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Chapter: 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | 14 | 15 | 16 |17 | 18
PATIENT GUIDE TO SURGICAL & MEDICAL HAIR
RESTORATION
PAGE 18 |
Making Informed Choices (About a Life-Long Decision) |
Deciding to use medical and/or surgical
hair restoration techniques is indeed a life-long choice. At least with the
medicines available today, continued use is required to maintain the benefits.
Surgery, whether it is scalp reduction, flaps, older styles of transplantation,
or state of the art follicular unit transplantation, will produce results, for
better or for worse, which will persist for a lifetime. Therefore, this is a
decision to be entered into thoughtfully, reasonably and with a working
knowledge of the procedures and of the possible pitfalls. To assist you in this
informed decision-making is the major purpose of this manuscript.
So let us
revisit for a moment some of the salient points that have been made thus far.
First of all, there is the significance of hair itself. Hair, or its absence,
has been historically, and continues to be, of singular importance, culturally
and individually. Like it or not, hair and hair styling speak volumes about our
tastes, our station in life, and our attitudes. Hair loss may have a powerful
affect on how we are seen and potentially how we feel about ourselves. Although
some may see this as indicative of a current cultural vanity or superficiality,
an interest in, if not an obsession with hair has existed for millennia.
We
have learned that hair grows as thick, strong terminal hairs and also as soft,
fine vellus hairs; also important is the concept of the stages of growth: anagen
(active), catagen (transitional) and telogen (resting). We now recognize that
hair is grouped together as "follicular units" of one, two, three, or more
terminal hairs, along with vital supportive structures. Transplanting these
single follicular units is recognized as the state of the art in current hair
restoration surgery.
Remember that the cause of balding in men and in women
is most often what we term androgenetic alopecia: this simply means that, in
someone genetically predisposed, the effects of androgenic hormones (especially
dihydrotestosterone, or DHT) over time lead to the process of miniaturization.
It is this miniaturizing of the normally robust terminal hairs that leads to the
condition we define as baldness, or thinning. The fine, short, less pigmented
(vellus) hairs that remain are inadequate to provide the scalp coverage
necessary to block light. It is this light shining on the scalp that causes the
appearance of balding. In addition, the anagen, or growth phase of the hair,
becomes progressively shorter, until eventually the hairs are lost for good. It
is important to note, that at this point our current medications for hair loss
will no longer be of assistance in preserving hair. These drugs are only useful
in slowing or reversing the miniaturization process.
Useful tools for
patients and physicians in staging the balding process are the Norwood and
Ludwig classifications. These are "typical" patterns of male and female hair
loss, respectively, but are only guidelines. They allow us to "speak the same
language" when discussing balding patterns. Remember, however, that it is
difficult or impossible to accurately predict the eventual progression of hair
loss in any individual. Thus, it is usually crucial, especially in younger men,
to assume that the pattern will at some point progress to its ultimate
conclusion (in other words, to a Class VII, or complete baldness). This
awareness is also invaluable in helping the hair transplant candidate develop
realistic goals for hair restoration, so that the result can stand the tests of
time and of continued hair loss. A true value is achieved if the surgical
product is aesthetically appropriate not only at an earlier age, but also as the
person continues to age.
There exist various medical, surgical and
prosthetic remedies for hair loss. No one method is right for everyone. Wigs, or
"hair systems", for example, may be the only option for the individual with very
advanced balding and minimal donor hair available. These hair systems are
manufactured in a wide variety of styles and attachment modes; they may be
cheaply mass-produced, or custom made, with great care and a correspondingly
high price. Many people think that a hairpiece or weave will be much less
expensive than surgical hair transplantation. On further consideration, however,
we realize the following: hair transplantation is naturally growing hair that
persists for life, and may possibly require a single procedure only. Hairpieces,
on the other hand, wear out and must be periodically replaced. In addition, two
must usually be purchased, and regular maintenance is a feature of almost every
type of hair system. The fees for this routine maintenance add up, and over the
lifetime of the individual, can entail more financial investment than a surgical
procedure! There are also some types of systems that may actually accelerate the
process of hair loss.
There are as many "cures" and treatments for hair loss
in the marketplace as there are entrepreneurs. Unfortunately, despite all the
testimonials and "before and after" photos, none of them have been shown to
work. Non-drug therapies are not under the aegis of the Food and Drug
Administration (FDA), and therefore can make claims that may not be based on
controlled scientific trials. Drugs, however, are required to pass rigorous
testing for safety and effectiveness under the auspices of the FDA, and we
currently have two such agents available: minoxidil (Rogaine) and finasteride
(Propecia). These drugs will not re-grow hair where none exists, but they may
slow or even reverse the miniaturization of terminal hairs in some people.
Like any drug, these two medications may cause side effects, although at
this point they are both felt to be fairly safe. One drawback to their use is
that the benefits are reversible. In other words, any advantage gained from
using the drugs is lost with in a few months of stopping the medications. Also,
they do not work for everyone, and their effects are generally more pronounced
in the back of the head, rather than in the frontal or hairline area, which is
usually more cosmetically important than the crown.
The art of surgical hair
restoration has been widely practiced in the United States for about four
decades, but it could be said that many of the major innovations in the field
have largely taken place only during the past ten years. Throughout the decade
of the 1990’s, older, more invasive procedures such as flaps, scalp lifts, and
scalp reductions were abandoned by many. At the same time, cutting-edge hair
surgeons began advocating follicular unit transplantation as the state of the
art, along with its associated techniques of single strip donor harvesting,
stereomicroscopic graft dissection, and, often, large sessions of a thousand or
more grafts. A desire to preserve as much of the precious donor hair as possible
for the future led to a new focus on the donor area; also, the development of
new techniques for decreasing trauma to the recipient sites produced quicker
healing, and less postoperative "detectability".
We have discussed at length
the different regions of the scalp, and their varying importance in terms of the
hair restoration process. The hairline and frontal area are usually of paramount
consideration, because of the aesthetic impact of "framing the face". The crown,
on the other hand, may be of somewhat less significance, as well as being an
area that may consume vast quantities of donor hair for a minimal cosmetic
impact. Again, the importance of long term planning cannot be overstated. The
patient’s hair density, hair characteristics (color, curl, caliber), age, degree
and type of hair loss, previous procedures, potential for "shock loss" (telogen
effluvium), and budget all play a role in determining the eventual outcome of
the transplant.
Another oft-neglected topic is the suitability of women for
hair transplant surgery. Interestingly, although a large percentage of the
balding population is female, only a small, albeit growing, number of the hair
transplants performed yearly involve women. The reasons for this are varied.
Many women have no idea that they may be candidates. Also, women’s hair loss is
often more diagnostically complex than men’s, and a number of other disease
processes may need to be ruled out. Be that as it may, we do know that hair loss
may be even more emotionally devastating for women than it is for men.
Also
significant, for either gender, is the decision to have a second or subsequent
procedure. These can be undertaken for a variety of reasons. One is to refine or
lower the hairline, and another is to increase fullness or density. Crown
restoration is also a consideration. An often-unforeseeable occurrence is simply
the progression of the patient’s hair loss; this may happen rapidly, or advance
slowly over years or decades.
The concept of long term planning will be an
obvious priority to the kind of surgeon you will want to work with. As we have
stated before, technical expertise is mandatory, but is not enough. Your hair
transplant surgeon must also have the aesthetic, visionary, and ethical
qualities to help you make the correct, sober and realistic decisions that will
be necessary for an optimal outcome. Does he discuss with you the cosmetic
impact of planned procedures? Is there a concern not only for the immediate
future, but also for the transplant you will be wearing for life? Is he willing
to tell you what you may not want to hear about your hair characteristics, donor
density, pattern of balding, and other factors which must be taken into account?
And does he have the courage to postpone your surgery, or even refuse it, if
that is truly in your best interests?
These are questions that will cast a
light on the moral, technical, and artistic character traits of the person in
whom you are placing your trust. These decisions are not always easy ones. Ask
the questions, but also learn to trust your instincts, or your "gut" feelings.
If you respect your physician’s character and motives, then allow him to counsel
you. He will help you come to a reasonable conclusion. Remember, as you go
forward with your plan, that a sense of trust will alleviate your anxiety about
the surgery, as well as improving your level of confidence. Taking such a step
toward boosting your self-esteem and refining your image is most ideally
undertaken with poise, enthusiasm, and great optimism. Indeed, the hair
transplant experience could be the most profound step you ever take in advancing
your physical appearance and emotional wellbeing. Enjoy it! |
Chapter: 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | 14 | 15 | 16 |17 | 18 |
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