Many people think that Hair Transplantation is the only surgical procedure to treat baldness. As a matter of fact, Hair Transplantation comes under the umbrella of a quickly developing branch of Plastic/Cosmetic Surgery, called Hair Restoration Surgery.

Male Pattern Alopecia or Baldness (MPB), clinically known as Androgenic Alopecia, can cause distress to some men, particularly when hair loss starts at an early age. Women are not immune to hair loss. However, fortunately the pattern is different; it is called Female Pattern Alopecia (FPA). In men, the hair loss usually starts at the front, where the hairline recedes. In some, it starts at the top of the head (crown or vertex), and works its way towards the front. The sooner the hair loss starts, the bigger the bald area would be and the shorter the time it would take to reach advanced baldness. On the other hand, FPA is different in the way hair loss is confined to a diamond shaped area at the front of the scalp. It is very rare for women to suffer from extensive hair loss.

People who have the baldness gene, either hereditary or mutation, have two types of hair follicles. The ones at the front and top of the head are genetically engineered to attract testosterone hormone to weaken and eventually turn them into miniature structures bearing a fur type of hair called Villus hair. The vulnerable follicles have receptors (chemical magnets) for the hormone. However, hair follicles at the horseshoe shaped area at the back and sides of the head do not have those receptors. Therefore, testosterone does not affect them.

Hair Transplantation works by removing hair follicles from the back of the head and translocating them to the front. The problem any hair restoration surgeon faces is the unrealistic expectations of patients. Patients who think surgery can give them a head full of hair.

I always explain to my patients that Hair Restoration Surgery is about supply versus demand. In other words, if the demand is too high (wide bald area), the supply (hair follicles that can be removed from the back of the head or the donor area) would be too small. As we cannot multiply hair follicles, we can reduce the “demand” area, to make the available follicles produce a more effective result. How do we reduce the demand? This is a procedure called Scalp Reduction. The bald Scalp can be surgically removed in stages and the hairy scalp at the sides and back of the head lifted to replace the removed scalp. Gradually, over four to five procedures, the whole, or most, of the crown’s bald area can be abolished, or at least dramatically reduced. To reduce the number of stages of this procedure, there are few devices on the market place that are implanted under the scalp for a relatively short period of time to help stretch the hairy scalp. When scalp reduction is carried out, it will only leave the frontal area bare. This makes the limited number of transplantable follicles more effective.

One other Hair Restoration procedure is Flaps. This is achieved by raising a dagger shaped piece of the scalp from the side of the head and moving it to the front. It is a time saving procedure as the effect is immediate. However, the result is too good. In other words, the hairline looks too thick. A more natural hairline is better created by making a gradual transition from thin to medium to thick density in an upwards direction using micrografts. Flaps are, these days, considered obsolete by many hair restoration surgeons. Many innovations and inventions have taken place in the field of Hair Restoration Surgery. These have made the procedures more comfortable and the results more pleasing.

Like any Cosmetic Surgery procedure, Hair Restoration Surgery is not for people who are looking for perfection. However, depending on the extent of baldness, it can transform ones look. However, because hair loss is a continuous process, and the number of hair follicles that can be transplanted is limited, there are limitations. Those are governed by the “demand versus supply” law.

Other areas that can be treated are eyebrows, eyelashes, beard and mustache.

Finally, hair restoration surgery has evolved dramatically during the last two decades. One can expect a naturally looking, undetectable result.

Hair Restoration Surgery – Facts And Limitations ( Dr. Riad Roomi )