The first consultation with your hair restoration surgeon is critical to success. A frank discussion of goals and treatment plans goes a long way to achieving satisfying results.
The surgical treatment of hair loss can be broadly divided into three main areas: hair transplantation, scalp reduction and scalp flaps.
Why Do We Loose Hair?
Though most humans no longer need hair for protection, heat retention, or camouflage, it still remains a very important means by which individuals are recognized. Appropriate appearance and grooming are still very important in our social networks and our customary relationships.
The human body contains approximately five million hair follicles while the scalp (prior to any kind of hair loss) contains 100,000-150,000 hair follicles. Blondes have the greatest number of scalp follicles, followed by brunettes. Humans with red hair have the fewest number of scalp follicles. The normal growth rate of scalp hair is one-fourth to one-half inch per month or about 5 inches per year.
The Normal Hair Growth Cycle
It is important to understand the normal growth cycle of hair in order to understand why hair loss occurs. The hair follicle is an anatomic structure that evolved to produce and subsequently loose the hair shaft itself. Hair is made up of proteins called keratins. Human hair grows in a continuous cyclic pattern of growth and rest known as the "hair growth cycle". There are three phases of the cycle: Anagen= growth phase; Catagen= degradation phase; Telogen= resting phase. Periods of growth (anagen) lasts from two and eight years. This is followed by a brief period, two to four weeks, in which the follicle is almost totally degraded (catagen). The resting phase (telogen) then begins and lasts two to four months. Shedding of the hair occurs only after the next growth cycle (anagen) begins and a new hair shaft begins to emerge. On average 50-100 telogen hairs are shed every day. This is normal hair loss and accounts for the hair loss seen every day in the shower and with hair combing. These hairs will regrow. Not more than 10 percent of the follicles are in the resting phase (telogen) at any time. A variety of factors can affect the hair growth cycle and cause temporary or permanent hair loss (alopecia) including medication, radiation, chemotherapy, exposure to chemicals, hormonal and nutritional factors, thyroid disease, generalized or local skin disease, and stress.
Androgens (male hormones including testosterone and dihydrotestosterone) are the most important control factors of human hair growth. Androgens must be present for the growth of beard, axillary (under-arm), and pubic hair. Growth of scalp hair is
NOT androgen-dependent but androgens are necessary for the development of male and female pattern hair loss.
Male-Pattern Hair Loss (Androgenetic Alopecia)
It is estimated that 35 million men in the United States are affected by androgenetic alopecia. "Andro" refers to the
androgens (testosterone, dihydrotestosterone) necessary to produce male-pattern hair loss (MPHL). "Genetic" refers to the inherited gene necessary for MPHL to occur. In men who develop MPHL the hair loss may begin any time after puberty when blood levels of androgens rise. The first change is usually recession in the temporal areas, which is seen in 96 percent of mature Caucasian males, including those men not destined to progress to further hair loss. Although the density of hair in a given pattern of loss tends to diminish with age, there is no way to predict what pattern of hair loss a young man with early MPHL will eventually have. In general, those who begin losing hair in the second decade are those in whom the hair loss will be the most severe. In some men, initial male-pattern hair loss may be delayed until the late thirties or early forties. It is generally recognized that men in their 20's have a 20 percent incidence of MPHL, in their 30's a 30 percent incidence of MPHL, in their 40's a 40 percent incidence of MPLH, etc. Using these numbers one can see that a male in his 90's has a 90 percent chance of having some degree of MPHL.
Androgens (testosterone, dihydrotestosterone) are necessary for the development of MPHL. The amount of androgens present may be completely normal and MPHL may still occur. If androgens are present in normal amounts and the gene for hair loss is present, MPHL will occur. Axillary (under-arm) and pubic hair are dependent on testosterone for growth. Beard growth and male pattern hair loss are dependent on dihydrotestosterone (DHT). Testosterone is converted to DHT by the enzyme, 5&alpha-reductase. Finasteride (
Propecia®) acts by blocking this enzyme and decreasing the amount of DHT. The cells which make the protein necessary for hair growth have receptors that bind androgens. These receptors have the greatest affinity for DHT followed by testosterone, estrogen, and progesterone. After binding to the receptor, DHT goes into the cell and interacts with the nucleus of the cell altering the production of protein by the DNA in the nucleus of the cell. Ultimately growth of the hair follicle ceases.
The
hair growth cycle is affected in that the percentage of hairs in the growth phase (anagen) and the duration of the growth phase diminish resulting in shorter hairs. More hairs are in the resting state (telogen) and these hairs are more likely to be lost with the daily trauma of combing and washing. The hair shafts in MPHL become progressively miniaturized, smaller in diameter and length, with time. In men with MPHL all the hairs in an affected area may eventually (but not necessarily) become involved in the process and may with time cover the region with fine (vellus) hair. Pigment (color) production is also terminated with miniaturization so the fine hair becomes lighter in color. The lighter color, miniaturized hairs cause the area to first appear thin. Involved areas in men can completely lose all follicles over time. MPHL is an inherited condition and the gene can be inherited from either the mother or father's side. There is a common myth that inheritance is only from the mother's side. This is not true.
In summary, male pattern hair loss (Androgenetic Alopecia) is an inherited condition manifested when androgens are present in normal amounts. The gene can be inherited from either the mother's or father's side. The onset, rate, and severity of hair loss are unpredictable. The severity increases with age and if the condition is present it will be progressive and relentless.
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