Hair Transplant Terminology

Terminology

Term	Definition
Compression	Can occur when putting grafts into slits when the existing tissue 'compresses' the follicle, which can cause poor growth and/or improper direction of the hair.
Free Flap	A type of scalp flap surgery where one or more large flaps of hair-bearing scalp is detached and used to form a new hairline and replace hair loss where the scalp has been reduced.
Follicular Units	Follicular units are the natural bundles of hairs (from 1 to 5) that grow out of the scalp. Often, one or more hairs grow out of the same spot and share some of the same anatomy underneath the skin (such as sebaceous glands). Many doctors consider follicular units superior since they preserve the follicles as they are present in the scalp before transplantation.
Full Graft ("Plugs")	The first type of graft performed, these consist of 10-20 hairs in a circular 4-5mm graft. They are responsible for the 'cornrow' dollhead look of older transplants when finer grafts were not used to soften and fill in hairlines.
Line Graft	A large graft similar to a full graft but in a line rather than a circular graft. The line graft is used to provide density behind the hair line with a more natural look which is softened by other smaller grafts for a natural look.
Median Reduction	This is a type of scalp reduction in which the scalp is reduced in an oval shape at the center of the bald area of scalp.
Megasession	This term describes a transplant operation in which a large number of grafts (1000-3000, usually mini and micrografts) is performed in one operation. Proponents of the operation say it prevents multiple operations while still providing good results. Opponents say it may put too much stress on the blood supply and cause a low yield of hairs growing back.
Micrograft	One or two fine hairs used in transplants to 'soften' the front hairline to give it a natural appearance.
Minigraft	Two to Six thicker hairs used to 'soften' and fill in hairline transplants and provide density with a natural look.
PÂTÉ	Prolonged Acute Tissue Expansion. A scalp expansion procedure that is done during an operation rather than before or after by inflating and deflating a scalp extension balloon many times over several hours to stretch the available scalp.
Paramedian Reduction	An ovular scalp reduction away from the center of the balding scalp.
Random Flap	A flap which isn't tied to a particular blood supply. Typically used to correct remaining bald areas after remaining after procedures such as a scalp extensions.
Scalp Expansion	A scalp reduction surgery in which balloons implanted below the scalp expand hair-bearing areas which are used to cover the reduced scalp area.
Scalp Extension	A scalp reduction surgery in which a hooked medical device applies force to the scalp and stretch the hair-bearing areas to allow them to cover the reduced section of the scalp.
Scalp Flap	A scalp reduction surgery in which surgically removed flaps of hair bearing skin are used to cover reduced areas of the scalp and hair line. There are different methods of scalp flap surgery.
Scalp Lift	A scalp reduction surgery which allows a larger reduction (about twice as much reduced area) to be performed without flaps or extension.
Scalp Reduction	The simplest scalp reduction surgery is one in which small areas of balding scalp are removed in a succession of several small surgeries to reduce the area of balding scalp so that better results can be gained from transplantation.
Slot Correction	A random flap procedure developed by Patrick Frechet to correct remaining bald areas left over from procedures such as scalp extensions or median scalp reductions.
Slot Punch	The slot punch is a recent development which is supposed to allow results similar to lasers and prevent compression.
Slit Graft	A graft inserted into a slit in the scalp rather than a circular hole. Some doctors perform this more commonly for a variety of issues such as healing, appearance, etc.
Transsection	Occurs during harvesting of the donor hair or dissection of the grafts when follicles are accidentally cut by the blade, resulting in a loss of the hair, typically anywhere from 3-20% depending on technique. It is currently being debated how important this is since the latest cloning information shows most follicles should regenerate even if transsected.
Transpositional Flap	Commonly known as a flap rotation, this surgery takes strips of surgically removed hair bearing scalp and uses them to form a new hairline and/or cover reduced balding areas of the scalp.

Hair Transplant Information

Transplants are the most popular and common form of surgical hair restoration. Transplants have been around for many years and have advantages and disadvantages compared to other surgical options. Unlike some of the more radical surgical options, transplantation is a relatively minor procedure with few complications. It has been practiced for so many years that many doctors believe that the techniques involved have gone about as far as they are going to go in advancement. Due to increased competition, prices are generally decreasing as well.

What Are Hair Transplants

Hair transplants are really a very simple idea and process. It is simply the removal of hair at the back and sides of the head where hair is very dense and surgically implanting them into the balding area of the scalp.

A transplant is a permanent operation, so you should research your doctor well to assure you get good results and the best price! Here are some tips for finding a good transplant surgeon.

The procedure is preceded by a series of anesthetic injections to the scalp to null any pain. This is actually the most painful part of the operation and depends on the individuals. Some people have found it pretty painful and said that doctors underplayed this. After the anesthetic sets in, there is no pain.

First, a small area of the scalp is selected as the donor area. The amount of hair you can transplant depends on how thickly this hair grows. This area is removed and the open area is stitched together so that it can heal. Scarring is generally minimal but depends on how easily you heal from scars and the skill of your surgeon. The hair near the scars overlaps the scar and therefore hides it. This flap of scalp containing the hairs to be transplanted is then taken and cut and divided into the hairs or groups of hairs to be transplanted.

The hairs are then grafted into position by the surgeon. This is the most critical part of the operation as far as results are concerned, since the hairs must be placed properly in order for the hair to have a natural appearance. This is why many doctors stress the need for your surgeon to have an artistic ability when creating hairlines and to see many examples of his work. A good surgeon can be the difference between a hairline that looks natural and one that makes it obvious you had a transplant. How you look afterward is obviously a concern. The above picture demonstrates how grafts often look after hairs have been transplanted before the slits for the graft have healed (source: Dr. Stephen Cotlar).

One problem with transplants is the matter of progression of hair loss after the transplant. For many, it is easy to get a good result for how your hair looks now. But how about later when your hair loss has progressed more? A good doctor will evaluate your eventual loss and plan for how to proceed should further loss occur. Don't think this is a concern? Check out these photos of a person who had micrografts and then later experienced loss behind the hairline. His initial grafts look great but check what happened later.

So you're thinking: "Great, I do this operation and then in a couple of weeks I'll have a full head of hair!" Hold on, partner. It'd be nice if it worked that way, but just as with medicinal treatments, hair growth takes time. Generally after a transplant operation, most of the hairs fall out and enter a resting phase before regrowing in their new location. For this reason it takes about three to six months for transplanted hairs to grow back in, and even up to a few more months to see the full results. One company called ProCyte that is working on a hair regrowth treatment is also using the same type of treatment to prevent transplanted hairs from going into resting phase. Their treatment, GraftCyte, has been approved by the FDA as a medical device for doing this. The treatment consists of many dressings soaked in the treatment that are placed on the newly transplanted area immediately after the surgery and for the next few days. The dressings are replaced every few hours and provide a moist, safe environment to heal the wounds in as well as the treatment which prevents hairs from falling out and going into their resting phase. The dressings themselves are only sold through transplant doctors, but the accesory treatments including a mist spray and soon shampoos are available from ProCyte directly or through a couple of other mail order stores.

When you consider transplants, you have to consider results. While most doctors are skilled and can perform natural looking mini and micrografts, there are still some quacks out there who just shouldn't be practicing. Look out for a doctor who wants to perform plugs and not micro or minigrafts. You don't want to end up looking like these patients did. Check out photos and if possible meet some of his previous patients. Be sure and check with your local better business bureau to see if this doctor has had problems in the past (or presently!)

After that, it's mostly a matter of waiting. Depending on the amount of hairs transplanted and how much hair was needed, followup transplants are often needed to achieve the desired density, although many doctors are performing "megasessions" that transplant large numbers of hairs in one session so that further operations are often unnecessary.

Want to relate your transplant experience? We will be adding a new section with peoples' experiences soon once we get a few. Please contact us using the link at the bottom of this page .

Hair Transplant Culturing / Cloning

Hair Culturing (also known as Cloning)
What Is It?	Hair culturing involves removing donor hairs from the back of the scalp, isolating the stem cells from which the follicle grows, and culturing (growing) them in a lab, and reimplanting the new stem cells into the balding area of scalp. Because many stem cells are being grown in the lab from a few hairs, you will be able to grow many times the number of hairs removed. This will end the limits of how much hair can be transplanted due to the limited amount of hair that can be extracted from the back of the scalp during normal hair transplants.
Status	Several doctors are developing this technique: A study is underway in Canada at the University of Toronto to develop hair culturing. A Dr. Gho in the Netherlands has been granted a European Patent as of 9/14/98 and is conducting a study on actual patients. They expect their study to be done in 8 months (early 2000), after which time they plan to license the technology if it proves successful. Dr. Colin Jahoda of the UK is researching the process. At least one doctor in the US is seeking to develop the technique privately as well.
Time to Availability	As soon as 2 years but could take 5-20 more depending on how far along the people working on it really are. At least 5 years is more likely.
Advantages	Unlimited or nearly unlimited hairs to implant/transplant. Less scarring where hair is removed since less needs to be taken. Stem cells may be implanted by syringe which may mean less trauma to the implant area than traditional transplants. Less invasive procedure may require less anesthetic and involve less pain to the patient. Recent research indicates it may be possible to take donor cells from other individuals.
Drawbacks	Costs may be dramatically higher than traditional transplants, especially when the technique first becomes available. Cultured cells often have shorter lifespans than normal cells and it is possible that the hairs will not last a lifetime (and since the procedure is so new there will be no way to tell until it has been available a while). Implanting stem cells in this fashion can carry a risk of tumor or cyst formation - it is unclear at this point whether this may be a stumbling block to development.

In Support of Follicular Unit Transplantation

The Logic of Follicular Unit Transplantation

Follicular Unit Transplantation is a method of hair restoration surgery where hair is transplanted exclusively in its naturally occurring, individual follicular units. Specifically, single strip harvesting, stereo-microscopic dissection, and large transplant sessions will be reviewed.

A donor is better if it is as small as possible. The reason is that if a donor is big, hairs grow in … a very unnatural appearance. Hajime Tamura - 19431

Preservation of the Follicular Unit

The underlying premise of follicular unit transplantation is that the intact, individual follicular unit is sacred. Theoretically, they should neither be broken up into smaller units, nor combined into larger ones.^2,3,4

This simple idea may not seem like a radical approach to hair transplantation, but when viewed in the context of how the surgery has been performed over the past forty years (when the very existence of the follicular unit went generally unrecognized), it is radical indeed. At present, the majority of hair transplant surgeons will, at times, combine several follicular units or split them up, as they are not convinced that this has a significant impact on either the anesthetic outcome or upon growth. Practitioners of follicular unit transplantation, however, are certain that only this procedure achieves the best cosmetic results and their hair "bristles" when they witness surgical techniques that divide follicular units or transect follicles, techniques they feel preclude optimal growth and waste precious donor hair. In spit eof the heated debate, good scientific studies have not yet been performed to resolve these issues.

The follicular unit was first defined by Headington in his landmark 1984 paper "Transverse Microscopic Anatomy of the Human Scalp.⁵ The follicular unit includes:
1. 1 to 4 terminal follicles
2. 1, or rarely 2, vellus follicles
3. associated sebaceous lobules
4. insertions of the arrector pili muscles
5. perifollicular vascular plexus
6. perifollicular neural net
7. perifolliculum - cirumferential band of fine adventitial collagen that defines the unit

Photo: Follicular units at the level of the papillary dermis above the entry of the sebaceous duct. Each hexagonal follicular unit encloses sebaceous glands, sebaceous ducts, and several terminal and/or "vellus" hairs. Trichrome staining demonstrates pink keratin, smooth muscle, and blue collagen.
Photo courtesy of Dr. David Whiting

Transplanting Individual Follicular Units

That scalp hair grows in follicular units, rather than individually, is most easily observed by densitometry, a simple technique whereby scalp hair is clipped to approximately 1mm in length and then counted observed via magnification. What is strikingly obvious when one examines the scalp by this method, is that follicular units are relatively compact, and are surrounded by substantial amounts of non-hair bearing skin. The actual proportion of non-hair bearing skin is probably on the order of 50%, so that its inclusion in the dissection will have a substantial effect upon the outcome of the surgery. The great benefit of using individual follicular units is that the wound size can be kept to a minimum, while at the same time maximizing the amount of hair that can be transplaced.

Small Recipient Sites

The importance of minimizing the wound size in any surgical procedure can not be over emphasized and hair transplantation is no exception. The effects of recipient wounding are felt at many levels. Large wounds can lacerate blood vessels and although the blood supply of the scalp is extensively collateralized, any damage to these vessels will have an impact on local tissue perfusion. An equally important issue is to minimize the disruption of the microcirculation. This is especially important when transplanting grafts in large quantities. The compact follicular unit is, of course, the ideal way to permit the use of the smallest possible recipient site, and has made the transplantation of large numbers of grafts technically feasible.

Densities between 10 to 40 follicular units per centimeter are routinely reported. Densities greater than 40 follicular units per centimeter in a single session have been accomplished, but may result in a decrease yield in some patients. It is important to note that a follicular unit density of 40 units/mm² can create a hair density of over 120 hairs/mm² (if all 3- and 4-hair units are used in select areas), and this is a density that many hair transplant surgeons feel is not necessary, or even desirable, to exceed.

Transplanting Follicular Units in Large Sessions

Putting aside anatomic, physiologic and technical issues for the moment, it is important to emphasize the practical reasons to strive toward large sessions. The specific events that bring a balding patient to the doctor for hair loss will vary, but the common denominator of those seeking hair restoration is to improve their appearance, and to improve the quality of their life, be it personal, professional, or social.

Until the transplant is cosmetically acceptable, the disruptions from the scheduling of multiple surgeries, the limitations in activity, and the concern about their discovery, can place a patient's life "on hold." It should therefore be incumbent upon the physician to accomplish their objectives as quickly as possible. Some patients prefer smaller sessions for economic reasons.

Microscopic Dissection

There is probably no other aspect of follicular unit transplantation that has generated more controversy than the use of the microscope. Stereo-microscopic dissection was introduced into the field of hair transplantation by Dr. Bobby Limmer⁶ in 1987.

The following statements summarize the use of magnification:

• In order to dissect intact individual follicular units, you must be able to see them clearly.
• Only magnification allows their clear visualization in both normal and scarred skin, independent of the specific hair characteristics of color, hair shaft diameter, and curl.

Follicular dissection can logically be divided into two parts; the subdivision of the initial donor strip into smaller pieces and the further dissection of these pieces into individual follicular units. The first part of the procedure, the handling of the intact strip, has always been the most problematic. The intact strip however, is difficult to stabilize and is too opaque for transillumination to be useful.

The dissecting microscope and other magnification methods allow the strip to be divided into sections (or "slivers") by actually going around follicular units leaving them intact. The dissecting stereo-microscope is able to accomplish this because of its high resolution (usually 5x more powerful than magnifying loops) and its intense halogen top-lighting that provides continuous illumination, as one dissects through the strip. Back light illumination has also proven beneficial. Stability can easily be achieved by applying slight traction to the free end of the strip. The thin slivers are then laid on their sides and the microscopic dissection of the individual units is completed. With stereo-microscopic dissection, except for the outer edges of the ellipse, every aspect of the procedure is performed under direct visualization, so that follicular transection can be minimized and the follicular units maintained.

Conclusion

The entire field of hair restoration surgery has moved toward the use of follicular unit transplantation. While the exclusive use of follicular units is not employed by the majority of transplant surgeons,. The impact of this approach has been significant. Hair restoration surgeons are becoming more scientific and precise in their approach to this field. The vague terminology of the past, i.e., round grafts, many grafts, micro grafts, has been replaced with more precise terms. We now converse in a language which details the number of follicular units per square centimeter, hair shaft diameter in microns, and incisional density of the recipient site for any given session. Perhaps the modern era of transplantation did not begin with the micrografting of the '80's, but its is only truly being realized with follicular Unit transplantation of the '90's.

References

1. Tamura: Hair grafting procedure, JPN J Dermatol Venereol [Japanese] 52(2):1943.
2. Bernstein RM, Rassman WR, Szaniawski W, Halperin A: Follicular Transplantation.
   International Journal of Aesthetic an Restorative Surgery 3:119-132, 1995.
3. Bernstein RM, Rassman WR: Follicular Transplantation: Patient Evaluation and Surgical Planning.
   Dermatologic Surgery 23:771-784, 1997.
4. Bernstein RM, Rassman WR: The Aesthetics of Follicular Transplantation. Dermatologic Surgery 23:785-799, 1997.
5. Headington JT: Transverse Microscopic of the Human Scalp. Archives of Dermatology 120:449-456, 1984.
6. Limmer BL: Elliptical Donor Stereoscopically Assisted Micrografting as an Approach to Further Refinement in Hair Transplantation. Dermatologic Surgery 20:789-793, 1994.

Copyright 1997 New Hair Institute, Inc.
All Rights Reserved

Tips on Finding a Good Transplant Doctor

The tips below are taken from Dr. Carlos Puig's transplant site:

Ask about and see the surgeon's credentials. Look for information from

• AACS: American Academy of Cosmetic Surgery
• ISHRS: International Society for Hair Restoration Surgeons
• AHLC: American Hair Loss Council
• ABHRS: American Board of Hair Restoration Surgery

or other reputable organizations.

Fees should never be quoted on the phone...every person's needs and expectations are different.

Take your time, have all your questions answered, and make sure you feel comfortable with the approach, results you'll get, and the people who will be working with you.

Understand the limitations - length of time it will take, density that can be accomplished and the costs.

Make sure you see numerous "before and after photos" of all types of hair and styles.

Ask about evaluations from previous patients on post-operative reactions...it should be documented.

The Hairline - The Hairline - The Hairline - Single hairs are the ultimate in artistry for great results.

Fees should include all follow-up visits.

The priorities of a physician's staff reflect those of the physician. If the office staff is patient-motivated, the physician is most likely patient-motivated. In other words, their service is primarily designed to meet your needs, not those of the doctor.

Complication rates: although the complications in this surgical procedure are few and rarely serious, an honest, conscientious medical group will track their complications and explain all the risks. A medical group that just "pushes it aside" is not educating you properly.

Buyer Beware: Avoiding Hair Loss Scams

Most of this applies only to the US, but may apply in other countries. In the late 1980s when Rogaine was first approved, the FDA (Food and Drug Administration) outlawed the advertising of products that grow hair unless they are approved by the FDA. The reason for this was obvious. For hundreds of years, people have been selling treatments with no scientific proof that those products regrow hair. As of this time, Minoxidil/Rogaine is THE only product that the FDA has approved to advertise that it regrows hair. When you see an advertisement for a hair growth products, there are either two possibilities:

1. The product is using fancy wording to make you THINK it regrows hair without ever actually saying it.
2. The product really is saying it regrows hair (illegal in the US!)

In situation 1, companies use phrases like "helps people who are balding" or "helps give your hair a healthy full look". If a product makes the hair you have look thicker, the company can say it "helps people who are balding" without advertising falsely. Does that mean the product will grow hair on your head? Nope. Then again, it does not mean the product doesn't work. It costs millions of dollars to get a product FDA approved, so sometimes companies will sell a drug as a cosmetic product rather than a hair loss drug. The drug may actually work, but the company can not claim it works since it has not been FDA approved for hair loss. Unfortunately, this leaves the consumer in the situation of not knowing which is the product that doesn't work and which does. The only thing you can really do is try to find others who have tried the problem to see if it has worked for them. Some companies offer information to back up their claims. However, even a con company can fake some scientific lingo to convince the average consumer that a product is good. Companies also use photos. Many times photos use varying lighting conditions and hair stylings to make it look like the person has grown more hair when they haven't. Be wary.

In situation 2, companies actually say something like "Our product is 2.5X more powerful than minoxidil at regrowing hair." This would be an illegal statement in the US. These sorts of statements are often made in internet newsgroups or on web pages and never come to the attention of the FDA or proper officials. Often, a company will say they have conducted double-blind scientific studies to back up their claims. Remember that if the company conducted double blind studies for the FDA that were successful, this product would be approved for hair loss treatment by the FDA. Many of these tests are internal and are not really 'blind'. You can come up with just about any result if that is your intention in creating a study. If these studies were so reliable and convincing, why were they never used to get FDA approval? It's possible the study really did show that the product was effective. It is just important to question the source before blindly accepting that what the company is telling you is true. They will ALWAYS try to put their product in the best light. Also, when they mention their studies, they don't cite who conducted them and present the full results. They only tell you what THEY want you to know. Sure their product was 2.5X more effective than minoxidil in their clinical studies. They forgot to mention on their web page it made everybody in the study blind!

The FDA has recently released a statement saying that it's rule applying to hair regrowth claims may not apply to the internet, since internet advertising and web sites may be considered 'conversations.' They are awaiting a court case to set a precedent as to whether they can apply their regrowth advertising rules to the internet. Click here for the full release.

Hair Loss Option: Cosmetic Concealers

Hair Loss Concealers are cosmetic sprays, powders, and creams that are applied to the hair and scalp to either make the hair appear thicker and/or darken the scalp. Hair loss concealers are for existing areas of thinning hair, not slick bald areas. The advantages of concealers are that they don't cost a lot and will immediately make your hair look better, unlike the treatment and transplant options which take many months to see results. They also do not have side effects so they are more appropriate for people who wish to take a more natural approach and do not want to use treatments or go through hair transplantation. The disadvantage of concealers is that they do not do anything to prevent you from losing hair in the long run, so eventually there will be no way for you to conceal the hair loss unless you use one of the other options to treat your hair loss. Also, while today's hair loss concealers are much better at not running in adverse weather or while swimming, there is always the risk of the concealer coming off or running under those conditions.

Hair Loss Option: Non-Surgical Hair Replacement

Non-surgical hair replacement (often called a hair system or hair piece), involves attaching a fine mesh to the scalp with hairs matched to your hair color attached. The hair piece is either taped, glued, or clipped onto the scalp to keep it in place and is styled to match your hair style. A technique called hair weaving is no longer performed by reputable companies and should be avoided, because it has been found to cause 'traction alopecia' (hair loss due to constant strain on the hairs). The advantage of non-surgical hair replacement is that it is the only option that can always make you look like you have a full head of hair no matter who you are. Also, there are no side effects as with medicinal treatments and it is not permanent like transplantation. The disadvantages are a continual high cost per year, extra time for maintenance required to keep the hair looking good, lack of comfort for some people, and paranoia regarding discovery for some. Costs vary widely, but typically range between $1,000 and $3,000 per year. Several companies are now marketing programs to teach you how to create and maintain your own hair system as well as how to purchase the unit directly at a much lower cost. By purchasing and creating the hair piece yourself, your cost per year should easily be in the $500 or less range, however you will have to perform a lot more maintenance on your own and it can be very difficult to create a natural hair piece on your own with little training.

Hair Loss Option: Hair Transplantation

Hair transplants involve surgically moving hair from the back of the head, where it does not fall out due to baldness, to the top of the head to give you the appearance of having more hair on top. It is a minor surgical procedure but not with out it's advantages and disadvantages. The advantages of hair transplantation are that it moves your own, permanent hair. No continual treatment is needed to keep it there. The disadvantages are the high cost (multiple transplants are usually needed to get the desired look or amount of hair), risk of scarring, limited amounts of movable hair, and variable abilities of different doctors and clinics. A scar is left where the hair is removed from the back of the scalp, but this is covered by the hair around it. However, the hair has to be long enough to cover the scar so you can not buzz your hair to a short length and still cover the scar once you have had a procedure. If you like your hair extremely short you should not have a transplant. (Costs can vary tremendously. An estimate would be $2,500-10,000 per session, $10,000 - 40,000 total)

Hair Loss Option: Other Hair Loss Treatments

Many commercial treatments and custom formulas are available for hair loss. These range from treatments marketed as "cosmetics" to off-label prescription medications. While some of these treatments do work for some people, there are many products available that seem to offer little benefit to anybody. The cosmetic treatments are best used as an addition to the approved products if you can afford them, or as a last results if the approved products do not work for you. Some of the prescription custom formulas may be very beneficial. Most contain 5% Minoxidil (or higher), the active ingredient in Rogaine Extra Strength, as well as other medications that help with hair loss. These do not undergo the same rigorous testing as approved medications, so caution should still be used.

Hair Loss Option: Rogaine

Rogaine (Minoxidil) was the first FDA approved treatment for hair loss. It is a topical liquid applied to the scalp twice a day and is approved in two strengths - Regular (2%) and Extra Strength (5%). Regular strength Rogaine claims to grow hair in 30-40% of individuals, while Extra Strength Rogaine claims to grow hair in 50-60% of individuals. Rogaine stimulates the hair follicle to grow, but may not prevent the eventual deterioration of the follicle since it does not block the male hormone causing hair loss, so results may deteriorate after 2-5 years unless it is used with a DHT blocker like Propecia. Rogaine costs $20-30 per month.

Introduction to Hair Loss

Hair is an important part of who we are. The average person has 5 million hairs (100,000 - 150,000 are on the scalp). Blonds usually have more hair (about 140,000 hairs), brunettes have slightly higher than average hair (about 105,000 hairs), and redheads have a little less than average (about 90,000 hairs). Hair is composed of keratin, the same protein that nails and the outer layer of skin is made of. Hairs are produced by a small structure underneath the skin called the hair follicle.

Hair follicles are formed while we are still a fetus, and after we are born no new follicles are produced. Hair growth is often regulated by hormones within the body. At puberty, certain male hormones trigger the growth of pubic, underarm, and beard hairs. They can also trigger the start of genetic male pattern hair loss.

Each hair grows in a series of phases. In the growth phase, the hair is continually growing for up to five years. At the end of the growth cycle, there is a transitional phase where the hair does not grow and begins to change into the third phase. The third phase is the resting phase. During this phase, the follicle is no longer growing, and at the end the old hair is pushed out, then the cycle starts over and a new growth phase starts. This happens repeatedly throughout our lives, and is why even people unaffected with hair loss lose 50-100 hairs per day.

In people affected with genetic hair loss, there appears to be a higher number of hormone receptors in the areas of the scalp with hair loss. In most people affected by hair loss, male hormone levels are the same as in normal people, but because there are more receptors in the balding areas of the scalp they are affected as if their hormone levels were higher than normal. Researchers are still working on how the presence of a certain male hormone, Dihydrotestosterone (DHT), causes damage to follicles in people with genetic hair loss. As the follicles are damaged, the hairs grown are thinner and the growth cycles are shorter with each new growth cycle, until eventually no hair or a small, miniaturized hair is all that can be produced. As more and more hairs become smaller and more miniaturized, the person appears balder.

Genetic hair loss causes about 95% of all hair loss. Another main cause is an autoimmune condition known as Alopecia Areata (patchy hair loss), Alopecia Totalis (loss of all hair on the head), and Alopecia Universalis (loss of all hair on the body). Researchers are also working on a treatment for this condition. Other causes include hair loss due to side effects of medication, stress, or dietary deficiency.

Hair Loss Option: Propecia

Propecia is the only FDA approved oral treatment for hair loss. It is taken once per day and grows hair in about 66% of individuals after two years of treatment. Roughly 83% of individuals on the treatment maintain their existing hair after two years as well. Propecia works by blocking an enzyme used to create the male hormone DHT, the hormone which causes hair loss. Propecia is for men only. It can cause lessening of libido, less semen production, and softer erections in roughly 2% of individuals for each of the three listed side effects. The side effects go away in over 50% of individuals who continue the treatment and 100% of individuals who stop using the medication. Propecia Costs approximately $45-55 per month.

Hair Loss Option: Do Nothing

In an ideal world, this is probably the best solution. It costs nothing or very little. The only downside is that if you do nothing, you will definitely continue to lose hair. Currently, short, buzzed haircuts are in style and many men find that they look good with this kind of hair cut and it minimizes the appearance of their hair loss. However keep in mind that fashions change and that this kind of hair cut may be out of style eventually. One thing that can be done to look better even if not treating your hair loss is the use of hair loss concealers. These are cosmetics that make your existing hair look like there is more (they require you to have some hair left and do not work on slick bald spots).