Basic information about the hair treatment
Hair loss occurs in more than 40% of men after age 35 and in approximately 8-9% of women. Androgenetic alopecia (male pattern baldness) is responsible from more than 95% of hair loss of men. Hair loss is seen even more than 70% of man after age 65.
Average number of hair follicles on the scalp is around 110.000. A daily hair loss of around 100 hair can be considered as a real hair loss.
Hair loss is a major concern for many people today and the hair transplant is most commonly cosmetic surgery for men lately. Also there are other short-term methods like 85% of male patients are using minoxidil or 15% of them are using finasteride as chemicals and there are different methods like laser hair restoration, using special hair growth shampoos, hair-care cosmetics, massagers and maybe others. There is no proven efficacity of any of them except the fact that they increase the volume of existing hair. Even chemicals have some side effects and patients decide to stop using them and then they lose more hair than before because of the changes in hormonal balance.
Contrary to the popular opinion, most people suffering from hair loss are unhappy as health is a state of complete physical and mental wellbeing. If people suffering from hair loss are unhappy we can not say they are totally healthy.
Methods of hair loss treatment
The methods of hair treatment of Dr. Okuda and Dr. Orentreich remained the standard hair replacement procedures for the next three decades. Micro-grafting improvements in 1980’s introduced a more natural look in the frontal hairline. Aesthetic qualities were realized with the new developments.
Follicular unit hair restoration was credited to Dr. Bob Limmer in 1988. Numerous practitioners attempted duplications without knowing that this area demands a high degree of experience to treat the hair loss. Experienced specialists recommend only professionals to attempt follicular unit hair replacement.
Follicular Unit Transplant (FUT, Strip method) is out of date since 2000. Most commonly we perform FUE (Follicular Unit Extraction) and its subtypes today. Discover more information about FUE in the following text.
Basic facts about the skin and scalp
It seems from outside that we have a bone covered by skin with some hair on it which is true but in fact the structure is more complicated than it seems. Let us explain just a few important points.
The skin contains all the appendages, including hair follicles which extend into the lower layer. If the hair loss appears, thinning of the outer two layers usually occurs. This situation can be appreciated when we compare the thickness of the scalp in recipient areas with that in donor areas.
We also have sebaceous gland next to shaft of hair. Finally let us mention the capillary network, nerves, other vessels, fat and so on.
Etiology - Causes of the hair loss
Hair loss by men is generally seen as a male pattern baldness and the exact cause of pattern is still unclear. We can say it is genetics and hair follicles with a genetic sensitivity to Dihydrotestosterone (DHT). If the hair follicle is sensitive to DHT then it is getting thinner with a shorter life span and after some time it stops producing new hair.
According to the reports, there is a stronger tendency to the hair loss on the mother’s side than on the father’s side. The Male pattern baldness is a the individual's lifetime.
During the physical examination we also check other causes like
- Systemic causes of hair loss:
- thyroid abnormalities,
- iron deficiency anemia or
- zinc deficiency.
- Dermatologic causes of hair loss that may be treated medically
- Telogen effluvium (temporary hair loss that can be healed after 2-3 months of hair loss treatment)
- Smoking, stress, eating habits, cosmetics or shampoos as a accelerating factors of hair loss
Smoking causes blockage and inflammation of vessels which means that not enough blood is going to the capillaries of the scalp. No blood means no nutrition and no oxygen and this is how the hair loss can appear.
Stress causes contraction of vessels so it is the same mechanism again: less blood flow causes problems.
Shampooing, combing and brushing cause hair breakage and hair loss in long term. Also when the hair is wet it is more fragile so combing it too much or using a hairdryer with high temperatures can cause the hair loss.
What to do before the hair loss treatment?
In case of healing or bleeding problems, the following tests should be done before the hair loss treatment:
- CBC count with platelets
- Prothrombin time (PT)
- Activated partial thromboplastin time (APTT)
Especially in the case of hair loss by women, a broad workup should be done:
- CBC count
- Total iron and ferritin
- Thyroid function tests and thyroid-stimulating hormone
- Total and free testosterone
- Dehydroepiandrosterone (DHEA) sulfate, in cases of irregular menses
Hair loss treatment
Nearly all men and the most women who have androgenic or inherited hair loss can be treated with hair transplantation.
Hair transplantation may not be the most effective therapy for some medical causes of hair loss; in some instances, it exacerbates the condition.
Therefore, it is important to rule out other treatable causes of hair loss, especially in the case of hair loss by women where can speak about nongenetic etiologies for the hair loss. These nongenetic causes of hair loss are more common by women than by men.
There are also other possibilities before going to the hair transplantion. Let us mention for example the chemicals named minoxidil and finasteride or some oils, cosmetics or even the laser treatment of hair loss. These methods are actually no treatments of hair loss. We can talk about a conservative approach generally for people under 20.
Hair transplant surgery
Today we perform the hair transplant surgery to more then 60% of hair loss diagnosed patients. There are different methods of hair transplant all over the world.
First of all, there is a technic called FUT which is an old technique nowadays but it used to be very popular from 90s to the beginning of 2000. It is also called strip method because the surgeon cuts a piece of the skin of the scalp from the back and then stitches it. Then he harvests the hair follicles from the piece of skin. That was brilliant but there are also disadvantages of the FUT method as the patient will have a scar on the back and the maximum graft harvested in a session is around 1.500-2.000.
Fue hair transplant
Today we have the FUE method which stands for the follicular unit extraction and it has 3 steps:
First step is harvesting which takes 2-3 hours. We harvest hair follicles one by one by micro-motors from the back side of the scalp (it is also called donor area). We choose to harvest hair follicles from the back because genetically they are not falling like frontal area or crown area and when we implant them to other areas they are as they are so they won’t fall again as they protect their genetics. You can see a good donor area picture on the left.
There are also other areas like chest or beard as donor areas if the patient’s donor area is not enough but the first problem is that they are prone to fall again and second they won’t look natural because the chest hair is generally curly compared to the scalp and beard hair is thicker than the hair of the scalp so we do not use them too much and they are generally the last chance.
Hair follicles from the back (donor) area can be 1, 2, 3 or 4 hairs from one root and we count them as a graft.
A graft is a generic term for any piece of hair-bearing tissue that is transplanted into the scalp.
So during the hair transplant surgery we count them one by one as a graft. For example if you have 4.000 grafts harvested from the donor area it means average 9.000-11.000 hair pieces.
Advantages of MicroFUE hair transplant method
Dr. Altan’s MicroFUE is called MicroFUE because we use the smallest punch in the world as it is 0.7mm. The advantages of a smaller punch is no pain after the hair treatment and also no scar after the hair restoration.
Before going to the second step of the hair loss treatment, we design the patient’s hairline and make a plan for the opening channels. Then we share it with the patient and if he likes it we continue with the process of hair transplant. If not, we continue drawing the patient’s hairline until the patient says Yes, I like it. By the way, the hair line is not depending on the doctor nor on the patient because we cannot draw it lower than the frontal muscles.
The second step of the hair transplant procedure is opening the channels: It takes around 1 hour. In this step we open the channels which means we make some new holes for the new hair grafts. It is very important that the channels are as much close as possible. If they are not close enough, the results of the hair transplant surgery will be less dense and if they unite they will cause a scar.
You can see on the picture on the right Dr. Altan’s MicroFUE technique and opening patelliform (flat) channels. Advantages of opening the patelliform channels are the facts that we can design it as close as possible (compared to round channels or Choi pen) and that they heal very fast. If there are 4.500 grafts, there will be 4.500 channels.
Choi pen: Hair loss treatment for women
Choi pen is a pen-like device that can open the channels and implant follicle in the same time so it can be a good choice of hair loss treatment for women who don’t want to cut their hair or men with a very limited hair loss.
But if it is a hair loss in a specific area or a total hair loss, there is no point to perform a hair loss operation with round-channels.
The third step is to implant hair follicles into the channels. It takes 3-4 hours.
We implant the hair follicles one by one to the channels. It is very important that the size of the channels matches the size of the graft. Bigger grafts and bigger channels should be done during the second step.
We implant the hair grafts as a zig-zag array to the frontal area because normal human hairline is not like a straight line. Otherwise it would look like a doll-hairline.
During the period of implanting the hair follicles, we wash it with saline solution spray to avoid scabs after the operation.