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Communication: The Bridge Between You and Your Physician Hair Restoration When you consult a hair restoration specialist, you and the physician sharethe same objective—to determine if your needs and wishes can besatisfied by a hair restoration surgical procedure or medical treatment. Youand your physician have to begin building mutual understanding about: . Your objective and subjective perceptions of yourself and what you want . The physicians objective evaluation of what can be accomplished . The cost of recommended treatment options.
The bridge of understanding is built by honest two-way communication: . You tell the physician why you want hair restoration, and what you want hair restoration to accomplish in improving your appearance. Hairrestoration may be only a part of your perceptions regarding self-image. Thinning or lost hair is not an isolated condition; it influencesyour image of yourself and the image you want to present to others.
Your wishes regarding hair restoration should be discussed in thecontext of your overall wishes—for example, “to look and feelyounger”, “not having a scalp that looks shiny and bare”, “beingmore comfortable around people”, “to improve self-confidence”. Ofparticular importance is the area of your scalp where hair lossbothers you the most.
. After the physician hair restoration specialist conducts a medical, physical and scalp examination, options for hair restoration can bediscussed, based on diagnosis and assessment of the probableprogression of hair loss. In rare cases a patients medical historyand/or examination indicates that the patient is not a candidate forhair restoration, or that the options for treatment are limited. In themajority of persons the cause of hair loss is male or female patternandrogenetic alopecia (inherited pattern hair loss) that is easilytreatable.
. The physician hair restoration specialist will show you collections of illustrative photos or sketches that you and the physician can use to identify the “look” you want to achieve. On the basis of diagnosisand assessment, the physician will describe and recommend thesurgical and/or non-surgical treatment most likely to give you that“look”. You should discuss with the physician the relative cost of therecommended treatments in dollar amounts, avoiding impreciseterms like “expensive”, “inexpensive”, “more” and “less”.
. Before agreeing to a treatment plan you should be certain you understand your options, and each treatments benefits, risks andcost. You should be comfortable that all of your questions have beenaddressed.
. After you are comfortable that all of your questions have been addressed, you and the physician hair restoration specialist canagree on a hair restoration treatment plan, including the outcome oftreatment that can reasonably be expected. Most hair restorationpatients are very satisfied with the outcome of treatment. Mutualunderstanding between you and the physician hair restorationspecialist is one of the most important steps in achievingsatisfaction.
Hair transplantation is the most common surgical method of hairrestoration. The most common reason for hair restoration is hair loss dueto an inherited tendency for androgenetic alopecia (AGA). In men, AGA isbetter known as male pattern hair loss, in women as female pattern hairloss. While hair transplantation is performed more often in men, it is also asuccessful method for surgically correcting the diffuse pattern of femalepattern hair loss.
Hair transplantation is an operation that takes hair from the back of thehead and moves it to areas of hair loss elsewhere on the scalp. The fringe(back and sides) of hair on a balding scalp is known as donor dominanthair. It is hair that will continue to grow throughout life, even in men whohave the most extensive form of male pattern hair loss. Donor dominanthair follicles are under a different form of genetic control than follicles onthe front and top of the head; they are not subject to inherited effects of“balding genes”.
When donor dominant hair follicles are transplanted to bald areas of thescalp they continue to grow hair. Donor dominance is the scientific basisfor the success of hair transplantation.
The area to which donor dominant hair follicles is transplanted is calledthe recipient area. Candidates for hair transplantation are those individualswith hair loss who have sufficient donor dominant hair from the back andsides of the scalp to transplant to recipient balding areas.
The most common method for harvesting donor dominant hair is to slice itout in strips with a special scalpel-like device. Follicles are separated outfrom the strip and prepared for transplantation. The transplant grafts areplaced into the recipient areas. Depending on how large a recipient area isinvolved, and on individual patient characteristics, transplantation of therecipient area may be accomplished in one, two, three or more sessions.
Multiple sessions are usually spaced several weeks apart.
Among the assessments made by the physician hair restoration specialistare (1) how rapidly, and (2) how much of the patients remaining hair islikely to be lost. A man with progressive male pattern hair loss may requirea number of hair transplantation procedures over a number of years tokeep pace with hair loss. In these patients the physician hair restorationspecialist wants to be certain that an adequate supply of donor dominanthair will be available for future transplantation. In some cases theprogression of hair loss between transplant procedures can be slowed orhalted by supplementary medical therapy with an FDA-approved hairrestoration drug—topical minoxidil (Rogaine®) or orally administeredfinasteride (Propecia®).
Hair transplantation surgery techniques have improved enormously overthe past decade and are still improving. The first hair transplants were characterized by “plugs” and “corn rows” of transplanted hair. Today, mosthair transplantation is done with mini-grafts of fewer than 5 hair follicles,micro-grafts of 2 or 3 hair follicles, and single-hair grafts. Plugs areoccasionally used for special purposes in individual patients. Employingnewer techniques and newer instruments, the physician hair restorationspecialist can create a natural hair appearance that is appropriate to eachindividual patient.
Naturalness of appearance is the goal of all hair transplantation today.
Mini-, micro-, and single-hair grafts provide the “softness” necessary forcreating a natural hairline. Graduated placement of single-hair, micro-, ormini-grafts allow creation of a gradually increasing hair density fromhairline to mid-scalp. Individual physician hair restoration specialists maketheir own adaptations of new technology to achieve desirable aestheticresults for individual patients.
Side effects of hair transplantation surgery are usually minor: mild pain anddiscomfort for a few days postoperatively, swelling over the operatedareas, and scab formation. The physician hair restoration specialistprovides medical for discomfort control and information about scalp care.
The physician also provides information and recommendations for long-term hair and scalp care to maximize the patients appearance.
Scalp reduction is simply the surgical removal of bald scalp. The operationis highly effective (1) in carefully selected patients, and (2) when performedby a skilled and experienced physician hair restoration specialist. The goodcandidate for scalp reduction is a man who has full hair on the back andsides of the head that can be stretched upward to cover the area wherebald scalp is surgically removed. A small number of hair transplant graftsmay still be needed to cover residual bald areas.
Scalp reduction may, in some patients, be preceded by scalp expansion. Athin plastic envelope is inserted under the scalp and gradually inflated withsaline over a period of time. As the envelope inflates the scalp expands inresponse to the inflation. When the envelope is removed, there is anexcess amount of bald scalp available for removal and for “stretching” hair-bearing scalp upward.
Scalp reduction can be associated with postoperative complications ofscarring, stretch-back of the bald area, and the creation of an unnaturalappearance called a slot deformity.
Scalp flap surgery entails moving entire segments of hair-bearing scalpinto a bald area. The movement is accomplished by surgically creating a“flap” of hair-bearing scalp that can be moved along with its blood supply toa bald area. Scalp flaps are also employed in reconstructive surgery tocover scalp areas with hair loss due to burns or physical injury. Thesurgeon performing scalp flap surgery should be skilled and experienced inthe procedure.
Eyebrows and eyelashes are important components of facial symmetry.
They can be lost or lacking for a number of reasons—physical injury,burns, disease, chemotherapy, radiation, scarring caused by long-termplucking, and congenital inability to grow them.
Eyebrows and eyelashes can often be restored by (1) transplantation ofhair-bearing skin from another area, or (2) flap surgery to move a flap ofhair-bearing skin from the scalp to the eyebrow. Eyebrow and eyelashrestoration requires a skilled and experienced surgeon.
Two hair restoration medications have been approved by the U.S. Foodand Drug Administration (FDA) after appropriate double-blind, placebo-controlled clinical trials. It is important to note that only two hair restorationmedications have won such approval. Many products are advertised andmarketed with a claim for hair restoration, but few have ever beensubjected to the clinical trials necessary to prove efficacy and safety.
The U.S. FDA-approved hair restoration medications are: . Minoxidil (Rogaine®)—a topical solution available over-the-counter in 2% and 5% strengths. Minoxidil is effective in some people, moderatelyeffective in some, and ineffective in others. When effective, minoxidilcan retard hair loss and stimulate new hair growth. Its mechanism ofaction is not well understood. Best results with minoxidil are oftenachieved by combining the topical solution with hair restorationsurgery.
. Finasteride (Propecia®)—an oral medication that treats the root cause of male-pattern hair loss by inhibiting the activity of the hormoneresponsible for hair loss. Finasteride is available only by prescription.
Finasteride is usually not prescribed for women; women who maybecome pregnant are at risk for a certain type of birth defect in theunborn child. Finasteride works best for early to moderate degreesof hair loss. Men with extensive hair loss are unlikely to have muchregrowth. Regrowth associated with finasteride is better over thecrown of the scalp than at the frontal receding hairline. When used inconjunction with hair transplantation, finasteride may prevent furtherhair loss while transplantation fills in areas such as the frontalhairline.
A small number of people with hair loss are not candidates for surgical ormedical hair restoration. For these persons, hair additions and total hairreplacement may be considered: . A person with temporary total hair loss due to radiation or chemotherapy may be a candidate for temporary total hair replacement (a wig).
. A person who is congenitally unable to grow hair may be a candidate for permanent total hair replacement (a wig, or several wigs for differentoccasions) . Hair additions may be a temporary measure for the person who wants hair loss corrected but is not yet ready to undergo hairtransplantation.
. Hair additions or replacements may be considered by the person who has too little donor dominant hair for use in hair transplantation.
The physician hair restoration specialist can recommend hair additions andreplacements for those persons who are not candidates for surgical ormedical hair restoration.


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