The FUT method involves the removal of a strip of skin with a high density of hair from the back of a patient’s scalp under local anaesthic. Once the strip of skin has been removed from the donor area, follicular units are separated under advanced microscopes and the separated units may contain one, two, three or four hairs with the average yield being 2.2. Single hair grafts are used to create a natural hairline whilst the larger units are positioned in other areas to produce greater density. The area where the strip was removed is then closed using tricho-closure, an advanced surgical technique in hair transplantation which allows hair to eventually grow through a linear donor scar, so the scar that remains is barely visible even in the case of shorter hairstyles.
Once the grafts are prepared a surgeon will create tiny openings, between 0.4 and 1.2 mm, using a hair laser, injection needle or scalpel in the surface of the skin in of the area of the scalp to be treated.
The follicular units are immediately transplanted to the prepared channels one by one. It is important here that the follicular units are transplanted in a natural direction and that the transitions from existing areas of hair are as natural as possible. The transplanted follicular units establish themselves within a matter of days.
An FUT hair transplant can take between 4-12 hours depending on the number of grafts or hairs being transferred. Early results from the treatment can be seen after 3-4 months with final results commonly seen after 12-15 months.
The FUE method (Follicular Unit Extraction) is a more recent method of hair transplantation which involves the removal of individual hair grafts one graft at a time. This can be from nearly every part of the body, although most typically from the back and sides of the scalp. The follicular units, comprising of one to four hairs, are removed from the donor area under local anesthetic with a hollow needle. The needles that are used to make the grafts loose are 0.5 mm to 1.0 mm thin and due to the use of these very small needles the area heals very quickly. In addition, the grafts are transplanted without changing the structure of the transplanted hair that results in a very natural look that is undetectable to the naked eye. The follicular units are then transplanted from the donor area to the target area one by one similarly to the FUT method and these units establish themselves within a couple of days.
The major advantage to FUE is that there is no linear scar as seen with FUT. As the FUE method does not require a strip of skin to be removed, as with the FUT method, only very small dots are left in places where the follicular units were removed which are hardly visible when the hair is shaved or cut to several millimeters in length. FUE is a good method that is more appropriate where a smaller number of hairs are required, where the strip method is not possible or where the patient wishes to maintain a very short hairstyle such as a no. 1 or 2 shaved look.
However, FUE is a smaller procedure yielding much less hair for a patient. Additionally, it is a lot more time consuming and is reliant on spreading the extractions over a large area of the scalp which significantly limits the number of grafts possible to transplant in a session compared FUT. It can also require a surgeon to harvest donor grafts beyond the safe donor area, meaning that grafted hair follicles may grow but possibly not permanently. Resulting not only in losing the transplanted hairs, but also leaving visible FUE scars. An FUE transplant takes approximately eight hours and during this time, a maximum of around 1400-2,000 follicular units can be transplanted. Should more transplanted units be required, it may be possible to do this on consecutive treatment days.
There are some genuine solutions and medication available to help stop hair loss completely and even, in some cases, reverse the process partially. Successful treatment of hair loss using medications is greatly dependent on early intervention. It is critical to begin treatment with an effective product as soon as you notice the onset of hair loss.
Finasteride’s success is due to its ability to inhibit the enzyme that converts testosterone into dihydrotestosterone (DHT). A 1mg dose of Finasteride can effectively lower DHT levels by as much as 60% when taken daily. It is DHT that shrinks or miniaturizes the hair follicle, which eventually leads to baldness. This 60% reduction in DHT has proven to stop the progression of hair loss in 86% of men taking the drug during clinical trials. 65% of trial participants experienced what was considered a substantial increase in hair growth.
What is also noticeable when taking Finasteride is that not only do the number of hairs increase, but the existing hair can also become thicker producing a much better coverage or density. It is important that the patient continues using Finasteride or any positive effects will be gone within a few months.
Finasteride is generally well tolerated at low doses, but there have been reports when using the higher dose of 5 mg Finasteride (5 mg per day) of decreased libido, impotence, breast enlargement, stomach pain, gastrointestinal disorders, headache and rash.
Dutasteride can also be used for hair loss prevention, but it is not officially registered for this use but for the treatment of enlarged prostates. The active substance in Dutasteride is an extended version of Finasteride that blocks both types of DHT, whereas Finasteride blocks only one. Although research has shown that it is more effective than Finasteride in treating hair loss, the downside is that the potential side effects found when using Finasteride are also more common.
Minoxidil is an older remedy for hair loss and is sold as a lotion or foam that has been found to be free of side effects apart from the occasional allergic reaction.
Minoxidil works quite differently from Finasteride and Dutasteride as it is applied directly to the scalp, ideally twice daily. The lotion or foam dilates the blood vessels to the hair shafts to ensure that hairs can grow better. The results of Minoxidil are negligible as it does not address the cause of the hair loss and only slightly delays the actual hair loss process.
However, Minoxidil is still one of the top 3 recommended products for hair loss and works well in combination with the previously discussed medications. Used in combination with Finasetride or Dutasteride it will target the cause of hair loss and provide optimal stimulation of the scalp to aid new hair growth.
Hair systems, hair replacement systems, hairpieces, toupees and wigs are often used interchangeably and all refer to the same non-surgical hair restoration procedure where human or synthetic hair is added to a thin base or foundation which in turn is attached to the scalp by varying methods. The latest hair systems can look very natural and virtually undetectable. They can work very well for almost anyone with hair loss and if done properly, the wearer can have a natural looking head of hair in relatively little time that can be styled in the way they prefer. It is no longer true that hair systems make people look like they are wearing a ‘rug’ on their head.
Hair systems are often custom made, as each wearer will have different needs and varying lifestyles, and are manufactured using human, remy , synthetic, cyber or robo hair. The cost of a top end custom made system can, however, run into thousands of pounds. Systems are attached to the scalp or balding area most commonly using double sided tapes and liquid adhesives, sometimes referred to as bonding. Weaving was previously used as a method, where the hair system is literally weaved into the client’s existing hair, but in recent years many believe weaving causes traction alopecia resulting in very few companies using this method of attachment.
One of the biggest drawbacks with hair systems is that the cost of maintaining them is typically high and can be very time consuming. Maintenance issues can range from periodic cleaning, adding hair, re-coloring, to daily attachment hassles with tapes, glues, adhesives, clips etc. Most people think that a hair system is a one off investment. This is not the reality and a hair system can ultimately be a very costly option for hair loss sufferers. Hair systems that look and feel the most natural are also the most expensive and the least durable and may last only 12 months. Maintenance can be quite costly too, sometimes over a hundred pounds a month, when it comes to changing a system front, adding hair or re-coloring.
HPT® scalp micro-pigmentation is a cost effective option for many men who wish to stop using a hair system and choose to sport their hair in a ‘shaven’ look with minimal maintenance Additionally, within diffuse thinning hair, HPT® scalp micro-pigmentation can be effectively used to create the illusion of more density at root level to draw attention away from the scalp or bare patches.
Hair loss concealers are designed to cover up thinning areas of hair and can help disguise any apparent hair loss to give a full and voluminous look from a distance. Hair loss concealers are widely available in most markets:
Nanogen contains tiny Keratin ‘nanofibres’ which are shaken onto thinning areas of the scalp. Each fibre has been electro-statically charged, causing it to bind to existing hair in a fir tree pattern. This gives the user instant volume and lift to even the smallest and finest hairs, giving what the makers call a ‘30 second hair transplant’. Nanogen is available in 10 shades and promises to blend seamlessly with any hair colour, while staying put even in strong winds and rain.
Unlike other brands, Nanogen does not run or change colour with sweat and does not contain synthetic fibres to gives a more natural and healthy look to the hair.
Nanogen gives the user a uniform coverage that looks more natural closer up, however it can make the hairline look ‘dirty’ if not applied correctly.
DermMatch is used by many TV make-up artists to effectively cover balding areas and reduce the contrast between the hair and scalp. This gives the appearance of a thicker and fuller head of hair as areas of visible scalp are harder to notice.
This product is supplied in a small disc containing a hard-packed powder formula and a brush shaped applicator. DermMatch is applied by first wetting the brush and wiping it across the coloured disc and then applying it to the scalp and hair.
When applied correctly the results give the illusion of more hair in an instant.
DermMatch lasts all day without rubbing off or running, even in extreme conditions. To remove DermMatch from the hair and scalp the user simply needs to wash their hair with any shampoo.
Toppik is the most established brand of hair concealer and is available in 8 colours which is applied to the hair by shaking the applicator. This dispenses thousands of tiny keratin fibres which stick to the hair, giving greater density. Toppik claims to be colour-fast and 100% natural, however there have been a number of complaints over the dye used in the fibres which can run when mixed with sweat. There is also some concern over the use of ammonium chloride in the formula which may cause potential side effects which has caused many to consider Nanogen as a better alternative, as their nanofibres are inert and do not contain ammonium chloride.
Using a quality hair loss concealer can instantly give the illusion of thicker hair, giving the user greater confidence and can safely be used alongside any existing hair loss treatment or used to disguise transplant scarring.
However, there are obvious disadvantages to using concealers due to the fact that the user needs to apply the product each day, which is time consuming and will be washed out after a shower. Users of concealers repeat the application day after day which ultimately can become costly but also acts as a reminder of their hair loss condition. Regular users of concealers often describe feelings of anxiety due to the fear of being ‘found out’ with makeup running in the rain, sweating during physical activities or stains left on shirt collars and pillow cases.
Although most modern versions of concealers are far more durable than previous versions there is still the risk that it can start coming off when the user least expects.
HPT® scalp micro-pigmentation is a fantastic alternative to the use of concealers which cannot do anything to reshape or restore a receding hairline as they cannot be applied to areas where there is no hair. Since concealers obviously don’t look like hair follicles, they are only undetectable from a distance and cannot work with very short hair or crop cuts. Additionally, the illusion of actual ‘hair’ follicles from HPT® scalp micro-pigmentation far surpasses the results achievable from any concealer product on close inspection, with no need for daily application and eliminates the fear factor of being ‘found out’, giving the patient the freedom to engage with physical and social activities with confidence.