As the International Society of Hair Restoration Surgery (ISHRS) prepares to kick off its 20th anniversary this October with a look back at the significant improvements made in the art and science of hair restoration surgery, millions of men and women around the world have better hair to show for the tremendous growth in this specialized field of medicine.
“Over the last 20 years, the ISHRS has grown to over 1,000 international members working in collaboration to establish the highest quality standards and best practices that have led to the modern-day hair transplant,” said ISHRS President Dr. Jennifer H. Martinick. “Now, results are natural looking and virtually undetectable, and ISHRS members are committed to pushing new frontiers in scientific research to further enhance results and possibly even reverse or delay the onset of hair loss.”
While there have been several improvements in hair restoration in the last two decades, the introduction of follicular units in hair restoration surgery and the oral medication finasteride are two of the most notable contributions in the field.
One of the biggest complaints about early hair restoration surgery was the appearance of visible plugs or “doll’s hair” in the transplanted area. This unnatural result was due to a single graft containing 15 to 25 or more hairs being transplanted in rows on the scalp. Now, advances in hair restoration surgery have led to the use of follicular units containing small bundles of one to four hair follicles.
There are two methods of harvesting donor follicles – follicular unit transplantation (FUT) and follicular unit extraction (FUE).
In follicular unit transplantation (FUT), the surgeon takes a strip of permanent donor hair from the back of the head, which are then divided up microscopically (so as not to damage them) by a team of highly trained technicians.
In follicular unit extraction (FUE), the specially trained hair restoration surgeon extracts individual follicular units directly from the patient’s donor area (usually at the back of the scalp or nape of the neck where scarring is less noticeable) and transplants them directly into the scalp or further divides them into smaller units before transplantation.
Today’s grafts can better imitate the manner in which hair grows naturally, resulting in a more natural, undetectable outcome. In addition, continual improvements in the instrumentation and techniques used for follicular unit extraction and transplantation, including robotic assisted FUE, may further enhance the results of hair restoration surgery in the future.
Approved by the U.S. Food and Drug Administration (FDA) in 1997, finasteride 1mg (Propecia) is the only oral medication approved for the treatment of male pattern hair loss. Several years of investigation and use by more than 1 million patients show that finasteride has long-term effectiveness and safety in treating male pattern hair loss in men of all ages and all ethnic backgrounds.
Research has shown that finasteride’s effects in slowing hair loss and stimulating new hair growth work best for early to moderate degrees of hair loss, and it is often used in conjunction with minoxidil (Rogaine), a topical medication approved by the FDA for treating hair loss in men and women, to further enhance results. In addition, the technology of low level laser therapy as been shown to be effective to slow progression of hair loss and can re-grow hair. Over the years, hair restoration experts have found that hair restoration surgery and proven medical therapies are an effective combination in treating people with thinning hair and limiting future hair loss.
Hair Restoration Surgery by the Numbers
Since the ISHRS began compiling practice data in 2004, the number of men, and women, around the world seeking treatment for hair loss has increased tremendously. For example, the extrapolated worldwide number of surgical hair restoration procedures performed in 2010 was approximately 279,381, up 11 percent from 2008. Compared to 2004, the number of procedures performed around the world in 2010 jumped 66 percent – with the Middle East (454 percent increase) and Asia (345 percent increase) experiencing the largest growth.
Although the majority of hair restoration patients have traditionally been men, over the years more women are seeking help for hair loss. In 2010, 85.9 percent of all hair restoration surgical patients worldwide were male and 14.1 percent were female. Since 2004, the number of female surgical hair restoration patients worldwide increased 24 percent.
Hair restoration experts believe the reason for this increase in the number of women turning to hair restoration surgery is threefold: there is now increased public awareness of the options for women with hair loss, more natural results are achievable with follicular unit grafting, and there are more applications available for women such as eyebrow, eyelash, and post-facelift reconstruction. In fact, according to the most recent practice data released by the ISHRS, hair restoration procedures performed on the eyelash, eyebrow and face in men and women increased 14.2 percent from 2008 to 2010.
The Next Biggest Advancements
Looking ahead to the next 20 years, hair restoration experts are optimistic that continued research in hair loss and hair restoration may result in cutting-edge therapies that will further improve results or, in some cases, delay the onset of hair loss.
For example, some experts believe that genetic research will make significant advances in the coming years and may lead to methods of preventing hair loss. Clinical trials involving cell therapy (more commonly referred to as hair cloning) are ongoing in humans to determine the safety and effectiveness of implanting lab grown cells into the scalp to potentially produce thousands of hair follicles from the one original follicle.
“This is an exciting time for hair restoration surgeons and our patients,” said Dr. Martinick. “New skills, tools and technologies are a part of the future of hair restoration, but they should not be embraced wholly without appropriate research and due diligence that ISHRS members strive for.”
About the ISHRS
Founded in 1993, the International Society of Hair Restoration Surgery (ISHRS) is a non-profit medical association with a membership of over 1,000 members worldwide dedicated to the advancement of the art and science of hair restoration. The mission of the ISHRS is to achieve excellence in patient outcomes by promoting member education, international collegiality, research, ethics, and public awareness. For more information and to locate a physician, visit www.ishrs.org.
About the ISHRS Member Practice Survey
Conducted by Relevant Research, Inc. of Chicago, IL, the ISHRS 2011 Practice Census survey is a compilation of information provided solely by participating physicians. The information published in this survey was developed from actual historical information and does not include any projected information. The margin of error for the sample is plus or minus 6.4 percent at the 95 percent confidence level. For a full reprint of the ISHRS 2011 Practice Census Report, visit www.ishrs.org/mediacenter/media-statistics.htm.