Hair loss (alopecia) is common amongst men (65%) and women (45%), yet the process is filled with panic, angst and sometimes embarrassment. Our hair is not just an expression of our identity, mood, and style, these days it is one of the few things left exposed as we venture outdoors. So when hair starts to fall, so too can a person’s confidence. We get it.
The most common form of hair loss is androgenic alopecia. It is genetically inherited and caused by an excess of androgens, namely dihydrotestosterone (DHT), a metabolite of testosterone. These affect the front and crown parts of the head, but curiously spares the back. As such, hair transplants have been developed by harnessing this property and moving hairs from the back to the affected areas on the hairline, vertex or crown of the scalp. Since the hairs of the back, or ‘donor zone’ are unaffected by the DHT, these hairs will continue to grow for the rest of the patients’ life, regardless of androgen levels. This is the beauty and simplicity of hair transplants.
Androgenic alopecia (baldness) occurs in stages for men, and is caused by DHT (a form of testosterone)
Medicines like Finasteride tablets and Minoxidil lotions have been the mainstay of prevention, but they require lifelong treatment, can be burdensome to patients, and can be associated with side effects ranging from skin irritation, breast tenderness, and changes in libido. However, androgenic alopecia is progressive and these medicines only prevent further loss and buy you time, they don’t grow back new hairs. Cue hair transplantation.
Medical therapy can only prevent further hair loss. The only definitive treatment is adding hairs to the balding areas (hair transplantation).
Hair transplantation has also evolved over recent decades, initially with Follicular Unit Transplant (FUT) which took a flap from the back of the scalp. This was quick, but often left patients with a visible scar on the back of the head and precluded fashionable fade cuts. The next leap in hair transplants came with Follicular Unit Extraction (FUE). This involved extraction using a punch (up to 1cm in diameter), rather than a scar. However, the large punch still often left ‘pock marks’ on the donor zone. These hairs were then implanted using pre-holes made by the surgeon, but were often implanted in rows that looked like ‘Barbie hair’.
The newest innovation in hair transplantation is Direct Hair Implantation (DHI), where grafts are removed from the donor zone individually with 1mm punches for an invisible extraction without undetectable scars. Once counted and organized, they are then directly implanted (hence the name) into the bald areas using a pen-like tool. The DHI method allows for less graft handling, higher numbers of hairs transplanted, better density and higher graft survival.
This patient had come to us after an FUT surgery, with minimal growth. His first Direct Hair Implantation (DHI) surgery was focused on filling the hairline area, then the second transplant focused on filling the vertex and crown. By carefully selecting the donor hairs, the back of the scalp grows evenly, without scars or gaps.
Having a second hair transplant is not uncommon, and can be due to progressing alopecia, adding density to a previous transplant, or to a new area altogether. It is important for patients to realize how far hair transplantation has improved, and to do their research properly. DHI hair transplants can usually be done on previous FUE and FUT, but a careful examination will determine the quality of the donor zone, including any scarring and potential number of hairs remaining. Make sure you read reviews, speak with the surgeon prior to the procedure, and ask to see recent results of patients.
Androgenic alopecia may continue relentlessly depending on your genetics, even after your first hair transplant. When and if this happens, don’t guess- see a hair loss expert to get the latest medical advice and discuss your options. When hair falls, don’t let your confidence shed with it.