Why does hair loss occur?
Hair loss can be due to a variety of causes and may include changes in diet, medication, recent illness, hair care habits, and family history of hair loss. It is normal to lose between 50 and 100 hairs per day. Excessive loss of hair or dramatic thinning can be appropriately evaluated by a dermatologist.

What is “pattern hair loss”?
All of us will lose scalp hair over our lifetime and by eighty years of age; some will lose most of the 100,000 hairs present at birth. Androgenetic alopecia or pattern hair loss can be seen in both men and women. Approximately 10% of all men will lose scalp hair in an accelerated fashion in each decade of life. In other words, they may lose 10% in their twenties, 20% in their thirties, 30% in their forties, etc. This process involves loss of the frontal scalp hair initially with progression to the back of the scalp. Women may also develop accelerated hair loss; 1-2% per decade of life. Female pattern hair loss usually involves the entire scalp but spares the frontal hairline. Both male and female pattern hair loss are genetically determined and have contribution from both maternal and paternal genes.

In pattern hair loss, follicles undergo a process of miniaturization as the length of time in the growth phase (anagen) decreases. This miniaturization is believed to occur because of increased formation of dihydrotestosterone by the hair follicle and is greater in men than in women.

What treatments are available for pattern hair loss?

• Minoxidil (Rogaine) is commercially available in 2% and 5% strength. It functions as a vasodilator and thus, increases blood flow to the follicle. Currently, only the 2% is approved for use in women.

• Antiandrogens such as spironolactone (Aldactone), cypropterone acetate, and flutamide (Eulixin) are all agents that have shown some benefit in female patients whose hair loss is due to androgen excess.

• Finasteride (Propecia) is a type II 5alpha-reductase inhibitor and blocks the conversion of testosterone to dihydrotestosterone.

• Hair transplantation is a permanent surgical procedure for restoring hair.

What is hair transplantation?
Hair transplantation is a way of restoring hair permanently. It is performed as an outpatient procedure usually in an office setting. Most candidates require 3 to 5 graft sessions over 1 to 2 years to cover the balding scalp. The patient is placed on any operating room table, face down, while the surgical team anesthetizes the back of the scalp (occipital scalp). This is the location from which the hair grafts are taken. Interestingly, these hairs are not sensitive to dihydrotesterone.

The surgeon harvests a strip of hair usually 5 to 7 inches long and 1 to 1 ½ inches wide, closes the defect with staples or sutures, and then cuts the strip into very minute grafts. These grafts may contain 1 to 2 hairs (micro-grafts) or 3 to 4 hairs (mini-grafts). After the frontal scalp is anesthetized, the micro-grafts are placed into small incisions to establish a very natural appearing hairline. This frontal hairline frames the face and is the most important part of the transplanting process. The surgeon proceeds with mini-graft placement behind the micro-graft rows. Finally, the patient’s head is wrapped in a special turban dressing which is removed the following day. Most people feel well enough to return to work within 3 to 5 days and to exercise with two weeks.

What happens to the transplanted hair after surgery?
Approximately 1% to 3% of transplanted hairs are lost; probably because of a “shock effect”. There is often a temporary drop out of 20% of hairs in 4 to 8 weeks. However, these hairs return because the hair roots remain in the scalp and are able to reproduce the hair shaft. In 9 to 15 months, the transplanted hair is full length and remains for as long as occipital hair remains – into the 8th and 9th decades of life.

Are there potential complications from hair transplant?
While most people do quite well with this surgical procedure, it is possible to experience one or more of the following:

• “Cobblestone” scarring at the punch graft sites – this usually resolves by 6 months
• Numbness or pain in the donor (occipital) or recipient (frontal) scalp – this usually resolves in 3 months. In rare occasions it can persist indefinitely
• Hematoma (bleeding under the skin) – this can be easily treated
• Potential infection – these are very rare and patients are given antibiotics prior to the procedure for prevention