By far, the most common cause of hair loss in men is androgenetic alopecia, now more favourably termed Male Patterned Hair Loss (MPHL). This type of hair loss is experienced by up to 80% of men in their lifetime. Global census suggests that more young men are experiencing MPHL than before, though no definitive answer has been offered for the reason behind that.
One other common cause of hair loss is telogen effluvium and results in hair shedding in excessive amounts across the whole scalp, leaving a uniformly thin head of hair. This can range in severity, with some men even losing more than 50% of hair volume. Sometimes, there is an underlying medical condition e.g thyroid disease or iron deficiency anaemia associated with telogen effluvium.
Disfiguring hair loss can also result from scarring of the scalp, both from medical conditions and traumatic injury such as burns or deep abrasions. Medical conditions that lead to scarring alopecia damage the hair follicle irreversibly usually resulting in focal areas of hair loss. Burns or trauma to the scalp, sometimes from childhood, can cause a patch or a strip of hair to not grow back in the injured scalp.
Discuss different types of male hair loss and the available therapeutic options
Male pattern hair loss can be treated and decades of research and development have been invested into the slowing down and reversing of balding.
A hair restoration surgeon will consider many factors when making a decision on what are the best treatment options for any individual. Male hair loss treatment that follows a dead, fixed protocol usually results in suboptimal results. Continued monitoring by way of frequent follow-ups and clinical photography help the treating doctor to tailor the treatment to suit the patient.
Some options that are usually discussed with the patient when male pattern hair loss warrants treatment would include medical treatment e.g. with DHT-reducing medication or medications to stimulate hair follicle activity, regenerative treatment to help heal damaged hair follicles, laser therapy to increase hair follicle metabolism and encourage stronger hair growth and hair transplant or hair restoration surgery.
Most of the time, multiple therapeutic measures are utilized concurrently, to optimize existing weak hairs and to regrow hair on areas of complete baldness.
Telogen effluvium treatment usually revolves around addressing any underlying causes. In chronic telogen effluvium (i.e. heavy shedding that lasts more than 6 months), further tests would be ordered to establish any underlying causes. Some examples of these include Vitamin D deficiency, iron deficiency, autoimmune conditions etc.
Some medications can trigger telogen effluvium e.g. medications for epilepsy, cholesterol lowering drugs, medications used in the treatment of psychiatric disorders or even oral acne medications (this list is not exhaustive). The hair restoration surgeon will inform you if any of the long term medications that you are on may be causing hair loss and together with other specialists, may discuss the possibility of using an alternative drug.
Scarring hair loss from medical conditions (cicatricial alopecia) is usually resistant to most forms of treatment. Oral medications and supplements may help to control the condition from deterioration. Hair transplantation is usually not a first line option until the condition has stabilized. Some examples of this condition include frontal fibrosing alopecia and lichen planopiliaris.
Hair loss from a traumatic scar, however, has a chance to respond to surgical hair transplant. The surgeon will assess the scar and advise the patient on the degree of success that he/she expects from a transplant procedure. Larger scars may require a few surgeries to fully correct.
Who is suitable for male hair transplant surgery
Male hair transplant surgery is most useful to treat male pattern hair loss when the patient fulfils the other criteria as determined by the hair restoration physician. Some questions that will be asked during the consultation include:
Age (a very large consideration)
Family history of hair loss
Rate of progression of hair loss
Any medical conditions that may compromise the safety and outcome of the procedure
A patient’s willingness to be on long term medications to prevent further hair loss
Last, but definitely not least, the patient’s expectation from the procedure
Both men and women who suffer from androgenetic alopecia may be candidates for hair transplant surgery as part of their treatment regimen. The physical examination will involve:
The quality of the donor hair
The size and adequacy of the donor area
The size and density of the areas requiring transplanted grafts
The proportions and symmetry of one’s’ face
The laxity of the scalp
Based on astute clinical judgement, various techniques of hair transplant surgery may be offered to the patient. Some patients may benefit more from a strip harvesting procedure whereas others will benefit from FUE (follicular unit excision) harvesting.
What to expect from hair transplant surgery
After your hair transplant surgery, strict after-care regime should be followed as prescribed. This usually involves steps to ensure your transplanted hair grafts stay moist, heal well and avoid infection.
The bandage that is applied immediately post-op will be removed the day after and you will be instructed on how to maintain scalp hygiene during the week immediately following surgery.
Within a week, transplanted hair in the recipient area starts to lengthen, showing that the grafts have re-established blood supply and are likely to be successful in the transplantation.
The first 3 weeks are what I term the honeymoon period – from the 3rd week onwards, implanted hair will start to shed at random. This shedding is expected and it reflects the hairs undergoing a change in the phase of the hair growth cycle.
Between 3-4 months after the transplant procedure, new hairs will emerge from the hair follicles that have been transplanted. At this point, the new hairline will be visible but not very dense.
Hair density of the implanted areas start to pick up from here on, with 80-90% of density achieved by 9 months.
At the anniversary of the procedure, almost all of the transplanted hair would have grown out and reveal a newly framed face and better scalp coverage will be seen. Transplant success rate is usually >90%, which means that if 2000 hair follicles were transplanted, more than 1800 hair follicles will grow strong hairs.
These transplanted hairs, if extracted from the proper donor area, are meant to be permanent. They behave like hairs from the transplanted area and are much less likely to be damaged in the same manner that other scalp hairs do in the context of male pattern baldness. In most patients, successfully transplanted hairs last decades, if not, for life. As such, hair transplant surgery is meant to be a permanent solution to male pattern baldness.