Why does baldness occur?

*Pattern hair loss of men and women (Androgenetic Alopecia) is an inherited condition caused by the normal level of androgens present in both men and women.  For men (Male pattern hair loss-MPHL), permanent baldness generally follows a specific pattern which starts either in temporal areas (sides of head) or vortex( top of head).

While it can also occur in women,  total baldness is rare and women usually manifest only diffuse thinning of hair, around menopausal age.  In pattern hairloss, hair undergoes shrinking or miniaturization and then progressively disappears.

Even, in the most extensive cases, a horseshoe-shaped fringe of hair remains in the back of the scalp. This hair-bearing fringe is insensitive to the androgen mediated balding process and usually will last a lifetime. These hairs, when transplanted into thinning or balding areas, will take root and grow, and continue to grow for the rest of a person's life.

How can baldness be treated? Who can undergo hair transplantation?

*Both medical and surgical treatments are  available. Medical treatments include minoxidil lotion and tablet finasteride. However the effect of these drugs lasts only as long as they are taken. Also these drugs can promote hair growth of existing follicles only and can not create any new hair.

Hence surgical treatment by transplantation is a useful alternative. The transplanted hair is removed from back of the scalp (donor site) and transferred to the balding site (recipient site). The transferred hairs are not "rejected" as they are patient’s own hairs and are not foreign tissue.

Any person with significant baldness can undergo the procedure. Women can also under go the procedure in selected cases. However it is important to understand that pattern hairloss is a continuous process and hence frequently combination with drug therapy is also required.

Very young people are not suitable candidates as they are not emotionally mature and their pattern of hairloss is yet to be established. Likewise, elderly people with extensive baldness are also not good candidates.

How is hair transplantation carried out?

*Previously, hair transplantation used to be done by a simple method called punch transplantation in which instruments called punches were used to transplant groups of 8-12 hairs. This method though simple, used to give an artificial , ugly “doll “ look. This method has been abandoned in favour of a new method called Follicular unit hair transplantation.

The procedure is simple, though time consuming ( lasting for 3-5 hours depending on the number of hairs to be transplanted). Some discomfort is to be expected as the anesthetic is injected into the scalp. Once the skin is anesthetized, there is no pain. Hospital admission is not required and patient can return to work the next day wearing  a cap

Are there any side effects? When will be the results seen?

*Since the procedure is performed under local anesthesia, there are no serious side effects.  After the surgery, small scabs will form on the scalp at the graft sites, which disappear in 4-7days. A cap will have to be won to hide these scabs.

Shampooing can be resumed 24 hours after surgery. Mild swelling of forehead can result on 3-4 days, which subsides in a day. The suture (stitch) used in the donor area is undetectable as it is completely covered by the existing hair and is removed two weeks after surgery.

Typically, the grafted hair will shed in 2-4 weeks. New growth will begin in 3-4 months and length will increase approximately 1/2 inch per month. Full results are seen in 8-9 months.

What is laser Hair transplantation? Can artificial hairs be used?

*Laser was used to create recipient holes and it was claimed that the use of laser caused  less bleeding.

However, laser also leads to destruction of tissue which can affect growth of hairs . Hence use of laser is not now preferred . Artificial hairs are poyproplylene fibres which look like hair. These are fixed to the innermost layer of scalp called galea in a knot in a simple procedure.

However, these fibres are on the banned list of FDA in USA and have a history of leading to frequent problems such as infections, allergy, frequent loss of fibres, cysts etc. Hence their use is not advocated.

The author is a hair transplant surgeon and can be contacted at 51148848 or email mysorevenkat@hotmail.com