Saf's Personal Guide To Hair Transplants

June 7, 2006

This story was introduced to Headofhair by Spex - a showcase from Feller Medical.

This is a detailed account of a patient from the U.K (S.A.F) who has recieved previous surgeries in the U.K with unsatisfactory results from differnet clinics. He has taken the time to document his experiences and been kind enough to share it with us all.

Introduction

I have written this ?guide? to hairloss in order to advise and help people suffering with this most frustrating and potentially distressing condition. I do not claim to be an expert but consider myself to be a ?veteran? who has gained a great deal of knowledge and experience on this subject over the past 10 or so years.

The fact that you are reading this now tells me that you are in a similar situation to the one that I have faced and want to do something about it. It also means that you have potentially met with Spex. I can assure you that he will give you good and honest advice, just as he did for me when I met with him.

I know that this is not an easy subject for many men to talk about, and so most have to conceal their anxiety. Help and support for hairloss sufferers is pretty hard to find and we can be vulnerable to people who see a chance to exploit us. Hopefully I can save you from wasting your time and money.

This is why Spex does what he does and why I have felt compelled to follow his example.

Why are you losing your hair?

The cause lies in your genes so unfortunately you cant change it any more than you can change your height or the colour of your eyes.

The hair on your head is known as terminal hair. You will notice that it grows thicker and longer than the other hair on your body. Each individual hair has its own growth cycle. Typically each hair will grow continuously for approx 3 years, it will then fall out (shed) and the follicle will enter a resting phase, approx 3 months. After this the growth cycle will begin again. As there are so many hairs on your head each at a different phase of its cycle your hair maintains its overall density.

So why are some men destined to lose their hair?

The condition is called androgenic alopecia, otherwise known as male pattern baldness (mpb). It is caused by the male sex hormone testosterone.

Testosterone is produced in the testical and enters the bloodstream and then flows throughout the body, where it is converted to another hormone called dihydrotestosterone (dht). Hair follicles are nourished by the blood supply to the scalp but for the man genetically predisposed to mpb it can have quite the opposite effect. This is because some or all of the hair follicles situated on the top of his scalp have receptors that are sensitive to dht. For some reason the hair at the back and sides of the head do not have these receptors and that is why they are not affected.

The follicle reacts to dht by slowly shutting down and eventually turning dormant. This can begin any time after puberty and can take a period of many years to manifest itself, with the growth cycle of the hair gradually getting shorter while the resting phase gets longer and longer until it becomes permanent. i.e.: the follicle becomes dormant. The physical signs of this can be seen as a miniaturizing of the hair shaft.

Many men suffering from hairloss will notice that their scalp is not actually bald but the hair they have is like a fine ?peach fuzz? that is virtually invisible to the naked eye. This is called vellus hair and is just terminal hair in a miniaturised state on its way to becoming dormant.

So you see the old excuses of baldness being caused by poor health, stress or lack of blood supply to the scalp are simply false.(Although its known that stress can cause thinning of the hair it has nothing to do with mpb).

To sum things up there is no lifestyle change that can prevent you from being affected by hairloss. If you have inherited the receptive genes you will eventually lose your hair.

Is hair important?

A hair is basically a strand of dead protein cells called keratin; it grows from a root (follicle) in the scalp. Its primary function is to protect the head and help keep it warm. In today?s world it is practically redundant in both of these uses and seems to serve no real purpose. (Or so you may think). Also hairloss does not affect a person?s physical health so:

Does it really matter?

The simple answer is Yes.

The greatest consequence that losing your hair can have is the psychological impact. There have been many studies over the years into just how far reaching the effects can be. Ordinary hairloss (mpb) can be measured on a scale known as the Norwood / Hamilton scale. Stage one is your original hair or no loss, stage 2 is a small loss usually just the recession of your youthful hairline to that of an adults e.g. as seen on the actor Jude Law. Nearly all men will have this slight receding at the temples and the overall change to the physical appearance is not too great. For many men it is simply part of the transition to adulthood and they will not suffer any further change, but for some this is just the start of their hairloss.

However as you progress through the scale the alteration to your overall appearance can be a massive transformation. The very top of the scale ( Norwood 7) would be a total loss of all the hair on the top of the head with just a horseshoe shaped bit on the back and the sides of the head. A good example of this would be the actor Patrick Stewart aka Startreks captain Jean Luc Picard.

Getting back to the original point studies of human psychology have proven that men who have lost or are losing their hair are much more likely to suffer from low self esteem and a lack of confidence, due to having a poor self image. They are also more likely to see themselves as less attractive.

The main reason for this is that although in today?s world we do not need hair for warmth or protection anymore it still has one defining purpose in today?s society.

Hair is an expression of self image and personality

Human nature is a funny thing although we may consider ourselves to be a highly evolved, advanced species the fact is that we still make most primary judgments with our eyes. This is a basic part of human nature. Consider the many styles and colours that you see in people?s hair. E.g. someone who wants to project a smart/sensible image would have a short neat haircut, while someone with an extravagant style may be projecting a youthful/trendy/fun image.

If you have no hair you can?t express yourself this way to people around you and this is a part of human social interaction.

Men are not supposed to be concerned about their appearance and some may consider it to be pure vanity but how many people would actually choose to be bald? Hairloss is associated with the aging process and makes many men look 10-15 years older than they actually are. Lets face it baldness is not attractive. Ask yourself would the likes of Brad Pitt be such a heartthrob if he had no hair. Would a bald David Beckham get so many advertising deals? (I seriously doubt it).

Some sufferers will say publicly that it doesn?t bother them but this is highly unlikely. I once read about a study where a psychiatrist asked 100 men if they could trade the last 10 years off the end of their life in return for not losing their hair would they do it? 92 of them said yes.

Although losing your hair is something that you cant conceal in public the implications of going bald are something that sufferers have to deal with in private.

It?s funny how no one would tell a fat person that they are getting fatter but you will find that people have no problem in pointing out to you that you are losing your hair. (As if you hadn?t noticed yourself). Indeed there will always be someone who takes great pleasure in giving you a daily progress report.

If you are unhappy with your physical appearance it can have a detrimental effect on your overall happiness in general.

So what can be done?

The simplest thing to do when faced with reasonable amount of hairloss is to just shave it all off. It?s a common solution among many bald men. If you are a Norwood 6/7 this is probably a good option for you. But how happy would you really be with this style? It can give you a tough/masculine look but only if you have the features to carry it off. Shaving seems to be more popular among black men than white, but I?m sure that?s is of little consolation to any black men who find themselves losing their hair.

Another solution that has been around for centuries is the wig. These days they are more sophisticated and go by various different names such as toupee,hairpiece,and hairsystem. They can give you a great head of hair and look realistic but are not very popular due to the social stigma that comes with them. Most men just would not feel comfortable wearing one and there are many other drawbacks such as the cost and inconvience of getting it regularly cleaned, refitted and replaced. (Ok if you are Elton John). Also how do you explain your new hair that has appeared seemingly overnight!

Cosmetic thickeners available in sprays creams and powders can do a good job of disguising thinning areas but the results are limited and if your hairloss continues they will be of little use.

There have always been unscrupulous companies who claim to have miracle cures for baldness, usually in the form of some highly expensive lotion or cream but in recent years medical science has made some successful breakthroughs.(Although there is still a long way to go until a real cure for mpb is found).

In the mid 90?s a topical solution called minoxidil (Rogaine) appeared on the market. It claimed to offer hair regrowth but only gave very limited results in a few men. More recently new drugs have become available the most widely recognised being Propecia. The active ingredient in Propecia is a drug called finesteride. Its benefit to men suffering from mpb was discovered by accident during the treatment of men with an enlarged prostate gland (benign prostatic hyperplasia). Whilst taking their medication that contained finesteride many began to report a welcome side effect, a slowing down or stoppage of their hairloss, and in some cases actual regrowth. Propecia has been shown to be effective in 80% of men but should only be considered as a preventative measure. So it is best to begin taking it at the start of your hairloss. If you have been bald for some time it will not work for you. Propecia cannot be used by women.

The final option available to you is surgery. The commonest form being hair transplantation. For many people this is a drastic measure considered to be a step too far. But for the majority of patients it has a positive outcome.

Surgery has been around for decades but has gone through many major changes of procedure. The basic theory is to take hairs from where you have plenty and redistribute them to areas where you don?t.

Transplant surgery first became commonly known about back in the 70?s when surgeons removed hair in 4mm discs from the back and sides of the head in the form of small ?plugs?. Holes were then punched into the scalp and the plugs were inserted. The results were not good. Decent coverage could not be achieved due to the limited supply of plugs that could be removed. The patient was left with excessive scarring in the donor area and the hair on the scalp had a dolls hair look. This type of surgery damaged the reputation of hair transplantation for a long time. It is a testament to the desperation of many bald men that they would go ahead with such a procedure.

Things improved in the 80?s with the arrival of minigrafts allowing for a more subtle, natural looking result. The transplanted hairs were no longer clumpy plugs sewed in rows over the scalp but smaller groups placed in a inconsistent, random fashion. This type of surgery was further refined in the 90?s (micrografting) and is still probably the most common form of transplant used today. Now hair is removed in a strip from the donor area, the incision is then stitched or stapled closed. Hair grows in naturally occurring follicular bundles. Typically between 1-4 hairs per bundle. These groups are then separated from the strip under a microscope. Then a series of tiny slits are made in the scalp, (instead of the old style punched holes). The follicles are then inserted and will grow in their new location just as they did when they were in the donor area.

The latest development in transplant surgery is called Follicular unit extraction (fue) It does away with the strip removal method as follicular bundles are now taken directly from the head using a microscope leaving no visible scarring. However as this method is more time consuming it makes it a more expensive option.

These days it is possible for surgeons to achieve a much higher level of density, provided you have the donor area to spare in the first place. Although it is not possible to give you back the same hair that you had in your youth a transplant can give you good coverage of the bald/thinning area. It can make a startling difference to your overall appearance, plus the hair will actually be your own.

The results do not come overnight it takes 3 months before the transplanted hairs begin to grow and 6 months before you see a really noticeable change of appearance. The hairs grow thinly at first, full results can only be seen after 12months when the hairs have returned to normal texture.

Important advice for those considering a hair transplant

Having had 4 transplants myself at 3 different clinics and learning the hard and expensive way (see my journey). I feel I must give my honest opinion with the following statements:

I cannot stress enough the importance of finding a good surgeon. Don?t be tempted to respond to the first flashy advert that you see. Remember a bad surgeon can leave you with horrible scarring and as everyone has a limited supply of donor hair you must make sure that when it is used you actually get decent results. My advice is to look on the Internet forums to see which surgeons consistently get good reviews. Good sites to visit are www.stophairlossnow.co.uk , www.hairtransplantnetwork.com, These could be your best tool in the search for the right person to perform your surgery.

Unfortunately I have to say that there appears to be no highly skilled surgeons in the UK. Believe me I have researched this thoroughly! I have seen their work from the very bad to the barely acceptable.

A good surgeon will offer a vast range of before and after photos (good clear quality, not blurry retouched ones). Many brochures just show models not real patients. They will even be able to put you in touch with previous patients. Forget confidentiality, people who are pleased with their surgeons work will be happy to recommend them. Many surgeons are barely qualified in hair surgery and just do it when not performing facelifts and nose jobs.

Make sure that your clinic and surgeon specialise only in hair transplantation and are members of the international society of hair restoration surgery (ISHRS) and the international alliance of hair restoration surgery (ISHRS).

Be realistic about the results. It is not possible to get back the same hair that you may of once had, especially if your hairloss is severe. But a top surgeon can make a little go a long way and occasionally on some patients with good characteristics for surgery you can see some truly amazing results.

Beware of salesmen. A reputable surgeon will do his own consultations, as it is important for him to see what he will be working with. The guy you meet should be the same person who eventually performs your surgery. Many of the worst clinics employ ?consultants? these are just salesmen who have no medical training and are just there to talk you into having surgery often promising unrealistic results.

Be suspicious of clinics that do not offer a set pricing policy. They will just ?size you up? as you walk through the door in order to decide how much they think that they can get out of you.

Many clinics claim to guarantee the results but they know that people are reluctant to kick up a big fuss over such a highly personal operation and their guarantees are usually just the offer of more free surgery. But why would you want to go back for another botched op? Many dodgy surgeons make their money and disappear after a few years once their reputation gets around.

Finally despite what the glossy brochures may tell you having a hair transplant is no picnic! Yes there is a little bit of pain involved, both during the op when you must have a series of injections and for a few days after when your head will be feeling a bit sore. Realistically you will need at least a week off work as you will have scabs where the grafts are implanted and swelling from the injections. The longer you can have off the better if you don?t want people to know what you?ve just had done.

It is also expensive not because of greedy surgeons but just because of the high cost of any surgical procedure.

Think of the equipment used and the staff involved (possibly about 5 people per surgery). This is especially true for people with a higher degree of hairloss, Norwood 4+ as they may need several procedures.

I myself have spent more than the cost of a new car on surgery but this is mainly due to making the wrong choices. With what I know now I could have done it for less than half the cost. This is why it is important to plan things right and do your research. Everybody?s situation is different. The advice you get from Spex will be a great help, as he will give you his opinion based on his wealth of knowledge.

Well if all that hasn?t put you off then my advice is to ?go for it!? Because it has made a huge difference to many people in you position. I know that having surgery is scary enough but as long as you follow my advice and go with a highly recommended surgeon you will be fine.

Disclaimer

As you can see I have given you the full truth both good and bad about transplants I hope this proves that I am not a salesman and will not benefit in any way should you decide to go ahead with surgery.

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