HEALTHWATCH
Restore your crowning glory
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Dr. H. KRISHNA HANDE looks at heredity-patterned baldness, a natural condition, and offers medical solutions to the problem.
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AFP
Hair loss ... natural but treatable.
HEREDITY-patterned baldness — or androgenic alopecia — is the most common cause of hair, affecting 30 per cent to 40 per cent of both men and women. Heredity-patterned baldness is not really a disease. It is a natural condition caused by some combination of genetics, hormone levels and the aging process. Hair loss typically begins in the 20s and 30s, although in women, the changes are most noticeable after menopause.
In recent years, researchers have begun to understand more about the cause of this type of hair loss. Under the influence of a form of the male hormone testoterone, there is a change in the normal cycle of hair growth, resulting in shorter, thinner or "miniaturised" hair. Eventually, hair growth in certain parts of the scalp stops entirely, which produces the typical pattern of hair loss. Contrary to folklore that baldness is inherited from one's maternal family, genes contributed by both parents appear to affect hormone levels as well as the general susceptibility to this process.
Heredity-patterned baldness starts with thinning of the hair and progresses to total hair loss in certain parts of the scalp. Hair strands on the pillow, in the bath or comb are unreliable symptoms of hair loss. The average non-balding person loses 100 hair strands per day, and more hair may fall out under certain circumstances, such as after childbirth or a serious illness.
In men, hair loss begins at the temples and crown and proceeds in an `M'-shaped pattern. In the most advanced stage, only a rim of hair along the side and back of the scalp remains. In women, hair loss tends to be more widespread. The top of the head down the middle is most commonly affected, often in a "Christmas-tree" pattern. In contrast to men, in women the hairline along the forehead and temples usually remains normal. Complete loss of hair in any one place on the scalp is unusual and may suggest that a different process is at work, such as alopecia areata (a skin disorder that causes bald patches), a fungus infection or one of a number of skin conditions.
If you begin to lose hair in a hereditary pattern you may be able to prevent further hair loss by using minoxidil (for men and women) or finasteride (for men only).
Minoxidil is a lotion, now available over the counter, that is applied to the scalp twice daily. It prevents further hair loss in most people within two months of starting treatment. Within four to eight months, about 30 per cent of people will grow new hair that is long enough to be cut or combed. Success is greatest in younger people who have just begun to lose hair. Women appear to respond just as well to minoxidil as men do.
Caution: If you stop using minoxidil, you will rapidly lose all the hair that was retained or restored by the medication.
Finasteride is a prescription-only, once-daily pill that blocks the formation of the type of testosterone that affects hair growth. Higher strengths of the same medication are used in men to block benign growth of the prostate gland. Studies suggest that finasteride helps to block hair loss in up to 99 per cent of men with hereditary-patterned baldness, and that two-thirds experience some new hair growth. As with minoxidil, any effects from the medication are quickly lost once it is discontinued. In addition, a small number of men develop difficulty with sexual function.
Finasteride is neither safe nor effective in preventive hair loss in women, and they should not use it. In some people, hair loss may be caused by certain hair treatments (straightening, colouring), hairstyle (tight braids) or hair-pulling. Although these factors are not present in most cases of hereditary patterned baldness, they may contribute to hair loss and should certainly be discontinued.
A variety of creams, oils, lotions and herbal remedies for hair loss are regularly advertised. Some over-the-counter scalp treatments can actually cause irritation or harm and worsen hair loss. However, only minoxidil and finasteride have been proven effective. As noted above, minoxidil and finasteride can actually promote new hair growth in addition to preventing hair loss. This effect is quite variable from one individual to the next and one must again remember that the effects of the drug stops once it is discontinued. Hair weaves, wigs and toupees can be used. In addition, a variety of surgical techniques can be used to cosmetically improve baldness. These include:
Scalp reduction — Strips of bald skin are surgically removed to decrease the size of a bald spot. This can be performed when the bald area is very small.
Hair flaps — A strip of skin with good hair growth can be moved from a less cosmetically important area to a more important one. The result of this procedure is not satisfactory.
Hair transplants — Tiny plugs of skin anywhere from 10 to 15 strands of hair used to be moved from the back or side of the scalp to a bald area.
The newer micrografts, where single or two or three follicles are transplanted individually, yield cosmetically superior results but are more time-consuming (upto 1,000 — 2,000 individual grafts are necessary to complete treatment). It may take up to eight months to a year to see the full benefit of hair replacement surgery.
In the article below, I will explain how the latest method of hair transplantation is performed ... .
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Hair transplantation
MALE pattern baldness (MPB) or Androgenic alopecia, is caused by the presence in the body of a group of male sex hormones collectively referred to as androgens. Although the androgen level of bald men is no higher than that of men with a full head crop of hair, the fact remains that a certain minimum amount of androgens must be present before male pattern baldness can occur. The average man has enough androgens circulating in his body to develop MPB.
Male pattern baldness is a genetic condition which affects millions of men. Whether or not a man will lose hair is determined before he is born.
Male pattern baldness is not due to the shampoo one uses or because of wearing a helmet, or hat, or because a person brushes or rubs his hair very often. On an average, a man loses 100 to 150 strands of hair every day, but most of this hair re-grows because the follicle remains healthy and intact. A typical adult head consists of about 150,000 hair follicles.
Hair transplantation is a form of surgery in which grafts of hair with the follicle is removed from the horseshoe shaped donor area around the back and sides of the head and then surgically placed in areas where baldness or thinning of the hair occurs. The transplanted hairs that have been taken from this area of the scalp are genetically programmed never to fall out.
The scalp is very elastic and once the donor strip is removed, the scalp on either side is sutured together, leaving no gap. The only evidence of surgery is a thin line hidden under the hair that grows on the back of the head. The fact that the transplanted hair has been moved from one area of the scalp to another has no effect on its genetic predisposition to grow hair.
Hair transplantation has been performed for over 35 years. It is the new technique, however, that has enabled surgeons to create more aesthetic and more natural looking results than ever before.
Old "plug style" techniques, where large circular punches of skin that contained 15 to 20 strands of hairs each were used (still being used by some surgeons) to create "dolls hair" or "corn-rows", but the recent use of tiny micro and mini grafts, called follicular micro-grafting, has dramatically improved the results of hair restoration surgery.
Hair transplantation is done under local anaesthesia and surgery is virtually pain free. Patients are usually between the ages of 20 and 70 years. Evaluation to decide if transplantation is suitable for the patient is done by the doctor during the initial visit. The patient need not be admitted and is alert and awake during the surgery.
The procedure typically takes about two to four hours depending on the type of session. After the procedure, the patient walks home wearing a disposable surgical cap as dressing. The cap is removed three days later and the patient is asked to have a shampoo bath.
The transplanted hairs are only a few millimetres in length immediately following surgery. Once transplanted, the hairs may appear to be growing, but in reality they are being thrust out.
Within three to four weeks, nearly all of the newly transplanted hairs will be shed. Anywhere from eight to 16 weeks following the initial shedding of hairs, new hair growth begins.
One can expect to see normal hair growth from three to four months following the procedure. On occasion, hair growth may be slower due to individual variation. However, eventually, growth occurs at the normal rate of ¼ to ½ inch per month. At times, one may require more than one sitting for satisfactory results.
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