Hair transplantation is a surgical technique that moves individual hair follicles from a part of the body called the 'donor site' to bald or balding part of the body known as the 'recipient site'. It is primarily used to treat male pattern baldness. In this condition, grafts containing hair follicles that are genetically resistant to balding are transplanted to bald scalp. It is also used to restore eyelashes, eyebrows, beard hair, chest hair, and pubic hair and to fill in scars caused by accidents or surgery such as face-lifts and previous hair transplants.
Male pattern baldness - Norwood classification
Androgenic alopecia is extremely common; 30 to 50% of men suffer from varying degrees of this condition. In recent times the frequency of androgenic alopecia has increased and the age profile of sufferers has become younger. Women can also suffer from this condition (see pic.) . The reason for the condition is the deleterious effect of the male hormone testosterone on hair roots (follicles) located on the forehead and the top of the head. Under the influence of male hormones (androgens), androgen-sensitive follicles atrophy and are re-absorbed by the body. Although the hormonal background mentioned above is characteristic for every male, only those who are genetically predisposed to baldness will lose hair.
Male pattern baldness - Norwood classification
Currently, there are only two drugs approved by the U.S. Food and Drug Administration (FDA) for the treatment of pattern hair loss – Minoxidil (Rogaine) – for topical use and Finesteride (Propecia, Proscar) – for per oral use. But, denoted drugs are not always effective; furthermore, they are displayed only in case of patients who have a persisting hair. These drugs might be considered as specific drugs for hair loss stoppage and not for hair regrow in bald areas.
This is why medical treatment of androgenic alopecia is not always successful; hair cannot grow without the follicles, and the follicles have atrophied and been re-absorbed. By comparison, the restoration of lost hair in bald areas by drug treatment is equally as impossible as growing hair on one's palms.
But at the same time, with androgenic alopecia there is always a certain amount of hair left in the nape of the neck and on the temples. The reason for this is that hair follicles in these areas do not have receptors sensitive to testosterone, thus they remain resistant to the factors which cause hair loss.
Hair grafting means the transplanting of healthy follicles from the back and sides of the head into the bald areas. These follicles retain their anatomical and physiological properties for almost the entire life of the individual. This is proven by the fact that bald men almost always have hair remaining in the nape of the neck and the temples. So, hair transplantation means the relocating of follicles from one site (where there are plenty) to another (where there are no longer any follicles). Following transplantation, these follicles continue to function normally and grow healthily.
History of hair transplantation takes roots from 1939 and is related to the name of Japanese physician S. Okuda. He used to transplant round-shaped (4 mm in diameter) skin islets (grafts) from occipital area of the head to treat scalp burns. The grafts continued to produce hair in their new location. But during II World War his works were forgotten, until American dermatologist N. Orentreich “rediscovered” hair grafting in 1952. He established the concept of “donor dominant” which stated that transplanted hair roots (follicles) function at any location just as they would at their initial “donor” location. This means that hair produced after transplantation has exactly same anatomical and physiological properties, as hair at donor location (back of the head) and therefore, will never fall out. The problem was though, that hair produced from 4-mm (so called large) grafts would grow in brush-like pattern (“tooth-brush”, “doll’s-head” effect). To correct this cosmetically unacceptable result, American surgeon E. Marrit attempted to transplant hair not in the form of skin islets, but as individual hair roots (follicles). Later, transplanting hair in the form of thinnest grafts (0.8-1 mm in diameter) was named micrografting.
In 1995-2000 American hair transplant surgeons R. Bernstein and W. Rassman have developed the Concept of Follicular Units Transplantation. According to this concept hair is transplanted in the form of follicular units, exactly as in its natural occurring. Follicular unit is morpho-functional unit of the scalp that contains one, two, four hairs (hair roots, follicles). Transplantation of follicular units creates impression of maximal naturalness, minimizes follicular loss during the operation and is considered “gold standard” of hair transplantation today. But this method requires complicated techniques of harvesting donor material, dissecting donor material under special stereomicroscopes by 5-10 experienced assistants which is extremely time-consuming and expensive process.
Today there is no doubt that replacing hair lost by androgenic alopecia is possible only through grafting. Some companies produce artificial or synthetic hair (microfilament) that are of limited use for transplantation. The reason is that artificial hair does not grow, causes bothersome itching, has many complications (chronic inflammation processes of the skin, formation of pus, scarring) and finally - falls out. Considering above mentioned, our centre does not practice transplantation of synthetic hair. We only transplant hair in the form of follicular units.
Thus, hair grafting is not transplantation of hair filaments, but of those micro organs (follicles) that produce hair. The only way to solve this problem is the timely redistribution of genetically healthy hair roots (follicles) by transplantation of one's own hair.
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1-2-3 hair follicular units.
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Hair covered skin of human in occiput area magnified 50 times. Hair is cut at the length of 1.5 mm.
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