Thoughts on hair loss and restoration

This is a guest post written by one of our members, Dr. Matthew Richardson, of Texas Facial Aesthetics.  

If you are suffering from hair loss, you are not alone. Hair loss affects more than 60% of men by the time they reach the age of 60.

Androgenetic alopecia (AGA) is the medical term for male-pattern baldness and is a relentless and progressive process of hair loss that can begin as early as the teenage years for some men. AGA is caused by the effects of a hormone known as dihydrotestosterone (DHT – a breakdown product of testosterone) on the hair follicles.

Until recently, there were few options for men who suffered from hair loss aside from embarrassing hair pieces or “combover” hairstyles to hide their thinning areas. The good news is that medical advancements have now created many excellent options for men (and women) with hair loss that can yield very natural results. Unfortunately, older hair restoration procedures were performed using very large grafts that resulted in the “hair plug” or “doll’s hair” looks that were hallmarks of hair transplantation for decades and gave hair restoration a bad reputation for looking unnatural.

In modern hair restoration, we transplant individual follicular units, which are made up of individual hair follicles and their supporting microscopic structures. This results in the movement of thousands of individual follicles from one area of the scalp to another, and allows skilled hair transplant surgeons to artistically create a hair line that looks extremely natural and age-appropriate.

We now know that hair follicles retain the characteristics of the area in which they are originally located, a phenomenon known as “donor dominance”, and this is the basic guiding principle of today’s hair transplantation techniques. As we all know, almost all men retain some if not most of the hair on the back and sides of the head. This hair is not responsive to the hormone DHT that causes male-pattern baldness. When these hair follicles are moved, they remain unresponsive to DHT and will most likely never fall out, even if they are moved to the frontal hairline or another thinning area of the scalp. This means that hair transplantation is a permanent solution to hair loss!

There are several different options for how the hair gets extracted from the “donor” area on the back of the scalp, and then moved to the “recipient” area on the frontal hairline or top of the head. An older technique (but one that I still use in my practice in select patients) is to harvest a strip of hair across the back of the scalp, cut that strip into individual follicular units under the microscope, and then move those follicular units to the desired recipient areas. In men and women who keep their hair longer, this may be a good option, as it does not require any shaving of the hair in order to perform the procedure. The incision is closed with sutures that are hidden under longer hair. The downside is that a linear scar is left on the scalp, and for anyone who wants the option to wear the hair short or might want the option to buzz or shave the head at a later date, this scar may be problematic.

A second option utilizes newer technology and a technique known as Follicular Unit Extraction, or FUE. With this method, the follicular unit grafts are extracted individually using very small instruments. In my practice, I utilize a device known as the NeoGraft, which allows me and my team to harvest the grafts one at a time. As you can imagine, this is a tedious process, but with a skilled team, several hundred grafts can be extracted per hour, and these grafts are then ready to be transplanted into the recipient sites. The advantage of this technique is that it leaves no linear scar and the hair can be worn very short without any signs of a prior hair transplant procedure.

With either technique, thousands of small recipient sites are created in the targeted transplant zones, and the grafts are then placed one at a time into the sites. The most critical part of the hair transplant process is the hairline design and the creation of the recipient sites. While not all doctors perform this part of the procedure, this is something that I ALWAYS perform myself in order to achieve the best results. After the transplant procedure, the hair follicles will take 6 months to start to grow and a full 12 months to mature. I love hair restoration for many reasons, but number one on my list is high patient satisfaction rates with transplant procedures.

There are also non-surgical hair loss treatment options such as minoxidil (Rogaine – a topical treatment), finasteride (Propecia – a prescription oral medication), laser/light therapy, topical shampoos and conditioners, and platelet-rich plasma (PRP) injections, and I manage many of these treatments for my patients. PRP is an exciting new treatment option that is becoming very popular, with new research emerging showing its benefits in stopping and reversing the signs of hair loss.

If you are considering treatment for hair loss or a hair transplant procedure, I recommend starting with a fellowship-trained hair restoration surgeon (there are very few). Many doctors simply purchase a device and turn the hair restoration process over to technicians, but this is destined to result in bad outcomes. I take pride in personally guiding patients through the hair restoration process, giving them all of their surgical and non-surgical options in detail, and helping them restore the hairline that they miss so dearly.