It is hair that give us unusual look and character. It is even our personal decoration. Every man finds hair as a kind of attribute of their masculinity. If they have a lot of it, it gives them a great satisfaction and builds their self-esteem. However, lack of hair in the region of the head or thin hair is a problem for women, too.
As far as I remember, all women in my family have always had thin hair. When I was a little girl, everybody paid attention to my grandma’s poor hair. As a young girl, she used to wear her hair in a bun. I saw her pictures when she was a young and beautiful woman with a beautiful bun. I thought that she had wonderful long hair. However, once I had a chance to see her in wet hair just after she washed it. Unfortunately, she didn’t manage to hide her thin hair form me. She always wrapped hair around her head that gave the impression of thick hair and wavy curly hair covered tightly the bald places. That time, however, I found out the truth.
My parents told me that when I was born, namely 32 years ago, I didn’t have thick hair. They were afraid a little as I was bald for a longer time. Not surprisingly, everybody, i.e. my mum’s friends and curious neighbors confused me with a boy. It was a real problem for my parents. They were afraid that I would not have any hair or that it would be as poor and thin as my grandma’s. However, after one year my hair started growing. They were becoming longer and thicker. When I was in the kindergarten, I was even taken a picture (a black and white picture) with my dark, long hair which I used to have loose or my mother pinned it up in two ponytails decorated with huge ribbons covering my ears. In elementary school and high schools I also didn’t have any problems with hair such as its excessive falling out. I had long up to my waist curly hair which soon became the object of admiration and jealousy. My friends used to call me a witch, and my teachers forced me to pinned my hair in a ponytail. Then, the problem of balding didn’t exist. I even didn’t suspect that it might concern me in the future. My wonderful hair was my pride. I did take care of them using best available shampoos and conditioners. I also didn’t dry my hair with a hairdryer because dry and hot air could dry my hair too much and destroy hair stems. I even tried not to pinned it up not to destroy it mechanically.
The problem appeared during my studies due to irregular lifestyle I led and unreasonable diet I followed. My diet consisted mainly of carbohydrates, fast-food and coca cola. Anything that was fast and cheap to eat in the city center became a part and parcel of my every day menu. I ate it during the breaks between my classes. Moreover, huge number of classes and studying at night, not enough sleep, stress caused by difficult exams, all that resulted in my hair falling out. At the very beginning, it was my mum who noticed it while sweeping my room. Then, I didn’t bother about it. I comforted her and myself that my long hair actually equaled 4-5 short hair, hence, it seemed that my hair was more than my father’s or brother’s. Besides, everybody had always short hair. Unconsciously, however, I became sensitive to the issue of my hair. I washed it once a week, but still I was scared looking into the bath and at my comb to check whether it didn’t fall out too much. Since then, I didn’t allow anyone to touch it. I didn’t like when my mother or my boyfriend stroke me on my hair or put their fingers in it. I also stopped going to the hairdresser. I did everything on my own including cutting. During the last year of my studies, I lost a few kilos due to huge stress I was under every day. First, I was happy as I wasn’t a thin person, however, my happiness did not last long. The loss of weight resulted after several months in loss of hair. I was scared seeing the condition of my hair. After having estimated it carefully I noticed that my hair got thinner on the temples and the forehead up to the head vertex. I was worried a lot. I thought, then, that my lifestyle led for the last years contributed to it. At that time I finished studies and started working professionally. I changed my diet. I ate huge amounts of fruits and vegetables. I spent my free time sleeping and relaxing. However, the change of my lifestyle did not improve the condition of my hair. I decided to cut my hair short however, it also did not bring any improvement. Then, I reminded myself my grandma and her problem. I broke down in tears. I asked my dear friend, who was a dermatologist, for advice. She advised me to go to a specialist dealing with hair transplantation. She knew like me that all conditioners, ointments or liquids were of no use, then. Before I decided to follow my friend’s advice, I search for some information in the Internet. I found out there were two ways of treating falling out hair, surgical one and non-surgical. Non-surgical methods consisted in suiting a wig. However, I crossed it out of my list at the very beginning. I was interested in the surgical method. I found a few addresses of the clinics where the surgeries of hair transplant from the anterior region of the head and back area, were performed. Driven by my curiosity and slightly being under my friends’ influence, I scheduled for the first visit with a surgeon who dealt with hair transplants. During the visit I explained the reasons of my coming and I suggested the possibility of female balding in my family. The doctor after having examined my hair carefully, could evaluate its density and the number of bald places as well as how a possible surgery could be performed. The consultation lasted almost hour. It was then when, I also found out what the most common reasons of balding were and what the possibilities of surgical treatment I could undergo. First, I needed to know whether my baldness was not due to some endocrynological disorders or even the tumor of the pituitatry gland or the adrenal glands. I was directed to the endocrynologist’s. The surgeon assured me that if he excluded the diseases of the hormonal system, I could count on the help of the surgeon. Eagerly or not, I went to the endocrynologist’s. I had my blood tested in various periods of the cycle. Eventually, it turned out that my hormonal system functioned properly, and the reason should have been searched for in some other areas. Having such a diagnosis I came back to the clinic. There I found out that it was necessary to have 1500 hair transplanted during the first surgery. After six months when my hair would start growing another surgery might have been taken into consideration to obtain a maximal density of hair. I left the clinic very happy. There was a ray of hope that my problem would disappear. If I underwent such a surgery, I would enjoy again beautiful hair. Maybe not as thick as before but at least not as thin as now. Hmmmmm. I needed to think it over. However, the vision of my hair, few and far between, in the mirror helped me to make up my mind.
I called the clinic next morning and I scheduled the appointment. Before the deadline, I had to have my blood tested and vaccinate against hepatitis and follow every instruction the doctor gave me. One week before the surgery I could not take aspirin and two days before I could not drink any coffee and smoke. All night before the surgery I could not sleep. I was so excited. In the morning I went by car to the clinic’s gate. I was accommodated in a 2-bed room with a bathroom. I was the only woman operated on that day. One hour later I was in the operating room. The surgery was performed by the surgeon known by me earlier. He was accompanied by two nurses, namely theater nurses. The only thing I remember was a nice music, atmosphere and a few tender tappings in the head skin in order to have anesthetic injected. Afterwards I had an evening off. ‘Fear has big eyes’, it is very much so. Before I entered the operating room I was really scared. First of all, I was afraid of the pain and unpleasant experience, but, on the other hand, I was not 100% sure of the results.
Next day the dressing was taken off. The sight was not nice. Among my hair I noticed numerous little red eschars. In the anterior part of my head I could feel slight pain and tension. So, I comb my hair so that no signs of the operation were visible. I even wrapped a scarf around my head and I went home.
The next few days were horrible. Not because of the pain but the swelling on my forehead and eyelids. I looked as if I got several punches from my husband. Fortunately, I could afford not going out for a week. One week passed and the swelling disappeared. After seven days I went again to the clinic for a visit control and to have the stitches taken off from the back region of my head. The eschars were slightly visible, but few days later there were less and less of them. After several days all the eschars fell out and I looked as before the surgery. I started even bothering that the transplants would not be tolerated and the surgery would not succeed. According to the doctor’s instructions, I tried to be patient. And it paid off. After three months the skin of my head was not so much visible. Of course, I needed to wait longer until my hair grew but still the results were already visible. I was extremely happy like a little kid. So, to celebrate my success, my husband and I drank the whole bottle of champagne.
Six months passed. My new hair grew as fast as the rest. I even went to the hairdresser to have it cut. I wondered whether my hairdresser would realize that I was after hair transplantation. But he didn’t notice anything. I felt wonderful. So, once again I went to the clinic. After having examined my hair, the doctor suggested one more surgery with 1500 hair transplants. Thanks to it, I would have more hair on my head. This time I agreed without any hesitation. The second surgery was similar to the first one. It was only me who was calmer and more confident as far as the method was concerned.
Two years have passed since that Saturday sunny morning when after the second surgery I left the clinic. Maybe I don’t have as dense hair as before but my hair grow very nice. I even change the haircut in the meantime. I have slightly longer hair up to my shoulders, and my hair is not a problem for me anymore. I am even not afraid of some curious glances and a despaired look of my hairdresser asking me what he should do with so little hair on my head. Now, I don’t hide my head under a scarf or cap. The most important for me is my good mood and my mental state which improved significantly. Who would think that balding is just a men’s problem?
The treatment of alopecia in the case of women – a different matter
The person who thinks that baldness is a typically male problem can never be more wrong. Indeed, baldness refers to males to a large extend. However, a balding man is commonly accepted by a society. The situation of women is much worse. Women, if they do not have hair, are not accepted by their surrounding environment, and consequently, those who are suffering from it are forced to hide the defect. Many times the only solution left is wearing a wig. However, it usually happens that baldness is not total and it is usually limited to some loss of hair in the region of the head vertex, with hair remaining in the forehead line. A well trained hairdresser may be of good help. However, more often balding women look for surgical help.
Surgical treatment of baldness in the case of women should be treated differently. Although balding can be one of the symptoms of a very serious diseases, most often it is connected with the hormonal system. For this reason, while qualifying a patient to a particular treatment such factors are taken into consideration as the symptoms which suggest some disorders in the system. The following data are extremely important:
- First period
- Regularity of menstruation
- Undergone deliveries and miscarriages
- Taking contraceptives and other hormonal medications
- Family history in terms of balding (especially in a woman’s line)
- The dependence of intensive balding on undergone deliveries
While the patient is examined, such issues as abnormal hair in the region of the face, chest and hypogastrium are taken into account. Also the condition of the thyroid gland is tested. In some justified cases endocrynological examination is recommended which estimates the level and proportions of sex hormones (oestrogen and androgen) especially when balding occurs for just a few years, i.e. it started clearly in a certain period of time and was connected with menstruation disorders. The confirmation of disorders in the hormonal system obligates the patient to its treatment first, and afterwards the treatment of balding should be applied. However, most often the treatment of the hormonal system diseases improves the condition of hair on the head.
The exclusion of hormonal disorders allows to prescribe some surgical treatment. It is performed similarly to the one in the case of men, however, also here there are some differences.
A female hair line differs a lot from the male one. In the case of women hair cover not only the majority of the forehead region but also a greater part of the temples. While covering those regions with transplants, such factors as the direction and angle of growing hair are taken into account. So, only transplants which contain single hair are used here. It requires using a special microsurgical technique by means of needles.
The treatment repeated many times comes down to make the thinner region of the peak of the head more dense. Also here a precision in making cuts plays an important role. It is important not to damage hair growing nearby. Usually before the surgery and just afterwards 2% of solution of Minoxidil is administered to prevent balding after the surgery (telogen efluvium).
In the case of operating scars (postrinjuries and postburn) the procedure is similar to the one in the case of children. Expanders, skin lobes and hair transplants are used here.
After hair transplantation surgery, the swelling of the forehead usually takes place. It remains usually from the second up to the fifth day after the surgery. However, using cold compresses may be a great relief. In order to improve the cosmetic effect, it is advisable to have a haircut done by a specialist and dying hair light colors.
A full understanding of women’s nature dissimilarity and taking into consideration the differences in the surgery and postoperational treatment allows to avoid operating those women at whom balding is just a symptom of another serious disease of the hormonal system.
Obtained good cosmetic effects of the treatment satisfy not only a doctor but also a patient.
Jerzy Kolasiński, M.D. Ph.D.
Hair reconstruction surgeries in the case of children
Loss of hair on the head is a horrible experience for children. It is the result of children’s personality as well as the environment around them which shows less tolerance in comparison to the adults environment. The case of a kid without hair in some parts of his/her head happens irrespectively of sex. It also differentiates this group of patients from the adult one as adult men with no hair are commonly accepted.
The main causes of hair loss in the case children are as follows; birth defects, perinatal injuries such as perinatal haematoma, mechanical injuries, termal and chemical burns, postoperative scars and radiation caused by roentgen rays during treatment therapy of the central nervous system cancer and leukaemia.
While correcting the loss of hair on a kid’s head, there are some operational techniques used most often such as straight excision, the excision together with the covering of the bald region by means of skin lobes, stretching hairy skin by means of expanders and forming the lobes by means of the stretched hairy skin as well as autogenic transplant of hair follicles.
While taking into consideration the application of proper techniques in the corrective treatment, a lot of factors are considered. One of the most important ones is the size and the character of the loss. Also dissimilarity of a child’s skin is taken into account. It is thinner, more flexible and susceptible to stretching. It facilitates, on the one hand, the use of expanders, but, on the other hand, it makes the postoperative scars wider due to stretching in the period of reconstruction. Moreover, children’s hair is thinner, and adipose tissue in the region of a kid’s head is poorer. The kid’s skin is well blooded which facilitates the performance of various surgeries in this region.
A little patient’s personality is also different. Children are usually more sensitive to pain. Hence, there is the necessity to use a general anesthetic during the surgery. Moreover, a kid is a more demanding patient, so gaining its trust requires more efforts on the part of the doctor.
In the case of multifocal loss of hair or considerable thin hair, the autogenic implant of hair follicles is applied. In order to get the transplant, a strip of skin of the width of 1 cm and the length depending on the presumed number of grafts (7-12cm) is taken from the back region of the head. Then, by means of triple enlargement, the transplants containing 1-2 pieces of hair (micrografts) or 3-4 (minigrafts) pieces of hair are prepared. The grafts are inserted into microexcisons made in the recipient region. The most precise and, at the same time, the fastest technique of transplant performance is the method called „four hands stick and place” worked by Hair Clinic Poznań.
In the case of massive regions deprived of hair, the treatment with the use of expanders is administered supported in some cases by autogenic transplant of hair follicles. During the first surgery, an expander is inserted under the hairy skin in the region of a scar. It is an implant in the form of an empty ‘bag’ connected with a valve which enables tapping many times. Two weeks after the first surgery, physiological solution is injected by the tap of the valve. The stretch of the expander to the required volume makes the hairy skin stretch over the implant. The second surgery consists in excision of the loss (scar or baldness) and covering it with the lobes of the stretched hairy skin.
The loss of hair in the case of children is most often caused by external factors such as injury, burn or radiation. The loss of hair is the cause of not only cosmetic defect, but also contributes to a deep psychological trauma.
The corrective treatment should be performed in such cases as early as possible before some permanent changes in a kid’s psyche happen.
Jerzy Kolasiński, M.D. Ph.D.
Hair transplantation in the treatment of baldness after radiation
Tumors in the case of children are most often the second (after accidents and injuries) cause of death from the age of 1-14. Leukeamia and tumors of the central nerve system constitute about 50% of all the tumor cases at children.
Associated treatment consists in surgical treatment, radiotherapy and chemotherapy. In many cases this type of treatment is effective and allows to obtain a high rate of survival in the case of little patients.
However, lasting baldness of the hairy region of the head is very often a result of radiation.
At the beginning of radiotherapy, balding encompasses the majority of the head. After the end of the treatment hair grows partially. However, there are still some regions of the head which are deprived of hair for ever. It constitutes a serious cosmetic defect, which many times, influences negatively the psyche of a little child.
One of the most effective ways to treat postradiation baldness is autogenic transplant of hair follicles.
It was Norman Orentreich, an American dermatologist, who as the first in the world suggested the treatment of baldness by means of autogenic transplant of hair follicles in the year 1959. The main assumption of the method was the conviction that hairy skin of the head from the regions of the back does not undergo balding and, moved into the regions of the skin that are bald, maintains its original features resulting in hair growth. Many clinical experiments confirmed the validity of the thesis. In the very first stage of using this method, the grafts had the diameter of 4-5 mm. Even though the obtained effect of hair growth was good, there was much left as far as cosmetic effect was concerned. Hair grew in convergence bringing about unnatural look. In order to improve the cosmetic effect, Rolf Nordstrőm from Finland as the first suggested in the year 1981 the use of micrografts containing 1-3 pieces of hair. Thanks to such little transplants, the cosmetic effect improved significantly, especially, in the region of forehead line. In 1986 Carlos Uebel from Brazil started performing massive operations using 1000 micrografts. The technique gained its popularity in the second half of the 90s. Right now, the standard is to use 1500-3000 micro- and minigrafts. Most often the treatment is applied in the case of androgenic balding of women and men. A well learnt technique allowed to administer the autogenic transplant of hair follicles in the treatment of postinjuries and postradiation balding. It is usually performed in advanced stages of baldness.
Due to the postradiation changes in the region of head skin in the form of endogenous growth of collagen and damage of bloodness it is recommended to use some modifications of the transplant hair surgery. The number of performed grafts should be lowered during one surgery and larger distance should be kept between the grafts, i.e. 1-1,5 mm. It allows to have 30-40 grafts per square cm.
In the case of baldness after radiotherapy, the density does not exceed 15-20 grafts per square cm. When there is a necessity to cover with the grafts huge areas of the head, then it is performed in stages, placing the grafts concentrationally from the perimeter to the central part of the baldness. A few months long breaks should be kept between the surgeries.
The care of having special asepsis during the performance of the hair transplant surgery is extremely important especially in the case of patients after radiotherapy. Worse bloodness of the hairy regions of the head results in their greater susceptibility to various infections. Antibiotics prophylactic is also important.
The time of performing hair transplantation operation is also crucial. It is commonly known that the viability of the grafts lowers 4 hours from the moment of their taking. The four hands stick and place technique worked out in Hair Clinic Poznań allows to shorten maximally the most time consuming stage of the operation, namely insertion of the grafts into the regions of baldness.
It consists in the immediate insertion of the grafts in the incised places. It allows to make the size of incision more precise and prevents from inserting two grafts into one cut.
The growth of hair in the case of patients after radiotherapy occurs later than in the case of patients who suffer from androgenous baldness, respectively 4-5 months and 3 months. It is probably due to worse bloodness of the recipient region. So, it requires greater patience on the part of a doctor and patient.
A properly performed surgery of hair transplant in the case of patients suffering from postradiation baldness allows to obtain good results and sometimes even very good cosmetic effects. Not only does a patient’s appearance improves, but also his/her psychological state. It is of great influence on the comfort of their lives.
Jerzy Kolasiński, M.D. Ph.D.
Reconstruction surgery of eyebrows and lower lip hair
Autogenic transplant of hair follicles is mostly used in the reconstruction of hair loss on the head skin. Baldness is most often caused by the so called autogenic typical of male balding that occurs both in the case of men and women. The loss of eyebrow and upper lip hair takes place very rarely. The most often reason of the lack of hair in those regions is an injury, for example a chemical one, like burning or mechanical one, for instance, accident with numerous face scars, too often extraction of eyebrow hair by women or remaining scars after cleft palate or harelip surgeries.
A skin scar does not contain in its structure the elements characteristic of healthy skin, namely, does not contain hair follicles.
In order to reconstruct hair in the region of eyebrows or moustache, a surgery, similar to the transplant of hair in the region of the hairy head, is performed. The technique of the surgery performed under a local anesthetic consists in extraction of a hairy skin strip from the back region. The strip is next cut into smaller pieces which contain single hair follicles (called micrografts). Then, in the regions into which we want to insert the graft, slight incisions are made, modeling at the same time a proper angle and the direction of new hair growth. Next, the obtained micrografts are inserted by means of very little tools. Usually, the scar skin itself is very hard and every tap is connected with pushing out the grafts which have already been inserted. So, delicacy is really important is such surgeries as well as precision and huge patience of the operator. Many surgeons may ask whether a transplanted skin in scar tissue is tolerated. Certainly, it is. The main condition, however, is inserting the grafts in proper distance. Thus, the necessity arrives to perform several surgeries in the same region. Every surgery finishes with a dressing on the donor and recipient areas. The patients usually stay in clinic for 24 hours. Next day morning, the dressing is taken off, and the patient may come back home without the dressing. For the following few days, the aftercare of the two regions, donor and recipient ones consists in bathing the places with spirit and spraying them with an antibiotics according to the doctor’s prescriptions. In the place of transplanted hair follicles little eschares are visible. After one week it is required to pay a control visit in the clinic. The stitches need to be taken out from the back region of the head and the evaluation of the operated places should be made. The eschares peel off after 10-12 days and from now on, one should wait patiently for hair to grow. It will appear on the skin surface three months later. In the case of injury scars or postoperational ones, the period of waiting for hair growth is sometimes slightly longer.
Małgorzata Kolenda, M.D. Ph.D.