Our hair is one of the most diverse and unique physical features. Historically, it has been a source of pride to humans and has had cosmetic, political, and even religious significance. Unlike our goals in rejuvenating the face or body where often excess tissues are removed or lifted, hair restoration is about providing the appearance of morehair. Certainly, youthful hair is plentiful, full-bodied, and shiny. There are few physical features that so clearly demonstrate advanced aging than loss of hair.
Hair loss is not a condition of males alone. It afflicts a significant percentage of women as well. The patterns of hair loss can differ significantly between males and females. Males have several typical patterns of hair loss: frontal and temple hair recession, vertex balding (top of scalp), or varying degrees of both. Females typically do not exhibit frontal or temple hair recession; more common patterns are generalized thinning of the hair (decreased density) throughout or on the top of the scalp. Age at onset of baldness varies greatly though the rate of hair loss decreases usually by age 40; hair loss does not stop completely, however.
There are three phases of hair growth: active growth, hair maturation, and the resting phase (hair loss). 90% of the hairs on a non-balding scalp are in the active growth phase, whereas 10% are in the resting phase. When this balance is tilted towards more the resting phase, hair loss and balding occurs. The hair we see externally is called the shaft. Growth occurs deep in the scalp fat in the hair follicle (the bulb). Causes for hair loss are primarily genetic and the degree of hair loss is influenced by the levels of circulating hormones. The gene for balding is sex-linked, meaning that for males, this is inherited from the mother. The old adage that you will be bald if your father is bald is simply not true. If a male's mother's father is bald, he has at least a 50% chance of exhibiting some hair loss (to varying degrees).
Treatments for hair rejuvenation have been historically quite disappointing. Wigs and weaves have been used for centuries. More recently, there are surgical procedures and medicines (such as Rogaine® and Propecia®) that can be used. Most medicines cannot claim with scientific proof to cure baldness or to grow significant amounts of hair. They are utilized primarily for prevention of further hair loss. Surgeries in the past for hair loss have involved the excision of bald areas (scalp reductions or flaps) which often left noticeable scars. More recent advances include hair transplantation with punch grafts, mini-grafts, and micro-grafts. Grafts are obtained from areas of the scalp with good quality hair (usually the posterior scalp). Punch grafts are larger plugs of hair (can contain 30 to 100+ follicles) and the cosmetic outcomes are not good. This technique has been abandoned for the newer techniques of Mini- and Micro- grafting, which have excellent and naturally appearing results. This involves the transplantation of individual (or up to 5) hair follicles using a microscope. Usually anywhere from 500 to 5000 grafts are placed in a session under local anesthesia. As you can imagine, this requires a great deal of skill and time (can take up to 8-10 hours for one session). Most mild to moderate cases can be successfully treated with one session of grafting; more extensive hair rejuvenation can require a second or third session to achieve the best results.
Ultimately, hair transplantation is limited by the availability of donor hair. You have to have enough to transplant. The principle is not to create more hair, but it is to re-distribute the density from areas that have plenty of hair to those bald areas. Thus, it is useful to slow or stop the rate of hair loss with medicines. This may be satisfactory in itself, but if further transplantation is necessary, more available donor hair and less area to treat can lead to improved results.
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