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Hair Transplants

What are hair transplants?
In punch transplanting, a plug containing hair follicles is removed from a part of the scalp where hair is more dense and transplanted to the treatment area. Hair transplantation has a high success rate as long as there is enough donor hair. This procedure does not have any long-term or major side effects.

What should first be done before considering a hair transplant?
Before the procedure, an ASDS doctor will review the patient’s medical history. This is the time for the doctor and patient to discuss expectations, potential risks and outcomes of the procedure. Patients should:

Avoid smoking two weeks before surgery.
Prepare to have someone drive home since most procedures are outpatient.
Prepare to take it easy for a day or two following surgery, with assistance if necessary.
Be aware that local anesthesia and, in some cases, sedation will be administered.
When are hair transplants appropriate?
The procedure is appropriate for the following conditions:

Hair loss
Who is not a candidate for a hair transplant?
Candidates must have healthy hair growth at the sides and back of the scalp to serve as donor sites. Hair color, condition and texture also are considerations.

What are the potential complications of hair transplants?
Excessive bleeding
Wide scarring
Follicle grafts won't "take."
Unnatural look, especially if grafted hair lies next to a patch that continues to thin out; additional surgery may be required in this situation.
What can I expect after having had a hair transplant?
The success and amount of hair coverage on a treated area depends on how many hair follicles remain healthy after being transplanted.
Often hair will fall out of a transplanted follicle, but a new hair will eventually grow to take its place.
They will probably need several surgeries to get the hair coverage they want.
Healing between surgeries usually takes several months.

Hair Loss
Overview
What is the normal cycle of hair growth and loss?
The normal cycle of hair growth lasts for 2 to 3 years. Each hair grows approximately 1 centimeter per month during this phase. About 90 percent of the hair on your scalp is growing at any one time. About 10 percent of the hair on your scalp, at any one time, is in a resting phase. After 3 to 4 months, the resting hair falls out and new hair starts to grow in its place.

It is normal to shed some hair each day as part of this cycle. However, some people may experience excessive (more than normal) hair loss. Hair loss of this type can affect men, women and children.

What is common baldness?
"Common baldness" usually means male-pattern baldness, or permanent-pattern baldness. It is also called androgenetic alopecia. Male-pattern baldness is the most common cause of hair loss in men. Men who have this type of hair loss usually have inherited the trait. Men who start losing their hair at an early age tend to develop more extensive baldness. In male-pattern baldness, hair loss typically results in a receding hair line and baldness on the top of the head.

Women may develop female-pattern baldness. In this form of hair loss, the hair can become thin over the entire scalp.

Causes & Risk Factors
What causes excessive hair loss?
A number of things can cause excessive hair loss. For example, about 3 or 4 months after an illness or a major surgery, you may suddenly lose a large amount of hair. This hair loss is related to the stress of the illness and is temporary.

Hormonal problems may cause hair loss. If your thyroid gland is overactive or underactive, your hair may fall out. This hair loss usually can be helped by treatment thyroid disease. Hair loss may occur if male or female hormones, known as androgens and estrogens, are out of balance. Correcting the hormone imbalance may stop your hair loss.

Many women notice hair loss about 3 months after they've had a baby. This loss is also related to hormones. During pregnancy, high levels of certain hormones cause the body to keep hair that would normally fall out. When the hormones return to pre-pregnancy levels, that hair falls out and the normal cycle of growth and loss starts again.

Some medicines can cause hair loss. This type of hair loss improves when you stop taking the medicine. Medicines that can cause hair loss include blood thinners (also called anticoagulants), medicines used for gout, high blood pressure or heart problems, vitamin A (if too much is taken), birth control pills and antidepressants.

Certain infections can cause hair loss. Fungal infections of the scalp can cause hair loss in children. The infection is easily treated with antifungal medicines.

Finally, hair loss may occur as part of an underlying disease, such as lupus or diabetes. Since hair loss may be an early sign of a disease, it is important to find the cause so that it can be treated.

Can certain hairstyles or treatments cause hair loss?
Yes. If you wear pigtails or cornrows or use tight hair rollers, the pull on your hair can cause a type of hair loss called traction alopecia (say: “al-oh-pee-sha”). If the pulling is stopped before scarring of the scalp develops, your hair will grow back normally. However, scarring can cause permanent hair loss. Hot oil hair treatments or chemicals used in permanents (also called "perms") may cause inflammation (swelling) of the hair follicle, which can result in scarring and hair loss.

Diagnosis & Tests
Can my doctor do something to stop hair loss?
Perhaps. Your doctor will probably ask you some questions about your diet, any medicines you're taking, whether you've had a recent illness and how you take care of your hair. If you're a woman, your doctor may ask questions about your menstrual cycle, pregnancies and menopause. Your doctor may want to do a physical exam to look for other causes of hair loss. Finally, blood tests or a biopsy (taking a small sample of cells to examine under a microscope) of your scalp may be needed.

Treatment
Is there any treatment for hair loss?
Depending on your type of hair loss, treatments are available. If a medicine is causing your hair loss, your doctor may be able to prescribe a different medicine. Recognizing and treating an infection may help stop the hair loss. Correcting a hormone imbalance may prevent further hair loss.
Medicines may also help slow or prevent the development of common baldness. One medicine, minoxidil (brand name: Rogaine), is available without a prescription. It is applied to the scalp. Both men and women can use it. Another medicine, finasteride, is available with a prescription. It comes in pills and is only for men. It may take up to 6 months before you can tell if one of these medicines is working.

If adequate treatment is not available for your type of hair loss, you may consider trying different hairstyles or wigs, hairpieces, hair weaves or artificial hair replacement.

Questions to Ask Your Doctor
What is causing my hair loss?
Is there a treatment that will work for me?
How long will it be before my hair grows back?
Will my hair grow back the same, or will the texture be different?
I have a fungal infection. How long will it take for the medicine to start working?
Should I change my hairstyle?
Can I do anything to make my hair look fuller?

Hair loss

Many conditions and diseases can result in hair loss, as can improper hair care.
The most common cause of hair loss is hereditary thinning or baldness.
While daily shedding is normal, people who notice their hair shedding in large amounts after combing or brushing and those whose hair becomes thinner or falls out should consult a dermatologist for proper diagnosis and treatment.
Causes of hair loss

Causes of hair loss, some of which are temporary, include:
Excessive or improper use of styling products such as perms, dyes, gels, relaxers or sprays, which can cause weathering or hair breakage.
Hairstyles that pull on the hair, like ponytails and braids.
Shampooing, combing or brushing hair too much or too hard, or pulling it out.
A variety of diseases, including thyroid disease.
Childbirth, major surgery, a high fever or severe infection, stress, or even the flu.
Inadequate protein or iron in the diet, or eating disorders such as anorexia and bulimia.
Certain prescription drugs, including blood thinners, high-dose vitamin A, and medicines for arthritis, depression, gout, heart problems and high blood pressure.
Use of birth control pills (usually in women with an inherited tendency for hair thinning).
Hormonal imbalances, especially in women.
Ringworm of the scalp, a contagious fungal infection most common in children.
Some cancer treatments, such as radiation therapy and chemotherapy.
Alopecia areata, a type of hair loss that affects all ages, which causes hair to fall out in round patches.
Psychosocial impact of hair loss

While the physical symptoms of hair loss can be traumatic for patients, the psychosocial impact of hair loss can be just as severe.
Hair loss can cause dramatic and devastating emotions in patients that can negatively impact their quality of life. Studies on the psychosocial impact of hair loss have found patients’ self-esteem, body image and self-confidence to be negatively affected.1-2
Known psychosocial complications include depression, low self-esteem, altered self-image, and less frequent and enjoyable social engagement.
The negative quality of life may be worse in women due to societal pressure to be attractive. Treatment from a dermatologist may be sought in order to improve quality of life.1-2
Treatment of hair loss

Topical minoxidil (for men and women; available over-the-counter) and oral finasteride (for men only; prescription only) have been shown to help the regrowth of hair or to slow hair loss. Hair loss caused by diseases such as thyroid disease may be reversed with treatment of the underlying disease.
Topical or injectable cortisone medications have been shown to accelerate the regrowth of hair in some types of hair loss.
Topical or oral estrogen or other female-specific hormones are sometimes prescribed for women experiencing hair loss.
Hair transplantation is a permanent form of hair replacement utilizing dermatologic surgery that involves moving some existing scalp hair to bald or thinning parts. It may benefit men with male pattern baldness, some women with thinning hair, and people who have lost some but not all hair from burns or other scarring injuries to the scalp, eyebrows or eyelashes.
Restoration surgery is another treatment option. In scalp reduction surgery, bald scalp is removed and hair-bearing scalp is brought closer together to reduce balding. In scalp expansion surgery, a physician temporarily inserts devices under the scalp to stretch hair-bearing areas, which also reduces balding. In scalp flap surgery, a hair-bearing piece of scalp is surgically moved and placed where hair is needed.

How Will Alopecia Areata Affect My Life?

This is a common question, particularly for children, teens, and young adults who are beginning to form lifelong goals and who may live with the effects of alopecia areata for many years. The comforting news is that alopecia areata is not a painful disease and does not make people feel physically sick. It is not contagious, and people who have the disease are generally healthy otherwise. It does not reduce life expectancy, and it should not interfere with going to school, playing sports and exercising, pursuing any career, working, marrying, and raising a family.

The emotional aspects of living with hair loss, however, can be challenging. Many people cope by learning as much as they can about the disease, speaking with others who are facing the same problem, and, if necessary, seeking counseling to help build a positive self-image.

What Research Is Being Conducted on Alopecia Areata?

Although a cure is not imminent, researchers are making headway toward a better understanding of the disease. This increased understanding will likely lead the way to better treatments for alopecia areata and eventually a way to cure it or even prevent it.

The National Institutes of Health (NIH) and other organizations support research into the disease and its treatment. Here are some promising areas of research:

Developing animal models. This is a critical step toward understanding any disease, and much progress has been made. By studying mice with problems similar to those encountered in human alopecia areata, researchers hope to learn more about the mechanism of the disease and eventually develop treatments for the disease in people.
Studying hair follicle development. By studying how hair follicles form, develop, and cycle through growth and resting phases, researchers hope to gain a better understanding of hair growth cycle biology that may lead to treatments for the underlying disease process.
Understanding stem cell biology. Epithelial stem cells are immature cells that are responsible for regenerating and maintaining a variety of tissues, including the skin and the hair follicles. Stem cells in the follicle appear to be spared from injury in alopecia areata, which may explain why the potential for regrowth is always there in people with the disease. By studying the biology of these cells, scientists hope to gain a better understanding of factors that trigger the disease.
Finding genes. Scientists have identified genetic variations associated with the development of alopecia areata. They also discovered that alopecia areata has genetic similarities to other autoimmune diseases, namely type 1 diabetes, rheumatoid arthritis, and celiac disease. An understanding of the genetics of the disorder will aid in disease prevention, early intervention, and development of specific therapies. To assist researchers searching for such genetic clues, the NIAMS supported the development of the National Alopecia Areata Registry, a network of five centers, to identify and register patients with the disease and collect information and blood samples (which contain genes). Data, including genetic information, is made available to researchers studying the genetic basis and other aspects of the disease and disease risk. For more information, log onto the registry website at www.AlopeciaAreataRegistry.org.

In alopecia areata, immune system cells called white blood cells attack the rapidly growing cells in the hair follicles. The affected hair follicles become small and drastically slow down hair production. Fortunately, the stem cells that continuously supply the follicle with new cells do not seem to be targeted. So the follicle always has the potential to regrow hair.

Scientists do not know exactly why the hair follicles undergo these changes, but they suspect that a combination of genes may predispose some people to the disease. In those who are genetically predisposed, some type of trigger—perhaps a virus or something in the person’s environment—brings on the attack against the hair follicles.

Who Is Most Likely to Get It?

Alopecia areata affects nearly 2 percent of Americans of both sexes and of all ages and ethnic backgrounds. It often begins in childhood.

If you have a close family member with the disease, your risk of developing it is slightly increased. If your family member lost his or her first patch of hair before age 30, the risk to other family members is greater.

Is My Hair Loss a Symptom of a Serious Disease?

Alopecia areata is not a life-threatening disease. It does not cause any physical pain, and people with the condition are generally healthy otherwise. But for most people, a disease that unpredictably affects their appearance the way alopecia areata does is a serious matter.

The effects of alopecia areata are primarily socially and emotionally disturbing. In alopecia universalis, however, loss of eyelashes and eyebrows and hair in the nose and ears can make the person more vulnerable to dust, germs, and foreign particles entering the eyes, nose, and ears.

Alopecia areata often occurs in people whose family members have other autoimmune diseases, such as type 1 diabetes, rheumatoid arthritis, thyroid disease, systemic lupus erythematosus, pernicious anemia, or Addison’s disease. People who have alopecia areata do not usually have other autoimmune diseases, but they do have a higher occurrence of thyroid disease, atopic eczema, nasal allergies, and asthma.

Can I Pass It On to My Children?

It is possible for alopecia areata to be inherited. However, most children with alopecia areata do not have a parent with the disease, and the vast majority of parents with alopecia areata do not pass it along to their children.

What Causes It?

Alopecia areata is not like some genetic diseases in which a child has a 50–50 chance of developing the disease if one parent has it. Scientists believe that there may be a number of genes that predispose certain people to the disease. It is highly unlikely that a child would inherit all of the genes needed to predispose him or her to the disease.

Even with the right (or wrong) combination of genes, alopecia areata is not a certainty. Studies suggest that in identical twins, who share all of the same genes, the concordance rate is only 55 percent. In other words, if one twin has the disease, there is only a 55-percent chance that the other twin will have it as well. This shows that other factors besides genetics are required to trigger the disease.

Will My Hair Ever Grow Back?

There is every chance that your hair will regrow with or without treatment, but it may also fall out again. No one can predict when it might regrow or fall out. The course of the disease varies from person to person. Some people lose just a few patches of hair, then the hair regrows, and the condition never recurs. Other people continue to lose and regrow hair for many years. A few lose all the hair on the scalp; some lose all the hair on the scalp, face, and body. Even in those who lose all their hair, the possibility for full regrowth remains. The course of alopecia areata is highly unpredictable, and the uncertainty of what will happen next is probably the most difficult and frustrating aspect of the disease.

In some, the initial hair regrowth is white, with a gradual return of the original hair color. In most, the regrown hair is ultimately the same color and texture as the original hair.

How Is It Treated?

Although there is neither a cure for alopecia areata nor drugs approved for its treatment, some people find that medications approved for other purposes can help hair grow back, at least temporarily. Keep in mind that although these treatments may promote hair growth, none of them prevent new patches or actually cure the underlying disease. Consult your health care professional about the best option for you. A combination of treatments may work best. Ask how long the treatment may last, how long it will take before you see results, and about the possible side effects.

In addition to treatments to help hair grow, there are measures that can be taken to minimize the effects of excessive sun exposure or discomforts of lost hair.

Sunscreens are important for the scalp, face, and all exposed areas.
Eyeglasses (or sunglasses) protect the eyes from excessive sun and from dust and debris when eyebrows or eyelashes are missing.
Wigs, caps, or scarves protect the scalp from the sun and keep the head warm.
An ointment applied inside the nostrils keeps them moisturized and helps to protect against organisms invading the nose when nostril hair is missing.

What Is Alopecia Areata?

Alopecia areata is considered an autoimmune disease, in which the immune system, which is designed to protect the body from foreign invaders such as viruses and bacteria, mistakenly attacks the hair follicles, the structures from which hairs grow. This can lead to hair loss on the scalp and elsewhere.

In most cases, hair falls out in small, round patches about the size of a quarter. In many cases, the disease does not extend beyond a few bare patches. In some people, hair loss is more extensive. Although uncommon, the disease can progress to cause total loss of hair on the scalp (referred to as alopecia areata totalis) or complete loss of hair on the scalp, face, and body (alopecia areata universalis).

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