Hair restoration is one of the most common aesthetic procedures. The true objective of hair restoration is to make the patient who has had hair restoration look as natural as possible as though he has had no procedure done at all. The final result should be a “natural-appearing” hairline with “natural-appearing” density.
Norwood classification of androgenic alopecia.(Reproduced from Unger MG, Cotterill PC. Hair transplantation. In: Achauer BM, Eriksson E, Vander Kolk C, et al. (eds) Plastic Surgery, vol. 5. St. Louis, Mosby, 2000, p. 2487. Redrawn from Norwood OT. Male pattern baldness: classification and incidence. South Med J 1975;68: 1359–1365.)
Medication For Hair loss:
The two most commonly used drugs for the management of hair loss are minoxidil and finasteride. Minoxidil is applied locally and is believed to work primarily by increasing the local blood flow and promote hair regrowth. Finasteride is an oral medication, which impacts the androgen receptors of the hair follicles and uptake of testosterone at the hair follicle level.
Studies have shown that 1 mg/day finasteride not only reduces hair loss but, in a limited percentage of patients, can cause some growth of hair. This is usually more effective in the younger population, and once true baldness has occurred, it is unlikely that finasteride will have any significant effect.
The use of finasteride has clearly been shown to stabilize hair loss, and there can be some reversal, although it primarily has its best effects on the vertex area of the scalp. Although both finasteride and minoxidil can be effective, finasteride may be more useful in younger patients and therapy must be long- term. Most of the studies have shown that it requires at least 6 months to 1 year for some significant improvement to be seen from the use of finasteride.
Surgical therapy for hair loss:
Broadly speaking, there are two techniques of hair transplantation:
- Follicular Unit Extraction (FUE)
- Follicular Unit Transplant (FUT / Strip method)
Both the techniques have their share of advantages and disadvantages. FUE involves harvesting individual follicular units with special devices without making any incisions on the scalp. FUT entails a thin strip of skin along with the hair from the back of the scalp and then slivering out individual hair follicular units from them.