Health Topics

Treatment Options for Hair Loss

Treatment Options for Hair Loss

The most common cause of hair loss in both men and women is genetic. In fact, heredity accounts for 95 percent of all the cases of alopecia (baldness) in this country. The remaining five percent of the cases can be due to a number of things including diet, stress, illness, and/or medications.

Specific factors that can cause hair loss:

  • Medications, vitamins, or minerals: medications used to treat high blood pressure, heart problems, depression or gout; chemotherapy or radiation treatment for cancer patients; and in some cases, unusually high levels of vitamin A or low levels of iron or protein. For women, birth control pills can cause hair loss.
  • Illness, including thyroid disease, severe infection or flu; fungus infections, such as ringworm of the scalp.

For women, childbirth may cause temporary hair loss as well, due to the changes that take place in the body. In some cases, adults or children may have a condition known as trichotillomania, where there is a compulsion to pull out hair from the scalp, eyebrows, or eyelashes.

What are the treatment options for hair loss?

Rogaine (minoxidil) and Propecia (finasteride) are the only drugs approved by the FDA to treat pattern baldness (baldness as a result of hereditary causes).

Rogaine is a topical solution that is applied by directly rubbing it onto the scalp where hair growth is desired. Only 10 to 14 percent of the people who try this lotion experience hair growth. However, 90 percent of the time, Rogaine lotion can help to slow hair loss.

Propecia is the first pill that can treat male pattern hair loss. Like all prescription products, it should be given under a physician’s care. While effective, if treatment is discontinued, results may not be maintained.

Permanent hair loss can also be treated by hair replacement procedures, such as micro-grafting, slit grafting, punch grafting, and scalp reduction. The type of hair loss as well as the patient’s circumstances and desires determine which hair replacement procedures are most suitable.

Who is a candidate for hair replacement?

  • Men with male-pattern baldness
  • Some women with thinning hair
  • A person who has lost some but not all hair as a result of burns or other scalp injuries

Who is not a candidate for hair replacement?

Hair replacement is not recommended for the following people:

  • Women with a diffuse, or wide-spread, pattern of hair loss
  • Those who do not have sufficient "donor" sites (hair-bearing portions of the head from which hair-bearing skin is taken)
  • People who form keloid scars or thick fibrous tissue that can result from trauma, burning, or radiation injury
  • Those whose hair loss is due to medication.

Common hair replacement procedures

Grafting: Grafting is an outpatient procedure performed in the dermatologic surgeon’s office. Micro-grafts contain only one to two hairs per graft, while slit grafts contain between four and 10, and punch grafts hold 10 to 15 hairs. A local anesthetic is injected into the scalp and sedation is available, if needed, for relaxation and comfort.

What happens during and after the procedure?

The dermatologic surgeon first removes a disc-shaped portion of the hair-bearing scalp from the back of the head. Then, the surgeon cuts the removed scalp into small segments with varying amounts of hair in each graft to achieve a very subtle thickening and "natural" look with this technique.

With each session, 100 to 1,000 hair-bearing segments are transplanted. "Donor" sites are closed with stitches, which usually are then concealed by the surrounding hair. After the grafting session is complete, the scalp is cleaned and covered with gauze and, if necessary, a bandage. Stitches will be removed approximately 10 days later.

How long does the procedure take?

Three to four sessions may be needed to achieve satisfactory "fullness." After each session, a healing process of two to four months is usually recommended prior to the next procedure.

Are there any side effects?

Most side effects that come with a hair transplant usually go away within one to three weeks. Among the most common side effects are:

  • Swelling
  • Bruising around the eyes
  • Crust may form on the "donor" and "recipient" sites of the scalp
  • A lack of feeling or decreased sensation around the "donor" and "recipient" sites of the scalp
  • Itching in the "donor" site

Scalp reduction: A scalp reduction is the removal of non-hair-bearing skin from the scalp so that the remaining hair-bearing skin can be stretched to fill in the bald area of the head. Scalp reduction can reduce as much as half of the bald area. It is a procedure performed to cover bald areas on the top and back of the head and is not found to be beneficial for the frontal hairline.

How is this procedure done?

The scalp is injected with local anesthetic and a bald segment of scalp is removed. The surrounding skin is then loosened and gently stretched so that the sections of hair-bearing scalp are brought together and closed with stitches. This procedure may also be performed during punch grafting sessions.

What are the side effects?

There will be a little more pain experienced after scalp reduction surgery than experienced after punch grafting. Headaches may occur and are treated with non-aspirin containing pain relievers. Mild scalp tightness may be felt for one to two months.