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No matter what the infomercials claim, hair loss is not caused by clogged follicles, frequent shampooing, poor circulation, the presence of mites or the wearing of hats and helmets.
On rare occasions, reversible hair loss can occur as a consequence of thyroid disease, iron deficiency, high fever, general anesthesia, crash diets,¯ or specific medications. In certain individuals, dermatological scalp disorders due to lupus, lichen planopilaris and alopecia areata can also lead to temporary or permanent hair loss.
In addition, hair loss in women can be triggered by specific hereditary factors or hormone-related events that include childbirth and menopause. (For more on causes of female hair loss, refer to the “ For Women   page.)
Prime suspect
However, for the vast majority of men experiencing hair loss more than 95 percent the culprit is hereditary androgenetic alopecia, commonly referred to as male pattern baldness. Two-thirds of American men will have some degree of hair loss by age 35. By age 50, roughly 85 percent of men will have noticeably thinner hair.
Male pattern baldness typically begins after puberty, when the hormone dihydrotestosterone (DHT) affects the hair follicles of men who are genetically susceptible.
In order to understand the phenomenon of male pattern baldness, you should know about the normal life cycle of human hair.
By week 22, a developing fetus has all of the hair follicles ever to develop about 5 million follicles on the body, with one hundred thousand of those follicles on the scalp. The follicle resides in the skin, and the hair shaft is visible above the scalp.
Hair on the scalp grows roughly .3 to .4 milimeters per day, totaling about six inches per year. Human hair growth and shedding is unlike that of other mammals, because it is random and not seasonal or cyclical. Hair on your scalp is always undergoing one of three stages that affect its growth or shedding:
- Anagen is the active phase. During this two- to six-year phase, cells in the root of the hair divide rapidly, causing it to grow about 1 centimeter every 28 days.
- Catagen is a transitional stage that lasts 2-3 weeks and affects about three percent of all hairs at any given time. In this phase, club hair (a type of hair that has stopped growing) forms.
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Telogen is a phase lasting about 100 days. During this time the follicle is completely at rest, and the non-growing club hair matures. Approximately six to eight percent of all hairs are in the telogen phase at a time. About 25 to 100 hairs in the telogen phase fall out normally each day.
In male pattern baldness, genetically vulnerable scalp hair (usually hair in the front and top of the scalp) begins to shrink in both diameter and potential length during each life cycle, eventually disappearing.
Hair on the back and sides is usually genetically programmed¯ to be permanent. It is from this plentiful supply of permanent hair that Dr. Vories harvests follicles during hair transplant surgery.
History of medical hair restoration
Research into hair biology and diseases has grown tremendously in the past 20 years, enabling Dr. Vories to create extraordinarily natural hair transplants that are virtually undetectable, even by stylists.
Hair transplantation surgery began in 1939, when Japanese dermatologist Dr. Okuda first documented his surgical attempts to restore hair in burn victims. Dr. Okuda used a punch technique¯ to extract sections of hair-bearing skin, which were then implanted into the scarred or burned areas of the scalps. After skin grafts healed, hair continued to grow in these previously bald areas.
In 1943, another Japanese dermatologist named Dr. Tamura refined hair transplant surgery by using significantly smaller grafts of one to three hairs, a process similar to many techniques used today.
These surgical breakthroughs remained lost to Western medicine until 1952. In that year, a New York dermatologist, Dr. Norman Orentreich, performed the first known hair transplant in the U.S. on a man with male pattern baldness.
Orentreich's theory of donor dominance¯ demonstrated that hair from the back and sides of men's scalps were generally resistent to balding. But Dr. Orentreich's surgical technique, which replicated the punch graft¯ technique of Dr. Okuda, produced less than satisfying results for men. By the mid-1990s, hair restoration surgeons abandoned these large grafts in favor of smaller grafts that produced more natural-looking results.
Today, Dr. Vories has refined the hair replacement transplant using Follicular Unit Extraction, a revolutionary advance that optimizes the harvesting of follicles and the natural look of hair while limiting scarring.
How to choose among the range of treatments
Hair transplant surgery is certainly not the only option for individuals experiencing baldness, nor is it used to the exclusion of other types of male hair loss treatment. For many patients, a combination of hair restoration surgery and prescription medication can produce the best results.
Many physicians now recommend that medical treatment of significant hair loss begin as soon as a problem is evident. Two medications are frequently prescribed for male hair loss treatment. Both of these prescriptions must be used continually in order to work. Individuals who stop using the medication will experience hair thinning once again.
- Finasteride (Propecia®) is an oral prescription used alone or in tandem with hair transplant surgery. Finasteride can regrow hair in some men and stop hair loss in an even higher percentage of men. It helps slow or reverse baldness by decreasing the production of DHT, the hormone chiefly responsible for male pattern hair loss. It has been proven safe and effective and does not reduce testosterone in men.
- Minoxidil (Rogaine®) is a topical solution that has been in existence for over 15 years, and it is used by both men and women who experience significant hair loss. It helps to slow down hair loss but is less effective at stimulating new hair growth. Men can use the stronger solution (5%), but women must use a less concentrated formula (2%), because higher concentrations can stimulate facial hair.
These options, however, do not provide the desirable, natural look and feel of Follicular Unit Extraction.
Ideal candidates for the Hair Restoration
Men with the following conditions or attitudes make the best candidates for surgical hair restoration:
Men experiencing male pattern baldness
Men who realize that some hair loss may continue after surgery, even with the use of prescription medications
Men whose balding pattern has stabilized, and who would like more hair to regain their youthful appearance
Men who have lost hair due to injuries, scarring, or burns
Men who have lost hair due to face lifts or other cosmetic procedures
Men who want to thicken or restore eyebrows, and beards
Men who want hair in an area where little exists
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