"How to Beat Hair Loss" is a source of information for men and women suffering from hair loss. It describes in detail and in an easy-to-read format the latest surgical, medical, and alternative
"How to Beat Hair Loss" is a source of information for men and women suffering from hair loss. It describes in detail and in an easy-to-read format the latest surgical, medical, and alternative treatments for hair loss.
1. how to beat hair loss third editionAntonio 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
3. about the author Dr. Antonio Alvi Armani has written this book as a sourceof information for men and women suffering from hair loss.He is a hair transplant surgeon who graduated from the Uni-versity Of Toronto. Dr. Antonio Alvi Armani is dedicated toresearch and development of new medical, surgical andalternative therapies for hair loss. His hair transplant practiceand 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 Pro-gram with M.D. Honours, after which he went on to per-form his residency at the Toronto Hospital. He is a memberof the American Academy of Cosmetic Surgery, the Inter-national Society of Hair Restoration Surgery, member of theAmerican Society of Hair Restoration Surgery, Italian Soci-ety of Hair Restoration Surgery, the Ontario Medical Asso-ciation, the College of Physicians and Surgeons on Ontario,and the Canadian Medical Association.Dr. Antonio Alvi Armani has won numerous awards in-cluding the: J.W. Billes Admission Scholarship, University ofToronto, W.K. Mc Gillis Trophy, Gold Medallist, Yetive HeardMemorial Trophy and Steven Clarfield Trophy, Italian Soci-ety of Hair Restoration Surgery Award, Toronto Sun Read-ers Choice Award 2002, for Best Cosmetic Surgeon, XTRAMagazine Readers Choice Award 2002 for Best CosmeticSurgeon.He has written articles and books on various aspects of hairloss, dieting, weight loss and fitness, and is conducting clini-cal research in the fields of hair transplantation and clon-ing of hair.
4. to my patientswho have allowed me to assist them
5. Acknowledgments I owe gratitude to many people who along the wayof my career have helped in supporting and guiding mywork. I cannot possibly list all those who deserve creditbut I must mention the names of a few that have beenmost instrumental in producing this book. I owe special gratitude to my main mentor in thefield of hair loss Dr. Dow B. Stough Jr. Dr. Stough trainedme in hair transplantation surgery and was the majorinfluence in my development as a hair loss surgeon.Dr. Stough has produced a masterful reference bookthat have been a constant source of reliance to me. Ithank him for this. I must also thank the following individuals who haveprovided technical assistance in the production of thisbook: Dr. Shaheen Azmi who edited it and helped to de-velop its design; Fernando Andrejin who photographedthe pictures and was a constant source of technicalassistance; and Alex Vasolla who drew its illustrations. Last but not least I must thank my parents and familymembers who have nurtured me and who have alwaysbeen there to support me in my every venture.
6. Table of ContentsIntroductIon ........................................ 1SectIon 1: KnowIng your type of haIr loSS ......... 5chapter 1: genetIc haIr loSS ................................................ 6chapter 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 ¨ 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 ........................................34SectIon 2: treatment for genetIc haIr loSS ....... 39chapter 1: medIcal treatment ...................................... 41 a. rogaIne .............................................................................41 b. propecIa .............................................................................44 c. comparIng rogaIne and propecIa .........................................47 d. other emergIng drugS ..........................................................52chapter 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
7. 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 ...........................................182chapter 3: alternatIve treatmentS ............................... 192chapter 4: haIr replacement treatment .......................... 200SectIon 3: about your haIr......................... xxchapter 1: anatomy of the haIr and haIr follIcle .................. xxchapter 2: ruleS for good haIr care .................................... xxa fInal recommendatIon ....................xxappendIx a: Sample conSent form ..........................xxappendIx b: Sample pre-operatIve InStructIonS ........xxappendIx c: Sample poSt-operatIve InStructIonS ......xxgloSSary .........................................xxIndex ...............................................xx
8. KNOWING YOUR TYPE OF HAIR LOSS 5 1 knowing your type of hair loss1. genetic hair loss ................................ 62. 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 ¨ 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
9. 6 KNOWING YOUR TYPE OF HAIR LOSS The first thing everybody with hair loss must know iswhat type of hair loss they have. Some people suffer fromcertain types of hair loss that are temporary, which may resultfrom a variety of causes. While these may be very stressful,many of these ailments can be corrected without resorting tomajor treatments. On the other hand, most men and womenwho suffer from hair loss are predisposed to genetic patternhair loss. This type of hair loss is hereditary and progressive.Many people who suffer from this turn to medical, surgicaland alternative treatments to combat their hair loss. In this chapter, you will learn about the different typesof hair loss so that you may classify your own type and beginthe 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 yourprofessional by providing accurate and relevant informationabout your hair loss based on the information that you findhere.NOrMal haIr lOSS Normally, each person will have around 100, 000hairs on his or her scalp at any given time. Some of thesehairs routinely take a rest from growing every few years andeventually fall out. These same hairs re-grow from their roots.as a result, the average person can expect to shed 50 to 100hairs everyday. however, this type of normal hair loss shouldbe spread out over the whole head and should not result inany balding or excessive thinning of hair on any particularpart of the scalp.aBNOrMal haIr lOSS abnormal hair loss is the falling out of excessive hairthat leads to unusual thinning or balding at specific spotson the head, which is probably the type of hair loss you areexperiencing. Medical professionals call abnormal hair lossalopecia. alopecia can be caused by many factors but the
10. KNOWING YOUR TYPE OF HAIR LOSS 7most common factor is your own genes, meaning that youinherit the tendency to lose your hair. This type of alopeciaaffects over 95 per cent of all cases of balding or thinninghair for both men and women. This type of genetic hair lossis given many names, including “male pattern baldness” or“female pattern baldness” because of the consistent patternthat the hair loss tends to follow in both men and women. Itsmedical term is “androgenic alopecia” because it is believedthat hereditary hair loss is associated with changes in theamount 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 doesnot suggest that it only applies to one sex or the other. It is important to remember that your hair loss may bethe result of a combination of factors. Other factors mayspeed up or increase your hereditary balding. Keep this inmind because it is a major error that many people makewhen determining their own type of hair loss and respondingto it. That being said, since hereditary balding is the mostcommon type of hair loss, I will be discussing it first, followed bya brief discussion of the other types of abnormal hair loss.ChaPTEr 1: GENETIC haIr lOSShOW COMMON IS IT? Genetic hair loss affects almost 50 per cent of allmales and almost 40 per cent of all females as they age.This means that if people lived long enough, almost halfof the population would show significant hair thinningor balding. Some ethnicities are more affected thanothers are. People with European origins show morehereditary tendency to hair loss than other ethnicities,though other groups are affected to a degree as well.
11. 8 KNOWING YOUR TYPE OF HAIR LOSSHOW dOES IT OCCur aNd CaN IT BE CurEd? like so many ailments that afflict us, medical professionalsare not certain as to what directly causes genetic hair loss.It is something that is programmed into your genes, but whatcauses the genes to act and what they cause your body todo, it not entirely known. as a result, there is no sure, full-proofcure for this kind of hair loss that we know of. researchershave different theories about the way genetic hair loss worksand they are working on various possible solutions based onthese clues. The most common explanation for how genetic hair lossworks suggests that it works through a complicated chemicalprocess operating in your body. Most researchers associateit with the chemical changes that occur with the malehormone testosterone as you age. Both men and womenhave this male hormone but the level of testosterone isdifferent for the sexes and changes with aging. There arealso other chemicals, which react with testosterone, thatchange as you age and may influence hair loss. Because most researchers believe that genetic hair lossis caused by chemical reactions in your body, most of theresearch being done in the field has focused on findingchemicals that can reverse the chemical causes of genetichair loss, and then forming them into medical drugs suitablefor usage. recent discoveries have found that an enzyme called“5-alpha reductase” is excessively produced by the hairfollicles of people with genetic hair loss. The enzymecombines with testosterone, one of the male hormonespresent in both men and women, to form a new chemicalcalled “dihydrotestosterone” (dhT), which is known to causehair to fall out. This chain of chemical reactions is one amongmany possible chemical chains that researchers are currentlyinvestigating in relation to genetic hair loss. In the last few years, researchers have been working onmany different drugs for combating genetic hair loss, but sofar only two have shown success in doing so. This first drugis called minoxidil, and it is currently being marketed by the
12. KNOWING YOUR TYPE OF HAIR LOSS 9upjohn Company under the name rogaine as a topicalsolution for both men and women. The second drug is calledfinasteride, and it is currently being marketed by Merck & Co.under the name Propecia in a tablet form for men only. Theadvantages and drawbacks of both these drugs, along withother drugs that are being tested and that show promise,will be outlined later in the chapter on medical treatmentsfor hair loss.WhaT dOES IT lOOK lIKE? Males with genetic hair loss often become at least partiallybald and the hair loss follows particular patterns. The mostcommon pattern of genetic hair loss for men is characterizedby a thinning of hair at the hairline and/or the crown area.Over time, the thinning expands, receding from the hairlineand in a circular fashion from the crown, until the two areas ofbaldness meet in the middle. The final result is a completelybald scalp except for a strip of hair along the back of thehead above the nape of the neck. Though this is the most common pattern that male patternbaldness follows, there are many other variations as well.Norwood’s classification describes this most common patternbut it is somewhat limited in addressing the other possibilities,including the one that applies to women. In the followingsection, I will outline the new patterns of genetic hair loss thathave been identified, giving you a better understanding ofthe variety of ways in which genetic hair loss occurs. Norwood’s classification has been used to classify malepattern hair loss for many decades and has been usefulin many cases. however, it is not complete. Norwood’sclassification only describes one pattern of male genetichair loss on a scale of seven degrees of severity. Therefore,a reclassification of genetic pattern hair loss is necessary toaccount for the other possible patterns of male and femalegenetic hair loss.
13. 10 KNOWING YOUR TYPE OF HAIR LOSS Genetic Pattern Hair Loss. Progression of hair loss for men according to Norwood’s classification Alternative male 1 patterns 2A 2 3 3A 3v 4 5A 5 6 6A 7
14. KNOWING YOUR TYPE OF HAIR LOSS 11Another depiction of the progression of genetic pattern hair loss according to Norwood’s classification 1 2 3 3 Vertex 4 5 6 7
15. 12 KNOWING YOUR TYPE OF HAIR LOSS Another depiction of genetic patterns of hair loss according to Norwood’s classification 3A 4A 5A 6A 7A
16. KNOWING YOUR TYPE OF HAIR LOSS 13Progression of hair loss for womenaccording to Ludwig’s classification
17. 14 KNOWING YOUR TYPE OF HAIR LOSSdrug-related hair lossMany prescription drugs can cause varying degrees ofhair loss for some people. It is likely that you have seencancer patients who have lost hair after undergoingchemotherapy. In fact, most cancer-fighting drugs Class 1 Class 1 Class 3 mild to mild hair moderate no hair loss hair loss loss Pattern 1 Pattern 2 Pattern 3 Pattern 4 Pattern 5
18. KNOWING YOUR TYPE OF HAIR LOSS 15cause hair loss. In addition, close to 300 more commonlyemployed drugs are known to be associated with hair loss.drugs commonly associated with hair loss Class 4 Class5 Class 6 Class7 mild to mild to large complete moderate large hair loss hair loss hair loss hair loss
19. 16 KNOWING YOUR TYPE OF HAIR LOSS New classification of genetic hair loss: Pattern 1 Examples of pattern 1 genetic hair lossNorwood’s traditional pattern where hair loss progresses fromthe back and the front, and meets in the middle.
20. KNOWING YOUR TYPE OF HAIR LOSS 17 New classification of genetic hair loss: Pattern 2 Examples of pattern 2 genetic hair losshair loss progresses only from the front hairline and recedesbackwards while maintaining the crown area.hair loss occurs mainly in the crown area and moves forward.
21. 18 KNOWING YOUR TYPE OF HAIR LOSS New classification of genetic hair loss: Pattern 3 Examples of pattern 3 genetic hair lossThe frontal hairline remains intact.“ludwig’s Pattern of hair loss” – Commonly seen in female
22. KNOWING YOUR TYPE OF HAIR LOSS 19 New classification of genetic hair loss: Pattern 4pattern hair loss, though it occurs in men as well. hair lossstarts 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
23. 20 KNOWING YOUR TYPE OF HAIR LOSS Examples of pattern 4 genetic hair loss in a female Examples of pattern 4 genetic hair loss in a male
24. KNOWING YOUR TYPE OF HAIR LOSS 21 New classification of genetic hair loss: Pattern 5 Examples of pattern 5 genetic hair lossfrom the Mediterranean and the Middle East, although itdoes occur in other ethnic groups as well. hair loss begins atthe two temples and moves in a circular pattern backwards,leaving a small forelock of hair at the frontal hairline.
25. 22 KNOWING YOUR TYPE OF HAIR LOSS 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.
26. KNOWING YOUR TYPE OF HAIR LOSS 23FemALe ANdRoGeNIC ALoPeCIA (FAGA) As has already been discussed, women can suffer fromgenetic pattern hair loss just like men do and both forms of genetichair loss are caused by similar chemical factors. The difference isthat it is much less common for women than it is for men, and thehair loss follows a different pattern. Women with female genetichair loss tend to experience a progressive thinning of the scalphair only around the crown area. It is also usually more diffuseand central than male genetic hair loss; and it is often referred toas a ‘widened part’. Less commonly, women may have a recedinghairline similar to that seen in balding men. It is unlikely thatfemale genetic hair loss will result in total baldness, though it doesoccur. Aside from female genetic hair loss, there are other waysthat women may suffer from hair loss that will be discussed in thenext chapter. Female pattern baldness frontal view Female pattern baldness top view
27. 24 KNOWING YOUR TYPE OF HAIR LOSS 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.
28. KNOWING YOUR TYPE OF HAIR LOSS 25Chapter 2: OThEr TYPES Of aBNOrMal haIr lOSS hair loss can be triggered by many factors other thangenetic predisposition. While these other types of hair lossonly make up five per cent of abnormal hair loss cases, theycan be more severe in their effects. however, the goodnews is that these other types outlined below are almostalways temporary or are often treatable. I will briefly discusseach of these common types of hair loss as well as the maintreatments usually given for them.dIET-rElaTEd haIr lOSSProtein: There are a number of nutritional deficiencies thatcan cause hair loss by altering your hair’s structure or haircycles. among these, protein deficiency is one of the mostcommon. Your hair is composed mostly of proteins, the samematerials that your nails are composed of. If your food doesnot provide you with enough protein then both your nailsand your hair may be negatively affected. Protein is foundin common foods like meats, poultry, fish, beans and dairyproducts. If a protein-deficient diet persists then your hairwill go into a premature resting stage and will start to fall outwithin a few months. unfortunately, many people simply donot eat well, or they become caught up in some fad diet.The kinds of things to watch out for are poor eating habitsthat lack in protein, vegetarian diets, or fad diets that restrictthe amount of protein you consume.Iron: another possible cause of diet-related hair loss is alow level of iron in your blood, which might result from aninadequate amount of iron in your diet. foods that arecommon 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 resultfrom some difficulty your body has in absorbing iron, whichis commonly linked with the condition anemia.
29. 26 KNOWING YOUR TYPE OF HAIR LOSSVitamin A: another nutrient that can affect your hair isvitamin a, which can be found in whole eggs, milk and liver.Both an inadequate and an excessive amount of vitamina can cause hair loss. Too little of this vitamin can resultin a condition called hyperkeratosis. It occurs in your hairfollicles and in the sebaceous glands (the small glands inyour skin that secrete oil into your hair) and it can complicatehair growth. Conversely, too much vitamin a can preventproper keratinisation (the process by which a protein calledkeratin builds your hair and nails), resulting in a kind of hairloss referred to as ‘toxic alopecia’. Other nutritional deficiencies that can affect your hairgrowth include deficiencies of: essential fatty acids, zinc,copper and vitamin C. fortunately, the damage done tohair by this type of diet-related hair loss is only temporaryand can be corrected by simply improving your diet. Yourdietary history is one of the first things a medical doctor whospecializes in skin and hair would ask when assessing your hairloss problem. Before considering anything else, you shouldassess your own diet in relation to any hair loss problems youmay be experiencing.druG-rElaTEd haIr lOSS Many prescription drugs can cause varying degrees ofhair loss for some people. It is likely that you have seen cancerpatients 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 tobe associated with hair loss.drugs commonly associated with hair loss: Birth control pills heart disease and high blood pressure pills, especially betablockers and ace inhibitors, like captopril Blood thinners, like heparin drugs for gout and arthritis, like allopurinol
30. KNOWING YOUR TYPE OF HAIR LOSS 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, likeisotretinoin 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, inaddition to your dietary history, before diagnosing hair lossproblems. Even drugs that are not currently associatedwith hair loss may cause you to lose hair, so you should takeyour drug consumption history into consideration no matterwhat. fortunately, drug-related hair loss is easily treated bysimply 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 notcause you to lose your hair.dISEaSE-rElaTEd haIr lOSS There are dozens of diseases and conditions that canresult in some type of hair loss. In this section, I will outlinethe major classes of diseases that cause hair loss, the kindof hair loss that they cause and possible treatments that areavailable. Since so many common ailments and conditions cancause you to lose hair, your recent and long-term health
31. 28 KNOWING YOUR TYPE OF HAIR LOSShistory is one of the first things a medical doctor wouldquestion when assessing a case of hair loss. You should alsoquestion your own medical history to determine if disease isa factor in your own hair loss.Skin diseases of the scalp There are a number of different conditions that canaffect the scalp and cause varying degrees and types ofhair loss. These include: infections like syphilis and ringworm;infestations like pediculosis, which is caused by lice;inflammatory diseases like folliculitis; genetic diseases likedarier’s disease and other syndromes of the skin like psoriasis.The hair loss in each case is usually only partial and can betreated.Ringworm: ringworm is a contagious disease that is causedby the infection of fungus. It results in small, scaly patcheson the skin and, when it occurs on the scalp, is also followedby a loss of hair. It can be treated effectively with a topicalsolution.Darier’s disease: darier’s disease is a genetic disordercharacterized by dark, crusty patches on the skin, sometimescontaining pus, which results in the hair becoming rough anddry with patches of baldness.Psoriasis: Psoriasis is a chronic skin disease characterized byscaling and inflammation. It is a disorder of the immunesystem that occurs when cells in the outer layer of the skinreproduce faster than normal and pile up on the skin’ssurface. The hair loss is reversible with treatment.Telogenic and anagenic alopecias To understand this type of hair loss, you first need tobe familiarized with the hair growth cycle. all human hairsgo through a natural cycle beginning with growth, calledthe anagen phase, followed by a period of rest, called the
32. KNOWING YOUR TYPE OF HAIR LOSS 29telogen phase, and ending with the hair falling out. Whenonly the hairs that belong in a particular phase fall out, we callthis either anagenic alopecia or telogenic alopecia. dozensof factors can cause either of these alopecias, includingstress, chronic diseases and nutritional deficiencies. Many ofthese different factors send anagen hairs prematurely intothe resting stage and result in excessive shedding monthsafter. This is called telogenic alopecia. In this section we willdiscuss some of the more common telogenic and anagenicsyndromes.Loose anagen syndrome: This condition generally affectsyoung, Caucasian blonde girls, although anyone issusceptible. The characterizing symptom is the ability ofanagen hairs (hairs that are in the anagen, or growth, stageof the hair cycle) to be pulled out easily and painlessly. Inchildren ages 2 to 5 years with loose anagen syndrome, thehair is usually unable to grow past the ears, though the densityis otherwise unremarkable and the hair is not particularlyfragile otherwise. Treatment is usually unnecessary becausealthough loose anagen hair grows slowly, it does grow andif it is accidentally pulled out, it grows back quickly.Pregnancy and childbirth: The stress of childbirth, similar tothat of a severe fever or chronic illness, can prematurely pushanagen hairs into the resting stage, resulting in excessiveshedding some months later. hormonal changes that occurduring 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 healthypeople with good eating habits, no notable diseases orinjuries to the scalp that can explain such a loss of hair.When this occurs, it is referred to as ‘alopecia areata’. Thisunpredictable but common disease affects 1.7 per cent ofthe world’s population. although it can affect men andwomen of all ages, onset most often begins in childhood.In most cases, the hair falls out in round patches all over the
33. 30 KNOWING YOUR TYPE OF HAIR LOSSscalp and body. In some extreme and rare cases, the hairloss may lead to a complete loss of hair all over the head andbody. alopecia areata that causes complete hair loss of thescalp is called ‘alopecia totalis’ and when it causes hair lossover the whole body it is called ‘alopecia universalis’. It is believed that alopecia areata is caused by theimmune system unexpectedly, and usually temporarily,attacking the hair follicles, causing them to fall out andpreventing re-growth in some cases. however, it is not knownwhy this occurs. Cases of alopecia areata usually disappear on theirown 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 thatinterfere with the immune system) have been found to beeffective in combating alopecia areata. although alopecia areata is not life threatening, it isso dramatic in its effects that it often damages the mentaland emotional states of its victims. for this reason, manysupport groups have been established to help people copewith alopecia areata. You can find a local support group inmost countries around the world by contacting the Nationalalopecia areata foundation via their website at www.alopeciaareata.com.Thyroid diseases Your thyroid gland resides in your neck and isresponsible for producing hormones that are involved inmany of your body’s functions, your metabolism in particular,making its proper functioning vital to your overall health. hypothyroidism occurs when your thyroid is under-active, meaning it is producing inadequate amounts ofhormones. When this occurs, there is a slight shedding ofthe hair on the scalp, and possibly of the armpits and pubicarea. an under-active thyroid gland may become enlargeddue to a bombardment of thyroid-stimulating-hormones (TSh)produced by the pituitary gland, which occurs in order to
34. KNOWING YOUR TYPE OF HAIR LOSS 31entice the thyroid to produce more hormones. The result isthe creation of ‘goiter’. The most common cause of hypothyroidism is aprevious (or ongoing) inflammation of the thyroid gland thatleaves a large percentage of the gland’s cells damagedor dead. This kind of inflammation is most likely the result ofautoimmune thyroiditis, which is caused by the patient’s ownimmune system. hypothyroidism may also be caused bycertain medical treatments that, indirectly or directly, affectthe thyroid gland. The hair loss that results from thyroid disease canbe reversed by treating the condition that is affecting thethyroid gland. There are many other symptoms of thyroiddisease, including fatigue, weakness, weight gain, dry skin,intolerance to the cold, constipation, memory loss, muscleaches and/or depression. The proper functioning of yourthyroid gland is very important and is worth seeing a medicaldoctor if you think you may be experiencing some or all ofthese symptoms.Psychiatric and psychological diseases The most common type of psychological conditionthat can cause hair loss is stress. Excessive stress can causetelogenic alopecia, which is described above.Anorexia nervosa: anorexia nervosa occurs when someonerestricts their diet to such a degree that there are nutritional,endocrinal and psychological impairments. The hypocaloricdiet (meaning there is an insufficient amount of caloriesbeing ingested) may result in a loss of hair. This may also beaccompanied by an increase in lanugo (the fine, light hairsthat cover the body) on the face, trunk and arms.Cancer-related hair lossNeoplasic alopecias: This term refers to hair loss that resultsfrom cancer spreading from one area of the body to thescalp. The word ‘neoplasic’ comes from the word ‘neoplasm’,which means ‘tumor’.
35. 32 KNOWING YOUR TYPE OF HAIR LOSSThe susceptibility of the scalp to neoplasic alopecia ishigher for women with breast cancer and for men with lungcancer in particular, as opposed to other types of cancer.It is believed that mucines, a certain kind of protein createdby breast and lung carcinoma, degenerate the cells of theouter root sheath of the hair follicle. however, not all casesof breast or lung cancer will cause hair loss. Ovarian and adrenal tumors are also likely to causehair loss. Both types of tumors can cause hyperandrogenism,which is the excessive production of androgens (malehormones). androgens are known to play a key role in maleand female pattern baldness. Once the tumor has beenremoved, however, the hair loss should go away.Cancer-fighting drugs: Most cancer-fighting drugs, likechemotherapy, attack the body, including the hair follicles,and cause considerable hair loss. The hair should grow backafter the treatment has stopped.Saha syndrome Saha syndrome is a skin condition that only affectswomen and is caused by hyperandrogenism, which is theexcessive production of male hormones (androgens) andwhich occurs in the whole body (cases of hyperandrogenismaffecting only particular parts of the body are considereddifferent conditions). The four main symptoms of this syndrome make up theacronym ‘Saha’: seborrhea, acne, hirsutism and alopecia.These four manifestations appear in this order, although not allwomen suffer from all of them. all sufferers of Saha syndromedo experience seborrhea, however. Seborrhea is a skin condition characterized byinflammation, dry or oily scaling, crustiness and/or itching. Itis 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 partof the condition because the increased sebum productionthat causes acne in this case is caused by androgenicaction. hirsutism, the third symptom, is the excessive growth
36. KNOWING YOUR TYPE OF HAIR LOSS 33of male-pattern hair in women, also caused by an increasein androgens. The hair loss that accompanies Saha syndrome is alsocaused by excessive amounts of androgens and results intypical female pattern baldness. a uniform clearing of thescalp of the crown occurs, though total alopecia is unlikelyand the frontal hairline remains intact. Treatment of Saha syndrome includes several drugoptions, 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 assimple as physical stress being put on the hair, the destructionof the hair follicles themselves or excessive amounts of hairbeing pulled out of the scalp. In these cases, we say that thehair loss is due to ‘external injuries to the scalp’ as opposedto a skin disease or disorder.Cicatricial alopecias hair loss may occur due to the destruction of the hairfollicle. In this case, the skin of the scalp is somewhat likescar tissue and is therefore unable to produce hair, meaningthat the hair loss is permanent and the only option is surgicaltreatment. This destruction of the hair follicles can result frommechanical, physical or chemical trauma (which mayinclude the use of acids, chronic traction, electrical or thermalburns, or freezing), as well as tumors, special skin diseases orsevere infections such as syphilis. The destroyed hair folliclesmay not necessarily cover the entire scalp, depending onthe method and type of damage. again, the only optionfor this kind of hair loss is surgical treatment.Trichotillomania hair loss among children can occur as a result of
37. 34 KNOWING YOUR TYPE OF HAIR LOSSa usually unrecognized behavioral disorder known astrichotillomania. It is characterized by uncontrollable hairpulling, similar to impulsive disorders such as pyromaniaor kleptomania. The disorder usually appears in males atthe age of 8 and in females at the age of 12 and has aprevalence of about one per cent. Sufferers of trichotillomania generally spend aboutone hour per day pulling their hair out. This can last for a fewseconds or minutes, or it may last for prolonged periods oftime. Some may try to resist the urge, while some are unawareof its occurrence, pulling hair absent-mindedly while driving,reading or watching television. While the disorder itself is a stressful condition, the hairloss that results is an unfortunate additional complication thataffects many children and teenagers psychologically andemotionally. The hair loss that occurs is usually focused on thescalp, but it may also occur among the eyebrows, eyelashesand pubic region. hair loss is usually patchy, irregularly-shaped and occurs most often on the side of the body thatcoincides with the person’s predominant hand. Most sufferersof trichotillomania are likely to feel embarrassed aboutthe disorder and may try to hide their hair loss, prolongingdiagnosis and complicating treatment. Treatment for trichotillomania involves behavioraltherapy and/or medication. Possible drugs include moodstabilizers, anxiolytics (drugs that work on the centralnervous system to relieve anxiety), neuroleptics (also knownas antipsychotics) and topical agents including steroids.however, behavioral therapy has been found to be moreeffective than drug therapy, especially if the hair pulling hasonly been occurring for less than 6 months and because thereare no clear guidelines for how drugs should be used to treattrichotillomania. With therapy, sufferers of trichotillomaniacan overcome this disorder and resume their normal liveswithout 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.
38. KNOWING YOUR TYPE OF HAIR LOSS 35unfortunately, there are many styling habits and treatmentsthat are bad for the overall health of your hair and thatpromote hair loss. hairstyles that require unusual pulling, dyingor conditioning may severely stress the natural workings ofyour hair and may lead to unusual balding. When a high degree of physical stress is constantlybeing put on the hair for styling purposes, hair loss may occur.This condition is referred to as ‘cosmetic alopecia’. It is usuallycaused by the constant use of curlers, brushes and othertools used to style hair as well as hairstyles that pull the hair.The alopecia appears as a slight shedding of the hair andoccurs because the strain that the hair is put under leadsto reduced blood flow in the capillaries at the bottom ofthe hair follicles. The hair’s growth is stunted and eventuallyleads to a slight loss of hair a few months later. This usuallyaffects the triangular areas above and in front of the ears,though it is dependant on the direction in which the hairstyleis aimed. It is also possible to damage the hair follicles and/or the scalp itself with the constant use of chemicals usedto curl or dye the hair. In most cases of cosmetic alopecia,the reduced blood flow that causes the hair loss disappearsafter the pressure is removed, although the shedding maytake a few months to return back to normal.
39. 36 KNOWING YOUR TYPE OF HAIR LOSS 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.
40. KNOWING YOUR TYPE OF HAIR LOSS 37Julia B. : Losing hair because of HypothyroidismAge: 27Occupation: HomemakerJulia B. went to a clinic complaining of fatigue, increase inweight, and sparse hair on the scalp and on the eyebrows. Shewas not taking any medications. Julia had no family historyof hair loss. Physical examination showed dry skin, diffusehair 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 thethyroid gland). often such a condition causes the unusual lossof hair not only on the scalp but on other parts of the body.Julia was started on a thyroid replacement medication. In sixmonths not only was her hair restored to normal, but Juliafound herself less fatigued and in better overall health.
41. 38 KNOWING YOUR TYPE OF HAIR LOSS 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.
42. KNOWING YOUR TYPE OF HAIR LOSS 39 Many people with other types of hair loss aggravatetheir situation by poor hair care habits. for example, thereare many genetically balding people who are losing morehair than they should be and at a faster rate because ofpoor hair care habits. In these cases, people can forestallthe appearance of baldness for years by maintaining goodhair care. You can learn how to properly take care of your hairand prevent, or forestall, the appearance of balding later inthis book in the section regarding ‘rules for good hair care’.
43. 2 treatment options for hair loss1. medical treatment ...........................41 a. rogaine (minoxidil) ................................................... 41 b. propecia (finasteride) ................................................ 44 c. comparing rogaine and propecia ............................. 47 d. other emerging drugs ............................................... 522. 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 ................................ 1823. alternative treatment ....................1924. hair replacement treatment ............200 39
44. 40 DRUG TREATMENTS FOR HAIR LOSS Over 90 per cent of all hair loss cases fall under the categoryof genetic hair loss. For this reason, all the treatment optionsdiscussed in this section, with the exception of hair replacementtherapy, are meant only for the treatment of genetic hair loss. Forall other types of hair loss, you should contact a qualified medicaldoctor to discuss treatment options. And while this section is meantto guide you in treating your hair loss, you should always contacta medical doctor before beginning any treatment program.
45. DRUG TREATMENTS FOR HAIR LOSS 41 chapter one: medical treatment The treatment of genetic hair loss with medication,taken either orally or applied topically on the scalp, haslong been the dream of people suffering from this type ofhair loss. But until recently this hope has been nothing but adream. During the last couple of decades researchers havebeen developing two drugs that have proven effective incombating genetic hair loss. First the drug minoxidil, which isnow marketed as Rogaine, was approved by the Food andDrug Administration and later on the drug finasteride, whichis now marketed as Propecia, was also approved for use infighting genetic hair loss. There are also many other drugs and combinations ofdrugs that are now being tested and which may be availablein the coming few years. It should be noted, however, thatthere is always the risk of side effects with any medications.Also, it takes decades to completely understand the fulleffects of any drug and many of these drugs have not beenaround long enough to determine these full effects.RogAIne (mInoxIDIl) Rogaine was introduced as a new drug for promotinghair growth by the Upjohn Company in 1988. It is sold as atopical solution, which means that it is a rubbing solutionmeant for the balding areas of your scalp. It comes in eithera 2 per cent or a 5 per cent solution depending on how much
46. 42 DRUG TREATMENTS FOR HAIR LOSSminoxidil the solution contains. Rogaine is available over thecounter and should be applied on the balding area(s) twicea day, every day.How does Rogaine work? Although there is only a small percentage of minoxidilin Rogaine, it is this drug that makes it work. minoxidil is knownas a hair growth stimulator. It was originally marketed in atablet form for the treatment of high blood pressure andunwanted 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 recognizesthat Rogaine works, it is well known that it doesn’t work foreveryone. Recent studies show that when the 2 per centsolution is used properly, it can stimulate hair growth 30 percent of the time, with a slightly higher rate in females. And thenew 5 per cent solution has shown only slightly more successthan the weaker solution. Rogaine is most effective when used at the first signsof balding and in relatively small areas of hair loss. It is alsomore effective in the center of the scalp than on the frontalhairline. Rogaine can inhibit further hair loss and can be usedto supplement hair transplantation. It should be noted, however, that if you stop usingRogaine you will lose any hair re-grown while you wereusing it. This means that once you start using Rogaine, youmust continue to use it for the rest of your life to enjoy itsbenefits.Are there any side effects to using Rogaine? every drug has some side effects. In the case ofRogaine the drug that makes it work, minoxidil, has adangerous effect on the body (and the heart in particular) if
47. DRUG TREATMENTS FOR HAIR LOSS 43taken orally. When it is diluted in a solution for topical use, asit is in Rogaine, the side effects are less severe because theamount of minoxidil entering the body is much less. However,even in small doses the use of minoxidil does have some minorand major side effects that should be noted.Minor side effects: These include skin irritations on the scalpsuch as dry red skin, flaking and itching; nausea and vomiting;and diarrhea. These are short-term, temporary side effectsthat should go away when your body adjusts to the use ofRogaine.Major side effects: These include back and chest pain;cold-like symptoms; rapid heartbeat; fluid retention; difficultybreathing; weight gain; worsening of hair loss. These are veryrare, extreme side effects that are similar to the effects ofminoxidil taken orally. Also, Rogaine is not safe for people who: Show allergicreactions to minoxidil; have heart disease; have high orlow blood pressure; have skin diseases like dermatitis; arepregnant; or who are nursing mothers.What improvements can we expect in the near future? The most likely advancements in the use of Rogainewill come from two different approaches:Increasing the amount of minoxidil: like the addition of the5 per cent solution to the 2 per cent solution, researchershave been trying to improve the effectiveness of Rogaineby increasing the amount of minoxidil in the solution.Increasing the ability of minoxidil to enter the skin: Researchershave also been trying to make Rogaine more effective byincreasing the ability of the minoxidil in the solution to enterthe skin and cause hair growth. Tests have shown that if
48. 44 DRUG TREATMENTS FOR HAIR LOSSminoxidil is mixed with certain other substances it may beable to enter into the skin better and cause more effectivehair growth.Final recommendations for Rogaine only use Rogaine if your health is good, if you arewilling to test how it works for more than one year whileaccepting the possibility of failure, if you are disciplined intaking medications and following detailed instructions, andif you are prepared and able to pay to use Rogaine for therest of your life.PRoPeCIA (FInASTeRIDe) In late 1997, the Food and Drug Administrationapproved Propecia for distribution in the United States as ahair-restoring drug. It is sold by the company merck in 1 mgpill form by prescription only. It is the first pill that effectivelytreats genetic hair loss. The active agent in Propecia is a drug calledfinasteride. It was originally used in a prostate medicationcalled Proscar that was found to grow hair. Propecia is alower-dose form of Proscar developed specifically to fighthair loss. one of the main differences between Rogaine andPropecia is that Propecia should only be used by men. It isdangerous for women of childbearing age and can causesevere birth defects in women that have handled Propeciain any way. Possible dangers aside, Propecia does not workfor any women of any age.How does Propecia work? Finasteride is the active agent in Propecia. It worksby manipulating the underlying chemical causes of genetichair loss. We know that men with genetic hair loss haveincreased levels of a hormone called dihydrotestosterone
49. DRUG TREATMENTS FOR HAIR LOSS 45(DHT) in their scalps and it is believed that the presence ofDHT in the scalp is related to the thinning of hair follicles andthe resulting genetic hair loss. DHT is a by-product of the malehormone testosterone, which is converted to DHT when itreacts with a natural enzyme that is found in human skin cellscalled 5 alpha-reductase (5AR). Propecia does not directlycounteract DHT itself, but rather blocks the action of 5AR toindirectly 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 notas successful in stimulating new growth. Studies suggest that about 80 per cent of baldingmen can stop any further hair loss by taking Propecia. Inaddition, two out of three men may see some re-growth ofhair. However, Propecia only works for men who have mildto moderate hair loss. Balding men with major or completehair loss will not benefit from Propecia. Like Rogaine, Propeciais more effective in the center of the scalp and less so alongthe frontal hairline. Propecia must be taken for at least three monthsbefore seeing any results. Because hair generally grows at arate of about ½ an inch per month, it usually takes betweenthree to six months to see the full effects of Propecia. If there isno significant growth after 12 months it is unlikely that Propeciawill ever work. Also like Rogaine, Propecia is effective only for as longas it is taken. This means that all benefits of using Propeciawill be lost if you ever stop using it.Are there any side effects to using Propecia? Contrary to the dangerous effects that Propecia hason women, it is generally well-tolerated by men. The Foodand Drug Administration described Propecia as having onlyinfrequent side effects that affected only a small number ofmen.
50. 46 DRUG TREATMENTS FOR HAIR LOSSGeneral side effects: These include allergic reactions such asrash, hives, itching and swelling of the lips and face; breasttenderness and enlargement; and testicular pain.Sexual side effects: Less desire for sex, difficulty in achievingan erection; decrease in the amount of semen; and problemswith ejaculation. These side effects occurred in less than 2per cent of men and were only temporary. Some men in particular should not take Propecia.These include men who have allergies to finasteride or arelated drug or who have liver function abnormalities. menfor whom the noted side effects are unusually severe or long-lasting should only continue using it with caution and underthe direct guidance of a medical doctor. As has already been mentioned, Propecia is also notsafe for women and may cause severe birth defects. Womenshould not even handle broken or crushed tablets, althoughall Propecia tablets have a protective coating when intact.Also, men taking Propecia pose no danger to women or theirfetuses. Although there are no known dangers in mixingPropecia with other drugs, the use of this drug has been linkedto decreases in levels of prostate-specific antigen (PSA).Though this decrease is insignificant in itself, PSA levels areoften measured for diagnostic reasons in the case of mensuspected of prostate cancer or other prostate problems.Because of this, all patients taking Propecia, especially thosewith prostate illnesses of any kind, should inform their doctorsof 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 obtaininggreater results from its use.Using Propecia as a topical solution: one approach has been
51. DRUG TREATMENTS FOR HAIR LOSS 47to formulate finasteride as a topical solution, like Rogaine. Thisapproach is more common outside of the United States, butsome American companies are already selling finasteride inthis form. At this point, however, a topical form of finasterideremains experimental as there have been no clinical studiesthat have shown the effectiveness of a finasteride topicalsolution.Combining Propecia with Rogaine: It is believed by somethat Rogaine and Propecia can complement each otherby combining Rogaine’s ability to stimulate new growth withPropecia’s ability to prevent further hair loss. This, however,is a relatively new approach and little has been done in theway of scientific studies to verify its effectiveness.Final recommendations for Propecia Rogaine Propecia Comment About $30 USD About $50 to Rogaine is a Cost per month $60 USD per little cheaper Safe for both Safe for men men may sexes, except for only choose those with heart, either, but Safety women can blood or skin problems only use Ro- gaine Topical solu- Single tablet Propecia tion, twice a taken once ev- is easier to U s - day every day ery day continu- use but both continuously ously must be used for life
52. 48 DRUG TREATMENTS FOR HAIR LOSSCOmpAring rOgAine And prOpeCiA, COntinued Rogaine Propecia Comment extra strength Can help 2 Propecia is (5 per cent out of 3 men more effective solution) can regain minimal in preventing help 2 out to moder- further hair of 3 people ate amounts loss. Rogaine is regain minimal of hair in the more effective to moderate central bald- in stimulating amounts of ings areas new growth. effect- hair in the cen- of the scalp. Propecia i v e - tral baldings Almost 90 per shows results in areas of the cent effective less time than ness scalp. There is in preventing Rogaine. a 10 to 40 per further hair cent chance loss. There is that your hair a 30 to 60 per regrowth will cent chance be significant. that your hair It may take up regrowth will to one year to be significant. see full effects. It may take 3 to 6 months to see full effects. Temporary Temporary Side effects are side effects: side effects: rare with either skin irritations rash, hives, drug. long-term on the scalp; itching and effects are un- nausea and swelling of known for both vomiting; and lips and face; drugs. Side diarrhea. Rare breast ten- effects side effects: derness and back and chest enlargement; pain; cold-like testicular pain; symptoms; rapid sexual impair- heartbeat; fluid ment including retention; dif- problems with ficulty breathing; ejaculation weight gain
53. DRUG TREATMENTS FOR HAIR LOSS 49examples of crownal hair loss helped by propecia
54. 50 DRUG TREATMENTS FOR HAIR LOSS examples of crownal hair loss helped by propecia
55. DRUG TREATMENTS FOR HAIR LOSS 51Anterior mid-scalp hair loss helped by propecia
56. 52 DRUG TREATMENTS FOR HAIR LOSSoTHeR emeRgIng HAIR gRoWTH DRUgS Although Rogaine and Propecia are the only two drugscurrently approved by the Food and Drug Administrationto combat genetic hair loss, there are several other drugsthat have shown great promise in restoring hair loss. Theseare not likely to be miracle cures but they may be moreeffective 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 availablebesides Rogaine and Propecia. All of these drugs are stillbeing tested and some are being seriously investigated bylarge pharmaceutical companies that are investing millionsof dollars to make them work.Dutasteride Dutasteride is another 5 alpha reductase inhibitorlike the finasteride used in Propecia but it is currently beingmarketed as Avodart for the treatment of benign prostatichyperplasia. Researchers are trying to formulate a form ofdutasteride that can be used for the treatment of genetichair loss. Like finasteride, it will likely have side effects on malesexual functioning.Antiandrogens Antiandrogens are drugs that prevent androgens(male hormones) from working. These drugs have shown themost promise in being able to provide a cure for genetic hairloss, as androgens are known to play a key role in causingthis kind of hair loss. Antiandrogens are used to treat many differentailments and one of the side effects commonly seen duringtheir usage has been the stimulation of hair growth all overthe body. Because male hormones are important to the properfunctioning of many male bodily functions, possible sideeffects of using antiandrogens include impairment to male
57. DRUG TREATMENTS FOR HAIR LOSS 53physical characteristics and sexual desire and potency. Work has been done to develop antiandrogens thatare safe for men to use to combat hair loss while avoidingthe unwanted side effects. Finasteride, the drug in Propecia,is an example of one such drug because it does not directlyinhibit male hormones but rather inhibits an enzyme thatinteracts with male hormones. Because antiandrogens target male hormones,antiandrogens are generally safer for women. Since womenare less damaged by the side effects of antiandrogensthey are more effectively treated by them. In europe,antiandrogens have been officially used to treat genetic hairloss in women for years. one of the two drugs approved by the Food and DrugAdministration for the treatment of genetic hair loss is Rogaine,whose active agent minoxidil is not an antiandrogen. So itwould not be surprising to discover that the most effectivedrug treatment for genetic hair loss might emerge from atype of drug that is also not an antiandrogen. outside of the antiandrogens, there have beenseveral drugs that have shown some promise as a treatmentfor genetic hair loss. The most prominent of these that arecurrently being developed and tested include the drugs listedbelow. look for these drugs to emerge in the near future tocomplement Rogaine as a drug treatment for genetic hairloss.Tricomin The American pharmaceutical company ProCyte istesting this drug in France. It has shown some effectivenessin increasing new hair growth by 40 per cent for three outof four of the balding men who used it in testing. Tricomin isa compound chemical that helps restore the health of skintissue. The compound drug is applied on the skin like Rogaineand is believed to restore a healthy skin base for new hair togrow.
58. 54 DRUG TREATMENTS FOR HAIR LOSSCyclosporine In several scientific studies conducted over the lastfew years, this drug successfully re-grew hair for at leastsome of the balding men who used it in testing. It is a typeof drug called an immunosuppressive, meaning that itfights the body’s immune system. Immunosuppressives areusually given to patients to prevent organ rejection after akidney, liver or heart transplant. Some experts believe thatthe ultimate cause of genetic hair loss is the immune systemreceiving the wrong messages that hair on certain parts ofthe scalp are foreign to the body, causing the immune systemto attack them. In tests, cyclosporine was applied on the skin in thesame way as Rogaine. This is done to localize the suppressionof the immune system to the scalp and protect the rest ofthe body from the effects of the drug. The partial successof cyclosporine is fueling great interest in researching anddeveloping immunosuppressive treatments for genetic hairloss.Cyoctol This drug has shown enough promise for Squibb, amajor pharmaceutical company, to work on developingand testing it as a treatment for genetic hair loss. It isbelieved to combat hair loss by binding itself to the rootsof hairs and protecting them from the negative effects ofdihydrotestosterone (DHT), which is linked to genetic hairloss.Diazoxide The Food and Drug Administration is currently testingthis drug for approval. It is usually used to treat symptoms ofdiabetes, such as abnormally high blood sugar. When it isused orally for this purpose, it has the side effect of causinghair growth all over the body. Recent research on diazoxidehas been focused on developing it for treatment of genetic
59. DRUG TREATMENTS FOR HAIR LOSS 55hair loss by trying to control and direct the hair growth to thescalp.
60. chapter two: surgical treatment Like medical drug treatments, surgical treatments forhair loss have developed significantly in the last couple ofdecades. However, unlike medical drug treatments that arestill years away from being able to provide a full head of hair,recent advancements in surgical treatments have made itpossible to achieve the appearance of a full head of naturalhair. At this point in time, surgical methods are the surest andmost effective way for most balding people to restore naturalhair to a balding head.BAsic questions ABout surgicAL treAtmentsWhat are surgical treatments? There are several types of surgical treatment for hairloss. They all involve the movement of hair from areas of yourscalp that normally never go bald, such as the back and sidesof your head, to the balding areas of your scalp, usually thecentral area on top and the frontal hairline. What is important to recognize about all surgicaltreatments for hair loss is that no surgical method can giveyou new hair or restore any of your lost hair. They canonly redistribute what you still have. It is also important to 55
61. remember that surgical treatments for hair cannot preventfurther balding. When deciding to employ any surgicaltreatment you must consider the possible progression of yourhair loss as well as what you have already lost.Who is a good candidate for surgical treatment? Because surgical treatments of hair loss can onlymove existing hair from one area to another, it can only workproperly with people who have enough remaining hair tocover the balding areas, and who are likely to retain it forsome time. With recent advances in hair transplantationeven people who have lost up to 50 per cent of their haircan get the appearance of a full head of hair with surgicaltreatment. But even with less than half your hair left, you canstill benefit from hair transplantation and have your remaininghair redistributed in a way that looks natural and attractive.When is surgical treatment appropriate? there are several different situations in which hairtransplantation is the best method to treat your hair loss.To produce a natural hairline: A hair transplant is alwaysrequired to produce a natural looking frontal hairline. thefrontal hairline is the most important part of hair restorationbecause it is the most prominent part of your hair. Thecreation of a natural looking frontal hairline requires therestoration of a delicate pattern of hair lengths at variousangles, 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 canprovide the restoration of a full set of hair. small grafts of one,two or three hairs can be precisely placed amidst thinninghair to restore a natural looking density.To implant on scars left by surgical cuts to the scalp: scars leftfrom surgical cuts into the scalp or physical traumas can beeffectively concealed by transplanting hair into the scarred 56
62. skin tissue.What are the different types of surgical treatments? Currently, there are two methods of hair transplantationthat offer the best and most natural results possible. Theseare follicular unit strip surgery (FUSS) and follicular unit extrac-tion (FUE). Both the FUSS and FUE procedures involve the extractionof follicular units from a donor area on the head. Follicularunits are small groupings of one, two or three hairs that grownaturally on the scalp. These follicular units are taken fromareas on the head where hair is genetically programmednot to fall out. They are then implanted in the balding areasof the scalp, where the transplanted hair will continue togrow naturally. The FUSS and FUE procedures approach thismethod differently, but both provide exceptionally naturalresults and are by far the most popular methods with surgeonsand patients.How much does surgical treatment cost? The cost of hair transplantation can vary enormouslydepending on who is performing it. Typically a doctorwill transplant 1000 to 4000 grafts in one session that canlast anywhere from two to twelve hours. The cost of theprocedure is based on a price per graft. The grafts used inthe 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 graftsbeing transplanted, the cost of the procedure can run intothe thousands, but patients should remember that a hairtransplant is a permanent and life-long investment. 57
63. 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 self- image. Since his brother had also displayed signs of male pattern hair loss it was clear that Alex had genetically- related 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
64. SURGICAL TREATMENTS FOR HAIR LOSS 59 Ideal candidates for surgical hair transplantCrownalhair loss:top view
65. 60 SURGICAL TREATMENTS FOR HAIR LOSS Ideal candidates for surgical hair transplant Frontal and central hair loss: Front view Frontal and central hair loss: front view
66. SURGICAL TREATMENTS FOR HAIR LOSS 61 Ideal candidates for surgical hair transplantFrontal hair loss: Front view Frontal andcentral hair loss: Front view
67. 62 SURGICAL TREATMENTS FOR HAIR LOSS Ideal candidates for surgical hair transplant Temporal hair loss: front view Temporal hair loss: Side view
68. SURGICAL TREATMENTS FOR HAIR LOSS 63 Ideal candidates for surgical hair transplant Temporal hair loss:front view Temporal hair loss: side view
69. 64 SURGICAL TREATMENTS FOR HAIR LOSS Ideal candidates for surgical hair transplant Central hair loss: Front view Central hair loss: Side view
70. SURGICAL TREATMENTS FOR HAIR LOSS 65 Ideal candidates for surgical hair transplant Frontal andcentral hair loss: Top view Frontal andcentral hair loss: Side view
71. 66 SURGICAL TREATMENTS FOR HAIR LOSSFOLLICULAR UNIT STRIp SURGERy (FUSS) The FUSS procedure involves the extraction of follicularunits from narrow strips of scalp taken from donor areas onthe back and sides of your head. The removal of these stripsresult in virtually undetectable scars. The follicular units arecut out from these strips and implanted into the balding areasof your scalp in pin-sized, surgically created holes. These siteswill also heal in just a few days, leaving nostep three: making the grafts the strips of skin taken from the scalp are cut into smallgrafts. Each of the small units is called a graft because it isintended to be placed in the bald portion of your head whereit 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 preventdamage to the skin while making the holes needed fortransplanting into the bald areas of the scalp. First, anesthetic and extra fluids are injected into theskin, causing the surface area to increase. the needles areinserted into the skin to make the holes. With small enoughholes, there is no tissue damage.Step five: placing the grafts Each graft is carefully placed according to the planinto specified holes. Usually 1000 grafts are more implantedin a single transplanting session. Mega sessions may involvethe transplanting of 1500 to 4000 grafts in one session.FOLLICULAR UNIT ExTRACTION (FUE) The follicular unit extraction (FUE) method, like the
72. SURGICAL TREATMENTS FOR HAIR LOSS 67session that can be performed in a single day. Each of thesesessions of hair transplantation involves the following steps:step one: making a plan A careful plan is made to design and mark a hairtransplant map on the patient’s scalp. In making this plan,the hair transplant surgeon is using the principles that governa natural head of hair to design a transplant that will lookappealing and go undetected.step two: Harvesting the hair using local anesthesia, a small strip of skin is cut outfrom a selected hairy portion of your head. The selection ofthis area as a source of hair is based on a few considerations.First, the portion of the scalp to be stripped should not besusceptible to balding. Otherwise, the transplanted hairwould eventually fall out of its new location, defeating thepoint of the transplant. Also, the selected portion of thescalp should be selected on the basis that after stripping andharvesting the donor grafts follicular unit strip surgery (fuss)
73. 68 SURGICAL TREATMENTS FOR HAIR LOSSharvesting the donor grafts follicular unit strip surgery (fuss)
74. SURGICAL TREATMENTS FOR HAIR LOSS 69harvesting the donor grafts follicular unit strip surgery (fuss)
75. 70 SURGICAL TREATMENTS FOR HAIR LOSSFUSS method, involves the transplantation of follicular unitsfrom donor areas on the back and sides of the scalp to thebalding areas. The difference between the two is that theFUE procedure extracts follicular units directly out of the scalp,one by one, using precise instruments and a high-poweredmicroscope. 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.
76. SURGICAL TREATMENTS FOR HAIR LOSS 71The strip is removedfrom the donor area.The strip will be dis-sected into the follicularunits under a micro-scopeThe individual folliculargroups of 1, 2, and 3hairs will be transplant-ed to the balding area
77. 72 SURGICAL TREATMENTS FOR HAIR LOSS
78. SURGICAL TREATMENTS FOR HAIR LOSS 73transplantation has the advantage of requiring no majorsurgical excisions. But while the FUSS procedure allows a largenumber of follicular units to be removed from a single stripof scalp, a fewer number can be removed during a singlesession of the FUE procedure because each unit must beremoved one at a time. However, a session can be repeatedone or two days apart. The FUE method of transplantation is particularlygood for those who do not have a lot of hair in their donorareas, those who are afraid of the surgical aspect of hairtransplantation and for those who do not want any surgicalscars in the donor areas. Due to the lack of cutting involvedwith the FUE procedure, patients retain the option of wearingstep four: making small holes
79. 74 SURGICAL TREATMENTS FOR HAIR LOSStheir hair very short without worrying about the appearanceof minor scarring. The grafts used in the FUE procedure are thinner thanthe ones used in the strip technique. this is an additionaladvantage because grafts can be placed closer together,which means that more grafts can be implanted to maximizethe density of the transplant. Thinner grafts are also more Small gauge needles used to expand the recipient area for the grafts.
80. SURGICAL TREATMENTS FOR HAIR LOSS 75step six: Allowing the grafts to settle the grafts are left to settle in their new places andthe scalp is allowed to heal for several months. During thishealing process, the skin closes around the grafts. the hairfrom the transplanted grafts usually falls out as a result of theshock of transplantation. However, after a few months theroots of the hair usually recover and the hair re-grows.
81. 76 SURGICAL TREATMENTS FOR HAIR LOSSeasily inserted amidst thinning hair to improve densityand they reduce the effect of shock, which causes hairin the transplanted area to temporarily fall out after theprocedure.then the skin with the hair follicles was removed and cut intosmaller hair grafts.In the first operation 586 grafts from AA were transplantedin FA and in the second operation 594 grafts from FA weretransplanted in AA. the transplants were performed on thetemples of both subjects, giving us a clear observation of hairgrowth. Also, the identification of hair growth was facilitatedbecause AA’s hair was black and FA’s hair was brown.postoperative hair growth was measured at 9 months andat 14 months, and pictures were taken at different intervalsto monitor growth at various stages.* pictures of AA and FAResults: postoperative hair growth was measured at 9 monthsand at 14 months. At 9 months, 45 of the 586 grafts on FAwere considered surviving grafts. The number of survivinggrafts was not determined on AA. At 14 months there wereno surviving grafts on FA.* chart of resultsConclusion: This study shows that allo-hair transplants donot work in the traditional format. However, there is reasonto believe that the hair itself is not antigenic but the tissuesurrounding the hair follicle is the reason why the hairwas unable to survive. It will be necessary to introducemodifications to the method of transplantation to changethe structure of the surrounding skin so it does not rejectallo-transplanted hair follicles. if the antigenic nature of theskin can be limited, this may present a new approach to thesurgical treatment of hair loss.
82. SURGICAL TREATMENTS FOR HAIR LOSS 77harvesting the donor grafts follicular unit extraction (fue)
83. 78 SURGICAL TREATMENTS FOR HAIR LOSSharvesting the donor grafts follicular unit extraction (fue)
84. SURGICAL TREATMENTS FOR HAIR LOSS 79Follicular units are extracted with the use of
85. 80 SURGICAL TREATMENTS FOR HAIR LOSS Donor area for Follicular Unit Extraction (FUE) one day after surgery. Donor hair has been extracted one at atime.
86. SURGICAL TREATMENTS FOR HAIR LOSS 813 weeks post-Follicular Unit Extraction (FUE) surgery No scalpel, sutures or staples results in a donor area with no scars.
87. 82 SURGICAL TREATMENTS FOR HAIR LOSS 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
88. SURGICAL TREATMENTS FOR HAIR LOSS 83 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 extractedone-by-one and transplanted to the front of the patient’s head.
89. 84 SURGICAL TREATMENTS FOR HAIR LOSScomparison of fuss and fue methodsfollicular 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
90. SURGICAL TREATMENTS FOR HAIR LOSS 85comparison of fuss and fue methodsfollicular unit extraction: Individual follicular units are extracted one-by-one. No major scalpel surgery involved No suture or stapling involved No scarring involved
91. 86 SURGICAL TREATMENTS FOR HAIR LOSScomparing needles gauge for fuss and fue
92. SURGICAL TREATMENTS FOR HAIR LOSS 87comparing fuss and fue grafts
93. 88 SURGICAL TREATMENTS FOR HAIR LOSScomparing 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.
94. SURGICAL TREATMENTS FOR HAIR LOSS 89comparing advantages and disadvantages for fuss and fue Follicular Unit Follicular Unit Strip Surgery extraction (classic method) Generally limited to this method allows 750 to 1500 grafts per up to 3500 to 4000 day, though sessions Number can be repeated grafts to be trans- of grafts over 2 to 3 days in a planted in one session row for more grafts, up to 2500 to 3000 grafts major surgical component, large minor surgical com- excision and ponent with no major bleeding. Staples excision. skin closes Surgical or sutures are very quickly requiring compo- required for 1 to 2 no staples or sutures, weeks to close the meaning minimal opening, meaning surgical risks surgical risks Who those who do not medium to large is best wish to have any baldness suited scarring at all Aver- $5 to $8 USD/graft $10 to $25 USD/graft age
95. 90 SURGICAL TREATMENTS FOR HAIR LOSSGOALS OF HAIR TRANSpLANT SURGERynatural appearance The artistry of hair transplantation begins with the properdesign of the frontal hairline. It is vital that the hairline be de-signed to suit the patient’s face so that the transplant appearsnatural and goes undetected to the casual observer. The hairline must be carefully placed in relation to therest of the face to ensure this natural appearance. LeonardoDa Vinci’s formula for the face produces the best results forthis purpose. the formula is as follows: the distance from theeyebrows to the hairline is half the distance from the eyebrowsto the bottom of the chin. By following this formula, each hairtransplant should be unique and suited to the patient. Thismay be age-adjusted so that younger patients have lowerhairlines and older patients have slightly higher ones. A combination of follicular unit micro-grafting is the onlyway to perform the precise manipulations needed to pro-duce this natural-looking hairline. An irregular pattern of hairdistribution is created with a combination of one-, two- andthree-haired follicular units for a natural look. A soft frontalzone is made with single-haired follicular units and then thetransition to high density is made with the placement of two-and three-haired follicular units farther back. The crown and temples are other areas that must beproperly designed. If transplantation is needed in the crownarea, the hairs should follow the natural swirling pattern char-acteristic of this particular region. Also, the way the hairlinemeets the temples requires correct angling and blendinginto the rest of the hair behind the ears.
96. SURGICAL TREATMENTS FOR HAIR LOSS 91hairlines
97. 92 SURGICAL TREATMENTS FOR HAIR LOSS 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
98. SURGICAL TREATMENTS FOR HAIR LOSS 93In the following cases you will see pictures of the restoredhairlines of middle-aged men. The hairlines are generallyhigher and the temple angles remain open to better reflect theage of the patients. BeFOre AFTer
99. 94 SURGICAL TREATMENTS FOR HAIR LOSS BeFOre AFTer
100. SURGICAL TREATMENTS FOR HAIR LOSS 95One 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.
101. 96 SURGICAL TREATMENTS FOR HAIR LOSSMaximum density It is important that your hair transplant provide enoughdensity to cover the balding areas of your scalp. This shouldbe discussed in the initial consultation with your doctor asyour financial investment in your surgery is dependant onthis. the hair transplant surgeon can, and should, outlinethe density you should be able to achieve with a certainnumber of grafts. The average person, before the onset of balding occurs,has 100 to 200 follicular units per square centimeter of thescalp. For a hair transplant, a density of 50 to 80 follicularunits per square centimeter is optimal and is possible for anexperienced surgeon in a single session. Future sessions canbuild on this density. Follicular unit extraction (FUE) has contributedsignificantly to the achievement of greater density. Byextracting the follicular units one by one using the FUEtechnique the grafts are thin enough to pack them in closertogether 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.
102. SURGICAL TREATMENTS FOR HAIR LOSS 97natural density
103. 98 SURGICAL TREATMENTS FOR HAIR LOSSdistribution of densityregions 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)
104. SURGICAL TREATMENTS FOR HAIR LOSS 99the following pictures demonstrate densityin transplanted patients BeFOre IMMedIATeLy AFTer grAFTIng
105. 100 SURGICAL TREATMENTS FOR HAIR LOSSthe following pictures demonstrate densityin transplanted patients After transplant: 70 to 80 grafts per square cm
106. SURGICAL TREATMENTS FOR HAIR LOSS 101the following pictures demonstrate densityin transplanted patients BeFOre
107. 102 SURGICAL TREATMENTS FOR HAIR LOSSthe following pictures demonstrate densityin transplanted patients AFTer After transplant: 60 to 70 grafts per square cm
108. SURGICAL TREATMENTS FOR HAIR LOSS 103the following pictures demonstrate densityin transplanted patients BeFOre After transplant: 70 to 80 grafts per square cm AFTer
109. 104 SURGICAL TREATMENTS FOR HAIR LOSSthe following pictures demonstrate densityin transplanted patients BeFOre After transplant: 50 to 60 grafts per square cm AFTer
110. SURGICAL TREATMENTS FOR HAIR LOSS 105the following pictures demonstrate densityin transplanted patients BeFOre AFTer
111. 106 SURGICAL TREATMENTS FOR HAIR LOSSthe following pictures demonstrate densityin transplanted patients AFTer After transplant: 50 to 60 grafts per square cm AFTer
112. SURGICAL TREATMENTS FOR HAIR LOSS 107mega-sessions With new advances in hair transplantation, mega-sessions are more common. these sessions allow for largeamounts 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 ofgrafts completed in one session over two consecutive daysis: 6, 298 grafts BeFOre AFTer
113. 108 SURGICAL TREATMENTS FOR HAIR LOSSworld record: largest session done over two days Before and after pictures of the patient can be seenin the previous two pictures. this patient wanted the wholehead covered at once from the front hairline to the crown.The whole procedure turned out to be the largest sessionever done over two consecutive days. The results (also shown below) were exceptionalconsidering the high degree of difficulty associated with ahair transplant session of this size. The patient was extremelypleased with regaining his youthful look and achievingexcellent density. The growth in this patient was excellent,with over 95 per cent of the follicular units transplantedsurviving. Age: 33 Profession: Import/Export One Session: 6298 grafts BeFOre AFTer
114. SURGICAL TREATMENTS FOR HAIR LOSS 109world record: largest session done in one day Age: 41 Profession: Upholstery One Session: 4624 grafts BeFOre AFTer
115. 110 SURGICAL TREATMENTS FOR HAIR LOSSpermanence transplanted hair is permanent. it is taken from theback and sides of the scalp where the hair is geneticallyprogrammed not to fall out. When it is transplanted to thefront and top of the scalp it maintains its original geneticmake-up to not fall out. That being said, hair loss is usually progressive. Futurehair loss must be anticipated by you and your surgeon. youcan minimize this progression by planning your surgeriescarefully at the opportune times. Although the transplantedhair is permanent, you may lose your non-transplanted hairwith time and age. The best solution is to replace any hairthat you may lose with permanent hair from the back andsides of the scalp.RISkS ASSOCIATED WITH HAIR TRANSpLANTS Hair transplantation is a relatively minor surgicaloperation and is generally safe. Nevertheless, there are somenotable risks that are associated with hair transplanting thatmay complicate the success of the operation. These risksinclude:infection With every surgical incision to the skin there is alwaysthe risk of infection. An antibiotic is usually sufficient to fightoff the threat of an infection and its spread.swelling on the forehead Swelling usually occurs in the forehead after hairtransplantation. sometimes the swelling can spread to otherparts of the head but it usually resolves itself in less than aweek after the procedure and does not affect the patient’shealth in any way.
116. SURGICAL TREATMENTS FOR HAIR LOSS 111Bleeding and scab formation In both the donor and the transplanted areas of thescalp bleeding and scab formation may occur after theprocedure. this should clear up in two to three weeks.scarring in the donor areas With the FUSS method of transplantation, minorscarring will occur in the area(s) where the donor tissue wasremoved. This is not a concern with the FUE method.Numbness in the scalp sometimes there is a loss of sensation in the scalp as aresult of nerve damage. If this occurs it is usually temporarybut may last longer in rare cases.Headaches, pain or tingling sensations the shock of hair transplantation sometimes leads tosensations and pain that are often temporary. In some cases,however, this may last longer.Dizziness or fainting these side effects sometimes occur in patients withhigh levels of anxiety. This is temporary and subsides withincreased fluid intake and rest.uneven graft setting Sometimes grafts heal in such a way as to be unevenwith the surrounding skin.
117. 112 SURGICAL TREATMENTS FOR HAIR LOSSpoor growth of hair follicles Grafts may also grow poorly. This may happen allover the transplanted area or in a small area. there aremany possible reasons for poor growth and it often occursunpredictably. A full list of possible risks and complications can befound in the appendix under the consent form.REpAIR CASES repair work requires far more experience on the partof the surgeon and is an endeavor that combines surgicaland aesthetic skills to meet the patient’s expectations. A case that would qualify for repair work includes atransplant that included or resulted in any of the following:Grafts that were too large, an improperly designedhairline, hair transplanted in the wrong direction, significantscarring in the transplanted area, difficulty dissecting undermagnification, a large amount of tension, poor growth, donorwastage or donor area scarring. With the use of follicular units, most errors from initialtransplants can be fixed. In cases where the hair was placedawkwardly or angled incorrectly, the surgeon can coordinatea surgical plan to ‘remodel’ the design of the hair. Hairs maybe moved, or removed, to optimize the outcome of the repairwork in terms of the overall appearance. setting goals withthe patient before the repair work is performed will also helpto ensure satisfaction and the most natural results possible. the following two cases are of patients who have hadsurgical treatment in order to repair previous procedures.
118. SURGICAL TREATMENTS FOR HAIR LOSS 113surgical repair case 1 BeFOre AFTer
119. 114 SURGICAL TREATMENTS FOR HAIR LOSSsurgical repair case 1 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
120. SURGICAL TREATMENTS FOR HAIR LOSS 115surgical repair case 2 BeFOre AFTer CASE SUMMARy · Plugs repaired on sides and temples where there was considerable scarring and fibrosis. · Covered nicely with follicular unit micrografts. Age: 30 Profession: Pharmacist One Session: 2, 490 grafts
121. 116 SURGICAL TREATMENTS FOR HAIR LOSSpRACTICAL DETAILS OF HAIR TRANSpLANT SURGERy the following section will go into some depth detailingthe practical stages involved in the hair transplantationprocess.Finding a good hair transplant surgeon the first stage of the hair transplantation processinvolves finding a good hair transplant surgeon. Surgicaltreatment of your hair loss requires you to put a lot of trustin the hands of the doctor you choose to perform yourtransplant. the advice of an experienced, skilled and honestdoctor is invaluable in dealing with your hair loss and thevarious options. The best method of finding a good surgeon is oftenthe internet. this provides patients from all over the worlda variety of choices from their home computers. Most hairtransplant centers have their own websites and you canresearch their services from the comfort of your home. Thewebsite is also often a reflection of the surgeon’s office andcan offer insight into the philosophy of the clinic. Other methods of finding a good surgeon are throughnewspapers, television, magazines, radio, your local phonedirectory, hair salons and spas, doctor’s offices and billboards.When looking at these ads, beware of negative ads thatattack other hair transplant centers. true professionals willnot resort to attacking other hair transplant surgeons. Finding a good doctor takes some effort. Here aresome rules to follow that should help you find a good doctorto work with.Check his/her credentials: check to see that the medicalprofessional is fully qualified from a reputable university.Check with your local licensing board to make certain thathe or she is fully licensed.Get a list of doctors from a neutral source: Do not rely on
122. SURGICAL TREATMENTS FOR HAIR LOSS 117the advice of someone who is promoting a service for-gainregarding the reputation of a particular surgeon. there aremany websites that look impartial, but are actually paidto advertise and promote particular surgeons and hairtransplant centers. patients should ask the site owners ifthey are financially compensated by the surgeons on theirrecommended lists.Get a second opinion on any treatment plan suggested:Even if you have already selected a surgeon to go to, get atleast one more opinion from another medical professional.There is no harm is looking for confirmation of what you havebeen 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 unitextraction?2. Has the surgeon performed a variety of hair transplantcases?3. is the surgeon interested in individualizing each transplantaccording to age, ethnicity and individual facial features,as opposed to doing the same transplant pattern on all theirpatients?4. Is the surgeon artistically competent?5. Has the surgeon performed transplants of higher degreesof difficulty, as well as repair cases? These rules may make selecting a doctor a moredifficult process, but if you follow them you should beprotected from the many abuses that take place all the timein the hair restoration business.the consultation in looking for a hair transplantation specialist, thepotential patient will have to go to an initial consultation. Atthis stage there are several things to look for:
123. 118 SURGICAL TREATMENTS FOR HAIR LOSSThe clinic: Look at the clinic when you are visiting your surgeonfor the consultation. is it clean? is it organized?Discussing your history: Is your history taken in detail, eitherthrough written forms or discussed verbally? Is the staffconcerned with your overall health and the impact ofsurgery on other medical conditions? Is the surgeon givingyou enough time to give your point of view on your hair losshistory?Expectations: This is one of the most important things to clarifybefore you book any surgery. Are you and your surgeonclear on what you are expecting from surgery? Can he orshe meet your expectations? you should both understandwhat can realistically be expected from your surgery.The number of grafts: The number of grafts you will need isthe most difficult decision to make in the hair transplantationprocess. This should be a joint decision between the patientand the surgeon and should be discussed in some depthduring the consultation. you will need to take into consideration: How muchcoverage you want; the cost of the procedure; and howmany sessions you are willing to have performed. yoursurgeon should be able to provide you with the followinginformation: The anticipated coverage and densityassociated with the number of grafts; the length of time thatwill be involved; the services provided by his or her clinicduring longer procedures; the level of required sedation; andhis or her recommendations. you may decide to get anywhere from 500 to 4000grafts in one session or in multiple sessions. To provide a betterpicture of what is entailed in selecting the number of grafts,see the following chart that summarizes all the informationyou need to make this decision: The coverage that can beanticipated based on various amounts of grafts; the lengthof the donor strip needed in the case of the FUSS procedure;and the expected costs from various centers. this chartsummarizes grafts that deal with one-, two- and three-hairedfollicular units. some surgeons use larger grafts and their fee
124. SURGICAL TREATMENTS FOR HAIR LOSS 119summary of number of grafts FUSS FUSS FUE Number strip size fee fee Coverage (cm) range range of grafts (USD) (USD) Small coverage - Front hair line OR 4, 000 - 6, 000 - 1, 000 10 x 1 - crown or 8, 000 17, 000 - temples Medium coverage - 1/4 top bald OR 6, 000 - 9, 000 - 1, 500 - Front hair line OR 15 x 1 - crown or 12, 000 25, 500 - temples or Med-Large coverage - 1/2 top bald OR 8, 000 - 12, 000 - 2, 000 20 x 1 - Front 1/2 OR 16, 000 34, 000 - Back 1/2 Large coverage - 1/2-3/4 top bald OR 10, 000- 15, 500 - 2, 500 25 x 1 - Front 1/2-3/4 OR 20, 000 42, 500 - Back 1/2-3/4 Large coverage - 3/4 top bald OR 12, 000 - 18, 000 - 3, 000 30 x 1 - Front 3/4 OR 24, 000 51, 000 - Back 3/4 Large coverage - 3/4 top bald OR 2 strips 16, 000 - 24, 000 - 4, 000 10 x 1 68, 000 - Front 3/4 OR 68, 000 - Back 3/4 30 x 1
125. 120 SURGICAL TREATMENTS FOR HAIR LOSSschedules vary.The procedure: As a patient, you have a right to have thesurgeon go over the entire procedure in detail, step bystep.Risks and complications: Ask the surgeon about any possiblerisks and complications associated with surgery. This shouldfirst be given verbally during the consultation. It should alsobe given in writing later on before any surgery. you shouldreview these with the surgeon beforehand.Pressure-sales tactics: Be wary of pressure-sales tactics beingused on you. Do not allow yourself to be pressured into signingany surgery agreement too soon.Before the surgery Most good hair transplant centers will bring you in fora preoperative assessment. This may include the signing ofconsent forms, preoperative instructions and payment.The consent form: The consent form should outline in easilyunderstandable terms any complications that may occur.you should discuss these with your surgeon. See AppendixA for a sample of a typical consent form.Preoperative instructions: These instructions should be asdetailed as possible. A detailed information package thatlists all instructions should be provided. Review the packageand ask any questions you may have. See Appendix B for asample of a typical preoperative instruction package.the most important of these instructions to take note ofare:Things to be avoided: Various medications and drugs willneed to be avoided for two to three weeks prior to surgery.these would include alcohol, vitamins, AsA containingmedications, marijuana and any other illicit drugs.
126. SURGICAL TREATMENTS FOR HAIR LOSS 121Clearance of medical drugs: patients taking any medicaldrugs will need to have these cleared by the surgeon to makesure it is okay to use them during the hair transplantationprocess.Day of the surgery On the day of the surgery several precautions wouldneed to be followed. It is advised that patients do thefollowing:1. Go to bed early the night before the procedure. Surgerywill test your patience and you will need to be well-rested.2. Have a good meal. For a morning surgery you should havea good breakfast. For an afternoon surgery you should havea good lunch.3. Bring extra clothing. your clothing may get wet or soiledduring surgery. Also, wear comfortable shoes and loosepants.4. Bring CDs or videos. Many hair transplant centers providetheir 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 15minutes early so that you can relax beforehand. Allow fortraffic delays.6. Arrange for your drive home. you will be medicated aftersurgery and unable to drive yourself home. Arrange to havesomeone drive you home or spend the night at a hotel nearthe surgeon’s office.7. keep the surgeon’s phone number handy. After you leavethe surgeon’s office make you are able to reach him or herin case of an emergency. each hair transplanting technique involves differentsteps. The following is a step-by-step outline of the follicularunit strip surgery and follicular unit extraction methods.
127. 122 SURGICAL TREATMENTS FOR HAIR LOSSFollicular unit strip surgery (FUSS):- preoperative medications are given. They may includeantibiotics 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 ona special pillow with the center removed. This will stabilizethe head for strip harvesting. Other surgeons may have thepatient 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 (todecrease stinging) and normal saline (to puff up the areaand move the hair follicles away from the scalp to facilitatecutting).- The donor area is surgically cut with a single blade in anelliptical pattern or with a multi-bladed knife. Because ofthe freezing in the area you should not feel any of this cuttingat all.- The donor strip is removed from the scalp area. Anybleeding 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 eitherby having anesthetic solutions injected into it or by havinga nerve block performed, based on the preference of thesurgeon.- the recipient area is cleaned and the incisions are madewith 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 duringthe procedure. Only the initial freezing will be felt. Mostpatients find it better than going to the dentist.Follicular unit extraction (FUE):
128. SURGICAL TREATMENTS FOR HAIR LOSS 123- preoperative medications are given. They may includeantibiotics 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 situp 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 (todecrease stinging) and normal saline (to puff up the areaand move the hair follicles away from the scalp to facilitatecutting).- The donor follicular units are harvested one at a time. youshould not feel anything due to the freezing.- the extracted follicles are put in saline.- the recipient area is prepared for transplantation eitherby having anesthetic solutions injected into it or by havinga nerve block performed, based on the preference of thesurgeon.- the recipient area is cleaned and the incisions are madewith 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 duringthe procedure. Only the initial freezing will be felt. Mostpatients find it better than going to the dentist.Immediately after the surgery There are several things to know about the post-surgery phase of hair transplantation for both the FUSS andFUE procedures.Bandaging: The degree of bandaging will depend on thepreference of the surgeon. Some surgeons prefer bandagingthe whole head, some prefer bandaging just the donorarea and some prefer no bandaging at all. All of these are
129. 124 SURGICAL TREATMENTS FOR HAIR LOSSacceptable.Rest: After returning home the patient should have a goodmeal, get plenty of rest and sleep with the head at a 45degree angle.Things to be on alert for:- Bleeding: Any sign of bleeding, either from the suture line orfrom the transplanted area, should be reported immediatelyto your surgeon or to an emergency room. Sometimes suturescan become loose and excessive bleeding may result. Thisshould be attended to immediately. This is less likely to occurwith the FUE procedure because there is no suturing involvedand because the extraction points in the recipient area arevery small and tend to close up quickly.- Swelling: Some temporary swelling is natural for bothprocedures and is to be expected.- Fever: The presence of a fever after surgery usually indicatesan infection. Surgeons often prescribe antibiotics to betaken after surgery as a precaution against infection. Thepersistence of an infection should be reported immediatelyto your surgeon or to an emergency room. Again, this isless likely with the FUE procedure because there is no majorsurgical incision.- Headache or pain: the presence of headaches or pain isfairly common after surgery. The surgeon and the patientshould anticipate this. Such pain is usually found in the areaof the suture. The absence of sutures in the FUE procedurewill eliminate some of the possibilities of headaches. Mostpatients who have undergone a FUE procedure report noheadaches or pain.- Nausea and vomiting: Sometimes a patient may experiencenausea or vomiting. This is usually related to the injection ofanesthetics or to the ingestion of sedatives or pain-relievingmedications. An anti-nausea medication can be used tocombat this and should be prescribed by your surgeon asa precaution.
130. SURGICAL TREATMENTS FOR HAIR LOSS 125Later post-surgery After the surgery, the waiting period for the resultsbegins. The following indicates what can be expected duringthis stage:The day after: most hair transplant centers look at the sutureline the day after the surgery. FUE patients are also examinedthe next day. The patient should lightly wash his or her headfor the first one or two weeks after surgery without touchingthe transplanted area. It is also very important that thepatient avoid itching or scratching this area.During the first two weeks: sutures or staples come out 10 to15 days after the FUSS procedure. Swelling may occur onthe forehead and around the eyes because of the freezingsolution moving down from the scalp. Scabs will form overthe transplanted area. This area should be dabbed gentlyusing vitamin E oil to dampen the scabs. Any heavy exerciseor strenuous activity should be avoided for three to four weekspost-surgery.During the first month: most of the transplanted hair will fall outin the first month after the roots take hold due to the shockof transplantation. The result will be that the patient will looklike he or she did before the surgery. While this may be atime of much worrying, the roots will grow new hair. The lossof hair may be less with the FUE procedure.During the first six months: The first growth of hair usuallystarts to appear sometime in the second or third month aftersurgery. By the six month mark there is growth of about 50 to60 per cent of the transplanted follicles. patients at this stageare fairly happy and can see an appreciable difference. Asecond session can be held at this time to increase densityin the transplanted area. Hair growth will continue for thenext six months.During the first year: It takes up to a full year to see the
131. 126 SURGICAL TREATMENTS FOR HAIR LOSSpatient and surgeon checklist Patient Surgeon 1. Have realistic 1. Anticipate and expectations understand the 2. Understand the cost, patient’s expectations time and tolerability of 2. Discuss the procedure a transplant session or in detail, including all sessions possible risks and 3. Follow preoperative complications instructions 3. Provide informed 4. Understand the full consent and surgical process preoperative 5. Follow postoperative instructions instructions 4. Provide all necessary comforts for longer sessions 5. Be available during the postoperative periodCASE STUDIES The case studies shown on the following pages involvetransplantation using follicular unit transplantation methods.
132. SURGICAL TREATMENTS FOR HAIR LOSS 127case study 1 BeFOre AFTer
133. 128 SURGICAL TREATMENTS FOR HAIR LOSScase 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: 32 Profession: Business Manager One Session: 2, 527 grafts
134. SURGICAL TREATMENTS FOR HAIR LOSS 129case 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.
135. 130 SURGICAL TREATMENTS FOR HAIR LOSScase study 2 BeFOre AFTer Age: 24 Profession: Marketing One Session: 1, 990 grafts
136. SURGICAL TREATMENTS FOR HAIR LOSS 131case study 2: close up the hairline
137. 132 SURGICAL TREATMENTS FOR HAIR LOSScase 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.
138. SURGICAL TREATMENTS FOR HAIR LOSS 133case study 3 BeFOre AFTer Age: 36 Profession: Construction One Session: 2, 383 grafts
139. 134 SURGICAL TREATMENTS FOR HAIR LOSScase 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.
140. SURGICAL TREATMENTS FOR HAIR LOSS 135case study 4 BeFOre AFTer Age: 53 Profession: Analyst One Session: 3, 052
141. 136 SURGICAL TREATMENTS FOR HAIR LOSScase study 5 BeFOre AFTer
142. SURGICAL TREATMENTS FOR HAIR LOSS 137case 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: 37 Profession: Restaurant Business Two Sessions: 27, 732, 258 grafts Total: 5, 031
143. 138 SURGICAL TREATMENTS FOR HAIR LOSScase study 6 BeFOre AFTer CASE SUMMARy · Pictures 6 months post surgery. · 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.
144. SURGICAL TREATMENTS FOR HAIR LOSS 139case study 6 BeFOre AFTer Age: 26 Profession: Business administrator One session: 2, 041
145. 140 SURGICAL TREATMENTS FOR HAIR LOSScase 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
146. SURGICAL TREATMENTS FOR HAIR LOSS 141case study 7: close up of hairline
147. 142 SURGICAL TREATMENTS FOR HAIR LOSScase 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.
148. SURGICAL TREATMENTS FOR HAIR LOSS 143case study 8 BeFOre AFTer Age: 24 Profession: Mechanic One session: 1, 852 grafts
149. 144 SURGICAL TREATMENTS FOR HAIR LOSScase study 9 BeFOre AFTer Age: 29 Profession: Student One Session: 1, 171
150. SURGICAL TREATMENTS FOR HAIR LOSS 145case study 9: close up of hairline case summary · Pictures from one year post surgery. · young African patient. · Curly, thick, black hair. · Dark brown skin. · Front hairline restored with good density. · Temple angles closed
151. 146 SURGICAL TREATMENTS FOR HAIR LOSScase study 10 BeFOre AFTer
152. SURGICAL TREATMENTS FOR HAIR LOSS 147case study 10 CASE SUMMARy · Pictures from one year post surgery. · 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 Two Sessions: 18, 491, 440 Total grafts 3, 289
153. 148 SURGICAL TREATMENTS FOR HAIR LOSScase study 11 BeFOre AFTer
154. SURGICAL TREATMENTS FOR HAIR LOSS 149case 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: 33 Profession: Security Two Sessions: 20, 071, 474 Total grafts: 3, 481
155. 150 SURGICAL TREATMENTS FOR HAIR LOSScase study 12 BeFOre AFTer
156. SURGICAL TREATMENTS FOR HAIR LOSS 151case 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
157. 152 SURGICAL TREATMENTS FOR HAIR LOSScase study 13 BeFOre AFTer
158. SURGICAL TREATMENTS FOR HAIR LOSS 153case study 13 CASE SUMMARy · Pictures 6 months post surgery. · Middle aged, Italian Canadian. · Curly silver pepper hair. · Olive skin. · Wide area coverage. · Medium density front hairline. · Low density back. · Overall, one session covered very large area very well. Age: 46 Profession: Construction One Session: 3, 170
159. 154 SURGICAL TREATMENTS FOR HAIR LOSScase 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.
160. SURGICAL TREATMENTS FOR HAIR LOSS 155case study 14 BeFOre AFTer Age: 43 Profession: Business owner One session: 2, 000
161. 156 SURGICAL TREATMENTS FOR HAIR LOSScase study 15 BeFOre AFTer
162. SURGICAL TREATMENTS FOR HAIR LOSS 157case study 15 CASE SUMMARy · Pictures 9 months post surgery. · Canadian of British descent. · Thin blond hair. · Light skin. · Goal was to repair the hairline and close the temple angles. Age: 40 Profession: Multimedia developer One Session: 2, 217
163. 158 SURGICAL TREATMENTS FOR HAIR LOSScase study 16 BeFOre AFTer
164. SURGICAL TREATMENTS FOR HAIR LOSS 159case study 16 BeFOre AFTer CASE SUMMARy Age: 52 Profession: Businessman One Session: 3, 533
165. 160 SURGICAL TREATMENTS FOR HAIR LOSScase study 17 BeFOre AFTer
166. SURGICAL TREATMENTS FOR HAIR LOSS 161case study 17: close up of hairline · Pictures one year later. · Dark thick hair, brown skin. · New lower hairline and temples closed. · Wide area coverage. Age: 26 Profession: Plastic Factory Two Sessions: 22, 081, 863 Total grafts: 4, 071
167. 162 SURGICAL TREATMENTS FOR HAIR LOSScase study 18 BeFOre AFTer
168. SURGICAL TREATMENTS FOR HAIR LOSS 163case 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: 41 One Session: 4, 624
169. 164 SURGICAL TREATMENTS FOR HAIR LOSScase 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
170. SURGICAL TREATMENTS FOR HAIR LOSS 165case study 19 BeFOre AFTer Age: 47 Profession: Engineer One Session: 1, 603
171. 166 SURGICAL TREATMENTS FOR HAIR LOSScase 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.
172. SURGICAL TREATMENTS FOR HAIR LOSS 167case study 20 BeFOre AFTer Age: 35 Profession: Neurosurgeon One Session: 2, 793
173. 168 SURGICAL TREATMENTS FOR HAIR LOSScase study 21 BeFOre AFTer CASE SUMMARy · Pictures 5 months post surgery. · young Iranian Canadian. · Dark thin hair, olive skin. · Lower hairline, temples closed · Density will increase over the next 7 months.
174. SURGICAL TREATMENTS FOR HAIR LOSS 169case study 21 BeFOre AFTer Age: 22 Profession: Sales Manager One Session: 2, 094
175. 170 SURGICAL TREATMENTS FOR HAIR LOSScase study 22 BeFOre AFTer
176. SURGICAL TREATMENTS FOR HAIR LOSS 171case study 22: close up of hairline CASE SUMMARy Age: 47 Profession: Showroom Manager Two Sessions: 23, 031, 922 Total Grafts: 4, 225
177. 172 SURGICAL TREATMENTS FOR HAIR LOSScase 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.
178. SURGICAL TREATMENTS FOR HAIR LOSS 173case study 23 BeFOre AFTer Age: 54 One Session: 2, 552 grafts
179. 174 SURGICAL TREATMENTS FOR HAIR LOSScase 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.
180. SURGICAL TREATMENTS FOR HAIR LOSS 175case study 24 BeFOre AFTer Age: 26 Profession: Network Administrator One Session: 1, 718 grafts
181. 176 SURGICAL TREATMENTS FOR HAIR LOSScase study 25 BeFOre AFTer CASE SUMMARy Age: 44 Profession: Construction One Session: 1, 098 grafts
182. SURGICAL TREATMENTS FOR HAIR LOSS 177case study 25 BeFOre AFTer
183. 178 SURGICAL TREATMENTS FOR HAIR LOSScase 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.
184. SURGICAL TREATMENTS FOR HAIR LOSS 179case study 26 BeFOre AFTer Age: 28 Profession: Airline Pilot One Session: 1, 508 grafts
185. 180 SURGICAL TREATMENTS FOR HAIR LOSScase study 27 BeFOre AFTer CASE SUMMARy Age: 29 Profession: Warehousing Two Sessions: 1, 707 and 1, 310
186. SURGICAL TREATMENTS FOR HAIR LOSS 181case study 27 BeFOre AFTer
187. 182 SURGICAL TREATMENTS FOR HAIR LOSScase study 28 BeFOre AFTer CASE SUMMARy · Italian Canadian. · Dark curly hair. · Crown area with large density. · On preventative medications for future hair loss. Age: 46 Profession: Restaurant Owner One Session: 3, 032 grafts
188. SURGICAL TREATMENTS FOR HAIR LOSS 183THE FUTURE OF SURGICAL TREATMENT the future of hair transplantation is developing fast.Three revolutionary new techniques are emerging that showgreat promise: Cloning, gene therapy and donor hair.cloning There are currently two methods of cloning beingdeveloped by researchers. The first is called ‘in-vivocloning’. It involves cutting the hair follicle at different levelsto produce more than one follicle. Dr. kim from korea hasmade significant contributions in this method. He has foundthat by cutting the follicle midway at the stem cell level,two follicles can be reproduced from one, though they arethinner in diameter than the normal hair follicle. the cuttingmust be made precisely at a very specific level to producevery specific stem cells. The other cloning method being researched is called‘in-vitro cloning’. In this method, the stem cells from thehair follicle are taken and grown in a petri dish. In this waynew duplicate cells are cloned. Later, these new cells canbe inserted back into the scalp instead of follicles with hair.It is believed that hair may be able to grow from the cellsthemselves. There are five or six centers in the world tryingto perfect this technique, which would mean that even theman or woman with very few hairs could have thousands ofcells replicated in a petri dish.Gene therapy Another method to restore lost hair that is likely toemerge in the near future is gene therapy. Gene therapypromises the potential to grow new hair follicles, as opposedto just stimulating dormant follicles to grow hair again. severalresearchers around the world have begun work on genetherapy to restore hair in lab mice and have displayed somedegree of success.
189. 184 SURGICAL TREATMENTS FOR HAIR LOSS The idea behind gene therapy is to correct aninherited condition that prevents hair growth by introducinga DNA sequence (a genetic chemical) into the baldingscalp. The introduced DNA sequence itself does not correctthe problem causing baldness, but it creates a sequence ofchemical transactions that enter into the patient’s cells. Thismakes the cells start producing the proteins necessary to givethe skin the ability to produce new hair follicle cells. Several researchers have been looking at genetherapy for some time now. One of the leaders in this field isDr. Elaine Fuchs at the University of Chicago. She has beenable to successfully convert normal skin cells into hair folliclecells using gene therapy on mice. These mice have displayedimpressive new hair growth in balding areas. But the existenceof side effects that include the growth of tumor cells mayendanger the future of gene therapy as a treatment methodof hair loss. Dr. Fuchs, however, is confident that these sideeffects can be eliminated with further development of genetherapy methods.Donor hair research This research is the first of its kind. I initially presented itat the International Society of Hair Restoration Surgery (ISHRS)meeting in puerto Vallarta, Mexico in 2001. This article wasthen 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. Auto- transplantation 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
190. SURGICAL TREATMENTS FOR HAIR LOSS 185strongly antigenic, meaning that if it were transferredfrom one person to another, the recipient’s bodywould be likely to reject the new hair. However, in 1999 it was reported for thefirst time by Jahoda et al. that human hair folliclescould be induced to grow in an incompatible hostof the opposite sex. With these recent advances infollicle cell transplants in incompatible hosts it wasconsidered necessary to evaluate an allogenic hairtransplant. A study was conducted where the goalwas to determine whether an allotransplant canbe successful or not. If unsuccessful, then the goalwould be to determine why it had failed and how toovercome the obstacles.Objective: An allo-transplant in two unrelatedindividuals was performed. the growth of the hair inthe incompatible hosts was observed over a periodof 14 months.Materials and/or methods: To test this hypothesis,two different male donors were selected: AA andFA. Hair follicles from AA were taken and successfullytransplanted in FA. In another similar operation, hairfollicles from FA were taken and transplanted in AA. Each of the subjects was provided withpreoperative medications and an area of scalpmeasuring 6cm by 1cm was shaved and anesthetized.then the skin with the hair follicles was removed andcut into smaller hair grafts. In the first operation 586 grafts from AA weretransplanted in FA and in the second operation594 grafts from FA were transplanted in AA. Thetransplants were performed on the temples of bothsubjects, giving us a clear observation of hair growth.Also, the identification of hair growth was facilitatedbecause AA’s hair was black and FA’s hair wasbrown. postoperative hair growth was measured at 9
191. 186 SURGICAL TREATMENTS FOR HAIR LOSS Allo-transplant: Method for transplant between incompatible Two male donors AA Donor Recipient & FA 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.
192. SURGICAL TREATMENTS FOR HAIR LOSS 187 Pre surgery
193. 188 SURGICAL TREATMENTS FOR HAIR LOSS Pre surgery
194. SURGICAL TREATMENTS FOR HAIR LOSS 189 Immediately after surgery
195. 190 SURGICAL TREATMENTS FOR HAIR LOSS Immediately after surgery
196. SURGICAL TREATMENTS FOR HAIR LOSS 1914 months post surgery
197. 192 SURGICAL TREATMENTS FOR HAIR LOSS 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 Number of Number graft s of graft s Subject count ed count ed at 9 at 14 mont hs 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
198. chapter three: alternative treatments In the last few years great interest has been expressedin various alternative medicines and how they can help treatgenetic hair loss. Some very specific remedies for hair losshave been developed and this chapter will review the onescurrently available and the advantages and disadvantagesof these treatments.The emergence of alTernaTIve medIcInes many doctors frown upon alternative medicines andsuggest that re-growing hair with alternative treatments isnot possible. But the fact is that millions of people in thewestern world have been turning to alternative medicinesin the last few decades to deal with problems that doctorsand conventional medicine cannot help them with. a studypublished in the new england Journal of medicine reports thatabout one third of americans surveyed preferred alternativemedicines over conventional ones to deal with their healthneeds. looking for a solution to hair loss in alternativemedicine is not necessarily the recommended choice but itis an option that should not be denied to those who prefer it.There are many who swear by the effectiveness of alternativetreatments to treat every health problem, including hair loss,and you may have come across some individuals who claimthat it has worked for them. 192
199. ALTERNATIVE TREATMENTS FOR HAIR LOSSThis section on alternative treatments for hair loss is beingincluded here to allow you to have a full understanding ofall the options you have for fighting hair loss, but no strongclaims will be made for any of these alternative treatments.You must use your own good sense when sifting throughthese options.how do alternative medicines work? The term alternative medicine refers to various medicalsystems practiced by trained professionals all over the worldthat have roots in the traditional medicines of the ancientworld. some of these medicines are continuations of ancientmedical traditions like acupuncture and traditional chineseand Indian herbal medicines. others are newer medicalsystems developed from the principles of ancient systems ofmedicine like homeopathy, cell therapy and magnetic fieldtherapy. all alternative medicines are based on a more holisticunderstanding of the human being than understood byconventional modern medicine. conventional medicinethinks of the human being as primarily a physical body, whileholistic medicine sees the human being as a trio of mind,body and spirit. conventional medicine looks for causesto ailments on the physical level only. holistic medicine,however, looks deeper into all levels of the human being forcauses and this, according to its proponents, is its greateststrength. all alternative medicines try to consider the wholehuman being using a number of methods to cure innerdistortions that cause physical ailments.how do alternative medicines treat hair loss? alternative medicines look for the inner psychologicaland spiritual causes of hair loss. While hair loss and its causesare different for each individual, similar patterns may exist.The treatments that the various alternative medicines offer
200. 194 ALTERNATIVE TREATMENTS FOR HAIRfor hair loss try to correct the inner imbalances that areunderstood to be the underlying causes of hair loss. modern medical research has acknowledged anastonishing phenomenon that suggests how alternativemedicine’s approach may work. This phenomenon is referredto as the ‘placebo effect’. a placebo is a dummy drug thathas no actual medical effect but works because the patientbelieves that it is helping them. The improvement in healththat results is called the placebo effect. studies consistentlyshow that between 30 per cent and 40 per cent of peoplewill show improvement with all sorts of health problems aslong as they believe they are taking a medication that willhelp. There has even been evidence of hair growth due tothe placebo effect in patients with hair loss. The placebo effect suggests that it is possible to correcthealth problems by mobilizing the emotional, psychologicaland spiritual forces within each of us, and this is precisely whatalternative medicines try to do by using various outside keysto trigger inward changes.common alTernaTIve TreaTmenTs for haIr losssaw palmetto saw palmetto is an herbal product that has shownsome evidence in being able to slow hair loss. It is made fromthe extract of berries from a palm tree native to the southatlantic coast and is also often used to treat an enlargedprostate. It works by inhibiting the activity of an enzymelinked to the chemical processes responsible for genetic hairloss, similar to the way finasteride, or Propecia, works.vitamin e vitamin e is an important vitamin known for its anti-aging effect, which is due to its ability to act as an antioxidant.It prevents oxidation of free radicals in the body, thusprotecting tissues against oxidation and generally helping
201. ALTERNATIVE TREATMENTS FOR HAIR LOSSthe upkeep of the skin and hair. The recommended dailydosage of vitamin e is 10 mg per day for an adult. But for thepurposes of treating hair loss, 400 mg to 800 mg should ideallybe consumed on a daily basis though you should consult adoctor to determine what the best amount is for you. common sources of vitamin e include: Wheat germ,almonds, hazel nuts, sunflower seeds and oils. Possiblereactions 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 skinand hair. like vitamin e, it is an antioxidant and treatshair loss in a similar fashion. It is not likely to stimulate newgrowth, but it may help maintain existing hair. a dosage of500 mg to 1000 mg taken orally on a daily basis is ideal tomaintain hair. It should be stressed that adequate hydrationis necessary to accompany the intake of vitamin c to avoidthe 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 andvomiting.multivitamins It is argued that everyone should take a multivitaminevery day because we may become deficient in manynutrients, regardless of our diet. as noted earlier in this book,hair loss may result from poor overall nutrition or particulardietary deficiencies. This is where a multivitamin can be avaluable asset in fighting hair loss. But before you choosea multivitamin, you should consider a few things first: 1)your activity level, 2) your stress level and 3) any medicalconditions. not every multivitamin is perfect for everyone. for
202. 196 ALTERNATIVE TREATMENTS FOR HAIRexample, if you are active or have a stressful life, you will likelyneed a higher dose multivitamin. If you have some contra-indication to high dose multivitamins, you should take a lighterone. This can be discussed with your healthcare and dietaryguide. a general rule is to try a time-release multivitaminthat slowly releases the vitamin ingredients over time. Thiswill improve the absorption of all the vitamins.oTher alTernaTIve TreaTmenTs various other alternative medicines offer generalsuggestions to promote hair growth. You can act on manyof these by yourself, but it is recommended that theyonly be tried in consultation with a trained professional.experience suggests that those who have a strong belief inalternative medicines tend to benefit from them, whereasthose who are skeptical do not. The faith you put into thesealternative self-help practices seems to play a key role intheir effectiveness. otherwise, this book makes no claim forthem other than that they have worked from some peoplein some circumstances.acupuncture acupuncture is an ancient chinese system of medicinethat treats many ailments by attempting to restore the innerimbalances that cause them. Acupuncture identifies anelaborate system of points on the body called accupointsthat are connected to inner forces, which are manipulatedwith needles and other devices to restore balance and curevarious ailments. a trained acupuncturist will know which accupointsto manipulate to stimulate hair growth. There have beenindividuals who have claimed success in growing hair afteracupuncture treatment, but there are also others who havefelt that it was no benefit to them and a waste of money. for information about acupuncture and how tofind an accredited acupuncturist in your area contact theAmerican Association of Oriental Medicine (www.aaom.org)or the american academy of medical acupuncture (www.
203. ALTERNATIVE TREATMENTS FOR HAIR LOSSmedicalaccupuncture.org).aromatherapy aromatherapy is a branch of herbal medicine thatuses the essential oils of various plants to produce medicallybeneficial effects on the body. Herbal remedies may increasecirculation, disinfect the scalp and result in stimulated hairgrowth. aromatherapists recommend four essential oilsto deal with hair loss: lavender, rosemary, thyme, bay,cedarwood, grapefruit, jojoba oil, lemon, roman chamomileand sage. The rubbing of these essential oils on the baldingparts of the head is prescribed as a possible way to fight hairloss. as a precaution, rosemary oil should not be used bythose with high blood pressure and lemon and grapefruit oilsare likely to irritate sensitive skin. For more information on aromatherapy and how to findessential oils and an aromatherapist in your area, you cancontact the national association for holistic aromatherapy(www.eskimo.com/~hhnews/naha).ayurvedic medicine ayurvedic medicine is an ancient Indian herbalmedicine that has been around for almost 5000 years. Twoayurvedic herbs are generally prescribed to stimulate hairgrowth: ashwagandha and amla. These herbs are usuallytaken in pill form or as rubbing oils for the scalp. for more information about ayurvedic medicine andproducts dealing with hair loss and other health problems,you can contact the national Institute of ayurvedic medicine(NIAM) (www.niam.com).
204. 198 ALTERNATIVE TREATMENTS FOR HAIRhomeopathy homeopathic medicine is an alternative medicalsystem developed in germany that is now practiced all overthe world. It cures ailments by prescribing dilutions of naturalsubstances that trigger the body’s own natural healingprocesses. The homeopathic medicines sepia, arnica andacidum nit are often prescribed to stimulate hair growth. Theycome in liquid form and are generally taken with water. for more information about homeopathic medicineand for referrals to professionals in your area, contact theNational Center for Homeopathy (www.healthy.net).naturopathic medicine naturopathic medicine is a comprehensive medicalsystem that combines many of the traditional nature-basedmedical systems of the world. It focuses on the entire humanbeing to identify the source of physical ailments and thentries to utilize the body’s own ability to heal by focusing onvarious natural treatments. since naturopathic medicine combines so manydifferent approaches it has several different remedies for hairloss. some of the easier ones to try include:Diet: various fresh raw juices are sometimes given to stimulatehair 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 forhair loss involves massaging the scalp with a combination ofone part rosemary oil and two parts almond oil on a nightlybasis. for more information on these and other naturopathicremedies for hair loss, contact the american association of
205. ALTERNATIVE TREATMENTS FOR HAIR LOSS advantages disadvantages • seems to work for • most alternative some people who treatments have not have faith in undergone scientific alternative medicines studies to determine • offers many different effectiveness over a choices simple placebo effect • You can try some • does not seem to work remedies at home for those who do not • costs less than have faith in alternative conventional medicines treatments • Its low cost becomes • generally involve few irrelevant if it does not risks and complications work • It can be dangerous if it is unwisely relied uponNaturopathic Physicians (www.naturopathic.org).
206. 200 ALTERNATIVE TREATMENTS FOR HAIRadvanTages and dIsadvanTages of alTernaTIveTreaTmenT This section on alternative medicines has beenincluded in the interest of providing you with all the possibleoptions for fighting hair loss. The following summarizes theadvantages and disadvantages that you should take intoaccount when considering alternative treatments for your hairloss.Final recommendationsYou 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
207. chapter four: hair replacement treat- ment Hair replacement is the last major approach to dealingwith hair loss. The basic idea of hair replacement is to replaceyour natural hair with various types of additives that makeyour hair look natural and complete. For most balding peopleit is a last resort, but because of improving techniques it hasbecome increasingly attractive even for those who haveother options. Over 500, 000 hair addition pieces are soldevery year in the United States alone. There are two basic ways to replace your hair. Thefirst is to camouflage your hair loss by filling out or intensifyingyour existing hair with various products and the second is tocover 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 forcamouflaging your hair loss. All of them assume that youhave some hair remaining and that you only want to makethis existing hair look more full and complete. if you onlyhave some thinning areas of baldness then camouflaging isa realistic and affordable option. many people have reliedon these simple methods and have been quite satisfied. 200
208. HAIR REPLACEMENT TREATMENT 201 There are two ways of camouflaging your hair loss.you can thicken your existing hair or you can apply substitutehair in thinning areas.Thickening your thinning hair This is a common approach to thickening thin hairwhere the goal is to create the illusion of thick hair by raisingthe hair away from the scalp. The way hair thickening isusually done is through rubbing various types of hair thickeningleave-in conditioners into the hair after shampooing andtowel-drying. These conditioners apply a thin layer of some polymerover the hair shaft. a polymer is a chemical combination thatsticks to the hair shaft leaving a plastic-like layer around it. Thepolymer creates a smooth surface over the hair shaft, makingit thicker and simultaneously easier to manage. Commonthickening conditioners include those from oil-based Pomadecreams as liquid rub-ins containing glycerin-based productsor as oil sheen sprays. Other hair thickening products includehair sprays, thickening gels and thickening mousses.Camouflaging using canned hair The second way to camouflage hair loss is to applycolored substances that look like your natural hair to thethinning portion of your scalp. There are many products thataccomplish this and they are often referred to as ‘cannedhair’ because they come in cans and are sprayed on thescalp to fill in the gaps. A dermatologist can recommend aproduct of this type that is most suitable for you.Hair PieCeS Hair pieces are any external hair-bearing devicesthat are added to the scalp or to existing hair to give the
209. 202 HAIR REPLACEMENT TREAT-appearance of fuller looking hair. These include numerousapparatuses and products available all over the world,including the following:• Wigs: Hair-bearing devices formed on a base material anddesigned to cover your entire scalp. if you have no hair ofyour own, this is your only option.• Demi-wigs: Similar to wigs except that they do not coverthe frontal hairline.• Toupees: Hair-bearing devices formed on a base materialand designed to meld with your existing hair.• Extensions: Hair-bearing devices that attach on to yourexisting hair to make it appear longer and fuller.• Hair units: Hair-like clumps that fit into your existing hair tomake it appear fuller.• Hair weaves: Synthetic or natural hair that is weaved,braided or knotted into your existing hair to make it lookfuller. almost all of these devices are available ready-madeand are relatively inexpensive. However, for anyone seriousabout replacing lost hair with a hair addition only a custom-made device can appear natural and be maintained in asafe and comfortable manner. Despite various shapes andsizes, all of these hair addition devices share several basiccharacteristics. To make a custom-made version of any ofthese devices, you have to answer three basic questions toknow 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 ofresearch and decide on your own preferences. a goodspecialist will detail each option for you and help you makea decision that is right for you. you can begin your researchhere with a few brief outlines to help you answer the previousquestions.
210. HAIR REPLACEMENT TREATMENT 203natural or synthetic hair? every hair addition piece employs either your ownnatural hair (if you have enough), purchased human hair,synthetic hair or some combination of these. althoughit would seem obvious that natural hair is always better,all things considered it is not so clear that this is the bestchoice. Because natural hair has to be purchased from willinghuman sources it is relatively expensive and what is availablemay not meet your needs. Due to availability, workabilityand cost, most hair additions use indian hair but if you havea european background then such hair must be treatedand colored to fit your needs. This coloring fades somewhatevery few months and needs to be constantly re-colored.However, human hair does tend to mix in better for thosewho still have existing hair. it is also preferable to those withan active lifestyle. aside from a slight disadvantage in appearance,synthetic hair has many advantages over natural hair. mostsynthetic hair fibers are made of plastics from molds andare consequently readily available. They are also relativelyinexpensive compared to human hair and easier to maintainbecause they dry faster and their colors do not fade aseasily. For most people in the western world, synthetic hairis the more logical choice unless you have a stigma aboutwearing fake hair or you are allergic to synthetic materials.What type of base? if your hair addition requires a base, as in the case ofa wig or a hair piece, then the first question to answer is whattype of base should be used. There are two types of basesthat are common today: mesh-like bases and solid bases.generally speaking, mesh-like bases are better ventilatedand are more comfortable, while solid bases allow forvacuum fitting and fit directly on the scalp. They each alsohave drawbacks that result from the method of attachment
211. 204 HAIR REPLACEMENT TREAT-to the scalp. The decision between the two types of basesshould consider the strengths and disadvantages of eachtype in consultation with your specialist.What method of attachment to the head? There are few things more embarrassing than ahair piece coming off and revealing a balding head.Various methods have been devised to firmly attach hairreplacements to the head to guard against this possibility butthere is currently no ideal mechanism of attachment. all theexisting methods of attachment have notable drawbacksthat need to be considered. at present there are only twopossible ways to attach hair pieces to the head: Directly onthe skin of the scalp or to some existing hair on the scalp. attaching a hair piece to the scalp is considerablymore difficult and fraught with complications than attachingit to existing hair. For this reason, if a person has enoughexisting hair left, attachment to this hair is usually preferredover trying to attach it to the scalp. That being said, a singleperson may benefit from a combination of these attachmentmechanisms. Depending on your specific needs you mightfind it beneficial to alternate attachment mechanisms overtime.Attaching to existing hair: When a person has some existinghair then it is almost always preferable to attach a hair pieceto this hair in some manner. a hair piece can be attachedto the existing hair either in a temporary manner using clipsor in a semi-permanent manner using one of three commonmethods: Bonding, sewing or weaving/braiding. Thesemethods offer the advantage of allowing hair pieces tofunction like normal hair for a relatively long period of time.They are also the most comfortable and the most naturallooking attachment methods. But since they are attached topermanent hair they are subject to the changes that normalhair growth causes. as a result, these attachments typicallylast for two to six weeks before they need professionalreadjustment.
212. HAIR REPLACEMENT TREATMENT 205• Bonding: The most popular semi-permanent method ofattaching a hair piece to existing hair is bonding. in thismethod the hair piece is attached by using a special gluegun to attach a ¼ inch vinyl strip at each edge of the hairpiece to matching bonds of cut hair, not the scalp. asthe existing hair grows the hair piece loosens and needsre-bonding. The chief advantage of bonding is its relativesimplicity and the cost benefit compared to other methodsof semi-permanent attachment.• Sewing: Sewing is less common than bonding, though itshares many of its characteristics. Tiny loops are sewn intothe fringe of the hair piece. Several existing natural hairsare pulled through the loops of the hair piece and arefused together by knotting or using glue. as the existing haircontinues to grow, the hair piece loosens and needs to bere-fused. The chief advantage of sewing is that it does notnecessarily require the use of an adhesive.• Weaving or braiding: These have long been used asmethods of thickening thinning hair. For this purpose, smallsections of the hair piece are formed into clumps andattached to the existing hair by carefully weaving naturalhairs into the hair piece using fine, durable strings. In recentyears, the idea of weaving has been introduced as a wayof attaching larger hair pieces to a mostly balding head.The chief advantage of weaving is that it allows for easiercleaning of the scalp as opposed to other methods of semi-permanent attachment. The disadvantage of attaching a hair piece to existinghair that is shared by all such mechanisms is that this kindof attachment puts unnatural amounts of tension on theexisting hair. if this is not carefully considered while creatingthe attachment mechanism the result can be that the hairpiece will lead to further hair loss. it is very important for a hairpiece that attaches to existing hair to be properly designedto avoid this problem.
213. 206 HAIR REPLACEMENT TREAT-Attaching to the scalp: If you lack a sufficient amount ofhair, or your hair is not strong enough, then you have nochoice but to attach a hair piece to your scalp in somemanner. Currently, there are three recognized methods ofattaching a hair piece to your scalp: By using an adhesive,with vacuum suctioning, or by using a surgically-made loopin the skin. each of these methods is reasonably safe andmaintains certain advantages and disadvantages that youshould thoroughly discuss with your specialist.• Adhesive: adhesives that can be used to attach a hairpiece to your scalp fall into two categories: glues that makea direct attachment to the scalp or double-sided tapes thatattach the hair piece to the scalp. every time the hair pieceis attached to the scalp a thorough cleaning of the adhesivesubstance must be done to maintain proper hygiene. Thechief advantage of adhesive attachment is that is allowsfor quick and frequent removal of the hair piece at minimalcost.• Vacuum fitting: If a hair piece is precisely fit it can beattached to the head by suction. The hair piece will naturallypull into the scalp as a vacuum is created under your scalp.The chief advantage of a vacuum attachment is that it is themost comfortable and easiest to remove and re-attach.• Using a surgically-made loop in the skin: in this method, anumber of loops of flesh are created in the scalp skin and clipsare anchored into these loops that firmly hold down a hairpiece. The surgical operation needed to create the loopsrequires a bridge of skin to be cut and raised from the scalp.The result looks like a fleshy tunnel-like outgrowth of skin. Thesurgically created loops have to be frequently cleansed toprevent infection. The chief advantage of this method ofattachment is that it provides the surest grip of all methodsof 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
214. HAIR REPLACEMENT TREATMENT 207you expected that hair replacement would be a cheaperinvestment than surgical or drug treatment than you weremistaken. it is not uncommon for hair replacement to costthousands of dollars annually. There are also hidden coststhat most people don’t immediately detect and are usuallynot told about. Depending on the chosen hair replacement piece aproper evaluation of the total cost may need to take intoaccount four different components:1. The cost of the hair piece itself2. The cost of the servicing and maintenance3, The cost of the attachment method4. The cost of the maintaining the attachment methodThe cost of the hair piece: Because of the enormous varietyof hair replacement pieces and the various options availablewith each, it is difficult to indicate precise prices for every hairpiece. generally speaking, a hair piece can cost anywherefrom $100 USD to $5000 USD. The cost of the hair piece willconform 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 thehair piece the more costly it will be• A hair piece’s price will rise with the more human laborneeded to produce and service it• Big advertiser’s charge more moneyThe cost of servicing and maintaining the hair piece: Onaverage, any hair piece will last no more than 18 monthsbefore it will need to be replaced. you can expect to paythe full cost of making a hair piece almost every year. also,good maintenance generally requires frequent servicingof the hair piece before it is replaced. The cost of normalservicing may vary enormously depending on the type of thehair piece. as a general rule the servicing costs are higherthe more the initial cost of the hair piece. One hidden costthat many tend to overlook is the cost of replacing a hairpiece while it is being serviced. if you are very conscious of
215. 208 HAIR REPLACEMENT TREAT-maintaining your appearance then just any replacement foryour hair piece will not be enough. if this is the case, thenyou will need to buy a second hair piece to back up youroriginal.The cost of the attachment method: This cost is only highfor a few methods of attachment. Whenever a hair piecerequires surgical manipulation, you can expect its cost to runinto the thousands of dollars. and whenever a hair piecerequires the attention of a professional, you can expect itscost to run normally into the hundreds of dollars.The cost of maintaining and servicing the attachmentmethod: There is always some cost in maintaining andservicing the attachment method. in some cases, like semi-permanent methods of attachment, these costs are upfront.These methods require the attention of a professional everyfew months and can cost up to $1000 USD annually. in mostcases, the cost of maintaining and servicing the attachmentmethod is a hidden cost that many people don’t immediatelyconsider. in some cases this may be minor, as in the caseof routine purchasing of adhesives and cleaning fluids.However, in cases where complications affect not only yourhair piece but also your health the costs of servicing anattachment 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 manypractitioners and specialists out there looking for your business.like surgical treatment, there are many practitioners tochoose from and many difficult choices to make. The adviceof a good hair restoration specialist is almost indispensable.But you have to be careful about which hair replacementspecialist you choose. There are many whose knowledge ofhair replacement extends only to the product they are tryingto sell you. Finding a good hair replacement specialist takes work
216. HAIR REPLACEMENT TREATMENT 209 ToP ANd boTToM sIdEs of A fuLL wIg.THE boTToM PICTuRE dIsPLAys A sTRIP RuNNINg ARouNd THE
217. 210 HAIR REPLACEMENT TREAT-and patience. The following rules will help you find someonethat will help you sort through your options and guide youin choosing the right hair replacement solution. These rulesrequire more work in finding a hair replacement specialistand a hair replacement plan but they are essential if youwant 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 expensivepractitioners and not necessarily the best. The bestadvertisement is always word of mouth from a pleasedclient.get a list of specialists from a neutral source Don’t just look for a list of hair replacement specialistsfrom your local phone directory. You can find out aboutthe different specialists in your area through other means:By asking someone who has already used one; by checkingwith your dermatologist; or by contacting the american Hairloss Council (www.ahlc.org).Talk to more than one hair replacement specialist you should consult many practitioners before youconsider committing yourself to anyone. look at all thedifferent services they offer and compare the prices.Distinguish between the ones who want to work with youto find a solution from those who want to sell you what theyhave. make certain you select someone who will spend timewith you to explain things without making you feel that youowe him or her something for taking this time. Before settling on any one practitioner to work withask to see real people he or she has treated. Pictures can bedeceptive. ask for phone numbers and addresses of several
218. HAIR REPLACEMENT TREATMENT 211clients of the specialist and, if possible, to meet and talk withthem.Don’t be tempted by low prices low prices often mean hidden costs or poorcraftsmanship. Use the section on cost above to figure outthe 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 hairreplacement plan you are considering.aDvanTageS anD DiSaDvanTageS OF Hair rePlaCe- menTFinal reCOmmenDaTiOnSyou should try hair replacement if:• If you have no other options because your baldness is toofar gone or progressing too quickly• If you can live with fake hair• If you can afford to maintain the cost of quality hairreplacement, which is more expensive long-term thansurgical treatment• If you would like to use it as a means of supporting othertreatment methods
219. 212 HAIR REPLACEMENT TREAT- advantages Disadvantages • results can be seen • it isn’t your own, natural relatively quickly hair • Quality hair • Quality hair replacement replacement can requires considerable restore a natural look maintenance to almost anyone • Quality hair replacement • Costs are well known is expensive • relatively pain-free • it takes a patient and • risks and complications thoughtful process to are minimal and rare find a good hair replace • non-commital ment specialist • Can be a useful bridge until you decide on a more permanent solution or until more effective surgical and drug methods are developed
220. HAIR REPLACEMENT TREATMENT 213Comparing wigs with surgiCal treatment for hair loss Wigs Surgical treatment • it is not permanent • your own permanent • it is more expensive on hair is transplanted a long-term basis • expense is much less on • Provides less confident a long-term basis results • Provides confident • maintenance is time- results consuming and costly • no long-term • restricting in sporting maintenance and social contexts • no restriction in sports • There is always the fear or social events, including of exposure swimming • There is no chance of exposure
221. a final recommendation To fight hair loss is understandable, but we must learn howto maintain a sense of balance in this pursuit. I have seen toomany men and women who have allowed their hair loss toundermine their sense of self worth. Some of these men andwomen have developed a mania bordering on paranoia inresponse to their hair loss. These men and women act rashlyout of desperation to fight their hair loss. Unfortunately, theymay suffer great pain and loss when their rash actions resultin their hopes being dashed in some way or another. What everyone who is fighting hair loss needs is knowl-edge of what is happening to them and knowledge of themost-up-to-date and safe procedures that can help themin this fight. It is for this reason that I have written this book.Having studied the book now, you should be aware by nowthat there is no full proof and simple way to defeat hairloss. There are many choices to make; every choice has itscosts and benefits. At least now you are well prepared tothoughtfully proceed in fighting your hair loss. The informa-tion I have given you, when used in consultation with trainedprofessionals, is sufficient for you to fight this battle and winto some degree. I say “to some degree” because as a medical doctor Ihave learned to accept certain realities. If you are a victimof hereditary hair loss you are fighting a battle against time.For most people hair loss is an irreversible part of the agingprocess. Despite fantastic claims to the contrary, the truth isthat aging is irreversible and we are all going to experienceits hardships in one way or another, including for many withhair loss. The real issue is not whether our bodies will experi-ence 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 everythingthen you can learn to deal with its loss, and thoughtfully finda way to restore its appearance with as little cost and painas possible. I wish all men and women the best in the future. 277
223. appendix In this appendix I provide sample drafts of threeimportant documents that are commonly provided byhair transplantation centres. The samples are actualdocuments I use in my own practice. The drafts providedinclude: Appendix A: Sample Consent Form Appendix B: Sample Pre-operation Instructions Appendix C: Sample Post-operation instructions 279
224. 280 appendixAppendix 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 yourcondition and the recommended surgical, medical, or diagnosticprocedure to be used so that you may make the decision whetheror not to undergo the procedure after knowing the risks and thehazards 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 INITIAL:
225. appendix 281Appendix A : sAmple consent form for surgicAl hAir trAnsplAntAtion4) 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 rec- ommendations 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 proce- dure. I understand that hair transplants are not perfect.8) I am aware that complications may occur. The more com- mon 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 anesthet- ics, 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 under- stand that such risks do exist. PAGE 2 OF 6 INITIAL:
226. 282 appendixAppendix A : sAmple consent form for surgicAl hAir trAnsplAntAtion9) I consent to and authorize the administration of such local an- esthetics 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 sur- gery by Dr. Antonio A. Armani, M. D., associate doctors, and hair assistant technicians.11) I believe I have been well informed. I understand that al- though 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 per- centage 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 INITIAL:Appendix A : sAmple consent form for surgicAl hAir trAnsplAntAtion
227. appendix 28315) 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, ir- respective 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
228. 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 WITNESS SIGNATURE PAGE 5 OF 6 INITIAL:Appendix A : sAmple consent form for surgicAl hAir trAnsplAntAtion
229. appendix 285 MORE COMMON COMPLICATIONS1) Nausea and vomiting from pain medication2) Bleeding (less than 1%)3) Infection (less than 1 %)4) Excessive Swelling (20-30%)5) Temporary headache6) Temporary numbness of the scalp7) Scarring around the grafts8) Poor growth of grafts9) 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) Keloid formation2) Complete failure of growth of transplanted hair3) Persistent scalp pain4) Total loss of donor hair5) Permanent numbness of scalp6) Noticeable scarring of donor area7) Loss of transplanted hair8) 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.
230. 286 appendixAppendix B: sAmple preoperAtive instructions for surgicAl hAir trAnsplAntAtion surgery DR. ANTONIO A. ARMANI 233 Carlton St. Toronto, Ontario, Can. M5A 2L2. 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 INSTRUCTIONSTO AvOID COMPLICATIONS (i.e. excess, bleeding and/or longerhealing process) AND ENSURE THE BEST POSSIBLE RESULTS.Two (2) WEEKS PRIOR TO SURGERY:1. ELIMINATE Intake of Vitamin E capsules or vitamin pills con- taining 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 As- pirin - see enclosed sheet - (e.g. some cold remedies). Note: You may use Tylenol5. 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.
231. appendix 287Appendix B: sAmple preoperAtive instructions for surgicAl hAir trAnsplAntAtion surgeryON DAY OF SURGERY:1. A gown will be provided during the surgery. For your own comfort you may wish to wear sweatpants forlonger 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.
232. 288 appendixAppendix B: sAmple preoperAtive instructions for surgicAl hAir trAnsplAntAtion surgery DR. ANTONIO A. ARMANI 233 Carlton St. Toronto, Ontario, Can. M5A 2L2. 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 Dolobid Quagesic Alcohol Dristan Robasisal alka Seltzer Easpirin Rufin Anacin Ecotrin Sine Off Anaprox Empirin Sine Aid Anaproxin Emprazil Trandate APC Excedrin Trental 5 ASA Feldene Trigesic Ascodeen Fiorinal Trilisate Ascriptin 4-way Cold tabs Vanquish Aspirin Ibuprofen Vitamin E Bufferin Indocine Voltaren Brufen Indomethacin Zectrin Cephalgesi Meclomen Zorprin Cheracol Capsule Medipren Children’s Aspirin Midol Clinoril Motrin Congesprin Nalfon Cope Naprosyn Coridicin Norgesic Coumadin Nuprin Darvon Percodan Darvon with ASA Phenaphen Phone numbers: Office:(416) 363-6655 / 1-800-365-6220 Dr. Antonio A. Armani’s cell phone: (416) 543-2716 Home: (416) 944-3805
233. appendix 289Appendix c: sAmple postoperAtive instructions for surgicAl hAir trAnsplAntAtion surgery DR. ANTONIO A. ARMANI 233 Carlton St. Toronto, Ontario, Can. M5A 2L2. Tel: (416) 363-6655 / 1-800-365-6220 Fax: (416) 363-1589 POSTOPERATIvE INSTRUCTIONS HAIR TRANSPLANTATION SURGERYFOR: ______________________________________Scheduled Date / Time of BANDAGE REMOvAL:Next day after surgeryScheduled Date / Time of SUTURE REMOvAL:One week after surgeryDAY OF SURGERY: BLEEDINGIf 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 areaNEXT DAY AFTER SURGERY:1. Medication Instructions: See Attached Sheet2. 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.
234. 290 appendixAppendix c: sAmple postoperAtive instructions for surgicAl hAir trAnsplAntAtion surgeryGeneral: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 fall- ing 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. Ar- mani choices in the following for your specific hair type.-Shampoos-Hair conditioners-Hair gels and mousses-Hair coloring and perms
235. appendix 291Appendix c: sAmple postoperAtive instructions for surgicAl hAir trAnsplAntAtion surgery 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.
237. glossary 293
238. glossaryAccupuncture: 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 benefi- cial 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 por- tion of the scalp to simulate hair.Cloning: The process of making copies of living cells. At- tempts 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
239. 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 treat- ment 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 com- bating 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 reductaseinhibitor. It blocks, receptors 1 and 2. The effect ofDutasteride 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 ingre- dient in Propecia.FUE:Follicular Unit Extraction is the hair transplant tech- nique, which extracts the follicular units one-by-one from the donor area. This technique does not require a scal- pel 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 tech- nique 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 micro- scopes 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 hair- bearing part of the head and “grafted” into parts of the head which are balding.
240. 296 glos-Hair Replacement: The methods of dealing with hair loss that replace your natural hair with various types of addi- tives 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 condi- tioners 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, affect- ing as many as 50% of all individuals as they age.Homeopathy: An alternative medical system developed in Germany, which cures ailments by prescribing dilu- tions 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 heredi- tary 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
241. glossary given placebos or dummy drugs as part of research test- ing 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 treat- ment 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 reduc- tion 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.
242. 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.
243. IndexA 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 24B Balding 159 C California College of Ayurveda 254 299
244. 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
245. index 301GGene therapy 209HHair care chemical treatments 274 drying 275 exposing hair 275 pulling hair 275 rules for 274 - 276 shampoos 274 using a conditioner 274Hair extensions 260Hair follicle cloning. See Hair graftingHair 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 88Hair loss 1 abnormal 6 diet-related 22 drug-related 23 hereditary causes of 7 incidence of 1 prevalence 12 symptoms 12
246. 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 advantages and disadvantages of 271 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
247. index 303 defined 88Minoxidil . See RogaineNNational Alopecia Areata Foundation 33National association of Holistic Aromatherapy 255National center for Homeopathy 256National Institute of Ayurvedic Medcine 255Neutrogena T/Gel 229New England Journal of Medicine 248PParathyroid disease 24Placebo effect 249Promising drugs Cyclosporine 240 Cyoctol 241 Diazoxide 241 Tricomin 240Propecia advantages and disadvantages of 243 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 230Proscar 227, 250Prostate-specific antigen (PSA) 236
248. 304 index R Ringworm 23 Rogaine advantages and disadvantages of 242 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
249. index 305Surgical treatment advances in 2 advantages and disadvantages of 135 future of 207 nature of 54 types 55 who appropriate for 55TThyroid disease 24Tissue expansion 200Tissue extension 200Toupees 260Tricomin 242WWeaving 264Wigs 260