What is the history of Hair Transplantation?
Sasagawa in Japan first described the hair-shaft insertion procedure way back in 1930. Okuda, again from Japan then described the 2-4 mm punches for alopecia treatment over various sites and this was carried on by Tamura who performed more than 100 transplantations by 1943. Tamura’s principles in the hair transplantation procedure were taken up by the surgeons in the West much later. Orentreich first performed the procedure in the US in 1952 using much larger grafts than Tamura. The principle of “donor dominance” then came in to place which remains the basic tenet of all hair transplantation surgeries. The procedure evolved to encompass minigrafts and then mini-micrografts and then finally into Follicular Unit Transplantation (FUT) in the 1990s by Bernstein &Rassman.
Hair loss: is it problematic?
The human scalp has around 100,000 to 150,000 hairs and around 90% of these hairs are in the growing phase. Loss of around 100 hairs per day is normal and not necessarily pathological therefore in most people finding hairs in your comb is not a cause for concern. However, if hair loss occurs typically in a pattern with a history of baldness in the family then it is a cause for concern and you should be evaluated by a plastic surgeon.
Mesotherapy and hair restoration products: are these advisable?
Desperate numerous patients who have been subjected to mesotherapy, the results are extremely dubious. Moreover, mesotherapy leads to scarring below the scalp skin which can lead to less blood supply in the areas of the scars so that when the patient is considered for future hair transplantation, the results might not be as expected! The medical literature also does not highlight any beneficial effects of mesotherapy. Therefore, Dr. Adhikari feels that mesotherapy should not be resorted to by patients as it can cause permanent damage to the scalp and affect results of hair transplantation.
Apart from mesotherapy, many other companies are advertising hair restoration products with beautiful end results. Please take these with a pinch of salt as studies have demonstrated that hair transplantation can be the only permanent solution to hair loss and cannot be matched by any other product or procedure!
What is hair transplantation?
If you watch closely a person with baldness, you would find that the hair over the back of the scalp is preserved as baldness continues. This is known as genetically resistant hair and usually persists despite hair fall from other areas of the scalp. Hair loss usually occurs under the effect of hormones and these hairs over the back of the scalp are resistant to the effect of these hormones. These are the target hairs in hair transplantation, whereby these hairs are taken and transplanted individually to the areas of baldness. Transplanted hairs show “donor dominance” in that the resistant effect persists even when they change places. Thus, hair transplant provides a person with permanent growing hairs that can be shampooed and cut just like normal hair.
How to diagnose androgenetic alopecia?
This is usually diagnosed by observing the typical “pattern” of hair loss and by the presence of miniaturized hairs in the areas of thinning which is progressive in nature. This is usually but not always associated with a history of baldness in the family. In women, the diagnosis can be much more difficult since the typical pattern found in males is absent and hair loss tends to be diffuse. The hair shaft tends to decrease in length as well as in diameter in androgenetic alopecia which can easily be observed with a magnifying instrument like Rassman densitometer.
Hair loss can then be classified according to the Norwood classification in men and by the Ludwig classification in females.
The Norwood Classification is shown below:
Causes of Hair Loss in Women
In women, apart from androgenetic alopecia, there can be various causes of hair loss including anemia, endocrine diseases (especially related to the thyroid), connective tissue diseases, PCOS, post-partum, crash diets, emotional and physical stress and several medications like OCP, thyroid drugs and so on.
Are you a proper candidate for Hair Transplantation? You are if….
- Age: more than 25 years
- Improper response to medication even after 1 year
- Significant hair loss described as Norwood Class III or greater
- Patient is not suffering from Diffuse Patterned Alopecia (DUPA)
- Other causes apart from androgenetic alopecia have been ruled out
- Medical contraindications to surgery are not there
- Patient expectations are reasonable