Less extensive baldness is commonly treated with hair transplants

HAIR TRANSPLANTATION

All surgical forms of hair replacement involve transplanting a patient’s own hair from one portion of the scalp to another. For men with large bald areas, operations called flap procedures may be necessary. Tissue expansion is another option, in which balloons are positioned under thick hair-bearing areas of scalp and infl ated slowly to stretch the scalp.

Later, portions of the bald scalp are removed and the stretched hair-bearing sections pulled over the excised bald areas. These kinds of operations require general anesthesia. Tissue expansion creates a significant, although temporary, deformity of the head shape and as a result may not be feasible for many men. For a man whose baldness is confined to a limited spot on the crown of the head, it may be possible simply to excise the bald area during a series of operations, often under local anesthesia. This surgical technique is called scalp reduction.

Less extensive baldness is commonly treated with hair transplants and has evolved from the visible plug transplants to what is called microtransplantation, in which tiny grafts of one to three hair follicles are moved from thick growth areas on the sides or back of the head to thinned areas in front or on top of the head. Microtransplants are performed with local anesthesia, with or without sedation, in an office setting. Because the procedure is tedious, multiple sessions over many months or years may be required. Some physicians specialize in hair transplantation and have developed an extremely streamlined, labor-intensive processcess in which up to several thousand grafts can be transplanted per “megasession.”

Successful hair transplants tend to be stable and long lasting; even though microtransplanted hairs fall out shortly after surgery, most will regrow. The best candidates for hair transplantation are patients with thick, healthy hair growth along the sides and back of the scalp, the prime donor areas. Patients with extreme baldness and very little donor hair are much less likely to have a natural looking result, no matter what procedure is performed, and most prospective patients in this category should be discouraged from undergoing surgical hair transplantation.

Complications of hair transplantation procedures are low. Major flap operations have higher risks, scarring may be visible, and additional procedures are often necessary. After microtransplantation some hairs will not survive, requiring additional sessions to achieve the desired effect. The characteristics of a transplanted hair may not be the same as the original hair, and original hairs in a balding area may continue to thin out over time.

The bottom line: Hair transplant techniques have improved dramatically, but in order to get a good result, most patients still need to submit to multiple tedious procedures over a long time period at significant expense.

Laser Hair Removal

Permanent hair removal has become very popular since the development of technology that permits effective hair reduction with limited risks to skin. The technology uses laser energy, IPL, or other energy sources such as microwaves. Laser hair removal is performed in an office or spa setting, usually without anesthesia. Multiple treatments are required and are spaced several months apart. Patients may develop redness or crusting that may take several days to resolve. The degree of permanent hair reduction varies considerably from patient to patient, depending on skin and hair color and body location. Light colored hair cannot be significantly reduced with current technology.

Laser hair removal is moderately painful. Some patients elect to use prescription or over-the-counter topical creams containing lidocaine or a related anesthetic in order to reduce the discomfort of treatments. Major complications of laser hair removal include scarring, permanent skin color changes, and topical anesthetic overdose. The bottom line: Laser hair removal can lead to permanent reduction of coarse dark hair, although multiple treatments are always necessary. Laser hair removal is one of the common cosmetic procedures performed without direct physician supervision, despite risks of serious or even fatal complications.

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