Hair Loss Diagnosis

Stopping hair loss and restoring lost hair is to many of us a distant dream. However, there are certain options for replacing lost hair that may seem surprisingly effective even to the most sceptical hair loss sufferer. The three main methods of hair restoration include surgical hair restoration, non-surgical hair replacement and therapies for regrowing hair using pills and topical applications. The main technique of surgical hair restoration today is hair transplant surgery, whereas wigs, hairpieces, hair loss concealers and hair thickeners are the most popular aids for replacing the lost hair by non-surgical means. The non-surgical camouflage is obviously the quickest and the least expensive method of replacing lost hair, though not tremendously popular, as many people believe that wigs and concealers cannot withstand adverse external influences such as rain and wind and do not look natural. In spite of this common belief, some of them are extremely resistant to external and can appear very authentic. Wigs and concealers are often the only option of restoring lost hair for people suffering from non-hereditary forms of hair loss such as unpredictable alopecia areata.

Surgical hair restoration is the most expensive way of restoring lost hair but also the most elegant solution. It can only be used in people suffering from hereditary baldness and burn patients. Candidates are required to have sufficient hair density at the back of their scalp and many women suffering from female form of hair loss with its typical diffuse balding pattern do not meet this condition. Hair restoration surgery has made great progress in the last twenty years with the introduction of the two main techniques used today - follicular unit transplantation and, more recently, follicular unit extraction. These advances in hair transplantation techniques enable the grouping of hairs very close together, which gives modern hair transplants a completely natural look. The main weakness of hair transplant surgery, besides the cost and the pain involved, is the limited supply of donor hair and the need for multiple surgeries to achieve the final change in appearance. Furthermore, patients have to commit themselves to the use of finasteride or any other adequate medicinal hair loss therapy for the rest of their lives in order to prevent further loss of hair.

Hair loss pills and topicals do not provide satisfactory hair restoration results yet despite great scientific advances and the discoveries of recent years. The two most frequently prescribed hair loss drugs, finasteride and topical minoxidil, can be effectively used to reduce hair loss but their ability to regrow lost hair is relatively weak. Their effectiveness generally declines sharply in the later stages of the balding process and they may become ineffective after several years of continued use. There is no existing medicinal or natural hair loss remedy that can deliver adequate visual results comparable to either hair transplant surgery or non-surgical hair replacements such as wigs and hair loss concealers. Although there are some promising medicinal hair loss drugs currently under development, especially in the area of genetic research, the ultimate pill for baldness is not expected to become commercially available within the next fifteen years. Other advances in hair science, such as hair multiplication or the generation of new hair follicles in wounds, also show some promise but it appears that hair transplant surgery will in the next ten to fifteen years remain the most complete method of hair restoration and these aforementioned techniques will be used in conjunction with hair transplantation.

The first hair transplants were carried out in Japan back in the 1930s. In the old days of hair transplant surgery relatively large strips of skin of four millimetres in diameter, the so called punch grafts, were transplanted from the back of the scalp to the frontal balding area. Hair transplantation techniques have been greatly improved since then and today’s hair transplants can give you a truly natural look. This is due to the miniaturisation of hair transplants, which now contain only one hair follicle (holding between one and four hairs) and are less than one millimetre in diameter. These tiny, single follicle grafts are then implanted into the needle poke holes in the balding area. Today’s technology enables dense packing of hair follicles, which gives modern transplants a completely natural-looking frontal hairline. Gone are the days of pluggy grafts that made you look like a toothbrush.

The two main hair transplantation technologies that are used today are called Follicular Unit Transplantation (FUT) and Follicular Unit Extraction (FUE). The difference between them is in harvesting hair follicles. The FUT is the older method, using strip harvesting, when a linear strip of skin of up to 20 centimetres long and 1.5 centimetres wide is extracted from the back of the scalp and the opening is then sewn closed. This strip is then placed under microscopes and dissected into small grafts, containing just one follicular unit each. Such follicular grafts are then implanted into the balding area. The advantage of this method is its high yield, calculated as a percentage of the follicles that are successfully transplanted into the bald area. This yield is around 98%. The greatest weakness is that it leaves the patient with a linear scar at the back of the head. The FUT is less expensive than the FUE and is used when a large area needs to be filled with transplanted hair in one single session.

The FUE method uses a micro-extraction technology to harvest individual hair follicles that can be directly implanted into the small needle-made incisions in the bald area. The FUE technique is the latest technology, introduced only in 2002. Its greatest advantage is the fact that it leaves the patient with only tiny scars at the back of the head, which are barely visible, and the healing time is much shorter than with the FUT, due to the small size of the wounds. However, this method cannot be used to cover large areas in one session and since it is much more labour intensive it is also more expensive. Additionally, its yield is significantly lower, due to the transaction of many follicles, and since the supply of donor hair is limited, it cannot be used in patients whose hair loss has progressed above NW4 level.

Potential future surgical hair restoration technologies currently under development, such as hair multiplication and the generation of new hairs in wounds, should help solve the problem of donor hair shortages. It seems that classical hair implantation will in the long future only be used for frontal hairlines and, therefore, the follicular harvesting should manage to provide a sufficient number of hair implants. However, none of the aforementioned potential future techniques is expected to become commercially available before 2012. Therefore, the immediate future probably lies in improving the harvesting techniques of the FUE in order to improve its yields and make it financially more affordable. The FUT with its typical strip harvesting, which started a revolution in the hair transplant industry less than two decades ago, may become history in the not too distant future.