Losing hair is a worrying prospect to many people, especially since it is a common problem. Although it is often associated with older men, hair loss (alopecia) can begin at any time of life and affect both sexes. There are a number of types of hair loss and various causes, but all can result in a significant impact on self-esteem. Luckily, there are treatment options available…
Types of hair loss
Humans have over 5 million hair follicles, with 100,000 of these on the scalp. While loss of scalp hair is the most common cause of concern, people can also experience hair loss in other places such as their eyebrows, eyelashes, beards, sideburns and moustaches.
Hair loss on the scalp can be either patterned or un-patterned:
- Patterned alopecia is the most common form, manifesting as male pattern hair loss (MPHL or androgenetic alopecia), which usually takes the form of a receding hairline or thinning mid scalp and crown, and female pattern hair loss (FPHL), which usually involves thinning of the central part of the scalp behind the hairline.
- Un-patterned alopecia is be further categorised into scarring and non-scarring:
- Scarring alopecia, as the name suggests, is the loss of hair that is accompanied by scarring. It may be due to:
- Trauma, burns or surgery
- Inflammatory dermatological conditions, e.g. lichen planopilaris (LPP), central centrifugal cicatricial alopecia (CCCA), fontal fibrosing alopecia (FFA)
- Infection
- Non-scarring alopecias are not associated with scarring and may be due to:
- Side-effects of medication
- Trichotillomania (compulsive hair pulling)
- Telogen effluvium (after an illness)
- Traction alopecia (from chronic use of tight hairstyles, braids or weaves)
- Anagen effluvium (after radiotherapy or chemotherapy)
- Hair shaft abnormalities (such as trichorrhexis nodosa)
- Nutritional deficiencies (such as iron, zinc and Vitamin D)
- Metabolic disorders (such as diabetes, thyroid disease)
- Scarring alopecia, as the name suggests, is the loss of hair that is accompanied by scarring. It may be due to:
Treating hair loss
There are a number of options for managing hair loss. Some people prefer to use prosthetics to simulate a normal appearance, such as false eyelashes or wigs, while others use makeup and camouflage techniques. However these must all be removed from time to time. There are more permanent solutions, both surgical and non-surgical:
Non-surgical treatments:
- Medication – very few medications are approved for hair loss treatment, and only two of these are approved for treating MPHL (minoxidil and finasteride). Bimatoprost has been used to strengthen eyelashes and eyebrows.
- Micro-pigmentation – typically used for eyebrow restoration, this is also an option for simulating the appearance of stubble on a shaved head, with the possibility of giving a more youthful hairline.
Surgical treatments (hair transplantation):
Hairs naturally grow in follicular units, which can consist of 1-4 hairs per unit. Hair transplantation takes advantage of this to create a natural appearance. The technique involves placing single hairs around the hairline, double hair grafts behind these, and triple or quadruple hair grafts further back to maximise hair density. The hairs are usually taken from elsewhere on the scalp, but can also be taken from the beard or chest.
- Strip follicular unit transplantation (strip FUT) procedure – an ellipse of skin is taken from a safe donor zone at the sides and back of the scalp; this is 1-2 cm wide and as long as is required for the number of hairs needed. The wound is sutured or stapled, resulting in a linear scar, which ideally will be hidden by the surrounding hair. The excised strip is dissected into the individual follicular units, which are called ‘grafts’ when transplanted.
- Follicular unit excision (FUE) procedure – individual follicular units are extracted using a variety of tools including handheld punches, automated drill devices, or robotic technology. The advantages of FUE are that it leaves small round scars that are much easier to hide with shorter haircuts, rather than a linear scar, and it is associated with less pain and faster healing than the strip FUT procedure. The disadvantages are that the grafts tend to be less robust, in cases where large numbers of grafts are needed the donor area must be shaved before FUE harvesting, and most importantly, fewer hairs are available for transplantation, which is a problem if large areas of thinning or balding scalp require coverage.
It is extremely important to manage patient expectations with hair transplant surgery. It can take 3-4 months for the transplanted hairs to start growing and 12-18 months for them to completely mature so the full effect on the patient’s appearance can be judged. Patients should be fully aware of this, along with a realistic idea of the hair density they can expect to achieve per procedure. It is also important to plan for the future in the case of MPHL and FPHL, as hair loss could continue, leaving transplanted hair in the hairline, temples or crown isolated, which could mean future hair transplant procedures might be needed. Growth of transplanted hair in areas of scarring can be disappointing, so again, expectations should be managed carefully and the possibility of further surgery to build up density explained and accepted.
Most people would agree that well-executed hair transplant surgery is one of the best aesthetic treatments to restore a more youthful appearance when it comes to hair loss, and with more and more people being open about having a hair transplant, the stigma surrounding it is disappearing. If you are interested in finding out the best options for you in combatting hair loss, you should consult a dermatologist who specialises in hair loss or a hair transplant surgeon.
