The Cause of Hair Loss

There are a variety of disorders that can cause loss of hair. Most, but not all, can be treated with hair transplantation. This is why it is very important to have hair loss diagnosed by a competent physician, such as a board certified dermatologist, prior to any restoration or surgery. By far, the most common cause of hair loss in both men and women is genetic hair loss also sometimes called male pattern baldness or androgenetic alopecia. Other conditions such as traction alopecia, scarring alopecia, telogen effuvium and alopecia areata need to be diagnosed since they can resemble genetic hair loss, but may respond differently to hair transplantation.

Both men and women have the hormone testosterone circulating in their blood stream. Men have a lot more; that is what makes them male in appearance and functionally. A metabolite or by-product of testosterone, di hydro testosterone, called DHT for short, is what makes hair follicles gradually turn off and finally altogether stop producing hairs. First the hair gets smaller in diameter. This is called miniaturization. You can see this as the first step in hair loss. The follicle then just quits producing hair and fades away.

Our genetic heritage, inherited from both parents, determines how sensitive our hair follicles are to DHT. Some men have hardly any hair loss, even in advanced years, because their hair follicles are not sensitive to the effect of DHT. Others can be bald by the age of 25. Their follicles are genetically programmed to be extremely sensitive to DHT.

The interesting thing is that everyone has hair follicles in the posterior scalp area that are not sensitive to DHT. You can notice that totally bald men still have a fringe of hair from ear to ear around the back of the scalp. This is sometime called the "Hippocratic Wreath," named for the ancient Greek physician Hippocrates, who was himself bald. The diagram below shows this area outlined in red.

We can remove hair from the shaded area surgically and transfer it to the bald area in grafts. The great thing is that the hair follicles, despite being moved surgically, behave in their new location just like they did in the back of the scalp. The hair grows and is not sensitive to DHT and the balding process. This concept was given the name "Donor Dominance" by an American hair transplantation pioneer, Dr. Norman Orentreich.

Options for Hair Loss:

• Do nothing
  
• Hairpiece, weave and other prostheses:
  Effective as camouflage, but they require maintenance as long as they are used; ultimately a costly option.
  
• Medications such as finasteride (Propecia®) and minoxidil (Rogaine®):
  The only medications scientifically proven to grow and conserve hair. For actually restoring hair they work best in the back of the scalp. They must be used indefinitely. However, these medications are quite effective in conserving hair all over the scalp. For people with partial hair loss we often recommend these FDA approved medications as a good adjunct to hair transplantation.
• Lotions, Potions and Concoctions:
  There are literally hundreds of hair growth products and devices marketed to the public via various media. A lot of these contain minoxidil, but are often overpriced. Others are pure scams. The treatments discussed here are the ones that are scientifically proven to restore hair.
• Scalp Reduction:
  The surgical removal of bald scalp while stretching hair-growing areas to cover. An invasive surgical procedure that generally will result in some degree of scarring; can be combined with hair transplantation.
  
• Micrograft/Follicular Unit Hair Transplantation:
  The permanent transplantation of healthy hair into balding areas; new advances make this the treatment of choice for many.
  

The History of Hair Transplantation

Since the dawn of recorded history men and women afflicted with thinning hair and balding have attempted to restore their youthful hairlines.

The ancient Egyptians wore elaborate wigs and used strange ointments that were purported to regrow hair. Julius Caesar, British Monarchs, Napoleon, and countless millions of others have used hair pieces and styling to conceal hair loss. There has been an ongoing quest for a reversal of this process which affects over 50% of American men and women.

The first hair transplants were performed in animal experiments in Germany in the early 19th century. Hair transplantation in humans was first practiced in the 1930's in Japan. The procedure gained prominence in the U.S. in the 1950's when celebrities and others had hair transplants. These early hair transplants are still growing today.

Hair transplantation works because of the principle of "donor dominance." The hair from the donor area at the back of the scalp is not genetically predetermined to fall out like the hair in areas subject to balding. In the old traditional hair transplantation, four millimeter (3/16 inch) round grafts, possessing 20 to 25 hairs, are surgically removed from the donor area and placed in similar sized round incisions in the bald area. The transplanted hair growth is excellent, thick and healthy. However the size and shape of the grafts often results in a tufted or "pluggy" look, even in the hands of the most skilled surgeons.

At Northern California Hair Transplantation we don't do this!

The Micrograft Revolution

The 1990's produced vastly improved results in hair transplantation. Natural, virtually undetectable results are now possible because of micrografting, a revolutionary new method of producing and placing the grafts.

As the name implies, the grafts are much smaller and therefore almost impossible to differentiate from natural hair. We have learned that hair grows in little clusters of one to six hairs. These clusters are called follicular units. Single-hair and double-hair follicular units, or micrografts, and slightly larger grafts having three or more hairs or even multiple follicular units (sometimes called minigrafts) can be strategically placed into carefully crafted incisions in the recipient area. The hair grows just as well as it does in the traditional large plug grafts but has a much softer, more natural look. The "doll's head" or "corn row" hairline is now a thing of the past.

Micrografting Illustrated

	First, a topical anesthetic is applied to the donor site. This makes everything that follows just about completely painless.
	A narrow strip is removed, the area is completely numb to any discomfort. After removal of the strip the incision is closed with stitches or surgical staples and heals to a fine line, often invisible, scar.
	The strip is sectioned into follicular unit micrografts. Multiple follicular unit grafts are at the left end of the sterile cutting blade. Single follicular unit grafts are seen to the center.
	Incisions, again under local anesthesia, are made at the hairline with a micro scalpel. Careful attention must be paid to match the exit angle of existing hair and avoid damage to any pre-transplant follicles.
	Here the grafts are being inserted into the tiny slit incisions.
	Finally the grafts are in place ready the recreate this person's hairline naturally.