Hair Replacement : Surgery, Hairpieces and Health-Related Hair Loss

by Food and Drug Administration (FDA)

(Page 2 of 3)

Surgery

Twenty years ago, many people felt they risked looking like a Cabbage Patch doll if they chose surgery to eliminate baldness. Now, says Carlos Puig, D.O., director of Puig Medical Group, which is headquartered in Houston, better surgical techniques — used by increasingly skilled surgeons — are getting more eye-pleasing results.

"When I started in 1973 ... it was like the Stone Age," the cosmetic surgeon says, referring to the equipment and techniques in use. Now, he says, surgeons have learned to create a much more natural-looking hair line, using scalpels to cut either small slits or holes in the scalp to receive transplanted hair.

While there are numerous types of surgery, they can be sifted into two main categories: transplantation and scalp reduction.

Transplantation involves moving hair from densely covered sites on the sides or back of the head to bald areas of the scalp.

The key to success, explains Anthony Santangelo, president of the American Hair Loss Council, is to have good sites on the sides or back of the head from which to move hairs. Otherwise, patients can't expect ample coverage. Because their hair loss is diffuse, women generally lack good donor sites, making transplantation impractical for them.

The biggest improvement in transplants is with "micro" or "mini" grafts. "You're looking at one to two hairs shot into the head with a needle," Santangelo says. "It achieves a very, very fine, natural-looking hair line. The significant difference there is you need a lot of hair to do that."

Surgeons also use larger round plugs of seven to 10 hairs. Line grafts, the shifting of strips of nine to 12 hairs, are common, too.

One thing to keep in mind is that prosthetic hair fibers for transplantation are banned by FDA. Implanting them, according to Stephen Rhodes, acting chief of FDA's plastic and reconstructive surgery devices branch, caused a high incidence of adverse reactions, including infection.

If male-pattern baldness has left you with too much balding area to cover, you may benefit from scalp reduction: the surgical removal of large sections of a bald scalp. Extenders and expanders, elastic devices placed under the skin to stretch the hair-bearing scalp regions on the side of the head, have been used as a complement to reduction surgery.

Another surgical method is the flap technique, which rotates hair-bearing scalp areas from the sides or moves those areas from the back forward. The flap technique has the highest complication rate, though, Puig says. Bleeding, scarring and infection can occur from surgery. But advances, such as knowing what size flap to use and how to enhance blood supply to the region, have cut down on the visibility of scars.

Hairpieces

Finally, if you prefer to dodge the pain, time and cost of surgery, there's always the old, reliable hairpiece.

Obviously, all toupees and wigs are not created equal. Just as the transplant is only as good as the surgeon, the hairpiece is only as good as the person creating it and the materials used.

There are a variety of ways of affixing the hairpiece, which consists of human or synthetic hair implanted one hair at a time into a nylon netting. No method is permanent.

The hair weave involves sewing a wig into existing hair.

Also there are more traditional methods: You can use bonding (a type of glue), metal clips, or simple tape to attach the hairpiece to the scalp. Unlike the weaves, these give you the option to take the hairpiece on or off with ease. Many companies advertise "hair systems" or "hair clubs," which, according to Santangelo, offer check-ups to clean, color and tighten the hairpiece.

Lark Lambert, consumer complaint coordinator for FDA's Office of Cosmetics and Colors, notes that in addition to maintaining the cleanliness of hairpieces and wigs, it is important not to neglect the scalp under the wig. Keeping it clean and healthy avoids skin irritation and disease, he says. Also, as a precautionary safety measure, first-time users of hairpiece adhesives and solvents should test a patch of skin for 48 hours to determine possible skin sensitization to these products.

Health-Related Hair Loss

While hair loss is more harmful to the psyche than anything else, some of the causes of baldness may represent serious health problems. That's why it's important to talk about hair loss with a physician.

One problem, says FDA's Cook, could be a condition called alopecia areata. It's an autoimmune disease of unknown cause in which inflammatory cells attack the bulbs of the follicles under the scalp, leaving hairless patches. In more serious cases, hair may fall out from the entire head — eyebrows and beard included — and the entire body. Many times, though, the hair returns spontaneously.

Childbirth, severe malnutrition, chemotherapy, thyroid problems, and a form of lupus can also cause hair loss.

Something as simple as pigtails or cornrows, if worn too long, can cause hair loss, too, because of the stress they cause to the hair shaft.

The medical opinion concerning the role of emotional stress in balding is mixed. If stress does play a role, however, it's only at times of extreme emotional trauma, according to Kayne at the University of Washington Medical Center.

About the Author

www.fda.gov
FDA is A United States government body that oversees medical devices, including contact lenses, intraocular lenses, excimer lasers and eyedrops. In the US, these products must be approved by the FDA before they can be marketed.