraction involves obtaining follicular graft units from donor areas on the scalp, while follicular unit transplantation involves transplanting the follicular unit into the scalp.

Most micro-hair transplant procedures incorporate local anesthesia, but a variety of modern sedation techniques including various levels of general anesthesia may be used for more extensive procedures. Hair transplants are typically performed on an outpatient basis at an outpatient surgery center, doctor's office or hospital. The procedure may take several hours to complete. Multiple treatment sessions may be needed over the course of two years.

During the transplant, microscopic segments of the scalp (grafts) which contain hair from the donor area are removed and then inserted into the balding area.

Besides micrografts, there are several other types of grafts that vary in size and shape. Slit grafts, which comprise one to five hair follicles, are inserted into slits in the scalp. Round-shaped punch grafts or “plugs” containing 10 to 15 hairs are rarely used anymore. Strip grafts containing up to 40 hairs are almost never used.

Preparing For Your Hair Transplant

The first step toward a fuller head of hair is a consultation with an experienced physician such as a board certified plastic surgeon or dermatologist.

During this visit, you will be asked about your expectations, previous experience with hair loss treatments, past scalp surgeries and any other co-existing medical conditions. Your doctor will also take a complete medical history and may order some blood tests to determine if you are a candidate for hair transplantation. The ideal candidate should have healthy existing hair on the back or sides of the head for grafting purposes.

Remember to tell your doctor about any medications that you are currently taking, including over-the-counter medications, vitamins and herbal remedies. These products can affect your blood's ability to clot and may affect the outcome of your hair transplant. The excess bleeding may affect the grafts ability to survive and may result in an infection in the donor site.

Your surgeon will provide you with a comprehensive list of pre-operative instructions. This list may include ceasing use of certain medications and supplements, as well as starting antibiotic treatment before the procedure to reduce your risk of infection. Other instructions include avoiding the consumption of alcohol for seven days before a hair transplant since alcohol acts as a blood-thinning agent and can interfere with wound healing.

Finally, you will need to shampoo your hair the night before your procedure.

Other Procedures to Treat Hair Loss

Sometimes hair transplantation is paired with another hair loss treatment to improve the overall results or to treat larger areas of baldness. For example, scalp reduction can be performed alone or in conjunction with a hair transplant. During scalp reduction, your surgeon removes all or a part of the bald scalp and brings the hair-bearing scalp closer together to reduce the size of the balding area.

Scalp expansion is another more radical procedure that can be used to treat certain types of hair loss that occur in a small population of individuals. Your surgeon inserts surgical tissue expanders under the scalp for about three to four weeks. During this time, saline water is added to the expanders at prescribed intervals to stretch out the skin. This procedure may be performed before a scalp reduction to make the scalp looser. It also can be performed solely to stretch hair-bearing areas, which may reduce balding.

Scalp flaps are another option. During this procedure, a hair-bearing segment of your scalp (not just a follicular unit or units) is surgically moved and placed where hair is needed.

The risks and benefits of each procedure must be discussed with a knowledgeable surgeon before moving forward.

Your doctor may also suggest medications to help treat your hair loss. They include:

Finasteride (propecia). This prescription medication slows hair loss and stimulates hair re-growth in men. This drug has not been shown to treat thinning hair at the temples and is not used to treat youth or female hair loss. Also used to treat enlarged prostate glands, finasteride is part of a class of medications called 5-alpha reductase inhibitors, which block the body's production of a male hormone.

Minoxidil. This topical solution works on hair follicles to reverse the shrinking process and stimulate re-growth on the top of the scalp. It is the only hair re-growth ingredient approved by the FDA for use by women.

Latisse. This is first drug that is FDA-approved to promote eyelash growth. Latisse will be available by prescription starting in the first quarter of 2009. It contains the active ingredient of the glaucoma drug Lumigan. Whether or not this drug promotes hair growth on the scalp is not yet known, but some doctors are eyeing it as potential treatment for hair loss.

Laser devices. Brushes, combs and other hand-held devices that emit low laser light may stimulate hair growth or make hair look more youthful. Such devices may not be approved by the FDA for stimulating hair regrowth.

Aftercare

Your doctor will give you a complete instruction list that you must follow to reduce the risk of complications after hair transplantation.

You should not attempt to resume normal activity for several days. This helps prevent the transplanted hair from falling out. Normal activity, including exercise, can usually be resumed after seven to 10 days. It is always best to seek the advice of your doctor for specific instructions. Your doctor may prescribe oral and topical medications to relieve minor discomfort, bruising and swelling.

It takes approximately five days for the transplanted hair grafts to settle permanently into the recipient sites. Small scabs or crusts will develop where the hair grafts were inserted. Do not pick at or disturb these scabs as this may cause the transplanted hair follicles to become dislodged. Scabs or crusts tend to drop away within 10 to 14 days. The transplanted hair stubble will often fall out within a few days to six weeks, but re-growth is expected to occur within three months. It can take up to 18 months to see full growth.

The results of hair transplantation are permanent.

The Complications and Risks of Hair Transplantation

There are risks associated with every medical procedure, especially micro-surgeries involving small elements of human tissue. Possible complications of hair transplantation include infection and scarring. There will likely be numbness in the donor and recipient sites, which typically subsides within three months but may last for six months to a year following the procedure. There may also be skin discoloration in the affected areas as well as an uneven appearance or dimpling of the skin. Both of these conditions tend to dissipate within a few weeks after the procedure. Some people experience nausea and vomiting after the procedure due to the medications used. Less than five percent experience bleeding after the procedure.

Consult a Qualified Surgeon

Board certified plastic surgeons and dermatologists are the specialists with the most hair loss treatment experience. To make sure you choose the most appropriate specialist, review the doctor's credentials, education, training and certifications by recognized professional medical societies. Make sure to discuss your specific hair transplantation procedure and its risks and possible complications with your chosen surgeon. Consider viewing before-and-after photos of the doctor's actual patients (people) with similar conditions who received similar hair restoration procedures .

Hair Transplantation Cost

Each case is highly individualized, which makes it difficult to estimate costs for hair transplants. The procedure usually comprises three costs: anesthesia fees, facility fees and surgical and support staff fees. You can expect the minimum average cost of total fees to range from $3,000 to of $15,000 for major surgical hair restoration. You may need three or more procedures to obtain the desired effects. .

Hair transplants are rarely covered by insurance.

Payment plans are fairly common. For financing options and tips, continue reading about patient financing.

About the Reviewer of This Article

Robert V. Mandraccia, MD, graduated from Temple University Medical School in Philadelphia, where he also completed his internship. Dr. Mandraccia did his general surgery residency at Temple, and his plastic surgery residency at the University of Oklahoma in Oklahoma City. He is now in private practive in Cape Coral, Fort Myers and Bonita Springs, Florida. A member of several prestigious societies including the American Medical Association, the Lipoplasty Society of North America, the American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery, Dr. Mandraccia is also a fellow of the International College of Surgeon sand board-certified by both the American Board of Surgery and the American Board of Plastic Surgery.

[page updated March 2009]