Hair loss

05 May 2011


Hair loss affects 60-70% of all men and 4-8% of women. Through the ages people have tried various remedies to treat hair loss. This article discusses the latest treatment options.

  • Hair loss occurs to some extent in 60-70% of all men, and 4-8% of women.
  • There appears to be a relationship between the male hormone testosterone and male pattern baldness.
  • It can also occur following events such as trauma, radiation therapy, burns and surgery.
  • Hair transplantation surgery is currently the most effective treatment.

What is baldness (alopecia)?

Losing hair is very traumatic for both men and women. While some people are able to stop their hair loss with drugs like Rogaine and Propecia, other people have no success and eventually go bald.

Hair transplants are a modern solution to an age-old problem. Man's obsession with hair dates back to 3500 BC. From ancient biblical times to the Roman period, the specter of male pattern baldness has reared its ugly head. Julius Caesar was preoccupied with his hair loss and grew his hair long in the back and combed it all forward. He also wore laurel wreaths to camouflage his baldness.

Hippocrates, the father of Medicine made a potion for hair loss consisting of opium, horseradish, pigeon droppings, beetroot; spices and many other exotic ingredients…….. (it didn’t work).

He observed that eunuchs (sexually immature men) never became bald. 2400 years later, researchers at Duke's University showed the association between the male hormone testosterone and male pattern baldness.

Baldness only affects the scalp in a "horse shoe" pattern on the top of the head. The hair on the sides of the head is never lost.

What causes baldness?

Hair loss occurs to some extent in 60-70% of all men, and 4-8% of women. This balding process is caused by hereditary factors. You inherit the tendency to lose hair from either of your parents. This is transmitted in your genes. You may even have this tendency despite the fact that your parents have full heads of hair - this is due to a process known as spontaneous mutation, whereby the genetic information changes at conception.

Hair loss can also occur following events such as trauma, radiation therapy, burns and surgery. This is often amenable to transplantation, as the donor sites can often be excellent.

A large number of drugs and diseases cause hair loss. This hair loss is only reversible once the initial cause has been remedied. Hair transplantation is not the answer in these cases. If you suffer from a scalp disease, you should consult a dermatologist.

How is it treated?

Myths regarding hair loss such as a decrease in blood flow, or a tight scalp, clogged or blocked pores, protein build-up, wearing of caps and hats no longer hold any truth.

Once the hair has fallen out no prayers, potions or lotions will bring back the hair. Because male pattern baldness is not due to a decrease in blood flow, advertising claiming to increase blood flow in the scalp by expensive laser therapy cannot be effective.


Hair transplantation surgery involves the relocation of individual micro and mini follicular units from the sides of the head (donor area), which are not affected by the hair-loss process, into the area of bald skin (the recipient site).

The hair taken from the donor area will continue to grow and not fall out as a result of pattern baldness because this hair in this area is not sensitive to the male hormone DHT.

Today's hair transplantation owes its success to the fact that the transplanted hair follicles (roots moved from their original location to another area) behave in the same way as they did in their original site. For example, even in the most advanced cases of male pattern baldness, a horseshoe-shaped fringe of hair persists. Hair follicles moved from this hairy fringe to the bald area on your scalp will take root and grow.

“Lateral” Slit technology

To best understand this concept one needs to look at the way in which hair grows in nature. It can be seen that rather than being arranged in random fashion, the follicular units are arranged in one of several patterns. Similarly the individual follicles within a follicular unit frequently are in set patterns. The follicles appear to be lined up alongside of one another in a plane perpendicular to the direction of hair growth.

This arrangement enhances the area of scalp covered by the follicles as opposed to being arranged in random fashion or one follicle behind the other. In practice there are many other advantages to the Lateral Slit technique. The follicular units often grow in lines perpendicular to the direction of hair growth. This optimises scalp coverage and avoids redundancy of coverage, which will occur if the follicular units were arranged randomly or in a plane parallel to the direction of hair growth. Other advantages of the Lateral Slit Technique include precise control of graft angulations relative to underlying scalp tissue. It also only requires local anaesthesia.

The incisions made by the Lateral Slit Technique are shallower than other incisions, thereby reducing trauma to the critical blood vessels deeper in the scalp. When grafts are placed in recipient sites in a sagital fashion, the outward pressure exerted by each follicular unit and the pressures exerted by neighbouring follicular units are cumulative. This build-up of pressure within the scalp limits the number of follicular units that can be safely placed in a given area without risking compression or popping. When the grafts are placed in lateral slits there is free transmission of pressure to the outer surface of the scalp and the pressures of neighbouring follicular units is not cumulative.

Through extensive research and state-of-the-art developments in technique and instrumentation, hair transplantation has become a highly sophisticated, yet relatively simple procedure. Three to four months later the transplanted follicles begin to grow. This hair will need to be cut, washed and styled. It will never fall out since it originates from the donor area on the sides of the scalp.

Bear in mind that hair loss is a lifelong process and further procedures may be necessary to fill in ongoing hair loss. The transplanted hair, however, will never fall out.

Written by Dr Craig Ress and Dr Larry Gershowitz at Medical Hair Restoration (021) 425 7755 or December 2008


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