An Overview Of A Hair Transplant & The Male Pattern Baldness

Introduction

The first hair transplant on male pattern baldness was performed by Okuda, a Japanese dermatologist in 1939. But as he was killed in the war and his work published in a Japanese journal was overlooked and not discovered until 1970 by a German physician. A New York dermatologist named Norman Orentreich independently and quite by accident found that hair-bearing grafts could be used in the treatment of male pattern baldness while studying how the transfer of various skin diseases occur from one portion of the body to the other. As his work was published in 1958, the hair transplant became the most common cosmetic surgical procedure performed on males. 

Principle Of Male Pattern Baldness

Caused by the interaction of three factors, male pattern baldness is found in males due to the following factors:

• Genetic predisposition (heredity)
• Male hormones (testosterone)
• Time or age

As they do not have enough testosterone, females don’t develop male pattern baldness. It is similarly not found in eunuchs castrated prepubertally due to lack of testosterone. But on the other hand, if a genetically predisposed female or genetically predisposed eunuch is administered testosterone later on in life, they develop the same degree of baldness which the person would have had if he or she has been normal developing rapidly within a few months. 

As baldness increases with age in normal males, time or age is an obvious factor. It has nothing to do with the blood or nerve supply as the genetic key is contained within the hair follicle. The result is that the hair follicles on the top of the scalp in a genetically predisposed male are falling out no matter where they are as long as they happen to be on the same person with adequate blood supply. This is the factor making hair transplant procedure possible. 

Hair Transplantation

The procedure of transplanting hair-bearing skin from sides of the scalp to bald or balding areas on top is called hair transplantation. With these grafts, hair survives, grows, and maintains the same characteristics which were already present in the old location. 

For male pattern baldness, medical therapy has recently received a lot of attention with some high blood pressure medications found to contain some anti-male hormone or anti-testosterone effects. The research ongoing currently is attempting to develop a medication blocking the action of testosterone on hair follicles without affecting other beneficial masculinizing properties. 

Required Time For The Procedure

Being a multi-stage procedure, hair transplantation requires four separate sessions so enough hair is present in the area for good coverage. The number of sessions varies as some may require more various other fewer sessions. It may require as many as six or seven sessions for the critical areas like the hairline to get thick natural-appearing hairline. Whereas the concealed hair may require just one session of the grating. 

It is possible to schedule the first two sessions in an area to be as close as one month apart, and subsequent sessions separated by at least three months. This time gap allows hair to grow between the sessions so that grafts can be used more efficiently in addition to hair growing reducing the risk of cutting out previously placed grafts. 

There are so many factors involved as in actual practice, it is difficult to give the patient a precise estimate of time when required for completion. This detailed explanation just serves to confuse the patient and so it is better to keep the discussion simple and advise the patient that it is a multi-stage procedure with certain requirements as to sequence and the frequency usually takes about one year for completion. 

Cost Of The Procedure

Discuss the cost of the procedure with the patient as generally the fee is based on cost per graft with surgeons basing their fee at the beginning based on the probable number of grafts required.

Hair transplantation being a cosmetic procedure, most of the surgeons expect the payment in advance or at the time of surgery. 

Concluding The Discussion With Cautions To Be Observed

It is impossible to predict the final result as there are so many variables, giving a realistic idea of what to expect is important. Overselling the surgery to young balding males observed with hair loss is easy. In case they are overeager, and the examination reveals the result may be marginal, they have to be warned that the hair may be thin with possibly tufted not appearing natural requiring careful styling. 

The patient is more apt to be satisfied if he realizes that before the surgery and does not expect miracles. In case their expectations are too much, they won’t be satisfied even with a good result.