State-of-the-Art Hair Transplant Techniques

By David Lavine, MD

Published on August 01, 2006

Mild to moderate male pattern hair loss affects approximately 50% of men by age 50. The exact cause of male pattern baldness is unknown, although there are several contributory factors. First of all, there is genetics. If you have a family history of baldness, it is more likely that you, too, will have some form of baldness, although this is not necessarily true. In my family, both my grandfathers and my father had significant male pattern baldness, but fortunately, they didn't pass that gene on to me. In other cases, I have patients who come in and tell me that there is no family history of baldness and yet they have significant male pattern baldness. So, as you can see, there is some luck-of-the-draw involved.

Researchers have also found that an increased level of dyhydrotestosterone (DHT) exists in the scalp of men with male pattern hair loss. Leading scientists believe that this increased level of DHT affects the hair growth cycle, contributing to the thinning of the hair on the scalp.

Finally, we know that men with male pattern baldness have decreased levels of oxygen in their scalps. This had led some to think that wearing a tight cap on a constant basis may contribute to baldness; but the question is, which came first – the chicken or the egg? It is common for men to wear baseball caps because they are bald and wish to cover their scalps.

What Can Be Done?

As a plastic surgeon, I am constantly asked by men who have signs of either early or late baldness what can be done to correct this. From a medical point of view, there are many answers, each of which consists of either medical or surgical treatment. About a decade ago, men on the blood pressure medicine Minoxidil noticed an increase in hair growth. Orthopharmaceutical then developed the topical product known today as Rogaine. The effectiveness of Rogaine varies, but the product does need to be applied to the scalp on a regular basis. There are also shampoo products available from Orthopharmaceutical that are offered as part of the Rogaine treatment therapy. Rogaine seems to be more effective in the crown of the scalp than in the front part. Side effects are minimal, but the main complaint is that is sometimes tends to make the hair a little more greasy.

The only other product that has been medically proven to help in hair growth is Propecia. This product is distributed by Merck Pharmaceutical and was developed from a drug for decreasing prostate size known as Proscar. Men on this drug started noticing an increase in hair growth with decrease in hair loss. I recently attended a symposium on this FDA approved drug. The results were pretty significant in that approximately 80% of men on the five-year study showed a stabilization of their hair loss. Sixty-six percent of the men had visible hair re-growth, as determined by an independent panel of dermatologists. Most men taking Propecia report an increase in hair count, decrease in hair loss and an improvement in appearance.

Propecia is available by prescription only and blocks the formation of DHT, an apparent cause of hair loss. Propecia was developed to treat male pattern hair loss in the vertex (top of the head) and anterior mid scalp area. It is important to note that Propecia cannot be taken by women.

As with any medication, both Rogaine and Propecia can have side effects, and it is best to talk to your physician or hair specialist regarding this. In addition, remember that if you stop using Rogaine or stop taking Propecia, your hair loss benefits will be gone and you will, in all likelihood, lose the hair that you saved or regrew during the use of these medications. Remember also that these are the only two medications approved by the FDA for hair loss, and they have clinical studies to back them up. The reason I mention this is that there are a lot of products on the market with no clinical studies to back up their supposed benefits; these products therefore fall under the term "cosmetic" rather than medical. I myself have seen multiple advertisements that use the same terminology as these medically proven products and purport to "block DHT." In my professional opinion, the proof is in the pudding and you are probably paying for a product that may increase hair shaft but not improve hair growth or decrease hair loss.

Permanent Hair Restoration

The only permanent method available for hair restoration is grafting. Many of you are probably aware of the old technique, hair plugs, which resulted in a "doll's hair" or "cornrow" pattern. Fortunately, this technique is now out of favor and a method known as micro-grafting, or mini-grafting, is used instead. With micro-grafting hairs are grafted in one-, two-, and three-hair units, which provide the most natural look possible. The hair is grafted from the dominant site in the back of the scalp. Fortunately, the hair never forgets where is comes from and therefore loss does not occur in transplanted hair, if done properly. Micro-grafting has made hair restoration a state-of-the-art procedure. I can assure you that the newer hair restoration techniques are much improved. In fact, you have probably seen many people who underwent one of these modern hair transplantation procedures walking around, but didn't realize it because of the quality of the technique.

Transplanting hair can be done as an office procedure. At our office, The National Center for Hair Restoration, the patient usually watches a videotape while the procedure is being performed. For maximum benefit, we like to graft hair in 500-600 unit sections. This way, the new hairline is established and can be filled in as the years go by.

When consulting with your physician, ask about his or her experience and request to see hair transplants before-and-after pictures. We show these to our patients and direct them to our website if they wish to view more pictures. This way, they get a good idea of what can be achieved even with significant male pattern baldness. It is also important to ask about pricing and how many sessions it will take. Prices vary, and it is often good to compare before proceeding. Always consult with the physician personally regarding the procedure so that you can establish a doctor-patient relationship. This relationship will continue for years, so make sure you are comfortable with your physician or hair restoration surgeon before proceeding to treatment.

David M. Lavine, M.D., is Director of the National Center for Hair Restoration.