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Hair Loss

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Facts about normal hair growth

About 90% of hair on the scalp grows continually. In fact, each hair grows for about 2 to 6 years. The other 10% of scalp hair is in a resting phase that lasts 2 to 3 months. At the end of the resting stage, this hair is shed.

Most people have around 100,000 hairs on their head, and shed 50 to 100 hairs a day. This is normal. When a hair is shed, it is replaced by a new hair from the same follicle and the growing cycle starts again. Scalp hair grows about one-half inch a month.

As people age, the rate of hair growth slows.

What causes hair loss?

Hair loss is believed to be primarily caused by a combination of the following:

  • Aging

  • Change in hormones

  • Illness

  • Family history of baldness

  • Burns

  • Trauma

  • Untreated ringworm of the scalp

  • Vitamin A excess

  • Protein or iron deficiency

  • Rapid weight loss

  • Certain autoimmune diseases

However, hair loss is not caused by the following:

  • Poor circulation to the scalp

  • Dandruff

  • Excessive hat-wearing

Generally, the earlier hair loss begins, the more severe the baldness will become.

What is hair replacement surgery?

The interest in hair replacement has significantly increased over the past several years.

There are a number of hair replacement techniques that are available, although hair replacement surgery can't help those who suffer from total baldness. Candidates for hair replacement must have a healthy growth of hair at the back and sides of the head. The hair on the back and sides of the head will serve as hair donor areas where grafts and flaps will be taken.

There are 4 primary different types of hair replacement methods, including the following:

  • Hair transplantation. During hair transplantation, the surgeon removes small pieces of hair-bearing scalp grafts from the back or sides of the head. These grafts are then relocated to a bald or thinning area.

  • Tissue expansion. In this procedure, a device called a tissue expander is placed underneath a hair-bearing area that is located next to a bald area. After several weeks, the tissue expander causes the skin to grow new skin cells. Another operation is then required to place the newly expanded skin over the adjacent bald spot.

  • Flap surgery. Flap surgery is ideal for covering large balding areas. During this procedure a portion of the bald area is removed and a flap of the hair-bearing skin is placed onto the bald area while still attached at 1 end to its original blood supply.

  • Scalp reduction. Scalp reduction is done in order to cover the bald areas at the top and back of the head. This technique involves the removal of the bald scalp with sections of the hair-bearing scalp pulled together filling in the bald area.

Possible complications associated with hair transplantation procedures

Possible complications associated with hair transplantation procedures may include, but are not limited to, the following:

  • Patchy hair growth. Sometimes, the growth of newly placed hair has a patchy look, especially if it's placed next to a thinning area. This can often be corrected by additional surgery.

  • Bleeding and/or wide scars. Tension on the scalp from some of the scalp reduction techniques can result in wide scars and/or bleeding.

  • Grafts not taking. Occasionally, there's a chance that the graft may not "take." If this is the case, surgery must be repeated.

  • Infection. As with any surgical procedure, there is the risk of infection.

About the procedure

Although each procedure varies, generally, hair replacement surgeries follow this process:

  • Location options may include:

    • Surgeon's office-based surgical facility

    • Outpatient surgery center

    • Hospital outpatient

    • Hospital inpatient

  • Anesthetic options may include:

    • General anesthesia

    • Local anesthesia, combined with a sedative (allows the patient to remain awake but relaxed)

  • Average length of procedure. Several surgical sessions are usually needed to achieve satisfactory fullness, with a healing interval of several months recommended between each session. It may take up to 2 years before seeing the final result with a full transplant series.

  • Recuperation period. Plugged or grafted hair falls out within a month or 2 after surgery, which is normal and almost always temporary. After hair falls out, it generally takes another month or more before hair growth resumes. A surgical touch-up procedure may be needed to create more natural-looking results after the initial incisions have healed. This may involve blending, a filling-in of the hairline using a combination of minigrafts, micrografts, or slit grafts.

Nonsurgical hair replacement with medication

  • Finasteride. Finasteride was approved by the FDA in December 1997, as a treatment for male pattern baldness. It's the first drug available in pill form for the treatment of baldness.
    Finasteride works by blocking an enzyme called 5-alpha reductase, which is responsible for the formation of dihydrotestosterone in a man's body. The enzyme converts testosterone to DHT (dihydrotestosterone). It's believed that DHT is a key factor in male pattern hair loss, and finasteride decreases the concentration of DHT in a man's scalp.

    Finasteride is available by prescription only.

  • Dutasteride. Dutasteride is another medication which blocks formation of the highly-active form of testosterone and may also help hair growth. 

  • Minoxidil. Minoxidil has been available since 1988 for the treatment of hair loss. It's currently available as an over-the-counter drug.

    Minoxidil is a topical solution that must be applied by applicator or fingers to the balding area twice a day, every day. Decreasing the dosage to once a day results in some hair loss, and discontinuing application causes regression to pretreatment baldness. There is a women's strength and a men's strength of minoxidil available over the counter. 

Always consult your health care provider for more information.

Hair Loss - WellSpan Health

Online Medical Reviewer: Berman, Kevin, MD, PhD
Online Medical Reviewer: Foster, Sara, RN, MPH
Last Review Date: 2015-04-30T00:00:00
Last Modified Date: 2015-05-09T00:00:00
Posting Date: 2008-11-30T00:00:00
Published Date: 2015-05-09T00:00:00
Last Review Date: 2007-03-30T00:00:00
© 2015 WellSpan Health. All Rights Reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional's instructions.

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