Alopecia or hair loss affects an estimate 35 million men and 21 million women in the United States alone. It is so common that most believe that it is a normal part of aging. Many men and women do not seek medical or surgical treatment despite the fact that these treatments exist. Hair replacement surgery has been pioneered, performed, and enhanced over the last four decades. Today several options for hair replacement exist, each vary in their cost and effectiveness. The effectiveness of hair replacement surgery is based largely on the degree of male pattern baldness. For example, hair replacement for men is most effective for baldness types IV and V on the Norwood-Hamilton classification scale of baldness. Patients with types VI and VII may have hair loss that is too extensive to be corrected by hair replacement surgery and those with types II and III may be too early in the process to justify the procedure or may require subsequent hair replacement later in life. Type I on this scale is reserved for patients with no sign of baldness.
Not all hair loss can be successfully corrected by hair replacement surgery. The most common cause of hair loss, pattern baldness, is usually caused by an overabundance of hormones. This form of baldness is quite amenable to hair replacement surgery and may even be treated with medical treatments such as minoxidil and finasteride. When hair loss is caused from some other medical condition, such as alopecia areata, hair replacement surgery may not be an option. This is because the disease usually destroys donor hair follicles just as it does native hair. Traction alopecia, that is, hair loss due to a consistent moderate extractive force (e.g. corn rows) can be successfully treated with hair replacement surgery. A physician should determine whether the hair loss is due to a serious medical condition or can be treated with hair replacement surgery.
The cost of hair transplantation can be fairly expensive and is paid completely out of pocket. According to the American Society for Aesthetic Plastic Surgery, the average hair replacement cost is around $5,000. The price varies depending on the quality of the native, donor hair (from the patient’s own head) and the extent of the baldness. While older hair replacement surgical procedures placed large hair “plugs” in the scalp leading to a “doll’s hair” look, newer micrografting and minigrafting techniques have more or less eliminated this unwanted transition period. However, micrografting takes considerably longer for the physician and explains some of the reason for the high hair replacement cost.
Another consideration facing hair replacement surgeons and their patients is the advancement of baldness over time. Despite hair replacement surgery, most patients continue to experience pattern hair loss. Since the original hair replacement surgery was aimed at correcting the degree of hair loss present at the time of procedure, as more hair is lost, unnatural hair loss patterns may emerge. Since the amount of acceptable donor hair also diminishes with progressive hair loss, these unnatural balding patterns may not be reversible. Because of this, many hair replacement surgeons are considering and discussing both the short and long term consequences of hair replacement surgery with their patients. Hair replacement surgery may need to be combined with a medical hair replacement starategies to achieve long-lasting hair restoration.