For Surgeons

Overseas Information

Hair, There and Everywhere

Occasionally one is confronted with bizarre requests for hair transplant surgery, be it pubic or laparotomy scar transplants and such like. The run-of-the-mill request, however, is from young males affected with androgenic pattern baldness. It is amazing how a young mans self-confidence and image can dive proportionately to his receding hairline.

John D Rockefeller Sr.’s hair loss began in 1886 and progressed to total body hair loss, alopecia totalis. The change in his appearance was startling. He suddenly looked old, puffy, stooped and all but recognizable. His self-esteem eroded completely, only to be partially restored by the acquisition of various hairpieces. What is equally interesting is the observation that 100 years since Rockefellers alopecia began, three facts remain unchanged: the devastation of its victims; the absence of a cure; and the lack of scientific knowledge about its pathogenesis. Happily, we are on the threshold of changing the status of all three problems.

The most common form of hair loss, androgenetic alopecia (AGA), also known as male pattern baldness, affects 50% of all males over age 50 years in the United States, and a large percentage of women. One fourth of all men 25 years old have sustained significant hair loss. This translates to a combined figure of nearly 40 million individuals who suffer from some form of inherited hair loss, with billions of dollars spent each year on essentially useless treatments. The hair loss in men results in considerable preoccupation, stress, and anxiety especially among young single men with an early onset of hair loss. A recent statistic quoted that 45% of men with AGA would sacrifice 5 years of their life span for a full head of hair! What, then of the advancements?


Until fairly recently, legitimate alternatives to hair loss were limited to wearing a hairpiece or opting for hair plug grafts that often resulted in an artificial looking replacement. Most surgeons no longer transplant large circular plugs of hair that result in a “dolls head” appearance. Instead, tiny hair grafts are blended throughout the balding area, creating hairlines that are often difficult to distinguish from those that are natural. This microfollicle hair transplant technique was efinitive by Uebel, amongst others, nearly ten years ago. He has visited this country and many of us have spent time and swapped notes with him, ensuring that South African patients are exposed to the latest techniques and technology. Briefly the technique consists of excision of a full thickness segment of occipital or parietal scalp tissue followed by primary closure. This tissue is then subdivided into follicular units or smaller micrografts consisting of 1 to 5 hairs.

The sensitivity to testosterone resides in the parafollicular area; thus transplanting hair from hormone-resistant areas (occiput etc) ensures permanent hair maintenance in the recipient area. The microfollicle grafts also result in scar free, natural results (Figs 1&2). The disadvantage of the technique is the laborious effort needed to accomplish the task, the wait of a few months for an appreciation of the result and the need for a few procedures to achieve the desired density of hair. The end result however, is far better than any previous techniques and improvement in methods have enabled the surgeon to produce unprecedented naturalness, the ability to complete the process in less number of sessions with a more limited amount of donor tissue. However, these newer procedures are technically more difficult, require a significant amount of well-trained staff, are more costly to deliver and are too impractical for some cosmetic surgeons to perform.

The initial excitement over laser-assisted hair transplants appears to have subsided, as the tiny sites needed for the grafts are ideally made by a microsurgical scalpel rather than by laser. Carbon Dioxide laser causes excessive tissue damage an

31 October 2002