What are the treatment options for hair loss?

Therapies for hair loss include:

  • Identifying and treating the underlying cause.
  • Minoxidil (Rogaine®) is FDA-approved for treating male and female pattern baldness. Minoxidil is a topical solution that is directly rubbed onto the scalp where hair growth is desired. It is available over-the-counter and does not require a prescription.
  • Finasteride (Propecia®) is FDA-approved to treat male pattern baldness. Finasteride is not approved for female pattern baldness. Like all prescription products, finasteride should be given under a physician’s care.
  • Hair transplantation or hair replacement surgery. Hair replacement surgery is a cosmetic procedure and includes such replacement procedures as micro-grafting, slit grafting, punch grafting, and scalp reduction.

The type of hair loss, as well as the patient’s circumstances and desires, determine which hair replacement procedures are most suitable.

Common hair replacement procedures: grafting

Grafting is an outpatient procedure performed in the dermatologic surgeon’s office. Micro-grafts contain only 1 to 2 hairs per graft, while slit grafts contain between 4 and 10, and punch grafts hold 10 to 15 hairs. A local anesthetic is injected into the scalp and sedation is available, if needed, for relaxation and comfort.

How is hair grafting done?

The dermatologic surgeon first removes a disc-shaped portion of the hair-bearing scalp from the back of the head. Then, the surgeon cuts the removed scalp into small segments with varying amounts of hair in each graft to achieve a very subtle thickening and "natural" look with this technique.

With each session, 100 to 1,000 hair-bearing segments are transplanted. "Donor" sites are closed with stitches, which usually are then concealed by the surrounding hair. After the grafting session is complete, the scalp is cleaned and covered with gauze and, if necessary, a bandage. Stitches will be removed approximately 10 days later.

Three to four sessions may be needed to achieve satisfactory "fullness." After each session, a healing process of 2 to 4 months is usually recommended prior to the next procedure.

Common hair replacement procedures: scalp reduction

A scalp reduction is the removal of non-hair-bearing skin from the scalp so that the remaining hair-bearing skin can be stretched to fill in the bald area of the head. Scalp reduction can reduce as much as half of the bald area. It is a procedure performed to cover bald areas on the top and back of the head and is not found to be beneficial for the frontal hairline.

How is scalp reduction done?

The scalp is injected with local anesthetic and a bald segment of scalp is removed. The surrounding skin is then loosened and gently stretched so that the sections of hair-bearing scalp are brought together and closed with stitches. This procedure may also be performed during punch grafting sessions.

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