Australian hair loss specialist Dr Russell Knudsen explains how hair transplant surgery restores healthy hair to the scalp:
In a market place dominated by advertising rather than science, it can be very confusing to wade through the competing claims made by various companies and technologies relating to hair loss in men. The cause of male pattern hair loss, which is by far the most common form of hair loss in men, is well understood by medical scientists and treatment options have improved significantly in recent years. Here, we tackle some of the myths relating to male hair loss, and explain how to restore long-lasting hair to the scalp.
Hair loss myths
Poor scalp hygiene, poor diet – even wearing tight hats – have all been blamed for male pattern baldness. Despite scientific evidence proving this not to be the case, many companies and websites continue to promote ‘remedies’ based on correcting these problems. Advertised solutions range from vitamins such as Biotin (Vitamin H), to Silica, Zinc and herbal remedies such as Saw Palmetto and Ginseng. There are, however, no ‘natural’ or herbal ‘DHT blockers’ that have ever been proven to work. Ordinary shampoos and conditioners do not have any effect upon the ability of the hair to grow so ‘scalp cleansers’ are an expensive waste of time and money.
Hair loss facts
Male pattern hair loss, or balding, is a genetic condition, inherited from either side of the family (mothers or fathers, and often from both sides). Typically, hair loss starts to be observed after puberty because of the influence of adult levels of certain male sex hormones.
The critical feature is that each and every hair follicle on the scalp is ‘coded’ for a certain amount of 5 alpha reductase enzyme activity. Curiously, balding males inherit more of this enzyme in the upper scalp follicles than in those of the lower scalp. This initiates a process of shrinking of the hair follicles in the upper scalp until, eventually, most are lost.
The crucial factor in the successful management of male pattern hair loss is early blocking of the enzyme. This is best achieved with prescription medicines that are commonly referred to as ‘DHT blockers’. These medications are much more effective in stopping or slowing the hair loss than they are in re-growing hair.
Some patients with early thinning can successfully regrow stronger hairs but this occurs in only approximately one third of patients. In contrast, over 80 percent of patients who regularly use the medication finasteride will stop further hair thinning.
Prescription medicines such as finasteride suffer from reports of potential sexual side-effects. However, these medications are not hormone-blockers, they are enzyme blockers. Side effects can occur but depend upon the dosage used. If you don’t take the medicine every day the risk of any side effects is dramatically reduced from one in 50 to one in 200 but is still an effective dose to block the enzyme activity. In other words, it is almost always possible to find an effective dose that doesn’t result in side effects.
If you use this prescription medicine as your base medication, you can choose to add other treatment options if you desire. The next most successful is minoxidil lotion, which is a hair stimulant that can strengthen existing hair and slow down future loss. It is, however , not very effective if used alone.
Although low power laser therapy has gained a lot of publicity, and is a proven mild stimulant for hair, the evidence for its continuing effectiveness in balding is lacking. It should not be used as a stand-alone therapy as it has not shown any significant effectiveness in balding if used alone. Unless the laser is applied for sufficient amount of time, hand-held laser devices are limited in their effectiveness. Lasercap, which can be worn at home, may provide better effectiveness and is now available.
Given that the principle benefit of medication is slowing or stopping hair loss, then what can we do for the balding man who wants to restore his hair? The simple answer is that to regain significant healthy hairs in the upper scalp, the only solution is a hair transplant.
Modern hair transplantation involves the transfer of tiny grafts containing one to three hairs (follicular unit grafts) from the healthy lower scalp to the balding area. As these hairs are coded to be ‘non-balding’, they survive in the bald areas and continue to grow healthy hairs. The use of natural hair groupings ensures that a properly designed and executed hair transplant is undetectable. The unnatural appearance of older-style plug transplants is a thing of the past, and they haven’t been performed for at least 20 years.
In my experience, men who undergo hair transplants achieve more self-confidence and even their hairdresser can’t tell they have undergone surgery. Modern techniques allow men to wear a shorter hairstyle without any evidence of the transplant. By continuing to use medication to prevent future hair loss, patients can reduce the need for further hair transplants and enjoy a long-term solution to their hair loss.