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Hair Loss in Men |
Nearly 50% of men will develop hair loss at some point in their lives. Usually such hair loss is androgenetic, resulting from hereditary and hormonal factors. Frequently men report that a parent or sibling is also affected. Hair loss is also progressive. This means that patients will continue to thin, despite the best medical and surgical treatment. The Norwood scale is used to assess the degree of male pattern hair loss at any one point in time (Figure). It may change over time as patients advance in age.
Propecia®, or finasteride, is an oral medication that blocks the conversion of one hormone (testosterone) to another (dihydrotestosterone) in the tissues surrounding the hair follicles. Most men can benefit from this medication. In 80-90% of men, it is helpful in retaining and thickening existing follicles, as well as regrowing other hairs over the course of 6-18 months. Rogaine®, or minoxidil, is a topical medication which can slow the progression of hair loss in men. Patients may use this alone or in conjunction with Propecia® or hair transplantation.
Regardless of age or extent of involvement, hair loss can affect both our own self-image as well as the way others view us. A crucial goal in hair restoration is to create a frame for the face, which is undetectable and completely natural in appearance.
Please Click Here for information about medical treatments for male and female pattern hair loss.
Hair Loss in Women |
For women, hair plays a central role in one’s appearance. Its color, texture, and style can be altered daily as a means of self-expression and re-invention. Hair dyes, permanent waves, and hot irons all provide means of changing the way hair appears. However, when women thin, it is more difficult to hide cosmetically. They cannot shave their heads or wear a baseball cap. Instead they may feel embarrassed or self-consciousness about the ‘see-through’ nature of their hair and scalp. Nonetheless, most women never go completely bald. Their stage of hair loss can be categorized as Ludwig I, II, or III, depending on the severity of hair loss over the crown area.
Minoxidil, or Rogaine®, is the most effective medical therapy for hair loss in women. It thickens existing follicles and can slow the progression of hair loss. Propecia® has not been found to be particularly effective in women, and can cause a specific type of birth defect if one becomes pregnant while on the drug. Hair transplantation can help relieve women of difficulties in styling 'problem areas.' Still, hair loss is as progressive in women as it is in men, and therefore several surgeries may be necessary to maintain satisfactory results.
Please Click Here for information about medical treatments for male and female pattern hair loss »
Hair Transplantation |
Contemporary hair transplantation can provide completely natural results that are cosmetically undetectable. The technique is highly effective in treating both male and female pattern hair loss, also known as androgenetic alopecia. It can also make a dramatic difference for patients with hair loss due to trauma, injury, or scarring from cosmetic or other surgical procedures. Areas such as the eyebrows, mustache, and beard areas are amenable to reconstructive transplantation as well.
Hair transplantation involves moving your own hair from the back of the head, where there is relatively greater density, to other areas which have lost hair. The reason this procedure is so successful is that it takes advantage of the fact that our hair is genetically programmed to grow for much longer in the back than in the front. When we move these hairs elsewhere, they retain their genetic destiny and continue to grow as long as they would have in the back of the head. They do not require any special treatment in order to grow. You can swim, run, and shower normally, because these are your own hairs.
Nearly any person may be a candidate for hair transplantation. We consider your rate of hair loss, hair caliber and hair color in planning the surgery. Large pluggy grafts from the 1980’s and 1990’s have fallen out of favor. We harvest a single narrow strip from the back of the scalp and divide it into individual 1-3 hair follicular unit grafts, matching their appearance in nature. Then, we distribute the hairs in a way that matches the direction and flow of your existing hair follicles. The entire procedure is done under local anesthesia and takes an average of 3-4 hours. Once transplanted, the hairs will grow in gradually and naturally over a 6-12 month period. Your results should look as natural 20 years from now as they do in 2-3 years.
During the consultation, we discuss your history of hair loss and evaluate your scalp to identify the reason for your hair loss. If the cause is uncertain, we may perform a small biopsy to find out the diagnosis. This takes only 5 minutes and can be performed during the consultation. We also discuss various other treatments for hair loss, including minoxidil and finasteride which are presently the only FDA-approved medicines available to treat hair loss. They can greatly help with hair loss and can even extend the time before hair transplantation is performed. Patients who do not want to use the medications may consider additional hair surgeries later on. We provide patients with plenty of time and information to design a plan that is best for them.
Click here for more information about contemporary techniques in hair transplantation »
Corrective Surgery |
The first hair transplantation surgery was performed in 1952, as large “punch grafts” were moved from the hair-bearing parts of scalp to thinning frontal areas. Over time, such large grafts can become more noticeable as surrounding hairs are lost. With the advent of follicular unit ‘micrografts” in 1988, Dr. Bobby Limmer created a means of hair restoration that could finally mimic nature. Hairs were transplanted as they occur in natural groupings of 1-4 hair follicles. Most hair transplant surgeons have adopted this technique as the current standard of care. However, large, pluggy grafts still exist among patients who underwent transplantation previously. Such patients can benefit from corrective surgery to excise these grafts, divide them into smaller groupings, and replace them in a more natural distribution. Patients may also undergo resurfacing procedures to improve cobblestoning or other texture irregularities. We also offer laser hair removal for patients who would like to remove unwanted hairs completely.
Inflammatory Conditions |
Hair loss can result from a number of inflammatory conditions. The most common of these is alopecia areata, which results from a T-cell mediated attack on one’s own hair follicles. It usually occurs as smooth round patches on the scalp or face. It should be evaluated by a physician for diagnosis and treatment. It is not usually amenable to hair transplantation but can be treated medically and will frequently regrow on its own. Lichen planopilaris is another common cause of hair loss. It is a type of scarring alopecia, where hair follicles are replaced by scar tissue. It can be rapidly progressive, so prompt medical evaluation and treatment is warranted. Pseuodopelade of Brocq, a similar type of scarring alopecia should also be evaluated and managed promptly.
Alopecia Areata |
Lichen Planopilaris |
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Fine regrowth of hair follicles is evident in this condition |
Redness and scale can be seen around the hair follicles. |
Hair Loss in African-Americans |
CCCA (central centrifugal cicatricial alopecia) and traction alopecia are frequent causes of hair loss in African-American women. Both can result from aggressive styling techniques such as relaxers, extensions, weaves, and hot combs. The combination of trauma and heat can lead to permanent scarring of the skin around the hair follicle. When recognized and treated early, there is hope of recovering the affected hair follicles. Patients may benefit from anti-inflammatory injections as well as topical and oral treatments. They can especially benefit from hair transplantation, depending on the areas affected and degree of inflammation present (if any). However they must be sure to limit the ongoing use of chemical relaxers and other damaging grooming practices.
Traction Alopecia |
Scarring Alopecia |
Central Centrifugal Cicatricial Alopecia (CCCA) |
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This non-scarring form of hair loss can result from chronic pulling or tight braids. |
Follicles are replaced with smooth scar tissue. |
An enlarging rim of hair loss can form in the vertex, usually due to ongoing use of heat or chemical relaxers. |
Reconstructive Hair Surgery |
Hair transplantation can provide a final, natural touch for patients who suffer hair loss from burns, scarring, surgery, or trauma. Although scar tissue does not have the same blood supply as the scalp, it can usually ‘take’ hair grafts and help camouflage any underlying tissue irregularities. Patients who lose sideburn hair after facelifts or skin cancer surgery may particularly benefit. Likewise, eyebrows which are lost due to trauma or surgery can be improved dramatically with transplantation. Although the consistency and nature of the hair growth are slightly different, this procedure can at least provide a more acceptable cosmetic match for patients who have lost all or part of an eyebrow.
Resources |
Meet our Team |
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It takes teamwork! Dr. Nicole Rogers, Danielle Barry, Nicole Hipps, Michele Gardner, Cherie Cattan, and Pam Rodrigue |
