CAUSES OF HAIR LOSS
Hair loss affects both men and women and can be equally devastating for both. Hair loss, or alopecia, can be broadly classified as un-patterned or patterned. Un-patterned hair loss can be further divided into scarring (cicatricial) and non-scarring (non-cicatricial) alopecia. The history and examination are crucial to differentiate these and a dermatoscope can improve the accuracy of the examination (for example shiny atrophic skin without follicular ostia especially with a previous history of inflammatory signs and symptoms suggest a scarring alopecia). Often a biopsy is required to confirm the diagnosis. Common causes of scarring alopecia include trauma, infection, and inflammatory conditions such as lichen planopilaris, discoid lupus, frontal fibrosing alopecia and central centrifugal cicatricial alopecia. Causes of non-scarring alopecia in men include alopecia areata, medications, telogen effluvium (after an illness), anagen effluvium (after radiotherapy or chemotherapy), trichotillomania, traction alopecia, metabolic disorders (iron deficiency,diabetes and thyroid disease) and hair shaft abnormalities (such as trichorrhexis nodosa). Patterned hair loss is usually inherited and the extent is genetically determined. There are different patterns of hair loss in men and women.
Please expand each section to read about male and female hair loss treatments.
Male Pattern Hair Loss
Male Pattern Hair Loss Non-Surgical Treatments
Female Pattern Hair Loss
Female Pattern Hair Loss Non-Surgical Treatments
Not everyone will be suitable for, or want to have, a hair transplant so the potential choices for managing hair loss can be divided into Surgical and Non-Surgical options. Some patients hair loss may be too extensive to be considered for a hair transplant and some patients hair loss may be considered by the Hair Transplant Surgeon to be too early to warrant a hair transplant. Very young patients are often counselled to wait until they are older to consider a surgical option. Patients may be concerned about hair loss but reluctant to undergo surgery, preferring to opt for a less invasive method of treating or managing their thinning hair.
To create the most natural hair transplant results requires in depth consultation and planning. The principal of hair transplant surgery is to relocate hairs from the back and/or sides of the scalp to areas where there is hair loss. The donor hairs have properties which make them resistant to hair loss, thus providing a potential lifelong hair restoration solution. In some situations, donor hairs can be harvested from the beard, chest and other hair bearing areas.
In order to achieve these natural results, hair transplant surgeons restore lost hair by using the naturally occurring groupings of hairs called ‘follicular units’ which, when transplanted, are called ‘grafts’. The follicular units may have 1, 2, 3,4 or very occasionally 5 hairs in the grouping. There are two main methods of harvesting donor hair – Follicular Unit Excision (FUE) and Strip Follicular Unit Transplantation (Strip FUT) - click the links below to read about each in detail.
Ultra-Refined Follicular Unit Transplantation (FUT or Strip)
Follicular Unit Extraction (FUE)
Whether opting for the FUE or Strip FUT methods of donor hair harvesting, both techniques result in follicular unit grafts which need to be transplanted into the recipient area. This requires an artistic eye by the surgeon to carefully plan the recipient sites in order to restore hair coverage in a natural looking way.
Various techniques exist for this stage of the procedure. Some surgeons prefer creating all the incisions into which grafts can be placed manually with forceps or dull implanting devices, other surgeons used sharp implanting devices which create incisions and implant hairs at the same time. There is also a method called ‘stick and place’ where the surgeon makes an incision and assistant immediately places the graft. All these techniques have their own merits and it is the surgeon’s preference and experience that determines which is used.
Once all the grafts have been implanted the hair transplant is complete. The procedure length depends on the number of grafts being transferred but can take 8-10 hours or longer. It is almost always performed under local anaesthetic and is usually well tolerated with majority of people going home within an hour of surgery.
From the day of the treatment it can take 3-4 months for new hair to start to grow. All new hairs are likely to be growing by 8 months post procedure with these hairs achieving full maturity after 18 months.
For those patients for whom hair transplant surgery is not an option, there are non-surgical possibilities that can be considered.
Medications Minoxidil for men and women, Finasteride for men
Low level light therapy
Camouflage products Hair Micro-pigmentation tattooing hair microfibers and scalp dyes
Hair Replacement systems partial or complete hair pieces and wigs