Hair Today, Gone Tomorrow, Hair Again

From the WebMD Archives

Jan. 4, 2000 (Atlanta) -- According to the American Academy of Facial Plastic and Reconstructive Surgery, hair loss affects two out of three men, and one in five women. But that doesn't have to be the end of it, thanks to the evolution of hair replacement techniques.

In a study in the recent issue of the Archives of Facial Plastic Surgery, Stephen C. Adler, MD, and Daniel Rousso, MD, compared aesthetic improvement, effectiveness, amount of postoperative pain, and complications of past and present techniques. According to their results, hair restoration procedures overall just keep getting better.

The main objective of the study was to actually prove that newer techniques are better than older techniques, Adler tells WebMD, and also to give patients a voice. "It's important, because as doctors we can always have an opinion of our own work and, yes, we can see that we have improved the hairline, the density, the scars by the new techniques. But basically its our own subjective opinion, and this is actually the first time that the patient's opinion based on an objective evaluation is actually performed and sufficiently proven," he says.

According to Adler, this type of study is not only important for hair restoration, but also for other procedures like facelifts and laser peels. He predicts the research will generate a wave of similar studies.

The researchers sent out 300 surveys to patients who had undergone hair replacement over the last three decades. Of that group, 66 responded, with an average age of about 44. The patients were grouped into three segments depending on when the surgery was done: before 1980, 1981-1990, and 1991-1996.

First, definitions of some terms and techniques are in order. For any hair replacement to occur, some hair is needed from a donor site. A totally bald person is out of luck. According to the authors, the science of hair grafting reaches back to the early 1800s. But the procedures commonly associated with hair replacement didn't begin in the U.S. until the next century.

Adler and Rousso focused on standard grafts (8-10 hairs per follicle), minigrafts (about 4 hairs per follicle), and micrografts (1-2 hairs per follicle). They also focused on scalp reduction, in which a piece of scalp is removed and the parts with hair are stretched over it; flaps, in which a section of hair-bearing scalp is partially disconnected to replace a bald part; strip harvesting, in which a strip of the scalp is entirely disconnected and moved to a bald spot, or punch harvesting. The "punch" method is the oldest method, wherein pencil eraser-sized plugs are removed and placed where needed, giving a person, as Adler describes it, a "doll's head" appearance.

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Patients surveyed said that they had fewer complications and the best results with the micrografts, which the respondents did not even begin to receive until 1991, and they said that the results were better with minigrafts than standard grafts, apparently an increasingly outdated mode of operation.

"Micrografts are going to become the benchmark, not only to improve the hairline, but actually for the area behind the hairline. Micrografts are going to be used more commonly and effectively because of the things we've shown already in the paper," Adler tells WebMD.

When comparing the more modern "strip" method of harvesting to the older "punch" technique, the researchers found a "significantly" lower rate of complications for strip harvesting.

But among the larger, more established types of surgery, such as scalp flap and scalp reduction, there were negligible differences in postoperative conditions or aesthetic results for patients during the last two decades. Adler acknowledges that not much has changed in these procedures over the last two decades.

This all goes to "suggest", writes Adler, "that the newer procedures are significantly better." But he cautions that the types of procedures compared require additional evaluation. The paper touched on laser hair transplantation surgery, a newer method. "It's a matter of looking at new technology critically before accepting it as the standard, which really means newer is not really [always] better," Adler tells WebMD.

For the future, Adler says cloning hair will be one of the turning points because it "will make a lot of candidates out of noncandidates."

For the present, though, things are looking up: "The recoveries are much faster, there's less pain, there's less bleeding, and less risk of scars all combined with an increase of aesthetic result, or a natural appearance. When you combine those it's hard to beat," Adler says.

The study was sponsored by a grant from the International Society of Hair Restoration Surgery in Schaumberg, Ill.

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