Hair is a beauty factor and part our appearance and attractiveness
Beauty is, above all, a socio-cultural concept. The criteria defining beauty change throughout history. There are, however, immutable criteria and one of them is hair.
Causes of hair loss
Baldness affects not only men but women as well. The most common cause in man is hereditary androgenetic alopecia also known as baldness.
The term « androgenetic » refers to androgens or male hormones (testosterone) and genetic refers to our «genetic heritage», personal and familial.
Androgens are produced in the gonads (testicles and ovaries) and the adrenal glands.
Dihydrotestosterone (DHT) is produced by interaction between testosterone and an enzyme called 5-alpha reductase that can be found in hair follicles.
In predisposed individuals,
DHT is the trigger for baldness.
The effects of stress, an unbalanced or deficient diet can amplify genetic predisposition. Among the rare causes of hair loss, reversible by treatment, are thyroid conditions, iron deficiency, high fever, surgical procedures or general anaesthesia, an unbalanced diet, giving birth and some drugs.
Certain types of scalp inflammation, such as lupus, lichen planopilaris and the mange can also cause temporary or permanent hair loss.
This kind of hair loss will initially appear as a loss of hair volume and mass. The progression is more or less rapid depending on the person and the final stage is hard to predict.
Genetic transmission stems from the father as well as the mother and is transmitted to both men and women. Baldness can skip a generation or can have different levels of severity for brothers and sisters of the same family.
Unfortunately it’s impossible to accurately predict the evolution of a person’s hair loss. Know, however, that 90% of hair loss cases in men are inherited and 75% respectively in women.
Tendency to hair loss of the masculine or feminine kind is transmitted through paternal or maternal genes and appears after puberty.
Predisposed hair, generally situated at the front of the head and at the head’s crown, will see a progressive decline in hair length and hair quality in cycles varying from 2 to 6 year before ultimately disappearing. Hair situated at the back and on the sides of the head differs genetically and will last a lifetime.
Androgenetic alopecia in women and children ?
During their lifetime a majority of women experiences hair loss. 75 % is androgenetic alopecia. The androgenic hormones cause this complex hereditary transmission. The loss of hair can vary in severity.
Initially alopecia will be rather scattered over the head’s surface. In adolescents, androgens are produced during puberty (approximately at the age of 18), when alopecia starts to appear. Children in pre-puberty are unaffected by this condition.
In conclusion, androgenetic alopecia is not a disease. Hormone levels are stable and normal.
Alopecia is not a disease
It must be stressed that androgenetic alopecia is not a disease : hormone levels are normal. Baldness is the result of a genetic sensitivity of hair follicles to the action of DHT. Finasteride and Minoxidil slow down the hair loss, nevertheless without the promise of stopping it all together. FUT and FUE for hair transplantation are so far the only proven techniques with lasting effect.
Evolution of hair loss
Hair grows in cycles of about two to six years and each hair is programmed to go through more or less 25 cycles.
It is interesting to note that each day one loses about 75 to 125 hairs as a result of a natural process whilst other hairs are dormant (telogen) and finally some hairs leave the dormant phase to start growing (anagen phase). As long as this process is balanced, the total amount of hairs on the scalp will remain constant.
Male and female predisposition to androgenetic alopecia is hereditary from both sides of the family and develops itself after puberty.
Genetically susceptible hairs (at the front and at the back of the scalp) will diminish (some lose their colour), will gradually disappear and the amount of hairs per follicle decreases. Hairs will go through their cycles at accelerated pace at a rate of only a few months per cycle. Hair density will then decrease.
Real density and perceived density,
truly a game of optical illusion
For patients, hair density is the second most important factor after natural appearance of hair implants. The amount of hair available in the donor zone is less than the amount previously present in the areas to be treated. A long term strategy needs to be adopted to match the individual characteristics of each patient (amount of hair in the donor area, areas to be treated, colour, size and general appearance of the hair).
One needs to distinguish between real hair density (density measurable per square cm) and the perceived density (subjectively perceived density). We tend to state that the observed density remains unchanged, even whilst the real density diminishes due to hair loss. At this stage people around you generally do not notice your hair loss . Changes in observed density will be noticed once a person passes the threshold of more or less 50% of the original actual density.
Being a game of optical illusion, we follow the principle of perceived density. As a result we can cover more surface for the areas to be treated and achieve a satisfactory perceived density through an even distribution of the grafts. This principle is also followed when extracting grafts in the donor area.
The principle of hair implantation rests on two surgical techniques that allow transfer of hair. The FUE technique (Follicular Unit Extraction) and the FUT technique (Follicular Unit Transplant).
Hair transplant is based on a proven concept : the bulbs or roots of the hair have a programmed longevity. Being genetically different and more resistant, hairs from the occipital region are programmed to last almost a lifetime and are perfect for re-establishing hair presence in areas that are void or low in density. Consequently, partial redistribution of a patient’s hair resources has no implications for the hair’s longevity.
Implanted hair will allow growth of new and resistant hair that will continue to grow for a lifetime.
Through follicle grafting, our cutting-edge hair restoration techniques (FUT-FUE) allow us to replace lost hair and restore the frontal hair line, the crown or any other area with sparse hair. Hair surgery offers such natural results that it often takes a discerning eye to spot its presence.
Limited donor area
Hair from the donor area, genetically different from hair situated on the rest of the scalp, is only of limited quantity. As no new hair can be created it is absolutely essential that the available hair is handled and treated with great care.
Follicle conservation is vital. Skill, instruments, experience and professional ethics are factors to take into consideration before taking your decision.
Hair transplant performed by a team that works to inferior quality standards can ultimately turn out to be more expensive and above all can have disastrous psychological effects.
The bottom line is that the essential part of your decision-making process will be to evaluate the specific skills of a team in being able to treat your donor area with the utmost care and with consideration for your expectations.