KnowIng your type of haIr loSS......... 5

Transcription

how
to beat
hair loss
third edition
Antonio A. Armani, M.D.
University of Toronto
Redom Books Inc.
233 Carlton Street
Toronto, Ontario
Canada M5A 2L2
Telephone: (416) 363-6655
1-800-365-6220
Fax: (416) 363-1589
© Copyright 1999 by Antonio Alvi Armani, M.D.
All rights reserved. Printed in Canada. No part of this
book may be used or reproduced in any manner
whatsoever without written permission except in the
case of brief quotations embodied in articles and
reviews.
How to Beat Hair Loss does not offer medical advice to replace the services of a physician or surgeon.
The information provided here is collected from various
sources and represents an effort to inform you about the
options available to treat hair loss. It is intended to assist
you to work with a trained medical and other hair care
professionals. The author assumes no responsibility for us
of information provided here or any other manner. For
information address:
Redom Books Inc.
233 Carlton Street
Toronto, Ontario
Canada M5A 2L2
Telephone : (416)363-6655
1-800-365-6220
Fax : (416)363-1589
[email protected]
ISBN 0-9683898-1-3
About the Author
Dr. Antonio Alvi Armani has written this book as a source
of information for men and women suffering from hair loss.
He is a hair transplant surgeon who graduated from the University Of Toronto. Dr. Antonio Alvi Armani is dedicated to
research and development of new medical, surgical and
alternative therapies for hair loss. His hair transplant practice
and research centre is located in the city of Toronto, Canada,
where he is the director of Cosmetic Surgery Spa.
He graduated from the University of Toronto Medical Program with M.D. Honours, after which he went on to perform his residency at the Toronto Hospital. He is a member
of the American Academy of Cosmetic Surgery, the International Society of Hair Restoration Surgery, member of the
American Society of Hair Restoration Surgery, Italian Society of Hair Restoration Surgery, the Ontario Medical Association, the College of Physicians and Surgeons on Ontario,
and the Canadian Medical Association.
Dr. Antonio Alvi Armani has won numerous awards including the: J.W. Billes Admission Scholarship, University of
Toronto, W.K. Mc Gillis Trophy, Gold Medallist, Yetive Heard
Memorial Trophy and Steven Clarfield Trophy, Italian Society of Hair Restoration Surgery Award, Toronto Sun Readers Choice Award 2002, for Best Cosmetic Surgeon, XTRA
Magazine Readers Choice Award 2002 for Best Cosmetic
Surgeon.
He has written articles and books on various aspects of hair
loss, dieting, weight loss and fitness, and is conducting clinical research in the fields of hair transplantation and cloning of hair.
To my patients
Who have allowed me to assist them
Acknowledgments
I owe gratitude to many people who along the way
of my career have helped in supporting and guiding my
work. I cannot possibly list all those who deserve credit
but I must mention the names of a few that have been
most instrumental in producing this book.
I owe special gratitude to my main mentor in the
field of hair loss Dr. Dow B. Stough Jr. Dr. Stough trained
me in hair transplantation surgery and was the major
influence in my development as a hair loss surgeon.
Dr. Stough has produced a masterful reference book
that have been a constant source of reliance to me. I
thank him for this.
I must also thank the following individuals who have
provided technical assistance in the production of this
book: Dr. Shaheen Azmi who edited it and helped to develop its design; Fernando Andrejin who photographed
the pictures and was a constant source of technical
assistance; and Alex Vasolla who drew its illustrations.
Last but not least I must thank my parents and family
members who have nurtured me and who have always
been there to support me in my every venture.
Table of Contents
Introduction ......................................... 1
Section 1: Knowing your type of hair loss. ........ 5
Chapter 1: Genetic hair loss ................................................. 6
Chapter 2: Other types of abnormal hair loss. ...................... 25
a. diet related hair loss............................................................25
b. drug related hair loss. .........................................................26
c. disease related hair loss. ......................................................27
......................................................... 28
........................................... 28
¨ sudden unexplained hair loss (alopecia areata)............................ 29
¨ thyroid diseases...................................................................... 30
¨ psychological diseases ........................................................... 31
¨ cancer related hair loss ......................................................... 31
¨ saha syndrome . .................................................................... 32
d. hair loss due to external injuries to the scalp......................... 33
e. hair loss caused by poor hair care. .......................................34
¨ skin diseases of the scalp
¨ telogenic and anagenic alopecias
Section 2: Treatment for genetic hair loss........ 39
Chapter 1: Medical treatment ....................................... 41
a. rogaine..............................................................................41
b. propecia. ............................................................................44
c. comparing rogaine and propecia. ........................................47
d. other emerging drugs. .........................................................52
Chapter 2: Surgical treatment....................................... 55
a. basic questions about surgical treatments..............................55
b. follicular unit strip surgery (fuss)..........................................65
c. follicular unit extraction (fue).............................................75
d. comparing fuss and fue methods. ..........................................83
e. goals of hair transplant surgery...........................................89
i
ii
table of contents
f. risks associated with hair transplants...................................109
g. repair cases.......................................................................111
h. case studies........................................................................125
i. the future of surgical treatment............................................182
Chapter 3: Alternative treatments ................................ 192
Chapter 4: Hair replacement treatment .......................... 200
Section 3: About your hair......................... xx
Chapter 1: Anatomy of the hair and hair follicle ................... xx
Chapter 2: Rules for good hair care..................................... xx
A final recommendation ....................XX
Appendix A: Sample consent form ..........................XX
Appendix B: Sample pre-operative instructions ........XX
Appendix C: Sample post-operative instructions ......XX
Glossary .........................................XX
Index ...............................................XX
KNOWING YOUR TYPE OF HAIR LOSS
5
1
knowing your type
of hair loss
1. genetic hair loss. ............................... 6
2. other types of abnormal hair loss...... 25
a. diet related hair loss....................................................
25
26
c. disease related hair loss. ............................................. 27
¨ skin diseases of the scalp ......................................................... 28
¨ telogenic and anagenic alopecias . .......................................... 28
¨ sudden unexplained hair loss (alopecia areata)............................ 29
¨ thyroid diseases...................................................................... 30
¨ psychological diseases ........................................................... 31
¨ cancer related hair loss ......................................................... 31
¨ saha syndrome . .................................................................... 32
d. hair loss due to external injuries to the scalp................. 33
e. hair loss caused by poor hair care. ............................. 34
b. drug related hair loss. ...............................................
6
The first thing everybody with hair loss must know is
what type of hair loss they have. Some people suffer from
certain types of hair loss that are temporary, which may result
from a variety of causes. While these may be very stressful,
many of these ailments can be corrected without resorting to
major treatments. On the other hand, most men and women
who suffer from hair loss are predisposed to genetic pattern
hair loss. This type of hair loss is hereditary and progressive.
Many people who suffer from this turn to medical, surgical
and alternative treatments to combat their hair loss.
In this chapter, you will learn about the different types
of hair loss so that you may classify your own type and begin
the task of finding proper treatment. You should, of course,
have your problem confirmed by a trained professional.
But you know yourself best, and only you can help your
professional by providing accurate and relevant information
about your hair loss based on the information that you find
here.
Normal hair loss
Normally, each person will have around 100, 000
hairs on his or her scalp at any given time. Some of these
hairs routinely take a rest from growing every few years and
eventually fall out. These same hairs re-grow from their roots.
As a result, the average person can expect to shed 50 to 100
hairs everyday. However, this type of normal hair loss should
be spread out over the whole head and should not result in
any balding or excessive thinning of hair on any particular
part of the scalp.
Abnormal hair loss
Abnormal hair loss is the falling out of excessive hair
that leads to unusual thinning or balding at specific spots
on the head, which is probably the type of hair loss you are
experiencing. Medical professionals call abnormal hair loss
alopecia.
Alopecia can be caused by many factors but the
7
most common factor is your own genes, meaning that you
inherit the tendency to lose your hair. This type of alopecia
affects over 95 per cent of all cases of balding or thinning
hair for both men and women. This type of genetic hair loss
is given many names, including “male pattern baldness” or
“female pattern baldness” because of the consistent pattern
that the hair loss tends to follow in both men and women. Its
medical term is “androgenic alopecia” because it is believed
that hereditary hair loss is associated with changes in the
amount and activity of male hormones called “androgens”.
I will be referring to this type of hair loss as “genetic hair loss”
because it is the easiest to remember and because it does
not suggest that it only applies to one sex or the other.
It is important to remember that your hair loss may be
the result of a combination of factors. Other factors may
speed up or increase your hereditary balding. Keep this in
mind because it is a major error that many people make
when determining their own type of hair loss and responding
to it. That being said, since hereditary balding is the most
common type of hair loss, I will be discussing it first, followed by
a brief discussion of the other types of abnormal hair loss.
CHAPTER 1: Genetic hair loss
How common is it?
Genetic hair loss affects almost 50 per cent of all
males and almost 40 per cent of all females as they age.
This means that if people lived long enough, almost half
of the population would show significant hair thinning
or balding. Some ethnicities are more affected than
others are. People with European origins show more
hereditary tendency to hair loss than other ethnicities,
though other groups are affected to a degree as well.
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How does it occur and can it be cured?
Like so many ailments that afflict us, medical professionals
are not certain as to what directly causes genetic hair loss.
It is something that is programmed into your genes, but what
causes the genes to act and what they cause your body to
do, it not entirely known. As a result, there is no sure, full-proof
cure for this kind of hair loss that we know of. Researchers
have different theories about the way genetic hair loss works
and they are working on various possible solutions based on
these clues.
The most common explanation for how genetic hair loss
works suggests that it works through a complicated chemical
process operating in your body. Most researchers associate
it with the chemical changes that occur with the male
hormone testosterone as you age. Both men and women
have this male hormone but the level of testosterone is
different for the sexes and changes with aging. There are
also other chemicals, which react with testosterone, that
change as you age and may influence hair loss.
Because most researchers believe that genetic hair loss
is caused by chemical reactions in your body, most of the
research being done in the field has focused on finding
chemicals that can reverse the chemical causes of genetic
hair loss, and then forming them into medical drugs suitable
for usage.
Recent discoveries have found that an enzyme called
“5-alpha reductase” is excessively produced by the hair
follicles of people with genetic hair loss. The enzyme
combines with testosterone, one of the male hormones
present in both men and women, to form a new chemical
called “dihydrotestosterone” (DHT), which is known to cause
hair to fall out. This chain of chemical reactions is one among
many possible chemical chains that researchers are currently
investigating in relation to genetic hair loss.
In the last few years, researchers have been working on
many different drugs for combating genetic hair loss, but so
far only two have shown success in doing so. This first drug
is called minoxidil, and it is currently being marketed by the
9
Upjohn Company under the name Rogaine as a topical
solution for both men and women. The second drug is called
finasteride, and it is currently being marketed by Merck & Co.
under the name Propecia in a tablet form for men only. The
advantages and drawbacks of both these drugs, along with
other drugs that are being tested and that show promise,
will be outlined later in the chapter on medical treatments
for hair loss.
What does it look like?
Males with genetic hair loss often become at least partially
bald and the hair loss follows particular patterns. The most
common pattern of genetic hair loss for men is characterized
by a thinning of hair at the hairline and/or the crown area.
Over time, the thinning expands, receding from the hairline
and in a circular fashion from the crown, until the two areas of
baldness meet in the middle. The final result is a completely
bald scalp except for a strip of hair along the back of the
head above the nape of the neck.
Though this is the most common pattern that male pattern
baldness follows, there are many other variations as well.
Norwood’s classification describes this most common pattern
but it is somewhat limited in addressing the other possibilities,
including the one that applies to women. In the following
section, I will outline the new patterns of genetic hair loss that
have been identified, giving you a better understanding of
the variety of ways in which genetic hair loss occurs.
Norwood’s classification has been used to classify male
pattern hair loss for many decades and has been useful
in many cases. However, it is not complete. Norwood’s
classification only describes one pattern of male genetic
hair loss on a scale of seven degrees of severity. Therefore,
a reclassification of genetic pattern hair loss is necessary to
account for the other possible patterns of male and female
genetic hair loss.
10
Genetic Pattern Hair Loss.
Progression of hair loss for men
according to Norwood’s classification
1
2
Alternative male
patterns
2A
3
3A
3v
4
5A
5
6
7
6A
Another depiction of the progression of genetic
pattern hair loss according to Norwood’s
classification
1
2
3
3 Vertex
4
5
6
7
11
12
Another depiction of genetic patterns of
hair loss according to Norwood’s
classification
3A
4A
5A
6A
7A
Progression of hair loss for women
according to Ludwig’s classification
13
14
Drug-related hair loss
Many prescription drugs can cause varying degrees of
hair loss for some people. It is likely that you have seen
cancer patients who have lost hair after undergoing
chemotherapy. In fact, most cancer-fighting drugs
Pattern
1
Pattern
2
Pattern
3
Pattern
4
Pattern
5
Class 1
Class 1
no hair loss
mild hair
loss
Class 3
mild to
moderate
hair loss
15
cause hair loss. In addition, close to 300 more commonly
employed drugs are known to be associated with hair loss.
Drugs commonly associated with hair loss
Class 4
mild to
moderate
hair loss
Class5
mild to
large
hair loss
Class 6
large
hair loss
Class7
complete
hair loss
16
New classification of genetic hair loss:
Pattern 1
Examples of pattern 1 genetic hair loss
Norwood’s traditional pattern where hair loss progresses from
the back and the front, and meets in the middle.
17
Pattern 2
Hair loss progresses only from the front hairline and recedes
backwards while maintaining the crown area.
Hair loss occurs mainly in the crown area and moves forward.
18
Pattern 3
The frontal hairline remains intact.
“Ludwig’s Pattern of Hair Loss” – Commonly seen in female
19
Pattern 4
pattern hair loss, though it occurs in men as well. Hair loss
starts in the center and moves sideways towards the ears.
This type of hair loss rarely results in total baldness.
“Crescent-shaped Hair Loss” – This pattern is common in men
20
Examples of pattern 4 genetic hair loss in
a female
Examples of pattern 4 genetic hair loss in
a male
21
Pattern 5
from the Mediterranean and the Middle East, although it
does occur in other ethnic groups as well. Hair loss begins at
the two temples and moves in a circular pattern backwards,
leaving a small forelock of hair at the frontal hairline.
22
Tom K.:
Male Pattern Baldness
Age: 38
Occupation: Construction Worker
Medications: None
Medical History: No significant illness
Family History: Father and two brothers all have
significant hair loss
It was one year ago that Tom went to see a surgeon concerning
his hair loss. He had tried a number of herbal products with
no change in hair growth. Based on his family history and
on detailed examination of his scalp, it was clear that Tom
had male pattern baldness. His surgeon discussed his options
with him, including medications like Rogaine and Propecia
and hair grafting surgery. Tom and his surgeon decided that
hair grafting surgery was his best option to replace his lost
hair. In addition, after surgery his surgeon suggested that he
employ medications to slow further hair loss and help retain
his new full head of hair. The hair grafting surgery went well,
and Tom feels rejuvenated with his restored hair.
23
Female Androgenic Alopecia (FAGA)
As has already been discussed, women can suffer from
genetic pattern hair loss just like men do and both forms of genetic
hair loss are caused by similar chemical factors. The difference is
that it is much less common for women than it is for men, and the
hair loss follows a different pattern. Women with female genetic
hair loss tend to experience a progressive thinning of the scalp
hair only around the crown area. It is also usually more diffuse
and central than male genetic hair loss; and it is often referred to
as a ‘widened part’. Less commonly, women may have a receding
hairline similar to that seen in balding men. It is unlikely that
female genetic hair loss will result in total baldness, though it does
occur. Aside from female genetic hair loss, there are other ways
that women may suffer from hair loss that will be discussed in the
next chapter.
Female pattern baldness frontal view
Female pattern baldness top view
24
Mary L:
Female Pattern Baldness
Age: 42
Occupation: Marketing Consultant
Medications: None
Medical History: No significant illness
It was two years ago that Mary L. went to see a surgeon
regarding hair loss. She was anxious that she was losing too
much hair too quickly. She was afraid that all her hair would
fall out and felt desperate that something had to be done. On
examination, it was clear that Mary was losing hair diffusely
in the centre “widened part” of her scalp. This type of hair
loss is a typical form of female pattern baldness. Her surgeon
reviewed her medical and family history and performed
a physical examination and laboratory testing. After this
detailed review, it became clear that Mary was losing hair as
a result of her genetic makeup. Weighing all factors it was
decided to start her on Rogaine treatment. Shortly thereafter
Mary’s hair loss slowed down.
25
Chapter 2: Other types of abnormal hair loss
Hair loss can be triggered by many factors other than
genetic predisposition. While these other types of hair loss
only make up five per cent of abnormal hair loss cases, they
can be more severe in their effects. However, the good
news is that these other types outlined below are almost
always temporary or are often treatable. I will briefly discuss
each of these common types of hair loss as well as the main
treatments usually given for them.
Diet-related hair loss
Protein: There are a number of nutritional deficiencies that
can cause hair loss by altering your hair’s structure or hair
cycles. Among these, protein deficiency is one of the most
common. Your hair is composed mostly of proteins, the same
materials that your nails are composed of. If your food does
not provide you with enough protein then both your nails
and your hair may be negatively affected. Protein is found
in common foods like meats, poultry, fish, beans and dairy
products. If a protein-deficient diet persists then your hair
will go into a premature resting stage and will start to fall out
within a few months. Unfortunately, many people simply do
not eat well, or they become caught up in some fad diet.
The kinds of things to watch out for are poor eating habits
that lack in protein, vegetarian diets, or fad diets that restrict
the amount of protein you consume.
Iron: Another possible cause of diet-related hair loss is a
low level of iron in your blood, which might result from an
inadequate amount of iron in your diet. Foods that are
common sources of iron include potatoes, dried beans,
liver, beef, fortified cereals, raisins, spinach and broccoli.
An inadequate amount of iron in your blood may also result
from some difficulty your body has in absorbing iron, which
is commonly linked with the condition anemia.
26
Vitamin A: Another nutrient that can affect your hair is
vitamin A, which can be found in whole eggs, milk and liver.
Both an inadequate and an excessive amount of vitamin
A can cause hair loss. Too little of this vitamin can result
in a condition called hyperkeratosis. It occurs in your hair
follicles and in the sebaceous glands (the small glands in
your skin that secrete oil into your hair) and it can complicate
hair growth. Conversely, too much vitamin A can prevent
proper keratinisation (the process by which a protein called
keratin builds your hair and nails), resulting in a kind of hair
loss referred to as ‘toxic alopecia’.
Other nutritional deficiencies that can affect your hair
growth include deficiencies of: essential fatty acids, zinc,
copper and vitamin C. Fortunately, the damage done to
hair by this type of diet-related hair loss is only temporary
and can be corrected by simply improving your diet. Your
dietary history is one of the first things a medical doctor who
specializes in skin and hair would ask when assessing your hair
loss problem. Before considering anything else, you should
assess your own diet in relation to any hair loss problems you
may be experiencing.
Drug-related hair loss
Many prescription drugs can cause varying degrees of
hair loss for some people. It is likely that you have seen cancer
patients who have lost hair after undergoing chemotherapy.
In fact, most cancer-fighting drugs cause hair loss. In addition,
close to 300 more commonly employed drugs are known to
be associated with hair loss.
Drugs commonly associated with hair loss:
 Birth control pills
 Heart disease and high blood pressure pills, especially beta
blockers and ace inhibitors, like captopril
 Blood thinners, like heparin
 Drugs for gout and arthritis, like allopurinol
27
 Antidepressants, like lithium carbonate
 Diet drugs, like phentermine
 Cancer-fighting drugs
 Hormone replacement therapy
 Drugs used to treat Parkinson’s Disease, like Levadopa
 Performance-enhancing steroids
 Acne medications derived from vitamin A, like
isotretinoin
 Anti-inflammatories, like naproxen
 Cholesterol-lowering drugs
 Anti-convulsants
 Anti-fungals
 Drugs used to treat thyroid disorders
 Ulcer medications, like Pepcid
Dermatologists always ask about drug histories, in
addition to your dietary history, before diagnosing hair loss
problems. Even drugs that are not currently associated
with hair loss may cause you to lose hair, so you should take
your drug consumption history into consideration no matter
what.
Fortunately, drug-related hair loss is easily treated by
simply discontinuing use of the drug causing the hair loss.
There are usually several drug options to treat every condition,
so you should be able to find an alternative that does not
cause you to lose your hair.
Disease-related hair loss
There are dozens of diseases and conditions that can
result in some type of hair loss. In this section, I will outline
the major classes of diseases that cause hair loss, the kind
of hair loss that they cause and possible treatments that are
available.
Since so many common ailments and conditions can
cause you to lose hair, your recent and long-term health
28
history is one of the first things a medical doctor would
question when assessing a case of hair loss. You should also
question your own medical history to determine if disease is
a factor in your own hair loss.
Skin diseases of the scalp
There are a number of different conditions that can
affect the scalp and cause varying degrees and types of
hair loss. These include: infections like syphilis and ringworm;
infestations like pediculosis, which is caused by lice;
inflammatory diseases like folliculitis; genetic diseases like
Darier’s disease and other syndromes of the skin like psoriasis.
The hair loss in each case is usually only partial and can be
treated.
Ringworm: Ringworm is a contagious disease that is caused
by the infection of fungus. It results in small, scaly patches
on the skin and, when it occurs on the scalp, is also followed
by a loss of hair. It can be treated effectively with a topical
solution.
Darier’s disease: Darier’s disease is a genetic disorder
characterized by dark, crusty patches on the skin, sometimes
containing pus, which results in the hair becoming rough and
dry with patches of baldness.
Psoriasis: Psoriasis is a chronic skin disease characterized by
scaling and inflammation. It is a disorder of the immune
system that occurs when cells in the outer layer of the skin
reproduce faster than normal and pile up on the skin’s
surface. The hair loss is reversible with treatment.
Telogenic and anagenic alopecias
To understand this type of hair loss, you first need to
be familiarized with the hair growth cycle. All human hairs
go through a natural cycle beginning with growth, called
the anagen phase, followed by a period of rest, called the
29
telogen phase, and ending with the hair falling out. When
only the hairs that belong in a particular phase fall out, we call
this either anagenic alopecia or telogenic alopecia. Dozens
of factors can cause either of these alopecias, including
stress, chronic diseases and nutritional deficiencies. Many of
these different factors send anagen hairs prematurely into
the resting stage and result in excessive shedding months
after. This is called telogenic alopecia. In this section we will
discuss some of the more common telogenic and anagenic
syndromes.
Loose anagen syndrome: This condition generally affects
young, Caucasian blonde girls, although anyone is
susceptible. The characterizing symptom is the ability of
anagen hairs (hairs that are in the anagen, or growth, stage
of the hair cycle) to be pulled out easily and painlessly. In
children ages 2 to 5 years with loose anagen syndrome, the
hair is usually unable to grow past the ears, though the density
is otherwise unremarkable and the hair is not particularly
fragile otherwise. Treatment is usually unnecessary because
although loose anagen hair grows slowly, it does grow and
if it is accidentally pulled out, it grows back quickly.
Pregnancy and childbirth: The stress of childbirth, similar to
that of a severe fever or chronic illness, can prematurely push
anagen hairs into the resting stage, resulting in excessive
shedding some months later. Hormonal changes that occur
during pregnancy also play a part in this telogenic alopecia.
The slight hair loss should fix itself within 6 to 12 months.
Alopecia areata
Hair loss may sometimes affect otherwise healthy
people with good eating habits, no notable diseases or
injuries to the scalp that can explain such a loss of hair.
When this occurs, it is referred to as ‘alopecia areata’. This
unpredictable but common disease affects 1.7 per cent of
the world’s population. Although it can affect men and
women of all ages, onset most often begins in childhood.
In most cases, the hair falls out in round patches all over the
30
scalp and body. In some extreme and rare cases, the hair
loss may lead to a complete loss of hair all over the head and
body. Alopecia areata that causes complete hair loss of the
scalp is called ‘alopecia totalis’ and when it causes hair loss
over the whole body it is called ‘alopecia universalis’.
It is believed that alopecia areata is caused by the
immune system unexpectedly, and usually temporarily,
attacking the hair follicles, causing them to fall out and
preventing re-growth in some cases. However, it is not known
why this occurs.
Cases of alopecia areata usually disappear on their
own and never occur again. If this type of hair loss persists,
however, medical treatment is a possibility. Various steroids,
Propecia, Rogaine, and various immunogens (drugs that
interfere with the immune system) have been found to be
effective in combating alopecia areata.
Although alopecia areata is not life threatening, it is
so dramatic in its effects that it often damages the mental
and emotional states of its victims. For this reason, many
support groups have been established to help people cope
with alopecia areata. You can find a local support group in
most countries around the world by contacting the National
Alopecia Areata Foundation via their website at www.
alopeciaareata.com.
Thyroid diseases
Your thyroid gland resides in your neck and is
responsible for producing hormones that are involved in
many of your body’s functions, your metabolism in particular,
making its proper functioning vital to your overall health.
Hypothyroidism occurs when your thyroid is underactive, meaning it is producing inadequate amounts of
hormones. When this occurs, there is a slight shedding of
the hair on the scalp, and possibly of the armpits and pubic
area.
An under-active thyroid gland may become enlarged
due to a bombardment of thyroid-stimulating-hormones (TSH)
produced by the pituitary gland, which occurs in order to
31
entice the thyroid to produce more hormones. The result is
the creation of ‘goiter’.
The most common cause of hypothyroidism is a
previous (or ongoing) inflammation of the thyroid gland that
leaves a large percentage of the gland’s cells damaged
or dead. This kind of inflammation is most likely the result of
autoimmune thyroiditis, which is caused by the patient’s own
immune system. Hypothyroidism may also be caused by
certain medical treatments that, indirectly or directly, affect
the thyroid gland.
The hair loss that results from thyroid disease can
be reversed by treating the condition that is affecting the
thyroid gland. There are many other symptoms of thyroid
disease, including fatigue, weakness, weight gain, dry skin,
intolerance to the cold, constipation, memory loss, muscle
aches and/or depression. The proper functioning of your
thyroid gland is very important and is worth seeing a medical
doctor if you think you may be experiencing some or all of
these symptoms.
Psychiatric and psychological diseases
The most common type of psychological condition
that can cause hair loss is stress. Excessive stress can cause
telogenic alopecia, which is described above.
Anorexia nervosa: Anorexia nervosa occurs when someone
restricts their diet to such a degree that there are nutritional,
endocrinal and psychological impairments. The hypocaloric
diet (meaning there is an insufficient amount of calories
being ingested) may result in a loss of hair. This may also be
accompanied by an increase in lanugo (the fine, light hairs
that cover the body) on the face, trunk and arms.
Cancer-related hair loss
Neoplasic alopecias: This term refers to hair loss that results
from cancer spreading from one area of the body to the
scalp. The word ‘neoplasic’ comes from the word ‘neoplasm’,
which means ‘tumor’.
32
The susceptibility of the scalp to neoplasic alopecia is
higher for women with breast cancer and for men with lung
cancer in particular, as opposed to other types of cancer.
It is believed that mucines, a certain kind of protein created
by breast and lung carcinoma, degenerate the cells of the
outer root sheath of the hair follicle. However, not all cases
of breast or lung cancer will cause hair loss.
Ovarian and adrenal tumors are also likely to cause
hair loss. Both types of tumors can cause hyperandrogenism,
which is the excessive production of androgens (male
hormones). Androgens are known to play a key role in male
and female pattern baldness. Once the tumor has been
removed, however, the hair loss should go away.
Cancer-fighting drugs: Most cancer-fighting drugs, like
chemotherapy, attack the body, including the hair follicles,
and cause considerable hair loss. The hair should grow back
after the treatment has stopped.
SAHA syndrome
SAHA syndrome is a skin condition that only affects
women and is caused by hyperandrogenism, which is the
excessive production of male hormones (androgens) and
which occurs in the whole body (cases of hyperandrogenism
affecting only particular parts of the body are considered
different conditions).
The four main symptoms of this syndrome make up the
acronym ‘SAHA’: seborrhea, acne, hirsutism and alopecia.
These four manifestations appear in this order, although not all
women suffer from all of them. All sufferers of SAHA syndrome
do experience seborrhea, however.
Seborrhea is a skin condition characterized by
inflammation, dry or oily scaling, crustiness and/or itching. It
is so called because of the excessive production of ‘sebum’
(the oily secretion of the skin) that causes the condition.
The acne associated with the syndrome is considered part
of the condition because the increased sebum production
that causes acne in this case is caused by androgenic
action. Hirsutism, the third symptom, is the excessive growth
33
of male-pattern hair in women, also caused by an increase
in androgens.
The hair loss that accompanies SAHA syndrome is also
caused by excessive amounts of androgens and results in
typical female pattern baldness. A uniform clearing of the
scalp of the crown occurs, though total alopecia is unlikely
and the frontal hairline remains intact.
Treatment of SAHA syndrome includes several drug
options, including the use of antiandrogens and estrogens
(female hormones).
Hair loss due to external injuries to the scalp
Hair loss commonly occurs as a result of something as
simple as physical stress being put on the hair, the destruction
of the hair follicles themselves or excessive amounts of hair
being pulled out of the scalp. In these cases, we say that the
hair loss is due to ‘external injuries to the scalp’ as opposed
to a skin disease or disorder.
Cicatricial alopecias
Hair loss may occur due to the destruction of the hair
follicle. In this case, the skin of the scalp is somewhat like
scar tissue and is therefore unable to produce hair, meaning
that the hair loss is permanent and the only option is surgical
treatment.
This destruction of the hair follicles can result from
mechanical, physical or chemical trauma (which may
include the use of acids, chronic traction, electrical or thermal
burns, or freezing), as well as tumors, special skin diseases or
severe infections such as syphilis. The destroyed hair follicles
may not necessarily cover the entire scalp, depending on
the method and type of damage. Again, the only option
for this kind of hair loss is surgical treatment.
Trichotillomania
Hair loss among children can occur as a result of
34
a usually unrecognized behavioral disorder known as
trichotillomania. It is characterized by uncontrollable hair
pulling, similar to impulsive disorders such as pyromania
or kleptomania. The disorder usually appears in males at
the age of 8 and in females at the age of 12 and has a
prevalence of about one per cent.
Sufferers of trichotillomania generally spend about
one hour per day pulling their hair out. This can last for a few
seconds or minutes, or it may last for prolonged periods of
time. Some may try to resist the urge, while some are unaware
of its occurrence, pulling hair absent-mindedly while driving,
reading or watching television.
While the disorder itself is a stressful condition, the hair
loss that results is an unfortunate additional complication that
affects many children and teenagers psychologically and
emotionally. The hair loss that occurs is usually focused on the
scalp, but it may also occur among the eyebrows, eyelashes
and pubic region. Hair loss is usually patchy, irregularlyshaped and occurs most often on the side of the body that
coincides with the person’s predominant hand. Most sufferers
of trichotillomania are likely to feel embarrassed about
the disorder and may try to hide their hair loss, prolonging
diagnosis and complicating treatment.
Treatment for trichotillomania involves behavioral
therapy and/or medication. Possible drugs include mood
stabilizers, anxiolytics (drugs that work on the central
nervous system to relieve anxiety), neuroleptics (also known
as antipsychotics) and topical agents including steroids.
However, behavioral therapy has been found to be more
effective than drug therapy, especially if the hair pulling has
only been occurring for less than 6 months and because there
are no clear guidelines for how drugs should be used to treat
trichotillomania. With therapy, sufferers of trichotillomania
can overcome this disorder and resume their normal lives
without worry of uncontrollable urges or hair loss.
Hair loss due to poor hair care
The effects of poor hair care on hair loss are significant.
35
Unfortunately, there are many styling habits and treatments
that are bad for the overall health of your hair and that
promote hair loss. Hairstyles that require unusual pulling, dying
or conditioning may severely stress the natural workings of
your hair and may lead to unusual balding.
When a high degree of physical stress is constantly
being put on the hair for styling purposes, hair loss may occur.
This condition is referred to as ‘cosmetic alopecia’. It is usually
caused by the constant use of curlers, brushes and other
tools used to style hair as well as hairstyles that pull the hair.
The alopecia appears as a slight shedding of the hair and
occurs because the strain that the hair is put under leads
to reduced blood flow in the capillaries at the bottom of
the hair follicles. The hair’s growth is stunted and eventually
leads to a slight loss of hair a few months later. This usually
affects the triangular areas above and in front of the ears,
though it is dependant on the direction in which the hairstyle
is aimed. It is also possible to damage the hair follicles and/
or the scalp itself with the constant use of chemicals used
to curl or dye the hair. In most cases of cosmetic alopecia,
the reduced blood flow that causes the hair loss disappears
after the pressure is removed, although the shedding may
take a few months to return back to normal.
36
Anna S. : Losing Hair Due to Iron
Deficiency
Age: 32
Occupation: Receptionist
Anna S. initially saw a surgeon three years ago, complaining
of ongoing hair loss over six months. A history and medication
review indicated no significant findings. No one in her family
had lost significant hair before. On physical examination,
it was discovered that her hair was thinning mainly on the
crown area of her head.
Her blood tests showed an iron deficiency, and she informed
her surgeon that she had been experiencing unusually heavy
periods over the last year. It was diagnosed that her hair loss
could be related to this. Anna started on iron therapy and
it was recommended that certain dietary changes be made
to support this. Within three months Anna’s hair loss had
stopped. Within six months Anna’s hair was back to normal,
and she was much relieved. She has had no recurrence of hair
loss ever since.
Julia B. : Losing hair because of
Hypothyroidism
Age: 27
Occupation: Homemaker
Julia B. went to a clinic complaining of fatigue, increase in
weight, and sparse hair on the scalp and on the eyebrows. She
was not taking any medications. Julia had no family history
of hair loss. Physical examination showed dry skin, diffuse
hair loss, and noticeable loss of hair on both eyebrows.
Lab testing revealed that Julia’s TSH levels were elevated.
Julia was suffering from hypothyroidism (the slowing of the
thyroid gland). Often such a condition causes the unusual loss
of hair not only on the scalp but on other parts of the body.
Julia was started on a thyroid replacement medication. In six
months not only was her hair restored to normal, but Julia
found herself less fatigued and in better overall health.
37
38
Peter K. : Losing Hair Because of a
Medication
Age: 40
Occupation: Accountant
Peter came to see me after having suffered ongoing hair loss
for over three years. He had no family history of hair loss, but
Peter did have high blood pressure for the last five years. He
had been on a drug called Propranolal, a type of beta-blocker
medication, that is often used to control high blood pressure. A
physical examination showed his hair to be thinning diffusely
at the center.
It was suspected that Peter’s hair loss was caused by his blood
pressure medication. The Propranolal that he was taking was
replaced with another medication, and He was monitored for
the effect this would have. Slowly but surely Peter’s hair loss
was reversed. After one year all his hair was regained.
39
Many people with other types of hair loss aggravate
their situation by poor hair care habits. For example, there
are many genetically balding people who are losing more
hair than they should be and at a faster rate because of
poor hair care habits. In these cases, people can forestall
the appearance of baldness for years by maintaining good
hair care.
You can learn how to properly take care of your hair
and prevent, or forestall, the appearance of balding later in
this book in the section regarding ‘rules for good hair care’.
2
treatment options
for hair loss
1. medical treatment ...........................41
a. rogaine (minoxidil)....................................................
41
b. propecia (finasteride) . ............................................... 44
c. comparing rogaine and propecia .............................. 47
d. other emerging drugs
................................................ 52
2. surgical treatment ..........................55
a. basic questions about surgical treatment. ....................
55
b. follicular unit strip surgery (fuss) ............................... 65
c. follicular unit extraction (fue) ................................. 75
d. comparing fuss and fue methods . ............................... 83
e. goals of hair transplant surgery ................................ 89
f. risks associated with hair transplants ........................ 109
g. repair cases ........................................................... 111
h. case studies ............................................................ 125
i. the future of surgical treatment
................................. 182
3. alternative treatment ....................192
4. hair replacement treatment ............200
39
40
DRUG TREATMENTS FOR HAIR LOSS
Over 90 per cent of all hair loss cases fall under the category
of genetic hair loss. For this reason, all the treatment options
discussed in this section, with the exception of hair replacement
therapy, are meant only for the treatment of genetic hair loss. For
all other types of hair loss, you should contact a qualified medical
doctor to discuss treatment options. And while this section is meant
to guide you in treating your hair loss, you should always contact
a medical doctor before beginning any treatment program.
chapter one:
medical treatment
The treatment of genetic hair loss with medication,
taken either orally or applied topically on the scalp, has
long been the dream of people suffering from this type of
hair loss. But until recently this hope has been nothing but a
dream. During the last couple of decades researchers have
been developing two drugs that have proven effective in
combating genetic hair loss. First the drug minoxidil, which is
now marketed as Rogaine, was approved by the Food and
Drug Administration and later on the drug finasteride, which
is now marketed as Propecia, was also approved for use in
fighting genetic hair loss.
There are also many other drugs and combinations of
drugs that are now being tested and which may be available
in the coming few years. It should be noted, however, that
there is always the risk of side effects with any medications.
Also, it takes decades to completely understand the full
effects of any drug and many of these drugs have not been
around long enough to determine these full effects.
Rogaine (minoxidil)
Rogaine was introduced as a new drug for promoting
hair growth by the Upjohn Company in 1988. It is sold as a
topical solution, which means that it is a rubbing solution
meant for the balding areas of your scalp. It comes in either
a 2 per cent or a 5 per cent solution depending on how much
41
42
minoxidil the solution contains. Rogaine is available over the
counter and should be applied on the balding area(s) twice
a day, every day.
How does Rogaine work?
Although there is only a small percentage of minoxidil
in Rogaine, it is this drug that makes it work. Minoxidil is known
as a hair growth stimulator. It was originally marketed in a
tablet form for the treatment of high blood pressure and
unwanted hair growth was one of the common side effects.
It is unclear why it is able to do this.
How effective is Rogaine?
While the Food and Drug Administration recognizes
that Rogaine works, it is well known that it doesn’t work for
everyone. Recent studies show that when the 2 per cent
solution is used properly, it can stimulate hair growth 30 per
cent of the time, with a slightly higher rate in females. And the
new 5 per cent solution has shown only slightly more success
than the weaker solution.
Rogaine is most effective when used at the first signs
of balding and in relatively small areas of hair loss. It is also
more effective in the center of the scalp than on the frontal
hairline. Rogaine can inhibit further hair loss and can be used
to supplement hair transplantation.
It should be noted, however, that if you stop using
Rogaine you will lose any hair re-grown while you were
using it. This means that once you start using Rogaine, you
must continue to use it for the rest of your life to enjoy its
benefits.
Are there any side effects to using Rogaine?
Every drug has some side effects. In the case of
Rogaine the drug that makes it work, minoxidil, has a
dangerous effect on the body (and the heart in particular) if
taken orally. When it is diluted in a solution for topical use, as
it is in Rogaine, the side effects are less severe because the
amount of minoxidil entering the body is much less. However,
even in small doses the use of minoxidil does have some minor
and major side effects that should be noted.
Minor side effects: These include skin irritations on the scalp
such as dry red skin, flaking and itching; nausea and vomiting;
and diarrhea. These are short-term, temporary side effects
that should go away when your body adjusts to the use of
Rogaine.
Major side effects: These include back and chest pain;
cold-like symptoms; rapid heartbeat; fluid retention; difficulty
breathing; weight gain; worsening of hair loss. These are very
rare, extreme side effects that are similar to the effects of
minoxidil taken orally.
Also, Rogaine is not safe for people who: Show allergic
reactions to minoxidil; have heart disease; have high or
low blood pressure; have skin diseases like dermatitis; are
pregnant; or who are nursing mothers.
What improvements can we expect in the near future?
The most likely advancements in the use of Rogaine
will come from two different approaches:
Increasing the amount of minoxidil: Like the addition of the
5 per cent solution to the 2 per cent solution, researchers
have been trying to improve the effectiveness of Rogaine
by increasing the amount of minoxidil in the solution.
Increasing the ability of minoxidil to enter the skin: Researchers
have also been trying to make Rogaine more effective by
increasing the ability of the minoxidil in the solution to enter
the skin and cause hair growth. Tests have shown that if
43
44
minoxidil is mixed with certain other substances it may be
able to enter into the skin better and cause more effective
hair growth.
Final recommendations for Rogaine
Only use Rogaine if your health is good, if you are
willing to test how it works for more than one year while
accepting the possibility of failure, if you are disciplined in
taking medications and following detailed instructions, and
if you are prepared and able to pay to use Rogaine for the
rest of your life.
Propecia (finasteride)
In late 1997, the Food and Drug Administration
approved Propecia for distribution in the United States as a
hair-restoring drug. It is sold by the company Merck in 1 mg
pill form by prescription only. It is the first pill that effectively
treats genetic hair loss.
The active agent in Propecia is a drug called
finasteride. It was originally used in a prostate medication
called Proscar that was found to grow hair. Propecia is a
lower-dose form of Proscar developed specifically to fight
hair loss.
One of the main differences between Rogaine and
Propecia is that Propecia should only be used by men. It is
dangerous for women of childbearing age and can cause
severe birth defects in women that have handled Propecia
in any way. Possible dangers aside, Propecia does not work
for any women of any age.
How does Propecia work?
Finasteride is the active agent in Propecia. It works
by manipulating the underlying chemical causes of genetic
hair loss. We know that men with genetic hair loss have
increased levels of a hormone called dihydrotestosterone
(DHT) in their scalps and it is believed that the presence of
DHT in the scalp is related to the thinning of hair follicles and
the resulting genetic hair loss. DHT is a by-product of the male
hormone testosterone, which is converted to DHT when it
reacts with a natural enzyme that is found in human skin cells
called 5 alpha-reductase (5AR). Propecia does not directly
counteract DHT itself, but rather blocks the action of 5AR to
indirectly reduce the presence of DHT.
How effective is Propecia?
Propecia seems to be at least as effective as Rogaine.
It is particularly potent in preventing further hair loss but is not
as successful in stimulating new growth.
Studies suggest that about 80 per cent of balding
men can stop any further hair loss by taking Propecia. In
addition, two out of three men may see some re-growth of
hair. However, Propecia only works for men who have mild
to moderate hair loss. Balding men with major or complete
hair loss will not benefit from Propecia. Like Rogaine, Propecia
is more effective in the center of the scalp and less so along
the frontal hairline.
Propecia must be taken for at least three months
before seeing any results. Because hair generally grows at a
rate of about ½ an inch per month, it usually takes between
three to six months to see the full effects of Propecia. If there is
no significant growth after 12 months it is unlikely that Propecia
will ever work.
Also like Rogaine, Propecia is effective only for as long
as it is taken. This means that all benefits of using Propecia
will be lost if you ever stop using it.
Are there any side effects to using Propecia?
Contrary to the dangerous effects that Propecia has
on women, it is generally well-tolerated by men. The Food
and Drug Administration described Propecia as having only
infrequent side effects that affected only a small number of
men.
45
46
General side effects: These include allergic reactions such as
rash, hives, itching and swelling of the lips and face; breast
tenderness and enlargement; and testicular pain.
Sexual side effects: Less desire for sex, difficulty in achieving
an erection; decrease in the amount of semen; and problems
with ejaculation. These side effects occurred in less than 2
per cent of men and were only temporary.
Some men in particular should not take Propecia.
These include men who have allergies to finasteride or a
related drug or who have liver function abnormalities. Men
for whom the noted side effects are unusually severe or longlasting should only continue using it with caution and under
the direct guidance of a medical doctor.
As has already been mentioned, Propecia is also not
safe for women and may cause severe birth defects. Women
should not even handle broken or crushed tablets, although
all Propecia tablets have a protective coating when intact.
Also, men taking Propecia pose no danger to women or their
fetuses.
Although there are no known dangers in mixing
Propecia with other drugs, the use of this drug has been linked
to decreases in levels of prostate-specific antigen (PSA).
Though this decrease is insignificant in itself, PSA levels are
often measured for diagnostic reasons in the case of men
suspected of prostate cancer or other prostate problems.
Because of this, all patients taking Propecia, especially those
with prostate illnesses of any kind, should inform their doctors
of the usage.
What improvements can we expect in the near future?
Although Propecia is relatively new on the market,
there have been several novel approaches to obtaining
greater results from its use.
Using Propecia as a topical solution: One approach has been
to formulate finasteride as a topical solution, like Rogaine. This
approach is more common outside of the United States, but
some American companies are already selling finasteride in
this form. At this point, however, a topical form of finasteride
remains experimental as there have been no clinical studies
that have shown the effectiveness of a finasteride topical
solution.
Combining Propecia with Rogaine: It is believed by some
that Rogaine and Propecia can complement each other
by combining Rogaine’s ability to stimulate new growth with
Propecia’s ability to prevent further hair loss. This, however,
is a relatively new approach and little has been done in the
way of scientific studies to verify its effectiveness.
Final recommendations for Propecia
Rogaine
Propecia
Comment
About $30 USD
per month
About $50 to
$60 USD per
Rogaine is a
little cheaper
Safe for men
only
Safety
Safe for both
sexes, except for
those with heart,
blood or skin
problems
Men may
choose
either, but
women can
only use Rogaine
U s -
Topical solution, twice a
day every day
continuously
Single tablet
taken once every day continuously
Propecia
is easier to
use but both
must be used
for life
Cost
47
48
Comparing Rogaine and Propecia, continued
Rogaine
Propecia
Comment
Extra strength
(5 per cent
solution) can
help 2 out
of 3 people
regain minimal
to moderate
amounts of
Effect- hair in the ceni v e - tral baldings
areas of the
ness
scalp. There is
a 10 to 40 per
cent chance
that your hair
regrowth will
be significant.
It may take up
to one year to
see full effects.
Can help 2
out of 3 men
regain minimal
to moderate amounts
of hair in the
central baldings areas
of the scalp.
Almost 90 per
cent effective
in preventing
further hair
loss. There is
a 30 to 60 per
cent chance
that your hair
regrowth will
be significant.
It may take 3
to 6 months to
see full effects.
Propecia is
more effective
in preventing
further hair
loss. Rogaine is
more effective
in stimulating
new growth.
Propecia
shows results in
less time than
Rogaine.
Temporary
side effects:
skin irritations
on the scalp;
nausea and
vomiting; and
Side
diarrhea. Rare
effects side effects:
back and chest
pain; cold-like
symptoms; rapid
heartbeat; fluid
retention; difficulty breathing;
weight gain
Temporary
side effects:
rash, hives,
itching and
swelling of
lips and face;
breast tenderness and
enlargement;
testicular pain;
sexual impairment including
problems with
ejaculation
Side effects are
rare with either
drug. Long-term
effects are unknown for both
drugs.
Examples of crownal hair loss helped by
Propecia
49
50
Examples of crownal hair loss helped by
Propecia
Anterior mid-scalp hair loss helped by
Propecia
51
52
Other emerging hair growth drugs
Although Rogaine and Propecia are the only two drugs
currently approved by the Food and Drug Administration
to combat genetic hair loss, there are several other drugs
that have shown great promise in restoring hair loss. These
are not likely to be miracle cures but they may be more
effective than current versions of Rogaine and Propecia,
and they may display features more suited to your needs.
You should know what other drugs may soon be available
besides Rogaine and Propecia. All of these drugs are still
being tested and some are being seriously investigated by
large pharmaceutical companies that are investing millions
of dollars to make them work.
Dutasteride
Dutasteride is another 5 alpha reductase inhibitor
like the finasteride used in Propecia but it is currently being
marketed as Avodart for the treatment of benign prostatic
hyperplasia. Researchers are trying to formulate a form of
dutasteride that can be used for the treatment of genetic
hair loss. Like finasteride, it will likely have side effects on male
sexual functioning.
Antiandrogens
Antiandrogens are drugs that prevent androgens
(male hormones) from working. These drugs have shown the
most promise in being able to provide a cure for genetic hair
loss, as androgens are known to play a key role in causing
this kind of hair loss.
Antiandrogens are used to treat many different
ailments and one of the side effects commonly seen during
their usage has been the stimulation of hair growth all over
the body.
Because male hormones are important to the proper
functioning of many male bodily functions, possible side
effects of using antiandrogens include impairment to male
physical characteristics and sexual desire and potency.
Work has been done to develop antiandrogens that
are safe for men to use to combat hair loss while avoiding
the unwanted side effects. Finasteride, the drug in Propecia,
is an example of one such drug because it does not directly
inhibit male hormones but rather inhibits an enzyme that
interacts with male hormones.
Because antiandrogens target male hormones,
antiandrogens are generally safer for women. Since women
are less damaged by the side effects of antiandrogens
they are more effectively treated by them. In Europe,
antiandrogens have been officially used to treat genetic hair
loss in women for years.
One of the two drugs approved by the Food and Drug
Administration for the treatment of genetic hair loss is Rogaine,
whose active agent minoxidil is not an antiandrogen. So it
would not be surprising to discover that the most effective
drug treatment for genetic hair loss might emerge from a
type of drug that is also not an antiandrogen.
Outside of the antiandrogens, there have been
several drugs that have shown some promise as a treatment
for genetic hair loss. The most prominent of these that are
currently being developed and tested include the drugs listed
below. Look for these drugs to emerge in the near future to
complement Rogaine as a drug treatment for genetic hair
loss.
Tricomin
The American pharmaceutical company ProCyte is
testing this drug in France. It has shown some effectiveness
in increasing new hair growth by 40 per cent for three out
of four of the balding men who used it in testing. Tricomin is
a compound chemical that helps restore the health of skin
tissue. The compound drug is applied on the skin like Rogaine
and is believed to restore a healthy skin base for new hair to
grow.
53
54
Cyclosporine
In several scientific studies conducted over the last
few years, this drug successfully re-grew hair for at least
some of the balding men who used it in testing. It is a type
of drug called an immunosuppressive, meaning that it
fights the body’s immune system. Immunosuppressives are
usually given to patients to prevent organ rejection after a
kidney, liver or heart transplant. Some experts believe that
the ultimate cause of genetic hair loss is the immune system
receiving the wrong messages that hair on certain parts of
the scalp are foreign to the body, causing the immune system
to attack them.
In tests, cyclosporine was applied on the skin in the
same way as Rogaine. This is done to localize the suppression
of the immune system to the scalp and protect the rest of
the body from the effects of the drug. The partial success
of cyclosporine is fueling great interest in researching and
developing immunosuppressive treatments for genetic hair
loss.
Cyoctol
This drug has shown enough promise for Squibb, a
major pharmaceutical company, to work on developing
and testing it as a treatment for genetic hair loss. It is
believed to combat hair loss by binding itself to the roots
of hairs and protecting them from the negative effects of
dihydrotestosterone (DHT), which is linked to genetic hair
loss.
Diazoxide
The Food and Drug Administration is currently testing
this drug for approval. It is usually used to treat symptoms of
diabetes, such as abnormally high blood sugar. When it is
used orally for this purpose, it has the side effect of causing
hair growth all over the body. Recent research on diazoxide
has been focused on developing it for treatment of genetic
hair loss by trying to control and direct the hair growth to the
scalp.
55
chapter two:
surgical treatment
Like medical drug treatments, surgical treatments for
hair loss have developed significantly in the last couple of
decades. However, unlike medical drug treatments that are
still years away from being able to provide a full head of hair,
recent advancements in surgical treatments have made it
possible to achieve the appearance of a full head of natural
hair. At this point in time, surgical methods are the surest and
most effective way for most balding people to restore natural
hair to a balding head.
Basic questions about surgical treatments
What are surgical treatments?
There are several types of surgical treatment for hair
loss. They all involve the movement of hair from areas of your
scalp that normally never go bald, such as the back and sides
of your head, to the balding areas of your scalp, usually the
central area on top and the frontal hairline.
What is important to recognize about all surgical
treatments for hair loss is that no surgical method can give
you new hair or restore any of your lost hair. They can
only redistribute what you still have. It is also important to
55
remember that surgical treatments for hair cannot prevent
further balding. When deciding to employ any surgical
treatment you must consider the possible progression of your
hair loss as well as what you have already lost.
Who is a good candidate for surgical treatment?
Because surgical treatments of hair loss can only
move existing hair from one area to another, it can only work
properly with people who have enough remaining hair to
cover the balding areas, and who are likely to retain it for
some time. With recent advances in hair transplantation
even people who have lost up to 50 per cent of their hair
can get the appearance of a full head of hair with surgical
treatment. But even with less than half your hair left, you can
still benefit from hair transplantation and have your remaining
hair redistributed in a way that looks natural and attractive.
When is surgical treatment appropriate?
There are several different situations in which hair
transplantation is the best method to treat your hair loss.
To produce a natural hairline: A hair transplant is always
required to produce a natural looking frontal hairline. The
frontal hairline is the most important part of hair restoration
because it is the most prominent part of your hair. The
creation of a natural looking frontal hairline requires the
restoration of a delicate pattern of hair lengths at various
angles, which leaves little room for error.
To fill in thinning hair: When hair only appears to be thinning,
short of complete balding, then hair transplantation can
provide the restoration of a full set of hair. Small grafts of one,
two or three hairs can be precisely placed amidst thinning
hair to restore a natural looking density.
To implant on scars left by surgical cuts to the scalp: Scars left
from surgical cuts into the scalp or physical traumas can be
effectively concealed by transplanting hair into the scarred
56
skin tissue.
What are the different types of surgical treatments?
Currently, there are two methods of hair transplantation
that offer the best and most natural results possible. These
are follicular unit strip surgery (FUSS) and follicular unit extraction (FUE).
Both the FUSS and FUE procedures involve the extraction
of follicular units from a donor area on the head. Follicular
units are small groupings of one, two or three hairs that grow
naturally on the scalp. These follicular units are taken from
areas on the head where hair is genetically programmed
not to fall out. They are then implanted in the balding areas
of the scalp, where the transplanted hair will continue to
grow naturally. The FUSS and FUE procedures approach this
method differently, but both provide exceptionally natural
results and are by far the most popular methods with surgeons
and patients.
How much does surgical treatment cost?
The cost of hair transplantation can vary enormously
depending on who is performing it. Typically a doctor
will transplant 1000 to 4000 grafts in one session that can
last anywhere from two to twelve hours. The cost of the
procedure is based on a price per graft. The grafts used in
the FUSS procedure range in cost from $5 to $8 USD each.
The grafts used in the FUE procedure range in cost from
$12 to $25 USD each. Depending on the number of grafts
being transplanted, the cost of the procedure can run into
the thousands, but patients should remember that a hair
transplant is a permanent and life-long investment.
57
58
SURGICAL TREATMENTS FOR HAIR LOSS
Alex:
Male Pattern Hair Loss
Candidate for Surgical Treatment
Age: 52
Occupation: engineer
Medications: none
Family history: brother has similar hair loss
Alex had been losing hair for 10 years. He was losing his
hair slowly but progressively over that time. Each year
seemed to get worse and worse. It began to effect his selfimage. Since his brother had also displayed signs of male
pattern hair loss it was clear that Alex had geneticallyrelated male pattern baldness. His surgeon outlined for
Alex all his treatment options. He could start on hair
growth medications like Rogaine or Propecia to decrease
further hair loss or he could undergo surgery with follicular
unit micrografting to replace his lost hair. He thought
about if for several days and discussed this with his wife
and friends. In the end he felt that he needed to restore his
hair to its former glory. He opted for surgery. Alex and his
surgeon decided together that he needed about 1500 grafts
Ideal candidates for surgical hair transplant
Crownal
hair loss:
top view
59
60
Frontal and
central hair loss:
Front view
Frontal and
central hair loss:
front view
Frontal hair loss:
Front view
Frontal and
central hair loss:
Front view
61
62
Temporal
hair loss:
front view
Temporal
hair loss:
Side view
Temporal
hair loss:
front view
Temporal
hair loss:
side view
63
64
Central
hair loss:
Front view
Central
hair loss:
Side view
Frontal and
central hair loss:
Top view
Frontal and
central hair loss:
Side view
65
66
Follicular unit strip surgery (FUSS)
The FUSS procedure involves the extraction of follicular
units from narrow strips of scalp taken from donor areas on
the back and sides of your head. The removal of these strips
result in virtually undetectable scars. The follicular units are
cut out from these strips and implanted into the balding areas
of your scalp in pin-sized, surgically created holes. These sites
will also heal in just a few days, leaving no Step three: Making the grafts
The strips of skin taken from the scalp are cut into small
grafts. Each of the small units is called a graft because it is
intended to be placed in the bald portion of your head where
it is supposed to literally ‘graft’ or meld into the existing skin.
Step four: Making the recipient sites
Following the plan previously sketched on the scalp,
small holes are cut. A thin gauge needle is used to prevent
damage to the skin while making the holes needed for
transplanting into the bald areas of the scalp.
First, anesthetic and extra fluids are injected into the
skin, causing the surface area to increase. The needles are
inserted into the skin to make the holes. With small enough
holes, there is no tissue damage.
Step five: Placing the grafts
Each graft is carefully placed according to the plan
into specified holes. Usually 1000 grafts are more implanted
in a single transplanting session. Mega sessions may involve
the transplanting of 1500 to 4000 grafts in one session.
Follicular Unit Extraction (FUE)
The follicular unit extraction (FUE) method, like the
67
session that can be performed in a single day. Each of these
sessions of hair transplantation involves the following steps:
Step one: Making a plan
A careful plan is made to design and mark a hair
transplant map on the patient’s scalp. In making this plan,
the hair transplant surgeon is using the principles that govern
a natural head of hair to design a transplant that will look
appealing and go undetected.
Step two: Harvesting the hair
Using local anesthesia, a small strip of skin is cut out
from a selected hairy portion of your head. The selection of
this area as a source of hair is based on a few considerations.
First, the portion of the scalp to be stripped should not be
susceptible to balding. Otherwise, the transplanted hair
would eventually fall out of its new location, defeating the
point of the transplant. Also, the selected portion of the
scalp should be selected on the basis that after stripping and
harvesting the donor grafts follicular unit strip surgery
(FUSS)
68
(FUSS)
69
(FUSS)
70
FUSS method, involves the transplantation of follicular units
from donor areas on the back and sides of the scalp to the
balding areas. The difference between the two is that the
FUE procedure extracts follicular units directly out of the scalp,
one by one, using precise instruments and a high-powered
microscope.
This second and newer method of follicular unit
The two different cuts:
The top shows the ellipse cut where the skin with hair is
removed by cutting around the edges. The multi-bladed cut
shown below often transects many hair follicles.
The strip is removed
from the donor area.
The strip will be dissected into the follicular
units under a microscope
The individual follicular
groups of 1, 2, and 3
hairs will be transplanted to the balding area
71
72
73
transplantation has the advantage of requiring no major
surgical excisions. But while the FUSS procedure allows a large
number of follicular units to be removed from a single strip
of scalp, a fewer number can be removed during a single
session of the FUE procedure because each unit must be
removed one at a time. However, a session can be repeated
one or two days apart.
The FUE method of transplantation is particularly
good for those who do not have a lot of hair in their donor
areas, those who are afraid of the surgical aspect of hair
transplantation and for those who do not want any surgical
scars in the donor areas. Due to the lack of cutting involved
with the FUE procedure, patients retain the option of wearing
step four: making small holes
74
their hair very short without worrying about the appearance
of minor scarring.
The grafts used in the FUE procedure are thinner than
the ones used in the strip technique. This is an additional
advantage because grafts can be placed closer together,
which means that more grafts can be implanted to maximize
the density of the transplant. Thinner grafts are also more
Small gauge needles used to expand
the recipient area for the grafts.
75
Step six: Allowing the grafts to settle
The grafts are left to settle in their new places and
the scalp is allowed to heal for several months. During this
healing process, the skin closes around the grafts. The hair
from the transplanted grafts usually falls out as a result of the
shock of transplantation. However, after a few months the
roots of the hair usually recover and the hair re-grows.
76
easily inserted amidst thinning hair to improve density
and they reduce the effect of shock, which causes hair
in the transplanted area to temporarily fall out after the
procedure.
Then the skin with the hair follicles was removed and cut into
smaller hair grafts.
In the first operation 586 grafts from AA were transplanted
in FA and in the second operation 594 grafts from FA were
transplanted in AA. The transplants were performed on the
temples of both subjects, giving us a clear observation of hair
growth. Also, the identification of hair growth was facilitated
because AA’s hair was black and FA’s hair was brown.
Postoperative hair growth was measured at 9 months and
at 14 months, and pictures were taken at different intervals
to monitor growth at various stages.
* Pictures of AA and FA
Results: Postoperative hair growth was measured at 9 months
and at 14 months. At 9 months, 45 of the 586 grafts on FA
were considered surviving grafts. The number of surviving
grafts was not determined on AA. At 14 months there were
no surviving grafts on FA.
* Chart of results
Conclusion: This study shows that allo-hair transplants do
not work in the traditional format. However, there is reason
to believe that the hair itself is not antigenic but the tissue
surrounding the hair follicle is the reason why the hair
was unable to survive. It will be necessary to introduce
modifications to the method of transplantation to change
the structure of the surrounding skin so it does not reject
allo-transplanted hair follicles. If the antigenic nature of the
skin can be limited, this may present a new approach to the
surgical treatment of hair loss.
harvesting the donor grafts follicular unit extraction
77
(FUE)
78
harvesting the donor grafts follicular unit extraction
(FUE)
Follicular units are extracted with the use
of
79
80
Donor area for Follicular Unit Extraction (FUE) one day
after surgery. Donor hair has been extracted one at atime.
3 weeks post-Follicular Unit Extraction (FUE) surgery
No scalpel, sutures or staples results
in a donor area with no scars.
81
82
The FUE technique does not require any stitches or
staples because there is no traumatic surgery involved
with the harvesting of the donor hair. This non-scalpel
technique also allows for a faster recovery because there
is
no major surgery involved as there is with the usual
These pictures were taken on the day after 395 grafts
were transplanted using the Follicular Unit Extraction
(FUE) technique. The small dots in the donor area
represent the follicular units that have been extracted
one-by-one and transplanted to the front of the patient’s
head.
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84
comparison of
FUSS and FUE methods
follicular unit strip surgery:
 Hair is harvested by extracting a strip
from the donor area.
 Requires scalpel surgery  Requires sutures or staples
 Minimal scarring in the donor area
comparison of
FUSS and FUE methods
follicular unit extraction:
 Individual follicular units are extracted
one-by-one.
 No major scalpel surgery involved
 No suture or stapling involved
 No scarring involved
85
86
comparing needles gauge for
FUSS and FUE
comparing
FUSS and FUE grafts
87
88
comparing density for
FUSS and FUE
50 to 60 grafts per square centimeter using 18 - 20 gauge
needles in FUSS transplants.
70 to 80 grafts per square centimeter using 21 - 23 gauge
needles in FUE transplants, achieving greater density in the
hairline. than with the FUSS procedure.
comparing advantages and disadvantages for
89
FUSS and FUE
Follicular Unit
Strip Surgery
(classic method)
Follicular Unit
Extraction
Number
of grafts
This method allows
up to 3500 to 4000
grafts to be transplanted in one
session
Generally limited to
750 to 1500 grafts per
day, though sessions
can be repeated
over 2 to 3 days in a
row for more grafts,
up to 2500 to 3000
grafts
Surgical
compo-
Major surgical
component, large
excision and
bleeding. Staples
or sutures are
required for 1 to 2
weeks to close the
opening, meaning
surgical risks
Minor surgical component with no major
excision. Skin closes
very quickly requiring
no staples or sutures,
meaning minimal
surgical risks
Who
is best
suited
Medium to large
baldness
Those who do not
wish to have any
scarring at all
Average
$5 to $8 USD/graft
$10 to $25 USD/graft
90
Goals of hair transplant surgery
Natural appearance
The artistry of hair transplantation begins with the proper
design of the frontal hairline. It is vital that the hairline be designed to suit the patient’s face so that the transplant appears
natural and goes undetected to the casual observer.
The hairline must be carefully placed in relation to the
rest of the face to ensure this natural appearance. Leonardo
Da Vinci’s formula for the face produces the best results for
this purpose. The formula is as follows: The distance from the
eyebrows to the hairline is half the distance from the eyebrows
to the bottom of the chin. By following this formula, each hair
transplant should be unique and suited to the patient. This
may be age-adjusted so that younger patients have lower
hairlines and older patients have slightly higher ones.
A combination of follicular unit micro-grafting is the only
way to perform the precise manipulations needed to produce this natural-looking hairline. An irregular pattern of hair
distribution is created with a combination of one-, two- and
three-haired follicular units for a natural look. A soft frontal
zone is made with single-haired follicular units and then the
transition to high density is made with the placement of twoand three-haired follicular units farther back.
The crown and temples are other areas that must be
properly designed. If transplantation is needed in the crown
area, the hairs should follow the natural swirling pattern characteristic of this particular region. Also, the way the hairline
meets the temples requires correct angling and blending
into the rest of the hair behind the ears.
hairlines
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92
In the following cases you will see pictures of younger patients.
The restored hairlines are lower and the temple angles are closed
in order to give the patients their youthful look back.
Before After
In the following cases you will see pictures of the restored
hairlines of middle-aged men. The hairlines are generally
higher and the temple angles remain open to better reflect the
age of the patients.
Before After
93
94
Before After
One way of restoring a natural hairline is by closing the
temple angles as demonstrated in the diagram above.
Exposed temple angles indicate a receding hairline.
95
96
Maximum density
It is important that your hair transplant provide enough
density to cover the balding areas of your scalp. This should
be discussed in the initial consultation with your doctor as
your financial investment in your surgery is dependant on
this. The hair transplant surgeon can, and should, outline
the density you should be able to achieve with a certain
number of grafts.
The average person, before the onset of balding occurs,
has 100 to 200 follicular units per square centimeter of the
scalp. For a hair transplant, a density of 50 to 80 follicular
units per square centimeter is optimal and is possible for an
experienced surgeon in a single session. Future sessions can
build on this density.
Follicular unit extraction (FUE) has contributed
significantly to the achievement of greater density. By
extracting the follicular units one by one using the FUE
technique the grafts are thin enough to pack them in closer
together and thus achieve maximum density.
density per square centimeter
Normally, a person would have 100 to 150 grafts per
square centimeter. Today, a maximum density of
70 to 80 grafts per square centimeter can be achieved
with follicular unit transplantation.
natural density
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98
distribution of density
Regions of the scalp:
1, 2
60 - 70 grafts per cm square centimeter (high density)
3
70 - 80 grafts per cm square centimeter (maximum density)
4
50 grafts per cm square centimeter (medium density)
5
30 - 40 grafts per cm square centimeter (light density)
The following pictures demonstrate density
in transplanted patients
before
Immediately after grafting
99
100
After transplant: 70 to 80 grafts per square cm
before
101
102
after
before
after
103
104
before
after
before
after
105
106
after
after
107
Mega-sessions
With new advances in hair transplantation, megasessions are more common. These sessions allow for large
amounts of grafts to be transplanted in a single procedure.
World record: Largest session done over two days
Currently, the world record for the most amount of
grafts completed in one session over two consecutive days
is:
6, 298 grafts
Before After
108
World record: Largest session done over two days
Before and after pictures of the patient can be seen
in the previous two pictures. This patient wanted the whole
head covered at once from the front hairline to the crown.
The whole procedure turned out to be the largest session
ever done over two consecutive days.
The results (also shown below) were exceptional
considering the high degree of difficulty associated with a
hair transplant session of this size. The patient was extremely
pleased with regaining his youthful look and achieving
excellent density. The growth in this patient was excellent,
with over 95 per cent of the follicular units transplanted
surviving.
Age:
33
Profession:
Import/Export
One Session: 6298 grafts
Before After
World record: Largest session done in one day
Age:
41
Profession:
Upholstery
One Session: 4624 grafts
Before After
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Permanence
Transplanted hair is permanent. It is taken from the
back and sides of the scalp where the hair is genetically
programmed not to fall out. When it is transplanted to the
front and top of the scalp it maintains its original genetic
make-up to not fall out.
That being said, hair loss is usually progressive. Future
hair loss must be anticipated by you and your surgeon. You
can minimize this progression by planning your surgeries
carefully at the opportune times. Although the transplanted
hair is permanent, you may lose your non-transplanted hair
with time and age. The best solution is to replace any hair
that you may lose with permanent hair from the back and
sides of the scalp.
Risks associated with hair transplants
Hair transplantation is a relatively minor surgical
operation and is generally safe. Nevertheless, there are some
notable risks that are associated with hair transplanting that
may complicate the success of the operation. These risks
include:
Infection
With every surgical incision to the skin there is always
the risk of infection. An antibiotic is usually sufficient to fight
off the threat of an infection and its spread.
Swelling on the forehead
Swelling usually occurs in the forehead after hair
transplantation. Sometimes the swelling can spread to other
parts of the head but it usually resolves itself in less than a
week after the procedure and does not affect the patient’s
health in any way.
111
Bleeding and scab formation
In both the donor and the transplanted areas of the
scalp bleeding and scab formation may occur after the
procedure. This should clear up in two to three weeks.
Scarring in the donor areas
With the FUSS method of transplantation, minor
scarring will occur in the area(s) where the donor tissue was
removed. This is not a concern with the FUE method.
Numbness in the scalp
Sometimes there is a loss of sensation in the scalp as a
result of nerve damage. If this occurs it is usually temporary
but may last longer in rare cases.
Headaches, pain or tingling sensations
The shock of hair transplantation sometimes leads to
sensations and pain that are often temporary. In some cases,
however, this may last longer.
Dizziness or fainting
These side effects sometimes occur in patients with
high levels of anxiety. This is temporary and subsides with
increased fluid intake and rest.
Uneven graft setting
Sometimes grafts heal in such a way as to be uneven
with the surrounding skin.
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Poor growth of hair follicles
Grafts may also grow poorly. This may happen all
over the transplanted area or in a small area. There are
many possible reasons for poor growth and it often occurs
unpredictably.
A full list of possible risks and complications can be
found in the appendix under the consent form.
Repair cases
Repair work requires far more experience on the part
of the surgeon and is an endeavor that combines surgical
and aesthetic skills to meet the patient’s expectations.
A case that would qualify for repair work includes a
transplant that included or resulted in any of the following:
Grafts that were too large, an improperly designed
hairline, hair transplanted in the wrong direction, significant
scarring in the transplanted area, difficulty dissecting under
magnification, a large amount of tension, poor growth, donor
wastage or donor area scarring.
With the use of follicular units, most errors from initial
transplants can be fixed. In cases where the hair was placed
awkwardly or angled incorrectly, the surgeon can coordinate
a surgical plan to ‘remodel’ the design of the hair. Hairs may
be moved, or removed, to optimize the outcome of the repair
work in terms of the overall appearance. Setting goals with
the patient before the repair work is performed will also help
to ensure satisfaction and the most natural results possible.
The following two cases are of patients who have had
surgical treatment in order to repair previous procedures.
Surgical repair case 1
Before
After
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114
Case Summary
· Pictures were taken 5 months post surgery
· Young Afghan Canadian
· Scalp burnt with oil in childhood
· Plugs transplanted by another surgeon
· Diffuse scarring secondary to burn and secondary fibrosis
· Fibrosis and scarring also due to plugs
· Tremendous scarring covered with follicular units
· Advised smaller surgeries for repairing area to maximize blood supply
· Very good results
· Next surgery planned for two months later
Age:
19
Profession: Machine operator
One Session: 1, 281 grafts
Before After
Case Summary
· Plugs repaired on sides and temples where there was considerable scarring and fibrosis.
· Covered nicely with follicular unit micrografts.
Age:
Profession:
One Session:
30
Pharmacist
2, 490 grafts
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Practical details of hair transplant surgery
The following section will go into some depth detailing
the practical stages involved in the hair transplantation
process.
Finding a good hair transplant surgeon
The first stage of the hair transplantation process
involves finding a good hair transplant surgeon. Surgical
treatment of your hair loss requires you to put a lot of trust
in the hands of the doctor you choose to perform your
transplant. The advice of an experienced, skilled and honest
doctor is invaluable in dealing with your hair loss and the
various options.
The best method of finding a good surgeon is often
the Internet. This provides patients from all over the world
a variety of choices from their home computers. Most hair
transplant centers have their own websites and you can
research their services from the comfort of your home. The
website is also often a reflection of the surgeon’s office and
can offer insight into the philosophy of the clinic.
Other methods of finding a good surgeon are through
newspapers, television, magazines, radio, your local phone
directory, hair salons and spas, doctor’s offices and billboards.
When looking at these ads, beware of negative ads that
attack other hair transplant centers. True professionals will
not resort to attacking other hair transplant surgeons.
Finding a good doctor takes some effort. Here are
some rules to follow that should help you find a good doctor
to work with.
Check his/her credentials: Check to see that the medical
professional is fully qualified from a reputable university.
Check with your local licensing board to make certain that
he or she is fully licensed.
Get a list of doctors from a neutral source: Do not rely on
117
the advice of someone who is promoting a service for-gain
regarding the reputation of a particular surgeon. There are
many websites that look impartial, but are actually paid
to advertise and promote particular surgeons and hair
transplant centers. Patients should ask the site owners if
they are financially compensated by the surgeons on their
recommended lists.
Get a second opinion on any treatment plan suggested:
Even if you have already selected a surgeon to go to, get at
least one more opinion from another medical professional.
There is no harm is looking for confirmation of what you have
been told.
Questions to ask yourself when looking for a doctor:
1. Is the surgeon up-to-date in the latest surgical techniques,
including follicular unit strip surgery and follicular unit
extraction?
2. Has the surgeon performed a variety of hair transplant
cases?
3. Is the surgeon interested in individualizing each transplant
according to age, ethnicity and individual facial features,
as opposed to doing the same transplant pattern on all their
patients?
4. Is the surgeon artistically competent?
5. Has the surgeon performed transplants of higher degrees
of difficulty, as well as repair cases?
These rules may make selecting a doctor a more
difficult process, but if you follow them you should be
protected from the many abuses that take place all the time
in the hair restoration business.
The consultation
In looking for a hair transplantation specialist, the
potential patient will have to go to an initial consultation. At
this stage there are several things to look for:
118
The clinic: Look at the clinic when you are visiting your surgeon
for the consultation. Is it clean? Is it organized?
Discussing your history: Is your history taken in detail, either
through written forms or discussed verbally? Is the staff
concerned with your overall health and the impact of
surgery on other medical conditions? Is the surgeon giving
you enough time to give your point of view on your hair loss
history?
Expectations: This is one of the most important things to clarify
before you book any surgery. Are you and your surgeon
clear on what you are expecting from surgery? Can he or
she meet your expectations? You should both understand
what can realistically be expected from your surgery.
The number of grafts: The number of grafts you will need is
the most difficult decision to make in the hair transplantation
process. This should be a joint decision between the patient
and the surgeon and should be discussed in some depth
during the consultation.
You will need to take into consideration: How much
coverage you want; the cost of the procedure; and how
many sessions you are willing to have performed. Your
surgeon should be able to provide you with the following
information: The anticipated coverage and density
associated with the number of grafts; the length of time that
will be involved; the services provided by his or her clinic
during longer procedures; the level of required sedation; and
his or her recommendations.
You may decide to get anywhere from 500 to 4000
grafts in one session or in multiple sessions. To provide a better
picture of what is entailed in selecting the number of grafts,
see the following chart that summarizes all the information
you need to make this decision: The coverage that can be
anticipated based on various amounts of grafts; the length
of the donor strip needed in the case of the FUSS procedure;
and the expected costs from various centers. This chart
summarizes grafts that deal with one-, two- and three-haired
follicular units. Some surgeons use larger grafts and their fee
119
Summary of number of grafts
FUSS
strip size
(cm)
FUSS
fee
range
(USD)
FUE
fee
range
(USD)
Number
of grafts
Coverage
1, 000
Small coverage
- Front hair line OR
- Crown OR
- Temples
10 x 1
4, 000 8, 000
6, 000 17, 000
1, 500
Medium coverage
- 1/4 top bald OR
- Front hair line OR
- Crown OR
- Temples OR
15 x 1
6, 000 12, 000
9, 000 25, 500
2, 000
Med-Large coverage
- 1/2 top bald OR
- Front 1/2 OR
- Back 1/2
20 x 1
8, 000 16, 000
12, 000 34, 000
2, 500
Large coverage
- 1/2-3/4 top bald OR
- Front 1/2-3/4 OR
- Back 1/2-3/4
25 x 1
10, 00020, 000
15, 500 42, 500
3, 000
Large coverage
- 3/4 top bald OR
- Front 3/4 OR
- Back 3/4
30 x 1
12, 000 - 18, 000 24, 000
51, 000
4, 000
Large coverage
- 3/4 top bald OR
- Front 3/4 OR
- Back 3/4
2 strips
10 x 1
30 x 1
16, 000 - 24, 000 68, 000
68, 000
120
schedules vary.
The procedure: As a patient, you have a right to have the
surgeon go over the entire procedure in detail, step by
step.
Risks and complications: Ask the surgeon about any possible
risks and complications associated with surgery. This should
first be given verbally during the consultation. It should also
be given in writing later on before any surgery. You should
review these with the surgeon beforehand.
Pressure-sales tactics: Be wary of pressure-sales tactics being
used on you. Do not allow yourself to be pressured into signing
any surgery agreement too soon.
Before the surgery
Most good hair transplant centers will bring you in for
a preoperative assessment. This may include the signing of
consent forms, preoperative instructions and payment.
The consent form: The consent form should outline in easily
understandable terms any complications that may occur.
You should discuss these with your surgeon. See Appendix
A for a sample of a typical consent form.
Preoperative instructions: These instructions should be as
detailed as possible. A detailed information package that
lists all instructions should be provided. Review the package
and ask any questions you may have. See Appendix B for a
sample of a typical preoperative instruction package.
The most important of these instructions to take note of
are:
Things to be avoided: Various medications and drugs will
need to be avoided for two to three weeks prior to surgery.
These would include alcohol, vitamins, ASA containing
medications, marijuana and any other illicit drugs.
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Clearance of medical drugs: Patients taking any medical
drugs will need to have these cleared by the surgeon to make
sure it is okay to use them during the hair transplantation
process.
Day of the surgery
On the day of the surgery several precautions would
need to be followed. It is advised that patients do the
following:
1. Go to bed early the night before the procedure. Surgery
will test your patience and you will need to be well-rested.
2. Have a good meal. For a morning surgery you should have
a good breakfast. For an afternoon surgery you should have
a good lunch.
3. Bring extra clothing. Your clothing may get wet or soiled
during surgery. Also, wear comfortable shoes and loose
pants.
4. Bring CDs or videos. Many hair transplant centers provide
their patients with a choice of listening or viewing material.
If you prefer your own material, bring it with you.
5. Be on time for the surgery. It is a good idea to be there 15
minutes early so that you can relax beforehand. Allow for
traffic delays.
6. Arrange for your drive home. You will be medicated after
surgery and unable to drive yourself home. Arrange to have
someone drive you home or spend the night at a hotel near
the surgeon’s office.
7. Keep the surgeon’s phone number handy. After you leave
the surgeon’s office make you are able to reach him or her
in case of an emergency.
Each hair transplanting technique involves different
steps. The following is a step-by-step outline of the follicular
unit strip surgery and follicular unit extraction methods.
122
Follicular unit strip surgery (FUSS):
- Preoperative medications are given. They may include
antibiotics and/or sedatives (usually Valium or Midazolam).
- The patient is seated on the operating room table.
- The donor strip to be removed will be shaved.
- The patient will be asked to lay face down on the table on
a special pillow with the center removed. This will stabilize
the head for strip harvesting. Other surgeons may have the
patient sitting up in something like a dentist’s chair.
- Anesthetic solutions are injected into the donor strip area.
These include: Xylocaine 2% or Morcaine (for freezing),
adrenaline (to decrease bleeding), sodium bicarb (to
decrease stinging) and normal saline (to puff up the area
and move the hair follicles away from the scalp to facilitate
cutting).
- The donor area is surgically cut with a single blade in an
elliptical pattern or with a multi-bladed knife. Because of
the freezing in the area you should not feel any of this cutting
at all.
- The donor strip is removed from the scalp area. Any
bleeding is controlled by electric cauterization.
- The area is sutured up or staples are inserted.
- The area where the strip was removed is bandaged.
- The strips are taken away to be cut in to grafts.
- The recipient area is prepared for transplantation either
by having anesthetic solutions injected into it or by having
a nerve block performed, based on the preference of the
surgeon.
- The recipient area is cleaned and the incisions are made
with very fine needles where the grafts should go.
- The grafts are then inserted into these incisions.
How you will feel: You will feel little to no pain during
the procedure. Only the initial freezing will be felt. Most
patients find it better than going to the dentist.
Follicular unit extraction (FUE):
123
- Preoperative medications are given. They may include
antibiotics and/or sedatives (usually Valium or Midazolam).
- The patient is seated on the operating room table.
- The donor area will be shaved.
- The patient will be asked to lie down on one side or to sit
up in something similar to a dentist’s chair.
- Anesthetic solutions are injected into the donor strip area.
These include: Xylocaine 2% or Morcaine (for freezing),
adrenaline (to decrease bleeding), sodium bicarb (to
decrease stinging) and normal saline (to puff up the area
and move the hair follicles away from the scalp to facilitate
cutting).
- The donor follicular units are harvested one at a time. You
should not feel anything due to the freezing.
- The extracted follicles are put in saline.
- The recipient area is prepared for transplantation either
by having anesthetic solutions injected into it or by having
a nerve block performed, based on the preference of the
surgeon.
- The recipient area is cleaned and the incisions are made
with very fine needles where the grafts should go.
- The grafts are then inserted into these incisions.
How you will feel: You will feel little to no pain during
the procedure. Only the initial freezing will be felt. Most
patients find it better than going to the dentist.
Immediately after the surgery
There are several things to know about the postsurgery phase of hair transplantation for both the FUSS and
FUE procedures.
Bandaging: The degree of bandaging will depend on the
preference of the surgeon. Some surgeons prefer bandaging
the whole head, some prefer bandaging just the donor
area and some prefer no bandaging at all. All of these are
124
acceptable.
Rest: After returning home the patient should have a good
meal, get plenty of rest and sleep with the head at a 45
degree angle.
Things to be on alert for:
- Bleeding: Any sign of bleeding, either from the suture line or
from the transplanted area, should be reported immediately
to your surgeon or to an emergency room. Sometimes sutures
can become loose and excessive bleeding may result. This
should be attended to immediately. This is less likely to occur
with the FUE procedure because there is no suturing involved
and because the extraction points in the recipient area are
very small and tend to close up quickly.
- Swelling: Some temporary swelling is natural for both
procedures and is to be expected.
- Fever: The presence of a fever after surgery usually indicates
an infection. Surgeons often prescribe antibiotics to be
taken after surgery as a precaution against infection. The
persistence of an infection should be reported immediately
to your surgeon or to an emergency room. Again, this is
less likely with the FUE procedure because there is no major
surgical incision.
- Headache or pain: The presence of headaches or pain is
fairly common after surgery. The surgeon and the patient
should anticipate this. Such pain is usually found in the area
of the suture. The absence of sutures in the FUE procedure
will eliminate some of the possibilities of headaches. Most
patients who have undergone a FUE procedure report no
headaches or pain.
- Nausea and vomiting: Sometimes a patient may experience
nausea or vomiting. This is usually related to the injection of
anesthetics or to the ingestion of sedatives or pain-relieving
medications. An anti-nausea medication can be used to
combat this and should be prescribed by your surgeon as
a precaution.
125
Later post-surgery
After the surgery, the waiting period for the results
begins. The following indicates what can be expected during
this stage:
The day after: Most hair transplant centers look at the suture
line the day after the surgery. FUE patients are also examined
the next day. The patient should lightly wash his or her head
for the first one or two weeks after surgery without touching
the transplanted area. It is also very important that the
patient avoid itching or scratching this area.
During the first two weeks: Sutures or staples come out 10 to
15 days after the FUSS procedure. Swelling may occur on
the forehead and around the eyes because of the freezing
solution moving down from the scalp. Scabs will form over
the transplanted area. This area should be dabbed gently
using vitamin E oil to dampen the scabs. Any heavy exercise
or strenuous activity should be avoided for three to four weeks
post-surgery.
During the first month: Most of the transplanted hair will fall out
in the first month after the roots take hold due to the shock
of transplantation. The result will be that the patient will look
like he or she did before the surgery. While this may be a
time of much worrying, the roots will grow new hair. The loss
of hair may be less with the FUE procedure.
During the first six months: The first growth of hair usually
starts to appear sometime in the second or third month after
surgery. By the six month mark there is growth of about 50 to
60 per cent of the transplanted follicles. Patients at this stage
are fairly happy and can see an appreciable difference. A
second session can be held at this time to increase density
in the transplanted area. Hair growth will continue for the
next six months.
During the first year: It takes up to a full year to see the
126
Patient and surgeon checklist
Patient
Surgeon
1. Have realistic expectations
2. Understand the cost, time and tolerability of a transplant session or sessions
3. Follow preoperative instructions
4. Understand the full surgical process
5. Follow postoperative instructions
1. Anticipate and understand the patient’s expectations
2. Discuss the procedure in detail, including all possible risks and complications
3. Provide informed consent and preoperative instructions
4. Provide all necessary comforts for longer sessions
5. Be available during the postoperative period
case studies
The case studies shown on the following pages involve
transplantation using follicular unit transplantation methods.
Case study 1
Before After
127
128
Case study 1
•
•
•
•
•
•
•
case summary
Pictures are one year post surgery
Younger patient with thick black hair and olive skin
Spanish background, American
Needed higher density
Hairline already lower.
Focused on completing the hairline and mid section
Grafts placed artistically to give an overall impression
of far greater number of grafts and maximum density.
Age: Profession:
One Session:
32
Business Manager
2, 527 grafts
Case study 2
Before After
case summary
· Pictures 6 months post surgery.
· Young Canadian of British descent.
· Curly hair, light skin.
· Lower hairline, temples closed.
· Very high density in the front hairline.
· On preventative medication for future hair loss.
129
130
Case study 2
Before After
Age:
24
Profession:
Marketing
One Session:
1, 990 grafts
Case study 2: close up the hairline
131
132
Case study 3
Before After
case summary
· Pictures are 9 months post surgery
· Younger patient
· French background, blond thin hair, Canadian with light skin
· New lower hairline.
· Temple angles closed
· Hair distribution crucial to cover front 1/2 scalp in a natural dense look.
Case study 3
Before Age:
Profession:
One Session:
36
Construction
2, 383 grafts
After
133
134
Case study 4
Before After
case summary
· Pictures are from one year post surgery.
· Middle-aged American.
· Medium brown hair, light skin.
· Wide area coverage.
· Higher hairline suitable for his age.
· Temple angles slightly closed.
· Very good density over a large area.
Case study 4
Before Age:
Profession:
One Session:
53
Analyst
3, 052
After
135
136
Case study 5
Before After
Case study 5: close up of hairline
case summary
· Pictures from one year post surgery.
· Canadian with an Iranian background
· Dark thick hair, olive skin.
· Wanted very high density.
· Achieved a very normal looking, super dense hairline and midscalp
Age:
Profession:
Two Sessions:
Total:
37
Restaurant Business
27, 732, 258 grafts
5, 031
137
138
Case study 6
Before After
case summary
· Young Canadian of Polish descent.
· Needed a lower hairline and temple angles closed.
· Needed to look his age or younger.
· On preventative therapy for future hair loss.
Case study 6
Before After
Age:
26
Profession: Business administrator
One session: 2, 041
139
140
Case study 7
Before After
case summary
· Canadian - British descent.
· Brown hair, light skin.
· Dense front hairline.
· Temples closed.
· Overall, artistically done hairline and high density gives the patient a more youthful look.
Age:
50
Profession:
Oral Surgeon
Two Sessions: 25, 102, 209
Total grafts
4, 719
141
142
Case study 8
Before •
•
•
•
•
•
After
case summary
Pictures from 6 months post surgery.
Young patient, Italian/ Canadian.
Thick black hair, olive Skin
Hairline restored to original position
Temple angles closed
Creates a more youthful appearance suitable for his age and for the future
• Taking prophylactic medications to prevent future
hair loss.
Case study 8
Before Age:
Profession:
One session:
After
24
Mechanic
1, 852 grafts
143
144
Case study 9
Before Age:
Profession:
One Session:
29
Student
1, 171
After
case summary
· Young African patient.
· Curly, thick, black hair.
· Dark brown skin.
· Front hairline restored with good density.
· Temple angles closed
145
146
Case study 10
Before After
Case study 10
case summary
· Young American of British descent.
· Dark medium thick hair.
· Light skin.
· Wanted lower hairline and temple angles closed.
· Achieved very high density and a very natural looking
hairline.
Age:
35
Profession:
Driver
Total grafts
3, 289
147
148
Case study 11
Before After
Case study 11
case summary
• Pictures one year post surgery.
• Middle Eastern background, Canadian.
• Dark curly hair.
• Medium brown skin.
• Lower hairline and temple angles closed.
• High density look overall.
Age:
Profession:
Two Sessions:
Total grafts:
33
Security
20, 071, 474
3, 481
149
150
Case study 12
Before After
Case study 12
case summary
· Pictures one year post surgery.
· Young Canadian of Irish descent.
· New hairline lower with temples closed to create a more
youthful look for his age
· On preventative medication for future hair loss
Age:
26
Profession
Student
One Session: 1, 587
151
152
Case study 13
Before After
Case study 13
case summary
· Middle aged, Italian Canadian.
· Curly silver pepper hair.
· Olive skin.
· Medium density front hairline.
· Low density back.
· Overall, one session covered very large area very well.
Age:
Profession:
One Session:
46
Construction
3, 170
153
154
Case study 14
Before After
case summary
· Picture one year post surgery.
· Canadian of British descent.
· Thin brown hair.
· Light skin.
· Mid-scalp hair loss.
· Goal to increase density.
· Typical female transplant.
Case study 14
Before After
Age: 43
Profession: Business owner
One session: 2, 000
155
156
Case study 15
Before After
Case study 15
case summary
· Canadian of British descent.
· Thin blond hair.
· Light skin.
· Goal was to repair the hairline and close the temple angles.
Age:
Profession:
One Session:
40
Multimedia developer
2, 217
157
158
Case study 16
Before After
Case study 16
Before After
case summary
Age:
52
Profession: Businessman
One Session:3, 533
159
160
Case study 17
Before After
· Pictures one year later.
· Dark thick hair, brown skin.
· New lower hairline and temples closed.
Age:
26
Profession:
Plastic Factory
Total grafts: 4, 071
161
162
Case study 18
Before After
Case study 18
case summary
· Dark hair, brown skin.
· Largest session ever done in one day.
· Front to back, full scalp surgery.
· Front hairline: moderate to high density.
· Remaining area: fair to moderate density.
· Overall: good result in wide area coverage in one
session
Age:
One Session:
41
4, 624
163
164
Case study 19
Before After
case summary
· Indian American.
· Dark hair, olive skin.
· Middle area of head was bald.
· High density was achieved with repair of the hairline
Case study 19
Before Age:
Profession:
One Session:
After
47
Engineer
1, 603
165
166
Case study 20
Before After
case summary
· European background - Canadian.
· Brown thin hair, light skin.
· Had a transplant prior to this surgery, as seen in the before
pictures - with almost no results.
· High density session seen in the after pictures with a lower hairline and temple angles closed.
· Overall, a much more youthful look.
Case study 20
Before Age:
Profession:
One Session:
After
35
Neurosurgeon
2, 793
167
168
Case study 21
Before After
case summary
· Young Iranian Canadian.
· Dark thin hair, olive skin.
· Lower hairline, temples closed
· Density will increase over the next 7 months.
Case study 21
Before Age:
Profession:
One Session:
After
22
Sales Manager
2, 094
169
170
Case study 22
Before After
case summary
Age:
Profession:
Two Sessions:
Total Grafts: 47
Showroom Manager
23, 031, 922
4, 225
171
172
Case study 23
Before After
case summary
· European - Canadian background.
· Brown thin hair, light skin.
· Class 7 baldness on the hair loss scale
· Natural, high hairline with temple angles left open.
· Medium density.
Case study 23
Before After
Age:
54
173
174
Case study 24
Before After
case summary
· European Canadian.
· Blond hair, light skin.
· Front half of head covered.
· Low hairline, temple angles closed.
· Excellent results with a more youthful look for the patient.
Case study 24
Before Age:
Profession:
One Session:
After
26
Network Administrator
1, 718 grafts
175
176
Case study 25
Before After
case summary
Age:
Profession:
One Session:
44
Construction
1, 098 grafts
Case study 25
Before After
177
178
Case study 26
Before After
case summary
· Pictures one year after surgery.
· Young American of British descent.
· Brown thin hair.
· Light skin.
· New lower hairline.
· Temples closed.
· More youthful look.
Case study 26
Before Age: 28
Profession: Airline Pilot
After
179
180
Case study 27
Before After
case summary
Age:
29
Profession:
Warehousing
Two Sessions: 1, 707 and 1, 310
Case study 27
Before After
181
182
Case study 28
Before After
case summary
· Italian Canadian.
· Dark curly hair.
· Crown area with large density.
· On preventative medications for future hair loss.
Age:
Profession:
One Session:
46
Restaurant Owner
3, 032 grafts
183
The future of surgical treatment
The future of hair transplantation is developing fast.
Three revolutionary new techniques are emerging that show
great promise: Cloning, gene therapy and donor hair.
Cloning
There are currently two methods of cloning being
developed by researchers. The first is called ‘in-vivo
cloning’. It involves cutting the hair follicle at different levels
to produce more than one follicle. Dr. Kim from Korea has
made significant contributions in this method. He has found
that by cutting the follicle midway at the stem cell level,
two follicles can be reproduced from one, though they are
thinner in diameter than the normal hair follicle. The cutting
must be made precisely at a very specific level to produce
very specific stem cells.
The other cloning method being researched is called
‘in-vitro cloning’. In this method, the stem cells from the
hair follicle are taken and grown in a Petri dish. In this way
new duplicate cells are cloned. Later, these new cells can
be inserted back into the scalp instead of follicles with hair.
It is believed that hair may be able to grow from the cells
themselves. There are five or six centers in the world trying
to perfect this technique, which would mean that even the
man or woman with very few hairs could have thousands of
cells replicated in a Petri dish.
Gene therapy
Another method to restore lost hair that is likely to
emerge in the near future is gene therapy. Gene therapy
promises the potential to grow new hair follicles, as opposed
to just stimulating dormant follicles to grow hair again. Several
researchers around the world have begun work on gene
therapy to restore hair in lab mice and have displayed some
degree of success.
184
The idea behind gene therapy is to correct an
inherited condition that prevents hair growth by introducing
a DNA sequence (a genetic chemical) into the balding
scalp. The introduced DNA sequence itself does not correct
the problem causing baldness, but it creates a sequence of
chemical transactions that enter into the patient’s cells. This
makes the cells start producing the proteins necessary to give
the skin the ability to produce new hair follicle cells.
Several researchers have been looking at gene
therapy for some time now. One of the leaders in this field is
Dr. Elaine Fuchs at the University of Chicago. She has been
able to successfully convert normal skin cells into hair follicle
cells using gene therapy on mice. These mice have displayed
impressive new hair growth in balding areas. But the existence
of side effects that include the growth of tumor cells may
endanger the future of gene therapy as a treatment method
of hair loss. Dr. Fuchs, however, is confident that these side
effects can be eliminated with further development of gene
therapy methods.
Donor hair research
This research is the first of its kind. I initially presented it
at the International Society of Hair Restoration Surgery (ISHRS)
meeting in Puerto Vallarta, Mexico in 2001. This article was
then published in 2002 in Hair Forum by the ISHRS.
Study: Hair transplant in incompatible hosts
Introduction: Auto-transplantation of hair normally
provides satisfactory correction of baldness. Autotransplantation refers to a normal hair transplant
where the redistribution of hair follicles occurs within
in the same individual, from one area of the body to
another.
Allo-transplantation of hair is the transplantation
of hair from one individual to another individual. This
has never been attempted because hair is considered
185
strongly antigenic, meaning that if it were transferred
from one person to another, the recipient’s body
would be likely to reject the new hair.
However, in 1999 it was reported for the
first time by Jahoda et al. that human hair follicles
could be induced to grow in an incompatible host
of the opposite sex. With these recent advances in
follicle cell transplants in incompatible hosts it was
considered necessary to evaluate an allogenic hair
transplant. A study was conducted where the goal
was to determine whether an allotransplant can
be successful or not. If unsuccessful, then the goal
would be to determine why it had failed and how to
overcome the obstacles.
Objective: An allo-transplant in two unrelated
individuals was performed. The growth of the hair in
the incompatible hosts was observed over a period
of 14 months.
Materials and/or methods: To test this hypothesis,
two different male donors were selected: AA and
FA. Hair follicles from AA were taken and successfully
transplanted in FA. In another similar operation, hair
follicles from FA were taken and transplanted in AA.
Each of the subjects was provided with
preoperative medications and an area of scalp
measuring 6cm by 1cm was shaved and anesthetized.
Then the skin with the hair follicles was removed and
cut into smaller hair grafts.
In the first operation 586 grafts from AA were
transplanted in FA and in the second operation
594 grafts from FA were transplanted in AA. The
transplants were performed on the temples of both
subjects, giving us a clear observation of hair growth.
Also, the identification of hair growth was facilitated
because AA’s hair was black and FA’s hair was
brown. Postoperative hair growth was measured at 9
186
Allo-transplant: Method for
transplant between incompatible
Two male
donors AA
& FA
Donor
Recipient
586
micrografts
obtained
from AA and
transplanted
on FA
594
micrografts
obtained
from FA and
transplanted
on AA
Transplanting was done on the temple areas for
better visibility. Also, AA has black hair and FA
has light brown hair, and that color difference
would facilitate identifications of hair growth.
Pre surgery
187
188
Pre surgery
Immediately after
surgery
189
190
Immediately after
surgery
4 months post surgery
191
192
months and at 14 months, and pictures were taken
at different intervals to monitor growth at various
stages.
Results: Postoperative hair growth was measured at 9
months and at 14 months. At 9 months, 45 of the 586
Subject
Number of
graft s
count ed
at 9
mont hs
Number
of graft s
count ed
at 14
mont hs
45
0
N/A
N/A
grafts on FA were considered surviving grafts. The number
of surviving grafts was not determined on AA. At 14
months there were no surviving grafts on FA.
Conclusion: This study shows that allo-hair transplants
do not work in the traditional format. However, there is
reason to believe that the hair itself is not antigenic but
the tissue surrounding the hair follicle is the reason why
the hair was unable to survive. It will be necessary to
introduce modifications to the method of transplantation
to change the structure of the surrounding skin so it does
chapter three:
alternative treatments
In the last few years great interest has been expressed
in various alternative medicines and how they can help treat
genetic hair loss. Some very specific remedies for hair loss
have been developed and this chapter will review the ones
currently available and the advantages and disadvantages
of these treatments.
The emergence of alternative medicines
Many doctors frown upon alternative medicines and
suggest that re-growing hair with alternative treatments is
not possible. But the fact is that millions of people in the
western world have been turning to alternative medicines
in the last few decades to deal with problems that doctors
and conventional medicine cannot help them with. A study
published in the New England Journal of Medicine reports that
about one third of Americans surveyed preferred alternative
medicines over conventional ones to deal with their health
needs.
Looking for a solution to hair loss in alternative
medicine is not necessarily the recommended choice but it
is an option that should not be denied to those who prefer it.
There are many who swear by the effectiveness of alternative
treatments to treat every health problem, including hair loss,
and you may have come across some individuals who claim
that it has worked for them.
192
ALTERNATIVE TREATMENTS FOR HAIR LOSS
This section on alternative treatments for hair loss is being
included here to allow you to have a full understanding of
all the options you have for fighting hair loss, but no strong
claims will be made for any of these alternative treatments.
You must use your own good sense when sifting through
these options.
How do alternative medicines work?
The term alternative medicine refers to various medical
systems practiced by trained professionals all over the world
that have roots in the traditional medicines of the ancient
world. Some of these medicines are continuations of ancient
medical traditions like acupuncture and traditional Chinese
and Indian herbal medicines. Others are newer medical
systems developed from the principles of ancient systems of
medicine like homeopathy, cell therapy and magnetic field
therapy.
All alternative medicines are based on a more holistic
understanding of the human being than understood by
conventional modern medicine. Conventional medicine
thinks of the human being as primarily a physical body, while
holistic medicine sees the human being as a trio of mind,
body and spirit. Conventional medicine looks for causes
to ailments on the physical level only. Holistic medicine,
however, looks deeper into all levels of the human being for
causes and this, according to its proponents, is its greatest
strength. All alternative medicines try to consider the whole
human being using a number of methods to cure inner
distortions that cause physical ailments.
How do alternative medicines treat hair loss?
Alternative medicines look for the inner psychological
and spiritual causes of hair loss. While hair loss and its causes
are different for each individual, similar patterns may exist.
The treatments that the various alternative medicines offer
194
ALTERNATIVE TREATMENTS FOR HAIR
for hair loss try to correct the inner imbalances that are
understood to be the underlying causes of hair loss.
Modern medical research has acknowledged an
astonishing phenomenon that suggests how alternative
medicine’s approach may work. This phenomenon is referred
to as the ‘placebo effect’. A placebo is a dummy drug that
has no actual medical effect but works because the patient
believes that it is helping them. The improvement in health
that results is called the placebo effect. Studies consistently
show that between 30 per cent and 40 per cent of people
will show improvement with all sorts of health problems as
long as they believe they are taking a medication that will
help. There has even been evidence of hair growth due to
the placebo effect in patients with hair loss.
The placebo effect suggests that it is possible to correct
health problems by mobilizing the emotional, psychological
and spiritual forces within each of us, and this is precisely what
alternative medicines try to do by using various outside keys
to trigger inward changes.
Common alternative treatments for hair loss
Saw palmetto
Saw palmetto is an herbal product that has shown
some evidence in being able to slow hair loss. It is made from
the extract of berries from a palm tree native to the South
Atlantic coast and is also often used to treat an enlarged
prostate. It works by inhibiting the activity of an enzyme
linked to the chemical processes responsible for genetic hair
loss, similar to the way finasteride, or Propecia, works.
Vitamin E
Vitamin E is an important vitamin known for its antiaging effect, which is due to its ability to act as an antioxidant.
It prevents oxidation of free radicals in the body, thus
protecting tissues against oxidation and generally helping
the upkeep of the skin and hair. The recommended daily
dosage of vitamin E is 10 mg per day for an adult. But for the
purposes of treating hair loss, 400 mg to 800 mg should ideally
be consumed on a daily basis though you should consult a
doctor to determine what the best amount is for you.
Common sources of vitamin E include: Wheat germ,
almonds, hazel nuts, sunflower seeds and oils. Possible
reactions to excessive amounts of vitamin E include: Nausea,
vomiting, dizziness, diarrhea, itchiness and fatigue.
Vitamin C
Vitamin C is also an excellent vitamin for good skin
and hair. Like vitamin E, it is an antioxidant and treats
hair loss in a similar fashion. It is not likely to stimulate new
growth, but it may help maintain existing hair. A dosage of
500 mg to 1000 mg taken orally on a daily basis is ideal to
maintain hair. It should be stressed that adequate hydration
is necessary to accompany the intake of vitamin C to avoid
the development of kidney stones.
Common sources of vitamin C include: Broccoli,
cantaloupes, cauliflower, citrus fruits, kale, mangoes,
peppers, potatoes, spinach, strawberries and tomatoes.
Possible reactions to excessive amounts of vitamin C include:
Diarrhea, abdominal cramps, sleep disturbance, nausea and
vomiting.
Multivitamins
It is argued that everyone should take a multivitamin
every day because we may become deficient in many
nutrients, regardless of our diet. As noted earlier in this book,
hair loss may result from poor overall nutrition or particular
dietary deficiencies. This is where a multivitamin can be a
valuable asset in fighting hair loss. But before you choose
a multivitamin, you should consider a few things first: 1)
your activity level, 2) your stress level and 3) any medical
conditions.
Not every multivitamin is perfect for everyone. For
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example, if you are active or have a stressful life, you will likely
need a higher dose multivitamin. If you have some contraindication to high dose multivitamins, you should take a lighter
one. This can be discussed with your healthcare and dietary
guide. A general rule is to try a time-release multivitamin
that slowly releases the vitamin ingredients over time. This
will improve the absorption of all the vitamins.
Other alternative treatments
Various other alternative medicines offer general
suggestions to promote hair growth. You can act on many
of these by yourself, but it is recommended that they
only be tried in consultation with a trained professional.
Experience suggests that those who have a strong belief in
alternative medicines tend to benefit from them, whereas
those who are skeptical do not. The faith you put into these
alternative self-help practices seems to play a key role in
their effectiveness. Otherwise, this book makes no claim for
them other than that they have worked from some people
in some circumstances.
Acupuncture
Acupuncture is an ancient Chinese system of medicine
that treats many ailments by attempting to restore the inner
imbalances that cause them. Acupuncture identifies an
elaborate system of points on the body called accupoints
that are connected to inner forces, which are manipulated
with needles and other devices to restore balance and cure
various ailments.
A trained acupuncturist will know which accupoints
to manipulate to stimulate hair growth. There have been
individuals who have claimed success in growing hair after
acupuncture treatment, but there are also others who have
felt that it was no benefit to them and a waste of money.
For information about acupuncture and how to
find an accredited acupuncturist in your area contact the
American Association of Oriental Medicine (www.aaom.org)
or the American Academy of Medical Acupuncture (www.
medicalaccupuncture.org).
Aromatherapy
Aromatherapy is a branch of herbal medicine that
uses the essential oils of various plants to produce medically
beneficial effects on the body. Herbal remedies may increase
circulation, disinfect the scalp and result in stimulated hair
growth. Aromatherapists recommend four essential oils
to deal with hair loss: Lavender, rosemary, thyme, bay,
cedarwood, grapefruit, jojoba oil, lemon, roman chamomile
and sage. The rubbing of these essential oils on the balding
parts of the head is prescribed as a possible way to fight hair
loss.
As a precaution, rosemary oil should not be used by
those with high blood pressure and lemon and grapefruit oils
are likely to irritate sensitive skin.
For more information on aromatherapy and how to find
essential oils and an aromatherapist in your area, you can
contact the National Association for Holistic Aromatherapy
(www.eskimo.com/~hhnews/naha).
Ayurvedic Medicine
Ayurvedic medicine is an ancient Indian herbal
medicine that has been around for almost 5000 years. Two
ayurvedic herbs are generally prescribed to stimulate hair
growth: Ashwagandha and Amla. These herbs are usually
taken in pill form or as rubbing oils for the scalp.
For more information about Ayurvedic medicine and
products dealing with hair loss and other health problems,
you can contact the National Institute of Ayurvedic Medicine
(NIAM) (www.niam.com).
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Homeopathy
Homeopathic medicine is an alternative medical
system developed in Germany that is now practiced all over
the world. It cures ailments by prescribing dilutions of natural
substances that trigger the body’s own natural healing
processes. The homeopathic medicines Sepia, Arnica and
Acidum nit are often prescribed to stimulate hair growth. They
come in liquid form and are generally taken with water.
For more information about homeopathic medicine
and for referrals to professionals in your area, contact the
National Center for Homeopathy (www.healthy.net).
Naturopathic medicine
Naturopathic medicine is a comprehensive medical
system that combines many of the traditional nature-based
medical systems of the world. It focuses on the entire human
being to identify the source of physical ailments and then
tries to utilize the body’s own ability to heal by focusing on
various natural treatments.
Since naturopathic medicine combines so many
different approaches it has several different remedies for hair
loss. Some of the easier ones to try include:
Diet: Various fresh raw juices are sometimes given to stimulate
hair growth, including one combination of carrots, beets,
spinach, nettle and alfalfa juices mixed with onion juice.
Herbal rubs: One herbal rub that is sometimes prescribed for
hair loss involves massaging the scalp with a combination of
one part rosemary oil and two parts almond oil on a nightly
basis.
For more information on these and other naturopathic
remedies for hair loss, contact the American Association of
Advantages
• Seems to work for •
•
•
•
some people who have faith in alternative medicines
Offers many different choices
You can try some remedies at home
Costs less than conventional treatments
Generally involve few risks and complications
Disadvantages
• Most alternative •
•
•
treatments have not undergone scientific studies to determine effectiveness over a simple placebo effect
Does not seem to work for those who do not have faith in alternative
medicines
Its low cost becomes irrelevant if it does not work
It can be dangerous if it is unwisely relied upon
Naturopathic Physicians (www.naturopathic.org).
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Advantages and disadvantages of alternative
treatment
This section on alternative medicines has been
included in the interest of providing you with all the possible
options for fighting hair loss. The following summarizes the
advantages and disadvantages that you should take into
account when considering alternative treatments for your hair
loss.
Final recommendations
You should try alternative medical treatments:
• If you don’t like conventional methods of treatment
• If you cannot afford other forms of treatment
• If you have faith in them
• Only in consultation with a professional trained in the particular
form of alternative treatment
chapter four:
hair replacement treatment
Hair replacement is the last major approach to dealing
with hair loss. The basic idea of hair replacement is to replace
your natural hair with various types of additives that make
your hair look natural and complete. For most balding people
it is a last resort, but because of improving techniques it has
become increasingly attractive even for those who have
other options. Over 500, 000 hair addition pieces are sold
every year in the United States alone.
There are two basic ways to replace your hair. The
first is to camouflage your hair loss by filling out or intensifying
your existing hair with various products and the second is to
cover your hair or add to it with some form of hair piece.
Camouflaging your hair loss
There are a number of products available to you for
camouflaging your hair loss. All of them assume that you
have some hair remaining and that you only want to make
this existing hair look more full and complete. If you only
have some thinning areas of baldness then camouflaging is
a realistic and affordable option. Many people have relied
on these simple methods and have been quite satisfied.
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HAIR REPLACEMENT TREATMENT
201
There are two ways of camouflaging your hair loss.
You can thicken your existing hair or you can apply substitute
hair in thinning areas.
Thickening your thinning hair
This is a common approach to thickening thin hair
where the goal is to create the illusion of thick hair by raising
the hair away from the scalp. The way hair thickening is
usually done is through rubbing various types of hair thickening
leave-in conditioners into the hair after shampooing and
towel-drying.
These conditioners apply a thin layer of some polymer
over the hair shaft. A polymer is a chemical combination that
sticks to the hair shaft leaving a plastic-like layer around it. The
polymer creates a smooth surface over the hair shaft, making
it thicker and simultaneously easier to manage. Common
thickening conditioners include those from oil-based Pomade
creams as liquid rub-ins containing glycerin-based products
or as oil sheen sprays. Other hair thickening products include
hair sprays, thickening gels and thickening mousses.
Camouflaging using canned hair
The second way to camouflage hair loss is to apply
colored substances that look like your natural hair to the
thinning portion of your scalp. There are many products that
accomplish this and they are often referred to as ‘canned
hair’ because they come in cans and are sprayed on the
scalp to fill in the gaps. A dermatologist can recommend a
product of this type that is most suitable for you.
Hair pieces
Hair pieces are any external hair-bearing devices
that are added to the scalp or to existing hair to give the
202
HAIR REPLACEMENT TREAT-
appearance of fuller looking hair. These include numerous
apparatuses and products available all over the world,
including the following:
• Wigs: Hair-bearing devices formed on a base material and
designed to cover your entire scalp. If you have no hair of
your own, this is your only option.
• Demi-wigs: Similar to wigs except that they do not cover
the frontal hairline.
• Toupees: Hair-bearing devices formed on a base material
and designed to meld with your existing hair.
• Extensions: Hair-bearing devices that attach on to your
existing hair to make it appear longer and fuller.
• Hair units: Hair-like clumps that fit into your existing hair to
make it appear fuller.
• Hair weaves: Synthetic or natural hair that is weaved,
braided or knotted into your existing hair to make it look
fuller.
Almost all of these devices are available ready-made
and are relatively inexpensive. However, for anyone serious
about replacing lost hair with a hair addition only a custommade device can appear natural and be maintained in a
safe and comfortable manner. Despite various shapes and
sizes, all of these hair addition devices share several basic
characteristics. To make a custom-made version of any of
these devices, you have to answer three basic questions to
know what type is best for you.
1. Do you prefer a natural or synthetic hair device?
2. If the device has a base material, what type of base do
you prefer?
3. How do you want the device attached to your head?
To answer these questions, you have to do a lot of
research and decide on your own preferences. A good
specialist will detail each option for you and help you make
a decision that is right for you. You can begin your research
here with a few brief outlines to help you answer the previous
questions.
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Natural or synthetic hair?
Every hair addition piece employs either your own
natural hair (if you have enough), purchased human hair,
synthetic hair or some combination of these. Although
it would seem obvious that natural hair is always better,
all things considered it is not so clear that this is the best
choice.
Because natural hair has to be purchased from willing
human sources it is relatively expensive and what is available
may not meet your needs. Due to availability, workability
and cost, most hair additions use Indian hair but if you have
a European background then such hair must be treated
and colored to fit your needs. This coloring fades somewhat
every few months and needs to be constantly re-colored.
However, human hair does tend to mix in better for those
who still have existing hair. It is also preferable to those with
an active lifestyle.
Aside from a slight disadvantage in appearance,
synthetic hair has many advantages over natural hair. Most
synthetic hair fibers are made of plastics from molds and
are consequently readily available. They are also relatively
inexpensive compared to human hair and easier to maintain
because they dry faster and their colors do not fade as
easily. For most people in the western world, synthetic hair
is the more logical choice unless you have a stigma about
wearing fake hair or you are allergic to synthetic materials.
What type of base?
If your hair addition requires a base, as in the case of
a wig or a hair piece, then the first question to answer is what
type of base should be used. There are two types of bases
that are common today: Mesh-like bases and solid bases.
Generally speaking, mesh-like bases are better ventilated
and are more comfortable, while solid bases allow for
vacuum fitting and fit directly on the scalp. They each also
have drawbacks that result from the method of attachment
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to the scalp. The decision between the two types of bases
should consider the strengths and disadvantages of each
type in consultation with your specialist.
What method of attachment to the head?
There are few things more embarrassing than a
hair piece coming off and revealing a balding head.
Various methods have been devised to firmly attach hair
replacements to the head to guard against this possibility but
there is currently no ideal mechanism of attachment. All the
existing methods of attachment have notable drawbacks
that need to be considered. At present there are only two
possible ways to attach hair pieces to the head: Directly on
the skin of the scalp or to some existing hair on the scalp.
Attaching a hair piece to the scalp is considerably
more difficult and fraught with complications than attaching
it to existing hair. For this reason, if a person has enough
existing hair left, attachment to this hair is usually preferred
over trying to attach it to the scalp. That being said, a single
person may benefit from a combination of these attachment
mechanisms. Depending on your specific needs you might
find it beneficial to alternate attachment mechanisms over
time.
Attaching to existing hair: When a person has some existing
hair then it is almost always preferable to attach a hair piece
to this hair in some manner. A hair piece can be attached
to the existing hair either in a temporary manner using clips
or in a semi-permanent manner using one of three common
methods: Bonding, sewing or weaving/braiding. These
methods offer the advantage of allowing hair pieces to
function like normal hair for a relatively long period of time.
They are also the most comfortable and the most natural
looking attachment methods. But since they are attached to
permanent hair they are subject to the changes that normal
hair growth causes. As a result, these attachments typically
last for two to six weeks before they need professional
readjustment.
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• Bonding: The most popular semi-permanent method of
attaching a hair piece to existing hair is bonding. In this
method the hair piece is attached by using a special glue
gun to attach a ¼ inch vinyl strip at each edge of the hair
piece to matching bonds of cut hair, not the scalp. As
the existing hair grows the hair piece loosens and needs
re-bonding. The chief advantage of bonding is its relative
simplicity and the cost benefit compared to other methods of semi-permanent attachment.
• Sewing: Sewing is less common than bonding, though it
shares many of its characteristics. Tiny loops are sewn into
the fringe of the hair piece. Several existing natural hairs
are pulled through the loops of the hair piece and are
fused together by knotting or using glue. As the existing hair
continues to grow, the hair piece loosens and needs to be
re-fused. The chief advantage of sewing is that it does not
necessarily require the use of an adhesive.
• Weaving or braiding: These have long been used as
methods of thickening thinning hair. For this purpose, small
sections of the hair piece are formed into clumps and
attached to the existing hair by carefully weaving natural
hairs into the hair piece using fine, durable strings. In recent
years, the idea of weaving has been introduced as a way
of attaching larger hair pieces to a mostly balding head.
The chief advantage of weaving is that it allows for easier
cleaning of the scalp as opposed to other methods of semi-
permanent attachment.
The disadvantage of attaching a hair piece to existing
hair that is shared by all such mechanisms is that this kind
of attachment puts unnatural amounts of tension on the
existing hair. If this is not carefully considered while creating
the attachment mechanism the result can be that the hair
piece will lead to further hair loss. It is very important for a hair
piece that attaches to existing hair to be properly designed
to avoid this problem.
206
Attaching to the scalp: If you lack a sufficient amount of
hair, or your hair is not strong enough, then you have no
choice but to attach a hair piece to your scalp in some
manner. Currently, there are three recognized methods of
attaching a hair piece to your scalp: By using an adhesive,
with vacuum suctioning, or by using a surgically-made loop
in the skin. Each of these methods is reasonably safe and
maintains certain advantages and disadvantages that you
should thoroughly discuss with your specialist.
• Adhesive: Adhesives that can be used to attach a hair
piece to your scalp fall into two categories: Glues that make
a direct attachment to the scalp or double-sided tapes that
attach the hair piece to the scalp. Every time the hair piece
is attached to the scalp a thorough cleaning of the adhesive
substance must be done to maintain proper hygiene. The
chief advantage of adhesive attachment is that is allows
for quick and frequent removal of the hair piece at minimal
cost.
• Vacuum fitting: If a hair piece is precisely fit it can be
attached to the head by suction. The hair piece will naturally
pull into the scalp as a vacuum is created under your scalp.
The chief advantage of a vacuum attachment is that it is the
most comfortable and easiest to remove and re-attach.
• Using a surgically-made loop in the skin: In this method, a number of loops of flesh are created in the scalp skin and clips
are anchored into these loops that firmly hold down a hair
piece. The surgical operation needed to create the loops
requires a bridge of skin to be cut and raised from the scalp.
The result looks like a fleshy tunnel-like outgrowth of skin. The
surgically created loops have to be frequently cleansed to
prevent infection. The chief advantage of this method of
attachment is that it provides the surest grip of all methods
of semi-permanent attachment to the scalp.
What are the costs of a hair piece?
The cost of an effective hair piece is not cheap. If
207
you expected that hair replacement would be a cheaper
investment than surgical or drug treatment than you were
mistaken. It is not uncommon for hair replacement to cost
thousands of dollars annually. There are also hidden costs
that most people don’t immediately detect and are usually
not told about.
Depending on the chosen hair replacement piece a
proper evaluation of the total cost may need to take into
account four different components:
1. The cost of the hair piece itself
2. The cost of the servicing and maintenance
3, The cost of the attachment method
4. The cost of the maintaining the attachment method
The cost of the hair piece: Because of the enormous variety
of hair replacement pieces and the various options available
with each, it is difficult to indicate precise prices for every hair
piece. Generally speaking, a hair piece can cost anywhere
from $100 USD to $5000 USD. The cost of the hair piece will
conform to the following rules:
• Custom-made usually costs more than ready-made
• Human hair costs more than synthetic hair
• Because of the need for more detail, the less hair on the
hair piece the more costly it will be
• A hair piece’s price will rise with the more human labor
needed to produce and service it
• Big advertiser’s charge more money
The cost of servicing and maintaining the hair piece: On
average, any hair piece will last no more than 18 months
before it will need to be replaced. You can expect to pay
the full cost of making a hair piece almost every year. Also,
good maintenance generally requires frequent servicing
of the hair piece before it is replaced. The cost of normal
servicing may vary enormously depending on the type of the
hair piece. As a general rule the servicing costs are higher
the more the initial cost of the hair piece. One hidden cost
that many tend to overlook is the cost of replacing a hair
piece while it is being serviced. If you are very conscious of
208
maintaining your appearance then just any replacement for
your hair piece will not be enough. If this is the case, then
you will need to buy a second hair piece to back up your
original.
The cost of the attachment method: This cost is only high
for a few methods of attachment. Whenever a hair piece
requires surgical manipulation, you can expect its cost to run
into the thousands of dollars. And whenever a hair piece
requires the attention of a professional, you can expect its
cost to run normally into the hundreds of dollars.
The cost of maintaining and servicing the attachment
method: There is always some cost in maintaining and
servicing the attachment method. In some cases, like semipermanent methods of attachment, these costs are upfront.
These methods require the attention of a professional every
few months and can cost up to $1000 USD annually. In most
cases, the cost of maintaining and servicing the attachment
method is a hidden cost that many people don’t immediately
consider. In some cases this may be minor, as in the case
of routine purchasing of adhesives and cleaning fluids.
However, in cases where complications affect not only your
hair piece but also your health the costs of servicing an
attachment method can be very high.
Choosing a good hair replacement specialist
Hair replacement is big business in the western world.
Billions of dollars are spent on it annually and there are many
practitioners and specialists out there looking for your business.
Like surgical treatment, there are many practitioners to
choose from and many difficult choices to make. The advice
of a good hair restoration specialist is almost indispensable.
But you have to be careful about which hair replacement
specialist you choose. There are many whose knowledge of
hair replacement extends only to the product they are trying
to sell you.
Finding a good hair replacement specialist takes work
209
Top and bottom sides of a full wig.
The bottom picture displays a strip running around
the
210
and patience. The following rules will help you find someone
that will help you sort through your options and guide you
in choosing the right hair replacement solution. These rules
require more work in finding a hair replacement specialist
and a hair replacement plan but they are essential if you
want to protect yourself.
Don’t rely on advertisements in papers or magazines
Big advertisers are usually just selling one product.
The biggest advertisers are also usually the most expensive
practitioners and not necessarily the best. The best
advertisement is always word of mouth from a pleased
client.
Get a list of specialists from a neutral source
Don’t just look for a list of hair replacement specialists
from your local phone directory. You can find out about
the different specialists in your area through other means:
By asking someone who has already used one; by checking
with your dermatologist; or by contacting the American Hair
Loss Council (www.ahlc.org).
Talk to more than one hair replacement specialist
You should consult many practitioners before you
consider committing yourself to anyone. Look at all the
different services they offer and compare the prices.
Distinguish between the ones who want to work with you
to find a solution from those who want to sell you what they
have. Make certain you select someone who will spend time
with you to explain things without making you feel that you
owe him or her something for taking this time.
Before settling on any one practitioner to work with
ask to see real people he or she has treated. Pictures can be
deceptive. Ask for phone numbers and addresses of several
211
clients of the specialist and, if possible, to meet and talk with
them.
Don’t be tempted by low prices
Low prices often mean hidden costs or poor
craftsmanship. Use the section on cost above to figure out
the real cost of a hair replacement piece.
Get second judgments on any hair replacement plan
It never hurts to get a second opinion on any hair
replacement plan you are considering.
Advantages and disadvantages of hair replacement
Final recommendations
You should try hair replacement if:
• If you have no other options because your baldness is too
far gone or progressing too quickly
• If you can live with fake hair
• If you can afford to maintain the cost of quality hair
replacement, which is more expensive long-term than
surgical treatment
• If you would like to use it as a means of supporting other
treatment methods
212
Advantages
• Results can be seen relatively quickly
• Quality hair replacement can restore a natural look to almost anyone
• Costs are well known
• Relatively pain-free
• Risks and complications
are minimal and rare
• Non-commital
• Can be a useful bridge until you decide on a more permanent solution or until more effective surgical and drug methods are developed
Disadvantages
• It isn’t your own, natural
hair
• Quality hair replacement
requires considerable maintenance
• Quality hair replacement
is expensive
• It takes a patient and thoughtful process to find a good hair replace
ment specialist
Comparing wigs with surgical treatment
for hair loss
Wigs
• It is not permanent
• It is more expensive on a long-term basis
• Provides less confident results
• Maintenance is time-
consuming and costly
• Restricting in sporting and social contexts
• There is always the fear of exposure
Surgical treatment
• Your own permanent hair is transplanted
• Expense is much less on a long-term basis
• Provides confident results
• No long-term maintenance
• No restriction in sports or social events, including
swimming
• There is no chance of exposure
213
a final recommendation
To fight hair loss is understandable, but we must learn how
to maintain a sense of balance in this pursuit. I have seen too
many men and women who have allowed their hair loss to
undermine their sense of self worth. Some of these men and
women have developed a mania bordering on paranoia in
response to their hair loss. These men and women act rashly
out of desperation to fight their hair loss. Unfortunately, they
may suffer great pain and loss when their rash actions result
in their hopes being dashed in some way or another.
What everyone who is fighting hair loss needs is knowledge of what is happening to them and knowledge of the
most-up-to-date and safe procedures that can help them
in this fight. It is for this reason that I have written this book.
Having studied the book now, you should be aware by now
that there is no full proof and simple way to defeat hair
loss. There are many choices to make; every choice has its
costs and benefits. At least now you are well prepared to
thoughtfully proceed in fighting your hair loss. The information I have given you, when used in consultation with trained
professionals, is sufficient for you to fight this battle and win
to some degree.
I say “to some degree” because as a medical doctor I
have learned to accept certain realities. If you are a victim
of hereditary hair loss you are fighting a battle against time.
For most people hair loss is an irreversible part of the aging
process. Despite fantastic claims to the contrary, the truth is
that aging is irreversible and we are all going to experience
its hardships in one way or another, including for many with
hair loss. The real issue is not whether our bodies will experience the ravages of aging, but how we deal with it.
In the end remember this, you are more than your hair.
As long as you can realize that your hair is not everything
then you can learn to deal with its loss, and thoughtfully find
a way to restore its appearance with as little cost and pain
as possible.
I wish all men and women the best in the future.
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278
appendix
In this appendix I provide sample drafts of three
important documents that are commonly provided by
hair transplantation centres. The samples are actual
documents I use in my own practice. The drafts provided
include:
Appendix A: Sample Consent Form
Appendix B: Sample Pre-operation Instructions
Appendix C: Sample Post-operation instructions
279
280
appendix
Appendix A : sample consent form for surgical hair transplantation
DR. ANTONIO A. ARMANI
233 Carlton St. Toronto, Ontario, Can. M5A 2L2.
Tel: (416) 363-6655 / 1-800-365-6220 Fax: (416) 363-1589
CONSENT FORM FOR SURGICAL HAIR TRANSPLANTATION
As a patient you have the right to be informed about your
condition and the recommended surgical, medical, or diagnostic
procedure to be used so that you may make the decision whether
or not to undergo the procedure after knowing the risks and the
hazards involved.
1) I _______________ do hereby consent and agree to have
hair replacement surgery performed upon me, and any
other medical services, which during the procedure become
medically reasonable and necessary.
2) I am aware that good results will depend, in part upon my
completing the necessary number of operations, which
has been estimated to me to be ___ session(s). However,
because many variables exist, I have not been promised or
guaranteed good results. I also understand the quality and
amount of my preexisting hair is a major factor in the ultimate
results. I understand I will not have hair the same thickness as
I had prior to the onset of my hair loss.
3) Prior to consenting to hair replacement surgery, I state that
I have read and discussed with my physician the following
literature, which has been supplied to me:
1. Brochure
2. List of Complications
3. Preoperative Instructions
4. Fee Schedule of Current Charges Per Session
PAGE 1 OF 6
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appendix
281
4) I fully understand the results that I may reasonably expect.
An explanation of this procedure has been given to me. I
do understand that I will not have a full head of hair after the
procedure is complete. I understand that visibility of the sites
following a hair transplant procedure can last several days.
5) A transplant may not look natural on those with dark hair and
light skin.
6) Dr. Antonio A. Armani has suggested ________ session(s) of
grafts as a minimum. I understand that more operations may
be recommended at a later date. I understand that all recommendations made during my consultation and treatment
are estimates and may change at a later date. __________
(Initial)
7) I understand there will be scarring associated with this procedure. I understand that hair transplants are not perfect.
8) I am aware that complications may occur. The more common complications and a partial list of rare complications of
this surgery have been explained to me and I have reviewed
a list of them, which I signed and dated. A copy of that list
is attached to this request. Unforeseen, rare complications,
such as unanticipated reaction to medication and anesthetics, uncommon infections, and unusual healing responses
(wide scars) are a possibility. Every unforeseen complication
may not have been discussed with me in detail, but I understand that such risks do exist.
PAGE 2 OF 6
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appendix
9) I consent to and authorize the administration of such local anesthetics and nitrous oxide as may be considered necessary
by those performing the surgery on me.
10) I consent to and authorize the performance of cosmetic surgery by Dr. Antonio A. Armani, M. D., associate doctors, and
hair assistant technicians.
11) I believe I have been well informed. I understand that although good results are hoped for and expected, cosmetic
surgery results can not be guaranteed because of the nature
of the human body and the healing process. There are also
risks of reasonable error in judgment and implementation,
which is possible in any surgical procedure.
12) The pros / cons and alternatives to transplants have been
explained. I have the option of doing nothing at all, wearing
a hairpiece or wig, using prescription medication, or receiving
a transplant. A combination of the above is also possible I am
informed of all options.
13) It has been explained to me that the amount and location
of future hair loss on the scalp, including the side or back area
can not at this point in time be predicted. I do understand
it is possible to lose my existing hair at any point in time in the
future. I do understand this may effect the appearance of
the grafted area. Hair transplants may not be permanent.
They are usually very long lasting but, rarely, have been noted
to fall out after one to ten years. In the majority of men some
thinning of all areas occur. Most men do not lose all of their
donor (back of the head) area with age. A very small percentage of men (less than 10%) do lose a majority of their
donor hair and this could affect the final result.
14) This consent was read and signed while I was not under
the influence of medications that cause drowsiness.
PAGE 3 OF 6
appendix
INITIAL:
A : sample consent form for surgical hair transplantation
appendix
283
15) I certify that this form has been fully explained to me that I
have read it, or have had it read to me, that the blank spaces
have been filled in, and that I understand all of it’s contents.
16) Some postoperative discomfort may be experienced. (Initial)
17) Dr. Antonio A. Armani and Cosmetic Surgery Spa does offer
procedures that will obtain the best results for the patient, irrespective of any profit motive.
18) I have had opportunities to ask questions on this subject.
19) I acknowledge that no guarantee has been made as to the
results that may be obtained.
20) I acknowledge that I am responsible for payment of these
services with no possibility of fee reimbursement regardless of
graft growth.
PAGE 4 OF 6
INITIAL: Appendix A : sample consent form for surgical hair transplantation
284
appendix
IN THE PATIENT’S OWN HAND WRITING
(Initial)
I have read and understood this consent form and fully agree to
all its points.
_____________________
PATIENT’S NAME (PRINT) ____________________
PATIENT’S SIGNATURE
_____________________
DATE: PATIENT’S INITIALS:
___________________________________________________
ADDRESS / CITY / PROV. / STATE / POSTAL / ZIP CODE
__________________________
___________
HOME PHONE
WORK PHONE
CELLPHONE
______________
WITNESS NAME
PAGE 5 OF 6
____________________
WITNESS SIGNATURE
INITIAL: Appendix A : sample consent form for surgical hair transplantation
appendix
285
MORE COMMON COMPLICATIONS
1)Nausea and vomiting from pain medication
2)Bleeding (less than 1%)
3)Infection (less than 1 %)
4)Excessive Swelling (20-30%)
5)Temporary headache
6)Temporary numbness of the scalp
7)Scarring around the grafts
8)Poor growth of grafts
9)Reactions to medications (less than 1 %)
10) Fainting (less than 1 %)
11) Occasional small ingrown hair-causing a cyst (less than 1%)
12) Scarring of the donor area, wide scars are possible (less than
1%)
INITIAL: RARE COMPLICATIONS (Partial list only)
1)
2)
3)
4)
5)
6)
7)
8)
Keloid formation
Complete failure of growth of transplanted hair
Persistent scalp pain
Total loss of donor hair
Permanent numbness of scalp
Noticeable scarring of donor area
Loss of transplanted hair
Allergic reaction or medication-related problems
INITIAL: I have read and understand all of the possible complications listed
above.
DATE:__________
TIME:______ A.M / P.M.
________________
PATIENT’S NAME
_______________
SIGNATURE
________
INITIAL
WITNESS NAME
WITNESS SIGNATURE
PAGE 6 of 6
INITIAL:
*Consent-taken and modified from consent used by
Dr. Dowling B. Stough Jr. 286
appendix
Appendix B: sample preoperative instructions for surgical hair transplantation surgery
Tel: (416) 363-6655 / 1-800-365-6220 Fax: (416) 363-1589
Preoperative INSTRUCTIONS FOR
HAIR TRANSPLANTATION SURGERY
FOR:
PATIENT’S NAME
Date / Time of Surgery: IMPORTANT: YOU MUST STRICTLY FOLLOW THESE INSTRUCTIONS
TO AVOID COMPLICATIONS (i.e. excess, bleeding and/or longer
healing process) AND ENSURE THE BEST POSSIBLE RESULTS.
Two (2) WEEKS PRIOR TO SURGERY:
1. ELIMINATE Intake of Vitamin E capsules or vitamin pills containing Vitamin E.
2. Notify our office regarding any medications you are currently
taking or might be allergic to at the time of surgery. They may
have to be discontinued or substituted with an alternative
drug.
3. Stop use of Minoxidil (Rogaine) or M.A.O. inhibitor drugs (some
antidepressants)
4. DO NOT take any ASPIRIN (ASA) or any drugs containing Aspirin - see enclosed sheet - (e.g. some cold remedies). Note:
You may use Tylenol
5. DO NOT drink any alcohol (wine, beer, liquors)
6. DO NOT use any non-approved drugs. Eg: marijuana, hashish
or others.
7. Do not get a hair cut 2 weeks prior to surgery.
appendix
287
Appendix B: sample preoperative instructions for surgical hair transplantation surgery
ON DAY OF SURGERY:
1.
A gown will be provided during the surgery. For your
own comfort you may wish to wear sweatpants for longer surgeries.
2.
Wash your hair well in the morning prior to surgery.
3.
Make arrangements to take a taxi home or have someone pick you up on the day of the surgery. You will not be able to drive home. Also, you can arrange to stay in a hotel near the clinic. Ask our staff.
288
appendix
Appendix B: sample preoperative instructions for surgical
hair transplantation surgery
Tel: (416) 363-6655 / 1-800-365-6220 Fax: (416) 363-1589
MEDICATION PRECAUTIONS FOR SKIN SURGERY PATIENTS
The following is a list of the more common medications and
substances that can increase your tendency to bleed:
Advil
Alcohol
alka Seltzer
Anacin
Anaprox
Anaproxin
APC
5 ASA
Ascodeen
Ascriptin
Aspirin
Bufferin
Brufen
Cephalgesi
Cheracol Capsule
Children’s Aspirin
Clinoril
Congesprin
Cope
Coridicin
Coumadin
Darvon
Darvon with ASA
Dolobid
Dristan
Easpirin
Ecotrin
Empirin
Emprazil
Excedrin
Feldene
Fiorinal
4-way Cold tabs
Ibuprofen
Indocine
Indomethacin
Meclomen
Medipren
Midol
Motrin
Nalfon
Naprosyn
Norgesic
Nuprin
Percodan
Phenaphen
Quagesic
Robasisal
Rufin
Sine Off
Sine Aid
Trandate
Trental
Trigesic
Trilisate
Vanquish
Vitamin E
Voltaren
Zectrin
Zorprin
Phone numbers: Office:(416) 363-6655 / 1-800-365-6220
Dr. Antonio A. Armani’s cell phone: (416) 543-2716 Home: (416) 944-3805
appendix
289
Appendix C: sample postoperative instructions for surgical
Tel: (416) 363-6655 / 1-800-365-6220 Fax: (416) 363-1589
Postoperative INSTRUCTIONS HAIR
TRANSPLANTATION SURGERY
FOR: ______________________________________
Scheduled Date / Time of BANDAGE REMOVAL:
Next day after surgery
Scheduled Date / Time of SUTURE REMOVAL:
One week after surgery
DAY OF SURGERY: BLEEDING
If Bleeding Should Occur:
Call Dr. Antonio A. Armani at his cell number (416) 543-2716 or at
home (416) 203-8553 and apply pressure 10-15 minutes over
the bleeding area
NEXT DAY AFTER SURGERY:
1.Medication Instructions: See Attached Sheet
2.Sleep at 45 degree angle for 3 days.
3.Do not wash the transplanted area for one week until the
stitches have been removed.
4.You can only wash the back (donor) area, do this gently the
next day after surgery.
5.The bandage will be removed the next day after surgery and
the donor and recipient areas inspected.
6.You may have swelling: use ice packs or ice on the area of
swelling.
290
appendix
General:
1.7th Day Following Surgery - You will have an appointment
approximately 7 days following surgery to have the sutures
removed.
2.CRUSTS – Do not pick at the crusts. They will fall off in 2-3
weeks. You may use Vitamin E oil on them if they are not falling off.
3.EXERCISE: For the first 2 weeks following surgery, you should
refrain from exercise and strenuous work.
4.VITAMINS: You may take Vitamin E, 400 I.U. to 800 I.U. daily.
Also you may take vitamin C 1g to 2g daily. Drink plenty of
fluids. You may also take a multivitamin with these.
5.MINOXIDIL (Rogaine) and/or PROPECIA: You should discuss
with Dr. Antonio A. Armani the options of taking either or both
for the growth of the transplanted hair and to prevent further
hair loss.
6.HAIR PRODUCTS: You should discuss with Dr. Antonio A. Armani choices in the following for your specific hair type.
-Shampoos
-Hair conditioners
-Hair gels and mousses
-Hair coloring and perms
appendix
291
If you have any complications or concerns, which were
not addressed in this handout, please contact our office at
(416) 363-6655 / 1-800-365-6220 / Dr. Antonio A. Armani’s cell
number (416) 543-2716 or his home (416) 944-3805. Our staff
will be more than happy to answer your questions.
292
glossary
293
glossary
Accupuncture: An ancient Chinese system of medicine
that treats ailments by manipulating key points located
on the body. It offers some treatments for dealing with
hair loss.
Alopecia: The medical term for all types of hair loss.
Alopecia Areata: A type of hair loss caused by unknown
factors. It results in sudden loss of hair, not only on the
head but also on other parts of the body.
Alternative Medicines: Types of medicine which are based
on holistic medical principles, and which are gaining
increasing popularity and acceptance. They include
medical practices like acupuncture, traditional Chinese
and Indian medicines, homeopathy, cell therapy, and
magnetic field therapy.
Androgens: Male hormones that are known to relate in
some way to hair loss.
Antiandrogens: A family of drugs which combat the effects
of androgens or male hormones, and which have shown
the ability to combat hair loss. Some antiandrogens that
are being tested to treat hair loss include: Cimetidine,
spironoclactone, and progesterone.
Aromatherapy: A branch of herbal medicine which uses
essential oils of various plants to create medically beneficial effects on the body. It offers several prescriptions for
dealing with hair loss.
Ayurvedic Medicine: The ancient herbal medicine of India,
which offers several different treatments for dealing with
hair loss.
Bonding: A popular method of attaching a replacement
piece to existing hair, which uses an adhesive.
Canned Hair: A method for camouflaging hair loss that
sprays or applies colored substances to the thinning portion of the scalp to simulate hair.
Cloning: The process of making copies of living cells. Attempts are now being made to clone hair, thus making
it possible to create an indefinite supply of natural hair
strands for hair grafting.
Conventional Scalp Reduction: A form of scalp reduction
that aims to remove only restricted sections of balding
294
glossary
on the top of the head.
Cyclosporine: A drug that is being tested as a possible
treatment for hair loss. It is a type of drug that suppresses
the body’s immune system.
Cyoctol: A drug that is being tested as a possible treatment for hair loss. It is believed to work by protecting hair
roots being attacked by dehydrotestosterone.
Cyproterone acetate: A strong antiandrogen that has
been used in Europe to treat hair loss in women.
Dehydrotestosterone (DHT): A type of male hormone that is
a major factor leading to hereditary hair loss.
Diazoxide: A drug that has shown promise towards combating hair loss. It is drug normally used to treat diabetes.
Dermatologist: A medical doctor who specializes in care of
the skin and the hair.
dutasteride: Dutasteride is another 5 alpha reductase inhibitor. It blocks, receptors 1 and 2. The effect of Dutasteride is to decrease OHT. It is still undergoing phase II and phase III trials for hair loss.
Finasteride: A drug that has proven to have significant
ability to combat hair loss. It indirectly acts to inhibit the
growth of dehydrotestosterone, and is the active ingredient in Propecia.
FUE:Follicular Unit Extraction is the hair transplant technique, which extracts the follicular units one-by-one from
the donor area. This technique does not require a scalpel and therefore no sutures or staples are involved. As
a result there is no scaring in the donor area of the scalp.
FUSS: Follicular Unit Strip Surgery is a hair transplanting technique that extracts donor hair from the scalp by using a
scalpel to remove a strip of the scalp with the donor hair
on it. The strip is further dissected with the use of microscopes into the individual follicular units.
Hair Extensions: Hair-bearing devices that attach on to
your existing hair to make it appear longer and fuller.
Hair Follicle: The central root of a strand of hair.
Hair grafting: A type of hair transplantation surgery in which
slices of hair-bearing flesh are removed from a hairbearing part of the head and “grafted” into parts of the
head which are balding.
296
glos-
Hair Replacement: The methods of dealing with hair loss
that replace your natural hair with various types of additives that make your hair look natural and complete.
Hair Thickening: A method used to camouflage hair loss by
thickening remaining hair. Various types of hair conditioners can be employed to thicken hair.
Hair Units: Hair-like clumps that fit into your existing hair to
make it appear fuller.
Hair Weaves: Synthetic or natural hair which is weaved,
braided, or knotted into your existing hair to make it look
fuller.
Genetic Hair Loss: A type of hair loss related to genetic
disposition. It follows a standard pattern in most of its
victims. It usually starts with thinning of the hairline at the
temple and/or at the crown of the head, and progresses
over time. It is the most common type of hair loss, affecting as many as 50% of all individuals as they age.
Homeopathy: An alternative medical system developed
in Germany, which cures ailments by prescribing dilutions of natural substances which trigger the body’s own
natural healing processes. It offers some prescriptions for
dealing with hair loss.
Male Pattern Baldness: The most common term for hereditary hair loss. It is called Female Pattern Baldness when its
affects women.
Micro-graft: A slice of flesh with only 1 or 2 strands of hair,
which is employed in hair grafting surgery.
Mini-graft: A slice of flesh with 3 to 5 strands of hair, which is
employed in hair grafting surgery.
Minoxidil: A type of drug called a vasodilator. It has the
effect of decreasing blood pressure and is primarily used
to treat high blood pressure. It is also known to cause
hair growth in some cases, and is the active ingredient in
Rogaine.
Naturopathic Medicine: A comprehensive medical system
that combines many of the traditional nature-based
medical systems of the world. It offers many prescriptions
for dealing with hair loss.
Placebo Effect: The improvement in health, including in hair
growth, that researchers find result when patients are
glossary
given placebos or dummy drugs as part of research testing of drugs.
Propecia: The brand name for a tablet used to treat hair
loss. Its active ingredient is finasteride. It is currently one
of the only two drugs approved for hair loss treatment by
the United States Food and Drug Administration.
Rogaine: The brand name for a rubbing tonic used to treat
hair loss. Its active ingredient is minoxidil. It is currently
one of the only two drugs approved for hair loss treatment by the United States Food and Drug Administration.
Scalp Expansion: A procedure now routinely employed to
expand sections of the scalp to improve results of scalp
reduction surgery. There are several different methods
employed to expand scalp skin.
Scalp Flaps: A new and effective type of scalp cut used in
scalp reduction surgery, which involves cutting into the
side of the hair-bearing scalp and rotating the resulting
flap-like pieces of scalp up to cover the cut-out portion
of the balding scalp.
Scalp Lifting: A highly effective radical form of scalp reduction in which large portions of the scalp are detached
from the scull and lifted and flapped to cover balding
areas of the scalp which are surgically removed.
Scalp Looping: A method of attaching a hair replacement
piece, which surgically creates small loops in the scalp
flesh which hair pieces clip in to.
Scalp Reduction: An operation in which areas of balding
are surgically removed with the remaining scalp being
stretched and stitched together to reduce or eliminate
balding.
Sewing: A method of attaching a hair replacement piece
to your existing hair, which “fuses” the hair piece to
strands of hair either by knotting or by employing an
adhesive.
Toupees: Hair-bearing devices formed on a base material
and designed to meld into your existing hair.
298
glos-
Tricomin: A compound chemical that has shown some
promise in fighting hair loss in tests conducted in France.
Weaving: A method of attaching a hair replacement
piece to your existing hair, which sews or weaves existing
hair into the hairpiece.
Wigs: Hair-bearing devices formed on a base material and
designed to meld with your existing hair.
Index
A
Alopecia, See Hair loss
Alopecia Areata
Sudden unexplained. See Hair loss
Alternative medicine
acupuncture 252
advantages and disadvantages of 256
Aromatherapy 253
Ayurvedic medicine 253
homeopathy 254
how they work 251
Naturopathic medicine 254
recommendation about 256
relevance of alternative medicine 3
treating hair loss 251
American Academy of Medical Acupuncture 251
American Association of Naturopathic Physicians 253
American Association of Oriental Medicine 251
Androgenetic alopecia . See Hair Loss
Antiandrogen drugs 239
how they work 239
safety for men 239
safety for women 239
side effects of 238
Auto immune disorder 24
B
Balding 159
C
California College of Ayurveda 254
299
300
index
Camouflaging hair loss
defined 258
thickening hair 259
Cancer 24
Colitis 25
Conventional scalp reduction. See Scalp reduction.
See scalp reduction
Crohn’s disease 25
Cyclosporine 240
Cyoctol 241
D
Dehydrotestosterone (DHT) 228, 238, 241
Diazoxide 241
Dr. Kieth Kaufman 228
Drug treatment advances in 2
Dutasteride 238
E
Experimental drugs 237
F
Female conditions. See Hair Loss, disease-related
Female pattern baldness. See Hair loss, hereditary
Finasteride. See Propecia
Food and Drug Administration, 2, 21, 222, 223, 227, 237, 239, 241
Fusion 268
G
Gene therapy 209
H
Hair care
chemical treatments 274
drying 275
exposing hair 275
pulling hair 275
rules for 274 - 276
shampoos 274
using a conditioner 274
Hair extensions 260
Hair follicle cloning. See Hair grafting
Hair grafting
advertising 116
consultation stage 116
costs of 115
defined 65, 115
expectations for 117
finding a specialist 116
hair follicle cloning 208
risks of 114
steps in 65
when appropriate 88
Hair loss 1
abnormal 6
diet-related 22
drug-related 23
hereditary
causes of 7
incidence of 1
prevalence 12
symptoms 12
index
301
302
index
normal 5
poor hair care 33
stress-related 24
sudden unexplained ( Alopecia Areata ) 32
Hair piece
attaching to hair 262
attaching to scalp 264
base type 260, 262
cost of 267
custom building 260
defined 260
finding a good specialist for 269
natural hair fibre 261
synthetic hair fibre 261
types 260
Hair replacement
popularity of 258
Hair units 260
Hair weaves 260
How to find a good hair surgeon 136
I
International Society of Hair Restoration Surgery 137
L
Lupus 24
M
Male pattern baldness. See Hair loss, hereditary
Manual scalp expansion 200
Merck & Co. 21
Micro-graft and Mini-graft
uses for 88
Micro-grafts and mini-grafts
index
defined 88
Minoxidil . See Rogaine
N
National Alopecia Areata Foundation 33
National association of Holistic Aromatherapy 255
National center for Homeopathy 256
National Institute of Ayurvedic Medcine 255
Neutrogena T/Gel 229
New England Journal of Medicine 248
P
Parathyroid disease 24
Placebo effect 249
Promising drugs
Cyclosporine 240
Cyoctol 241
Diazoxide 241
Tricomin 240
Propecia
compared to Rogaine 244
costs of 237
effectiveness of 228
general background 227
how it works 228
people not safe for 229
side effects of 230
Proscar 227, 250
Prostate-specific antigen (PSA) 236
303
304
index
R
Ringworm 23
Rogaine
compared to Propecia 244
costs of Rogaine 223
discovery of 223
drug profile 223
effectiveness of 21, 223
future of 226
people not safe for 226
recommendations about 242
side effects of 225
S
Scalp expansion. See Scalp reduction
Scalp lifting. See scalp reduction
Scalp reduction
Conventional
defined 196
limitations of 198
risks of 198
Scalp lifting
defined 202
risks of 205
steps in 202
who suitable for 204
With scalp expansion
defined 199
methods of 199
risks of 201
with scalp flaps 199
Surgical treatment
Surgical treatment
advances in 2
future of 207
nature of 54
types 55
who appropriate for 55
T
Thyroid disease 24
Tissue expansion 200
Tissue extension 200
Toupees 260
Tricomin 242
W
Weaving 264
Wigs 260
index
305

KnowIng your type of haIr loSS......... 5

Transcription

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