Hair loss is a medical condition that affects some 25% of men in their twenties and an astounding two-thirds of men over sixty. Male-pattern baldness has no medical side effects other than hair loss, so many consider it purely cosmetic, but those who have it can suffer from very tangible psychological trauma.
Cures for male baldness have been around for thousands of years, from ancient Egyptian pigeon droppings to early-20th-century electroshock treatments for the scalp. Indeed, the search for that elusive cure has been ongoing, but it wasn’t until recently that we actually discovered what causes baldness. It turns out that male-pattern baldness is a result of a gene in the body that converts large quantities of testosterone into DHT (di-hydrotestosterone).
Hair loss occurs to some degree in 60 – 70% of men and 4 – 8% of women. Balding is hereditary however some people suffer from its effects despite both their parents having all their hair. This is due to what is known as spontaneous mutation, whereby the genetic information changes at conception.
Hair loss can also occur as a result of traumatic events, radiation therapy, burns or surgery. These circumstances are often amenable to transplantation, as the donor areas are still healthy. Many drugs and diseases can also cause hair loss that is only reversible once the initial cause has been remedied. Hair transplantation is not the answer in such cases. If you suffer from a scalp disease, you should consult a dermatologist.
The DHT hormone, though helpful during fetal development, can cause irreversible damage and shrinkage to hair follicles. The usual life cycle of a hair follicle is five years, four of which are spent growing, while the last cycle is stagnant. Damaged follicles fall out and are not replaced by new follicles. This is why male-pattern baldness is gradual but irreversible in its later stages.
Hair loss affects all demographic groups. It does not discriminate based on wealth, class or social standing. So why do a few filaments of minerals cause so much anxiety? When men lose hair, they see it as a sign of aging and, by association, a loss of virility. Young men feel it is too early and middle age men see youth slipping away.
On the other hand, if you are concerned about losing your hair you are perceived as insecure. Very few people discuss their feelings with close friends or family. As we grow older we look at our male family members with a sense of impending doom if they have gone thin. Confronting this demon can be harder than accepting it. The basic truth is that you do not want to see yourself bald.
Technically speaking, almost anyone can have hair transplant but this does not mean the procedure is suitable for everyone. Factors such as age, stage of loss, potential for future loss, donor management and patient desires are all part of the equation. With this in mind the decision is always finalized after a detailed and personal consultation with the doctor prior to any procedure. Every person has different issues, be they cosmetic or psychological, and these have to be taken into consideration to ensure long-term satisfaction. The goal of hair transplant is to enhance your quality of life and personal happiness. We believe this is best achieved through education and transparency between patient and doctor.
Evaluating a patient with clear-cut androgenetic alopecia for hair transplant generally consists of the physician determining:
- Norwood classification
- Designing hairline
- Examining donor area
- Estimate the graft number
One often over looked aspect of a consultation can be checking miniaturization levels in the patient’s donor area. This is more commonly seen in the recipient area and manifests visibly with color and hair diameter change, the weight of the hair lessens as so does the growth stage. The spring action in the hair also weakens and it can be pulled out easily will little to no pain. This can be present in the donor to varying degrees and will become evident upon inspection and often when assessed under magnification. Although some level of miniaturization is normal, Dr. Bisanga feels that anything near 20% and above can potentially rule out a patient from having surgery, or from being a good candidate.
Miniaturization does not affect the density of the donor hair as such because that is just the calculation of FU per cm2 but it will affect the number of FU that can be safely removed in a certain area. Miniaturization can be spread all over the donor or just in isolated areas, either way it will reduce the number of grafts that can be extracted safely. The causes can be genetic or due to medication, stress to the scalp or previous surgery to name a few. Depending on the cause, some patients may benefit from FDA medication to help also the donor area and can be re-assessed again at a later time if there were high levels when assessed. When miniaturization affects a person’s donor area, it will (progressively) reduce the available donor hair supply (as well as the longevity of transplanted hair) of and decrease the chances that a patient will be a candidate for a hair transplant. The evaluation of the donor is very useful in planning the surgery. It gives the doctor the necessary information about the available donor supply, and the quality of the follicular unit grafts.
Treatments for baldness range from medicinal to surgical.
FDA-approved medications like Rogaine and Propecia can provide effective short-term relief from baldness and have been a popular baldness remedy for years. Rogaine is a topical solution that helps follicle regrowth, but only works for about 60% of patients. Propecia is effective in stemming existing hair loss but is better when used in the early stages of baldness. Unfortunately, both medications are temporary in nature: results stop when the medication stops.
Minoxidil/Rogaine – Stimulates blood flow and nutritional support to hair follicles. In most men, it reduces hair loss and strengthens hair shafts. It is dispensed as a lotion or foam that is applied to the scalp twice daily.
Propecia – Reduces the body’s production of DHT by countering the effects of the 5 Alpha Reductase enzyme on testosterone. This once a day tablet is available by prescription only.
Hair Transplant – More appealing than alternative treatments because it is a permanent, undetectable and most importantly provides a natural solution to hair loss. It redistributes hair to the loss area, which will then grow as if it were in its original location.
There are two recognized techniques: strip or Follicular Unit Transaction (FUT), and Follicular Unit Extraction (FUE), including Body Hair FUE. The major difference between FUE and FUT is how the follicular units are harvested from the donor area. In some cases, these procedures are combined to maximize the donor surface area and give the individual the most transplanted hair possible.
The present and actual concern of the Afro candidate about the possibility of benefiting from advanced capillary grafting techniques has attracted the attention of BHR Clinic. Dr. Christian Bisanga has responded to this new request, with the mission of guaranteeing the most excellent capillary transplantation to “All” his patients, with surprising results, on any type of hair. True to its tradition, BHR Clinic wishes to address the lack or inadequacy of precise information on the treatment of afro or frizzy hair. Although the latter have different structural, anatomical, physiological and cosmetic characteristics compared to other ethnic groups, these characteristics are not in themselves a handicap for satisfactory capillary surgery. It is however very important that the candidate for surgery be mindful that afro or frizzy hair requires a specific treatment compared to the hair of other ethnic groups because of the fuzzy character of its stems and the curvature of the roots. These capillary peculiarities require that the surgeon first and foremost perform an accurate and meticulous evaluation of the capillary zone of the patient in order to avoid possible risks of hypertrophic or keloid healing and also to avoid any hyperpigmentation reaction such as an exaggerated development of the scalp tissue color or hypopigmentation , a decrease in the usual coloring of the hair.
Characteristics of afro or frizzy hair – Afro hair resembles a helical and spiral stem, in a flattened or elliptical form. The density of the hair is more or less than 20% and its rate of growth is more or less 30% compared to other ethnic groups. However, in terms of the percentage of telogen, afro hair has a much higher percentage than the others. The roots are curved at the level of the scalp, however, it must be added that afro or frizzy hair is prone to fragility of the capillary stems which can nevertheless be corrected with appropriate treatment.
Different types of alopecia seen in afro or frizzy hair
Androgenetic Alopecia – The most common type; secondary to a genetic conversion of large amounts of testosterone into DHT (Dihydrotestosterone: a biologically active testosterone metabolite which results in hair loss).
Traction Alopecia – Caused by the excessive practice of different types of hairstyles such as braids, dreadlocks, ponytails, pigtails, hairpieces, weaves and extensions as well as practices such brushing and curling. Such practices of pulling and stretching hair mostly in the forehead are the basis of the majority of cases of female alopecia. Alopecia is particularly found in the fronto-temporal region.
Central Centrifugal Alopecia – The main cause of centrifugal alopecia remains unknown, but it is often identified in people with uneven hair length with extreme fragility of hair resulting in excessive break at the slightest manipulation. It affects mainly women because of the external aggression’s caused by excessive practices of different types of hairstyles, the use of chemical softeners, heat and traction; centrifugal alopecia is usually associated with traction alopecia. The only difference is that in the case of centrifugal alopecia, hair loss occurs in the form of a small plaque at the level of the vertex, which begins to spread gradually, centrifugally and symmetrically. It should be emphasized here that this phenomenon rarely results in an inflammatory reaction of the scalp. In addition, it is not uncommon that in spite of everything, to still have some hair in the area affected by the disease. Therefore it is strongly advised to undergo treatment before considering any capillary surgery.
Alopecia of the heating comb – Caused mainly by the abuse of the hair straightener, ointments that are derived from petroleum and combs. It is located in the vertex region.
Alopecia Folliculitis and Pseudo-Folliculitis – The result of awkward hair removal or bad shaving. Indeed, during these daily practice hair may curve by housing itself on the skin surface, thus causing infections such as follicular papulo-pustules, perifollicular papulo-pustules or granulomas.
Alopecia Seborrheic Dermatitis – It mainly affects people who usually use products designated to promote heathly hair and scalp such as: castor oil, soybean oil, lanolin, lecithin, wheat germ oil or squalene. It is important to know that the use of these products causes considerable long-term damage to the hair and scalp.
Pelvic Alopecia – The most widespread, is in the form of a plate. It is localized in the region of the vertex , usually due to stress or emotional shock.
Trichotillomania – A behavioral disorder, consists of pulling hair, causing alopecia on the delimited area of the scalp or other hairy parts of the body. The causes are often genetic in origin. A treatment is advised before any intervention.
Fibrosing Frontal Alopecia – It is a particular form of LPP (Lichen planar pilar) that affects mainly women after menopause. The main cause is not yet known and to date there is no established treatment to stop its slow but evolutionary progression. Nevertheless, it should be emphasized that the disease may spontaneously stabilize in the long term. The relapsing nature of the disease requires foresight in the part of the physician. The choice for surgical treatment is evaluated on a case by case basis. Fibrosing alopecia is characterized by a crown-shaped scar-like alopecia affecting the anterior area of the scalp, in other words gradual hair loss occurring mainly at the border of the frontal and temporal zone.
Cicatricial Alopecia – These are inflammatory diseases or large chronic infections of the scalp, causing the destruction of hair follicles which in turn are replaced by fibrous tissue. The result is definitive hair loss in marked areas. Probable causes of scarring alopecia includ serious illnesses, such as infections requiring long and drastic treatments. Prompt treatment is necessary to avoid permanent loss of hair.
The diagnosis is established by the doctor using a surgical specimen or biopsy of the inflammatory zone of the scalp. BHR Clinic would like to emphasize here that it is only after treatment of the area affected by scarring alopecia that the surgeon will judge whether the patient is fit or not to undergo capillary surgery.
Treatments for afro or frizzy hair – Cases of skin inflammation, large infections, sensitivity of the scalp due to various external aggressions, must first be subjected to medicinal care or other indications prescribed by BHR Clinic before considering capillary surgery. Evaluation of alopecia must be done carefully, in a climate of total confidence. Close collaboration between the patient and his physician contributes to the success of an excellent experience of capillary implants.
Gender reassignment surgery also known as sexual reassignment surgery (SRS) allows an individual to alter their existing physical appearance in order to acquire characteristics of the opposite sex. Thanks to facial feminization, a man can modify his facial appearance to bring it closer in shape and size to typical female facial features.
This type of operation, carried out by BHR Clinic, is aimed at transgender candidates; individuals whose gender, psyche and social identity related to the concepts of men and women are in conflicts with their biological sex.
Indeed, for many candidates, certain aspects and features of the face retain a very pronounced masculine character such as:
- High line of implantation of the hair in the shape of ” M ” compared to a much lower and arched one in women.
- More prominent frontal bosses
To complete the feminization journey, the patient often has to undergo several types of surgery, such as the Facial Feminization Surgery (FFS). The success of a more feminine and natural frontal design requires a particular and personalized expertise. For many years, BHR Clinic has developed techniques for the reduction in the height of the forehead as well as changes in hairline design of our transgender patients.
The facial image for the transgender patient plays an undeniable role in the image he wishes to project in public. At BHR Clinic we aim at helping patients better cross this psychological barrier necessary for self-realization.