Baldness is uncomfortable for most men. As far back in human history as 5000 b.c., a cure for baldness has been sought. Eventually, time and technology have provided us with a real solution. We now have a natural-looking hair transplant technique that has replaced the "hair tonics" of yesterday and the more recent telltale "hair plug" look of a hair transplant.

WHY WE GO BALD

There are many reasons why a person may go bald: illness, poor nutrition, chemotherapy. Some patients develop alopecia (baldness) for no known reason. The most common reason men go bald is the male-pattern baldness gene. This involves a genetic inheritance from either the mother or father. The male-pattern baldness gene will be expressed if, and only if, there are normal levels of testosterone present in the bloodstream. Hair follicles around the sides and back of the head are not affected by this gene, so the hair can be transplanted from these locations and repositioned in the bald areas. The hair transplanted in the new location will grow, eliminating the baldness in these areas. If, however, one has generalized thinning all over the scalp, one is not a good candidate for hair transplantation (see Figs. 25-1, 25-2, and 25-3).

Courtesy of Carlos Uebel, M.D.

Figure 25-1. This sixty-four- year-old patient had two hair transplant procedures.

Courtesy of Carlos Uebel, M.D.

Figure 25-2. This thirty-eight- year-old had excellent results with just one procedure.

Courtesy of Carlos Uebel, M.D.

Figure 25-3. This twenty-eight-year-old patient had two micrograft procedures.

WHAT TYPES OF HAIR TRANSPLANTS ARE AVAILABLE TODAY?

Micrografts

Hair loss treatment is most commonly performed for men with acquired male-pattern baldness, but it is also available for females who have thinning hair in the anterior scalp area due to various types of alopecia. In male-pattern baldness, one can change the posterior portion of the scalp and its normal hair-bearing state by transplanting varying amounts of hair from the anterior hairline back to the crown.

Micro- and minigraft techniques are the most successful treatment modalities for male-pattern baldness. This procedure minimizes scarring and provides the patient with instantaneous long-term results that won't vanish over time. Microsurgical hair grafts consist of one to five hairs that are taken from the back of the scalp and surgically placed into the bald area, using a small incision. The remarkably small size of these grafts provide the patient with a natural appearance. Due to these technological advancements, microsurgical hair grafts alleviate the "corn row" or "doll's head" appearance that has long stigmatized hair replacement surgery.

Scalp Reduction

Another technique used in hair replacement surgery is the scalp reduction, which reduces the bald area by direct excision and removal of scalp skin. This is usually accompanied with future micro- and minigrafts.

Scalp Extension

The scalp extension is a flat, rubberbandlike device placed below the scalp to stretch the hair-bearing area. This technique is also used in conjunction with scalp reduction to accelerate the rate at which one can excise the bald scalp.

Tissue Expansion

In tissue expansion, we surgically place a balloonlike device underneath the part of the scalp that contains hair. The balloon is then expanded weekly. This stretches the hair-bearing scalp to two to three times its length and width. We can then almost excise the bald scalp area and relocate the "expanded" hair-bearing scalp into the area of baldness.

Scalp Rotation

The scalp rotation technique rotates the hair-bearing skin from the back and sides of the scalp to the front or anterior portion of the scalp. The best technique for you is up to you and your surgeon.

ADVANTAGES AND DISADVANTAGES OF EACH TECHNIQUE

One of the advantages of scalp-rotation is that when micro- and minigrafts are placed, the hairs actually fall out once they're transplanted. They regrow after two or three months, and they never stop growing after that. With scalp rotation or other types of scalp flaps, the hairs within the flaps do not go through a stage of hair loss. Micrografts and minigrafts are fairly simple office procedures, but scalp flaps and tissue expanders are more extensive procedures entailing more invasive surgery. The great disadvantage of tissue expansion is that one has to have large balloons underneath the scalp for approximately eight weeks.