Have you ever looked in the mirror and wondered, “Why can’t my hair grow on the top of my head the way it grows on the side of my head?”
Well, that’s pretty much what a hair transplant does—it takes the strong, healthy hairs on the sides and back of your head and “plants” them onto the top of your head. When done by a qualified physician, the results can be very natural and virtually unnoticeable.
But it’s also the most expensive. Hair transplants are considered minor outpatient surgery. But it’s a fairly simple, painless procedure. And it’s not as though you walk in bald and walk out with a head of beautiful hair. The transplanted hairs must grow, just like regular hairs. So the effect is gradual and natural.
As far as the cost of hair transplants, it depends on how much work is needed.
When your patient is losing hair due to normal androgenetic alopecia, known as pattern baldness in men, you may feel like reassuring him with a joke and telling him there’s not much he can do about it. But reassurance might not be enough, given the genuine psychological effect baldness has on many men in a culture that prizes youth and identifies baldness with age. You may do the patient anxious about baldness a service by informing him of the cosmetic and surgical options available for camouflaging hair loss, especially since many advertised remedies are of no proved value and some are positively dangerous.
A brief explanation of the physiology of androgenetic alopecia may help your patient distinguish false claims from legitimate options. Explain that androgenetic alopecia is a trait inherited by about half the population, both men and women, and expressed to varying degrees. The follicles affected by this trait are hypersensitive to normal circulating levels of dihydrotestosterone, which stimulates them to grow smaller, finer, lighter hair in each successive anagen phase of hair growth. Eventually, the pigmented terminal hairs in the affected area give way to the fine non-pigmented velus hairs that cover most of the body.
Cosmetic techniques for camouflaging hair loss are advertised by diverse and confusing names, but most are just ways of attaching a hairpiece of human or synthetic hair. If the hair is attached to the scalp with tape, it is called a toupee. If it is glued semi-permanently to the scalp or to other hair, it is called a bond. If the supplemental hair is knotted and braided onto the existing hair on the sides, it is called a weave.
While relatively harmless, these techniques can all cause problems. Rarely, the patient may have an allergic reaction to the tape or glue. Hair weaving may exacerbate hair loss by inducing traction alopecia, which may in rare instances be permanent.
Greater risks accompany introduction of sutures or of stainless steel wires covered with a nonstick coating (Teflon) into the scalp for attachment of a hairpiece. These stitches eventually become a source of chronic infection and irritation in most patients. Caution your patient against this invasive procedure.
Tunnel grafting is based on a similar principle. The surgeon incises bad scalp and forms it into tubes with epithelium on the inside. If these tubes heal properly, the surgeon can run a fiber or wire through them to which the toupee is attached. If your patient is willing to undergo a procedure that is this invasive, however, you might recommend transplants by punch grafting instead.
Implantation is the most dangerous and least satisfactory technique promoted recently for correction of male pattern baldness. Now banned by the Food and Drug Administration and in almost total disuse, the technique involved sewing a synthetic fiber or processed human hair into the scalp, knotting one end of the fiber or hair, and pulling the knot into the subcutaneous tissue. The procedure was painful and induced considerable bleeding in many patients. Within a few weeks the fibers typically fell out or broke off; broken ends left in the scalp then caused infection, foreign body reactions, and permanent scarring.