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Between 40% and 50% of men and women suffer from male and female pattern hair loss. Over time, hair loss can have a profound impact on sense of self-image, self-awareness, and self-confidence. Hair provides an important frame to the face, and it also serves as a means of self-expression. Individuals may cut, color, and style their hair however they choose. The involuntary loss of this ability can be extremely distressing. When it affects young people in their teens and twenties, it can be especially devastating.

As hair restoration surgeons, we have the unique ability to help recreate our patients’ sense of self-image and confidence. However the results of early hair transplantation were not always cosmetically acceptable. Hair transplantation for many still carries the stigma of oversized “pluggy” grafts and hairlines placed too low or unnaturally. It is imperative for novice surgeons to learn the conservative steps necessary for optimal, natural results. It is especially important to learn these steps so that we as practitioners of this profession do not repeat history.

Hair naturally grows in groupings of one to four hairs per follicular unit (FU) (Fig. 42-1). By separating the FUs from one another and allowing the hairs to remain as they do in nature, they can be relocated to areas of thinning with natural and undetectable results.

Figure 42-1

Hair follicles naturally grow in groupings of one, two, three, and four hairs.


Presently, there are only two FDA-approved medications for hair loss that come in a variety of formulations (Fig. 42-2). Propecia® is a 1 mg finasteride pill that is taken once daily and is approved for use in men only. It works by blocking the enzyme 5-alpha reductase type II, which converts testosterone to dihydrotestosterone (DHT). DHT has been shown to have a miniaturizing effect on hair follicles and is believed to be one factor contributing to the development of male pattern hair loss. With ongoing use of finasteride, men can expect to have continued increases in both hair counts and hair thickness for up to 2 years before this effect reaches a plateau.1,2

Figure 42-2

FDA-approved medications for hair loss include Propecia and Rogaine.

Rogaine® (active ingredient minoxidil) is FDA approved for hair loss in both men (5% foam and solution) and women (2% solution). Recent evidence has shown that women can use the 5% once daily at bedtime with the same effects as seen using 2% twice daily.3 Its exact mechanism of action is unknown but it is believed to work through a combination of local vasodilation, the opening of potassium channels, and possibly by down-regulating inflammation.4 Even after surgery, minoxidil plays a ...

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