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Hair Loss

Picture of a man working on the computer, talking on the phone

Facts about normal hair growth:

About 90 percent of hair on the scalp grows continually. The other 10 percent of scalp hair is in a resting phase that lasts two to three months. At the end of the resting stage, this hair is shed.

Shedding 50 to 100 hairs a day is normal. When a hair is shed, it is replaced by a new hair from the same follicle and the growing cycle starts again. Scalp hair grows about one-half inch a month.

As people age, the rate of hair growth slows.

What causes hair loss?

Hair loss is believed to be primarily caused by a combination of the following:

  • aging
  • change in hormones
  • illness
  • family history of baldness
  • burns
  • trauma

However, hair loss is not caused by the following:

  • poor circulation to the scalp
  • vitamin deficiencies
  • dandruff
  • excessive hat-wearing
  • a gene passed on from an individual's maternal grandfather

Generally, the earlier hair loss begins, the more severe the baldness will become.

What is hair replacement surgery?

The interest in hair replacement has significantly increased over the past ten years. Two out of every three men suffer from hair loss by the time they are 60 years old. Women make up 40 percent of individuals suffering from hair loss. For men, the main cause of a diminishing hairline is heredity. Hormonal changes such as menopause can cause both thinning and hair loss in women.

There are a number of hair replacement techniques that are available, although hair replacement surgery cannot help those who suffer from total baldness. Candidates for hair replacement must have a healthy growth of hair at the back and sides of the head. The hair on the back and sides of the head will serve as hair donor areas where grafts and flaps will be taken.

There are four primary different types of hair replacement methods, including the following:

  • hair transplantation
    During hair transplantation, the surgeon removes small pieces of hair-bearing scalp grafts from the back or sides of the head. These grafts are then relocated to a bald or thinning area.
  • tissue expansion
    In this procedure, a device called a tissue expander is placed underneath a hair-bearing area that is located next to a bald area. After several weeks, the tissue expander causes the skin to grow new skin cells. Another operation is then required to place the newly expanded skin over the adjacent bald spot.
  • flap surgery
    Flap surgery is ideal for covering large balding areas. During this procedure a portion of the bald area is removed and a flap of the hair-bearing skin is placed on to the bald area while still attached at one end to its original blood supply.
  • scalp reduction
    Scalp reduction is done in order to cover the bald areas at the top and back of the head. This technique involves the removal of the bald scalp with sections of the hair-bearing scalp pulled together filling in the bald area.

Possible complications associated with hair transplantation procedures:

Possible complications associated with hair transplantation procedures may include, but are not limited to, the following:

  • patchy hair growth
    Sometimes, the growth of newly placed hair has a patchy look, especially if it is placed next to a thinning area. This can often be corrected by additional surgery.
  • bleeding and/or wide scars
    Tension on the scalp from some of the scalp reduction techniques can result in wide scars and/or bleeding.
  • grafts not taking
    Occasionally, there is a chance that the graft may not "take." If this is the case, surgery must be repeated.
  • infection
    As with any surgical procedure, there is the risk of infection.

About the procedure:

Although each procedure varies, generally, hair replacement surgeries follow this process:

  • Location options may include:
    • surgeon's office-based surgical facility
    • outpatient surgery center
    • hospital outpatient
    • hospital inpatient
  • Anesthetic options may include:
    • general anesthesia
    • local anesthesia, combined with a sedative (allows the patient to remain awake but relaxed)
  • Average length of procedure:
    Several surgical sessions are usually needed to achieve satisfactory fullness, with a healing interval of several months recommended between each session. It may take up to two years before seeing the final result with a full transplant series.
  • Recuperation period:
    Plugged or grafted hair falls out within a month or two after surgery, which is normal and almost always temporary. After hair falls out, it generally takes another month or more before hair growth resumes. A surgical touch-up procedure may be needed to create more natural-looking results after the initial incisions have healed. This may involve blending, a filling-in of the hairline using a combination of mini-grafts, micro-grafts, or slit grafts.

Non-surgical hair replacement with medication:

  • Finasteride (Propecia™)
    Finasteride, produced by Merck and Company under the name Propecia, was approved by the FDA in December 1997, as a treatment for male pattern baldness. It is the first drug available in pill form for the treatment of baldness.

    In men with mild to moderate hair loss, clinical trials showed that 83 percent of the male patients had kept their hair or grown more after one year of treatment. Propecia (finasteride) works by blocking an enzyme called 5-alpha reductase, which is responsible for the formation of dihydrotestosterone in a man's body. The enzyme converts testosterone to DHT (dihydrotestosterone). It is believed that DHT is a key factor in male pattern hair loss, and finasteride decreases the concentration of DHT in a man's scalp.

    Finasteride is available by prescription only.

  • minoxidil (Rogaine™)
    Minoxidil, a drug produced by Upjohn under the name of Rogaine, has been available since 1988 for the treatment of hair loss. It is currently available as an over-the-counter drug.

    Minoxidil is topical solution that must be applied by applicator or fingers to the balding area twice a day, every day. Decreasing the dosage to once a day results in some hair loss, and discontinuing application causes regression to pretreatment baldness.

Male pattern baldness and heart disease:

While a receding hairline may be just enough to bother some men, hair loss on top of the head may actually increase the risk of heart disease.

The latest in a series of studies conducted over the past several years regarding hair loss in men, has confirmed that those men who are balding on the crown of their heads have a 36 percent greater risk of developing coronary heart disease.

Publishing the results of an 11-year study involving more than 22,000 men in the publication The Archives of Internal Medicine, researchers found that men with vertex pattern balding, or balding on the top of the head, appeared to be a marker for increased coronary heart disease. This association was even greater for men with hypertension or elevated cholesterol levels.

Previous studies have pointed to a link between male pattern balding and heart disease, but this study constitutes one of the largest conducted. Researchers also included detailed information about various patterns of balding and used these to identify the risk of developing heart disease in men of all ages.

The study looked at physicians who were between the ages of 40 and 84 years old who were involved in the Physician's Health Study beginning in 1982, and followed them over an 11-year period. Of the 22,071 US male physicians studied, 19,112 were free of coronary heart disease when the study began.

Every six months for the first year, and then annually after that, the men were asked to complete follow-up questionnaires to obtain information about new medical conditions and diagnoses. These were confirmed through medical records.

The researchers defined coronary heart disease events as nonfatal myocardial infarction (heart attack), angina pectoris (chest pain), and/or coronary revascularization (heart bypass surgery and angioplasty). Nearly 1,500 of the men reported one of these coronary events.

The researchers also looked retrospectively at the pattern of hair loss of the men at the age of 45. Participants were asked on the 11-year follow-up questionnaire to choose from options that included no hair loss, frontal baldness only, or frontal baldness with mild, moderate, or severe vertex (crown of the head) baldness.

What they found was that men whose crowns were completely bald had a 36 percent greater risk of having one of the coronary events; men with moderate crown balding had a 32 percent greater risk; those with mild balding of the crown were at a 23 percent greater risk; and men with frontal balding had a 9 percent greater risk of coronary events.

In addition, men who were balding and had hypertension were at nearly twice the risk for heart disease, and those with high cholesterol had nearly three times the risk, when compared to non-balding men with the same conditions.

Always consult your physician for more information.

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