Baldness: Causes and Cures

Baldness is an extremely common phenomenon and affects a considerable percentage of men. It has been seen that around 40% of men experience noticeable hair loss by the age of 35 years and it rises with age so that around 80% of men would have noticeable hair loss by the age of 60 years. Therefore, you are not alone in your quest for the solution for baldness!

The average human scalp comprises of around 110,000 to 150,000 hair follicles with each follicle comprising of 1-4 hairs. Hair fall occurs in everyone and loss of up to 100 hairs in a day is considered as normal. Loss of more hair would mandate evaluation by a hair restoration surgeon. Initially the baldness is confined to the frontal aspect and the vertex and as it progresses it empties out most of the scalp so that only the hairs at the back or the occipital region remain. This region comprises of genetically resistant hairs that are unaffected by the balding process and are therefore the most important component in hair restoration surgery.

In all patients however, the process does not occur like this. In quite a few individuals there is diffuse hair loss which does not follow this specific pattern. These patients are not very good candidates for hair transplantation.

The pathology of balding is related to the male hormones. In genetically susceptible individuals in whom there is a family history of baldness, the male hormones tend to attack the hair follicles over the anterior part of the scalp and this leads to atrophy of the follicles and eventual loss. This process initially makes the hair thin and then it is ultimately shed off.

Baldness is not only confined to males, females are also similarly affected. However, in females, the process is generally diffuse so that the hair restoration surgery is more difficult. Again, a disarray of the hormonal status is incriminated.

1. Hair Restoration Agents

A wide range of hair restoration agents are now available in the market some claiming wonderful results. Patients need to know that most of these do not work! A host of herbal medications are advertised but there is no data regarding their safety and efficacy so it is best on part of patients to avoid these agents as these can be harmful in the long run. It is important to know that there are 2 agents that have been proved to work in baldness albeit to some extent and which may delay the hair loss process. The first one is minoxidil which increases vascularity to the scalp and thereby delays the hair loss process. This agent is an anti-hypertensive so it is imperative that patients get a prior measurement of their blood pressure and apply this medication over their scalp prior to going to bed. The second agent is finasteride which antagonizes the male hormonal effect on the hair follicles but can be associated with some degree of sexual dysfunction in a few individuals (this is reversible on stopping the medication) so it might not be appropriate in everyone.

Therefore, if your hair restoration product comprises of anything other than these 2 agents then take it with a pinch of salt!! Remember, the remnant hair is yours and you should not do anything that can harm it!!

2. Mesotherapy

Quite a few doctors especially dermatologists advocate mesotherapy for baldness in which a variety of proteins and growth factors are needled into the scalp. Patients should remember that the efficacy of this procedure is dubious and causes more harm than good! Please do a search in PubMed regarding the effect of mesotherapy to be convinced of its results.

Hair transplant surgeons worldwide feel that mesotherapy causes scarring in the scalp which adversely affects a future hair transplantation as scar tissue has less vascularity. Therefore, if you go in for mesotherapy please remember that you might not get good results with a future hair transplantation!

3. Stem Cell Therapy

Many clinics now advocate stem cell therapy claiming excellent results. Stem cell therapy has the propensity of creating new follicles in the area of baldness and therefore can be an excellent solution to baldness. However, till date this procedure has not been standardized and results are also doubtful. This process would require a great deal of refinement before it can be advocated as a viable alternative to hair transplantation. Till then, hair transplantation or hair restoration would remain the mainstay for baldness.

4. Hair Transplantation

The only therapy till date that gives natural results is hair transplantation, a process in which the genetically resistant hairs over the back of the scalp are transferred to the areas of balding to give natural hairs. Since it is the body's own hair, these are readily accepted by the body and the hair growth that occurs is completely natural. The hair that grows following transplantation can be cut, shampooed and so on.

Hair transplantation is carried out commonly by 2 methods: FUT and FUE. In FUT or strip method, a strip of the hair bearing scalp is taken out and the individual follicles isolated. These are then individually transferred to the zone of baldness leading to natural hair growth. This process results in the formation of a scar over the donor area from where the strip is taken which is readily concealed by growth of the adjacent hair. This is the most popular method of hair restoration worldwide.

Another technique of hair transplantation is by the FUE method in which individual follicles are taken out from the scalp and transferred to the bald area. This method does not therefore result in the formation of a scar as is encountered with a FUT. However, this technique has its limitations. Loss of follicles is more, the process is more time consuming and much more expensive. Therefore, not all surgeons perform FUE in their patients especially when the bald area is quite large.

Many individuals do not have adequate scalp hair in the donor region. In these patients, body hair transplant can be advocated if they have excess body hair. However, the growth of body hair does not match scalp hair and this is therefore the last resort in hair restoration.

A lot of doctors including dermatologists, plastic surgeons and other specialties are now performing hair transplantation. Since this is a cosmetic procedure, it is imperative that a patient researches a bit about the doctor performing hair transplantation. Plastic surgeons are exclusively trained in performing hair transplantation and other cosmetic surgeries and therefore should be an obvious choice to patients.

Hair transplantation is a procedure which requires teamwork and therefore it is imperative on part of patients to know who the team members are. The team commonly comprises of other doctors and technicians who are especially trained in hair transplantation. However, the team leader is the most important person and must be adequately trained as in today's world many untrained doctors advertise themselves as pioneers in hair transplantation which therefore affects the end results. Therefore, choose your hair transplant surgeon carefully to avoid disappointment as this can be an expensive procedure!!