In our modern world, physical appearance weighs heavily. Hair loss produces a profound psychological impact on many individuals that may affect success in the workplace and in personal relationships. There is significant psychological investment in ones appearance directly related to self-image, self-esteem, and confidence. Many men, particularly in their 20s, 30s, and early 40s are particularly sensitive to their hair loss.

Women are highly sensitive to a social expectation that "a woman's hair is her crowning glory." When she perceives that hair loss detracts from her appearance, a woman is likely to experience a loss of self-esteem.

Individuals who experience hair loss on the scalp or in other regions (e.g., eyebrows, eyelashes, moustaches/beards) as a result of birth defects, trauma, and/or scarring, often look and feel disfigured. Many times these individuals obviously stand out in a crowd and do not look "normal." These people are very self-conscious about their appearance, and it greatly affects their quality of life.

By restoring hair and educating patients on methods to maximize the appearance of their hair, physicians with hair restoration surgery training can improve the self-image and self-esteem of men, women, and children who suffer from unwanted hair loss. Hair Restoration Surgery can positively enhance one's quality of life.

Hair Loss, Why?

The causes of hair loss are complex and may vary in multiple ways from person to person. The physician must establish a proper diagnosis for the cause of each patient's hair loss. This step is critical to the development of an individualized hair restoration treatment plan.

Physician hair restoration specialists understand that hair restoration must be individualized to the patient on the basis of (1) cause, pattern, rapidity and extent of hair loss, and (2) the wishes of the patient regarding desired result, cost, investment of time, and potential complications and side effects.

Hair Loss in Men

It is estimated that 35 million men in the United States alone are affected by male pattern baldness or androgenetic alopecia. Male pattern baldness is the most common cause of hair loss in men. Androgenetic alopecia is an inherited condition and the gene can be inherited from either the mother or father's side. In men who develop androgenetic alopecia, the hair loss may begin any time after puberty when blood levels of androgens rise.

Hamilton, and later Norwood, have classified the patterns of male pattern baldness. Although the density of hair in a given pattern of loss tends to diminish with age, there is no way to predict what pattern of hair loss a young man with early male pattern baldness will eventually assume. In general, those who begin losing hair in the second decade are those in whom the hair loss will be the most severe. Involved areas in men can completely lose all follicles over time. The first change is usually recession in the temporal areas, which is seen in 96 percent of mature Caucasian males, including those men not destined to progress to further hair loss.

The onset, rate, and severity of hair loss are unpredictable. The severity increases with age and if the condition is present it will be progressive and relentless.

Hair Loss in Women

Unlike hair loss in men, female scalp hair loss may commonly begin at any age through 50 or later, may not have any obvious hereditary association, and may not occur in a recognizable "female-pattern alopecia" of diffuse thinning over the top of the scalp. A woman who notices the beginning of hair loss may not be sure if the loss is going to be temporary or permanent-for example, if there has been a recent event such as pregnancy or illness that may be associated with temporary hair thinning.

Women tend to have less obvious patterns of hair loss than men, and non-pattern types of hair loss are more frequent in women than in men. In women as in men, the most likely cause of scalp hair loss is androgenetic alopecia-an inherited sensitivity to the effects of androgens (male hormones) on scalp hair follicles. However, women with hair loss due to this cause usually do not develop true baldness in the patterns that occur in men-for example, women rarely develop the "cue-ball" appearance often seen in male-pattern androgenetic alopecia. Patterns of female androgenetic alopecia can vary considerably in appearance.

Unlike the case for men, thinning scalp hair in women due to androgenetic alopecia does not uniformly grow smaller in diameter (miniaturize). Women with hair loss due to androgenetic alopecia tend to have miniaturizing hairs of variable diameter over all affected areas of the scalp. While miniaturizing hairs are a feature of androgenetic alopecia, miniaturization may also be associated with other causes and is not in itself a diagnostic feature of androgenetic alopecia. It is important to note that female pattern hair loss can begin as early as the late teens to early 20s in women who have experienced early puberty. This hair loss associated with early puberty can progress to more advanced hair loss, if it is left untreated.

In women more often than in men, hair loss may be due to conditions other than androgenetic alopecia. Some of the most common of these causes are trichotillomania, alopecia areata, triangular alopecia, telogen effluvium, and scarring alopecia, which can be caused by, for example, lupus erythematosus, scleroderma, and infectious agents.

Hair Loss as a Result of Disease or Trauma

In both men and women, hair loss can also be a result of disease and trauma which may leave an unnatural and disfiguring appearance. The impact of this type of hair loss can negatively affect a person's well being. An example of this is a toddler burned by scalding water on the scalp which can lead to a life long disfigurement that produces a severely negative psychological impact.

Hair Loss - Other Areas

Other areas besides scalp hair can be affected by hair loss and require hair restoration surgery, such as beard/moustache, cleft lip repair, reconstitution of eyebrows or eyelashes that have been lost, and pubic hair. Additionally, hair restoration surgery is often used to cover scars or disfigurements to other areas such as chest, legs, face, and the pubic region.


There are both surgical and non-surgical options for hair restoration (see Hair Replacement Options).

Hair transplantation surgery has dramatically improved over the past decade. The days of the "plugs and corn rows" are gone and the age of follicular unit, micro-, and mini- grafting has arrived. Through the use of variable sized hair grafts, along with new and improved instrumentation, the accomplished hair transplantation surgeons can now create a natural hair appearance that is appropriate for each individual patient. Individual needs of the patient directs the choice of treatment to one of several hair restoration options which, in addition to hair grafting, also include scalp reduction surgery, scalp flap surgery, scalp expansion surgery, and eyebrow and eyelash hair restoration.

Nonsurgical options for hair restoration are viable options for many patients. When researching information about hair loss treatment, you will find a host of creams, ointments, lotions, nutrition supplements, and scalp stimulants, all promising to stop hair loss and re-grow hair. However, you will find only two that have been approved by the U.S. Food and Drug Administration (FDA), and that are recommended by hair restoration physicians: minoxidil (Rogaine®) and finasteride (Propecia®).

Research Frontiers in Hair Loss and Hair Restoration - The future of understanding hair loss and treating it non-surgically will come from studies at the cellular and molecular levels, e.g., stem cell multiplication ("cloning"), tissue engineering, etc.

Patient Brochures on Hair Loss

The ISHRS is pleased to provide an educational brochure on hair loss and restoration. The brochure is in PDF format and available in several languages.

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