Information provided by Dr Nilofer Farjo of the Farjo Hair Institute
Normally we shed an
average of 100 hairs per day. Fortunately these hairs are replaced; but, when
these lost hairs are not replaced or when the daily shedding exceeds the
normal, then true hair loss occurs. Genetic or pattern hair loss (androgenetic
alopecia) is the commonest cause of hair loss in men and women. It is inherited
from one or both parents and is triggered by hormones at any time after puberty.
In this type of alopecia hair can be lost at the front, top and/or the crown of
the scalp. The back and sides of the scalp are spared and usually grow hair for
life (permanent area). The hormone that triggers hair loss is called
dihydrotestosterone (DHT) which is a break down product of testosterone.
Because women have a much smaller level of this “male” hormone they never thin
as much as men. Traditional treatments include medications such as minoxidil which
stimulates the growing phase of hair follicles; finasteride (for men only) which
blocks the production of DHT; and hair transplantation which involves moving permanent
hair to areas where hair has been lost.
There are many
other causes for hair loss such as metabolic conditions (diabetes, thyroid
disease, anaemia, etc), skin conditions that cause scarring, long-term traction
on the hair with tight braids, certain drugs, trauma such as accidents or burns
and autoimmune conditions. Alopecia areata (AA) is thought to be in the latter
category. In this condition the hair is commonly lost in patches but can be
diffuse and mimic genetic balding. Some of these conditions can be treated with
hair transplant surgery but in other situations it cannot. In any situation
where someone loses their hair the first step is to confirm the diagnosis
before any treatment can be recommended.
If AA is diagnosed
there are only certain situations where hair surgery is recommended and this is
when there are only 1 or a few discrete patches that have remained unchanged
for several years. For most people AA is a condition that comes and goes and
changes location on the scalp or elsewhere on the body. Because we can’t
determine where the permanent hair is going to be surgery only works if the
condition is burnt out and is unlikely to come back or extend further. Of
course when someone loses all the hair on their head there is no available
donor hair as we can’t use hair from another person.
Modern hair transplant techniques involve follicular unit grafting. A
follicular unit is the natural grouping of hairs with most hairs grouped as 2,
3, or 4 hairs in a close bunch. There will also be a small number of single
hairs that grow on their own. When we do surgery we try to keep these natural
groupings together and move them surgically by two main techniques. One method
involves the removal of a strip of hair bearing scalp from the back of the head
then stitching the area. The hair above the surgery site will disguise the
stitches until they heal at which point you are left with a scar averaging 1mm
in width. The strip of skin and hair is then dissected under microscopes to
isolate the follicular units. The other method is called follicular unit
extraction (FUE) and is a process of meticulously coring out each grouping with
a tiny punch. Usually with this technique the back of the head needs to be
shaved. When the scalp heals there are small dot scars that are left behind.
Once the follicular unit grafts are
prepared these are then inserted into a
small incision made in the bald area. We normally place 20-40 of these grafts
in each square centimetre of bald scalp. The procedure is done as a day case
under local anaesthetic.
In a completely bald area with one operation we can achieve about 30% of the
original density so some patients may require 2 operations to achieve a thicker
look. If hair loss is due to genetics then the result should be long lasting.
In other situations, if hair is lost due to a medical condition such as AA,
then transplantation cannot be guaranteed as the disease process can recur at
any time. But for some patients even a temporary return to ‘normal’ hair is