Cosmetic Procedures for Hair Loss

The most common cause of hair loss in both men and women is genetic. In fact, heredity accounts for 95% of all the cases of alopecia (baldness) in this country. The remaining 5% of the cases can be due to a number of things including diet, stress, illness, and/or medications.

Factors that can cause hair loss include:

• Medications, vitamins, or minerals. Drugs used to treat high blood pressure, heart problems, depression, or gout; chemotherapy or radiation treatment for cancer patients; and in some cases, unusually high levels of vitamin A or low levels of iron or protein. For women, birth control pills can cause hair loss.
• Illness. Including thyroid disease, severe infection, or flu; fungus infections, such as ringworm of the scalp.

For women, childbirth may cause temporary hair loss as well due to the changes that take place in the body. In some cases, adults or children may have a condition known as trichotillomania, where there is a compulsion to pull out hair on the scalp; eyebrow hair, or eyelashes.

What Are the Treatment Options for Hair Loss?

Rogaine (topical minoxidil) and Propecia (finasteride) are the only drugs approved by the FDA to treat pattern baldness (hair loss as a result of hereditary causes).

Rogaine is a topical solution that is applied by directly rubbing it onto the scalp where hair growth is desired. Only about 10% to 14% of the people who try this lotion experience hair growth. However, Rogaine lotion can help to slow hair loss.

Propecia is the first pill that can treat male pattern hair loss. Like all prescription products, it should be given under a doctor's care. While effective, if treatment is discontinued, results may not be maintained.

Permanent hair loss can also be treated by hair replacement procedures, such as hair transplantation methods (like micro-grafting, slit grafting, punch grafting) and by scalp reduction. The type of hair loss as well as the patient's circumstances and desires determine which hair replacement procedures are most suitable.

Who Is a Candidate for Hair Replacement?

Candidates for hair replacement procedures include:

• Men with male-pattern baldness
• Some women with female-pattern (genetic) hair loss
• A person who has lost some but not all hair as a result of burns or other scalp injuries

Who Is Not a Candidate for Hair Replacement?

Hair replacement is not recommended for the following people:

• Women with a diffuse, or wide-spread, pattern of hair loss
• Those who do not have sufficient "donor" sites (hair-bearing portions of the head from which hair-bearing skin is taken)
• People who form keloid scars or thick fibrous skin tissue that can result from trauma, burns or radiation injury
• Those whose hair loss is due to medication

Common Hair Replacement Procedures

Hair Grafting or Hair Transplant

Hair grafting -- also called a hair transplant -- is an outpatient hair replacement procedure performed in the dermatological surgeon's office. Micro grafts contain only one to two hairs per graft, while slit grafts contain between four and ten, and punch grafts hold 10-15 hairs. Also available are mini-grafts (containing two to four hairs) and strip grafts (long thin grafts containing 30 to 40 hairs). Local anesthetic is injected into the scalp and sedation is available, if needed for relaxation and comfort.

Quick GuideHair Loss: Causes, Treatments, and Prevention

What Happens During and After Hair Grafting?

In hair grafting, the dermatological surgeon first removes a portion of the hair-bearing scalp from the back of the head. Then, the surgeon cuts the removed scalp into small segments with varying amounts of hair in each graft, which when transplanted into the balding area, achieves a very subtle thickening and "natural" look.

With each session, 50 or more hair-bearing segments are usually transplanted. "Donor" sites are closed with stitches, which usually are then concealed by the surrounding hair. After the grafting session is complete, the scalp will be cleaned then covered with gauze and, if necessary, a bandage. Stitches will come out approximately 10 days later.

How Long Does Hair Grafting Take?

Several sessions may be needed to achieve satisfactory "fullness." After each session, a healing process of two to four months is usually recommended.

Will There Be Any Discomfort or Side Effects With Hair Grafting?

Most side effects that come with hair grafting usually go away within one to three weeks. Among the most common side effects are:

• Swelling
• Bruising around the eyes
• Crusting on the "donor" and "recipient" sites of the scalp
• A lack of feeling or sensation around the "donor" and "recipient" sites of the scalp
• Itching in the "donor" site

Scalp Reduction

A scalp reduction is the removal of non-hair-bearing skin from the scalp so that the remaining hair-bearing skin can be stretched to fill in the bald area of the head. Scalp reduction can reduce as much as half of the bald area. It is a procedure performed to cover bald areas on the top and back of the head and is not found to be beneficial for the frontal hairline.

How Is Scalp Reduction Done?

The scalp is injected with local anesthetic and a bald segment of scalp is removed. The surrounding skin is then loosened and gently stretched so that the sections of hair-bearing scalp are brought together and closed with stitches. This procedure may also be performed along with hair grafting.

What Are the Side Effects of a Scalp Reduction?

There will be a little more pain experienced after scalp reduction surgery than experienced after punch grafting. Headaches may occur and are treated with non-aspirin-based pain relievers. Mild scalp tightness may be felt for one to two months.

WebMD Medical Reference

Reviewed by Norman Levine, MD on February 21, 2010

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