Never before have I thought that I might have problems with balding. When I was young a student of high school, I noticed slight receding hairlines at my friends. My father whereas had some thinning places in the forehead region and on the top of his head. However, I have always had thick hair. Then I thought that this problem would never concern me.
After my final exams in high school, I started studies at the Technical University in Poznań in the Department of Computer Science as computers have always been my passion. During the studies I experienced a lot of stressful situations connected with the exams and hard studying. I eat irregularly and suffered from insufficient amount of sleep. It was not until the third year that I had a little more free time. I met then a wonderful girl and I wanted her to like me. I started going regularly to the hairdresser to have my hair always cut shortly Afterwards I could model it with a small amount of gel so it didn,t give the impression of a chaos. I also used very good perfumes. I could afford them as I gave private classes on mathematics and computer science. A part time job I took up in my father,s company helped me to save some pocket money for a cinema or coffee with my beloved. So, the months passed happily. Unfortunately, once I noticed that my hair was thinning in the region of the hairlines and the forehead. I was then 23 years old and I did get worried. I asked my father about the history of balding in his case and what our grandparents, who I didn,t have a chance to meet, looked like. I heard then that the problem of balding concerned every male in my family. All of them went bald similarly. First, it was only in the region of the hairlines and then in the region of the forehead and the top of the head. The good thing was that none of them was as bald as a coot, which comforted me somehow.
Since then I started taking care of my haircut. I bought a set of shampoos against balding, conditioners and special ampoules with Minoxidil to be rubbed in the skin of my head for the following 40 days. Was it enough? I didn,t know. I just had the feeling that I did my utmost to prevent balding.
A few years more passed. I graduated from my school, got married. My two wonderful daughters were born. I also had a good, responsible and quite a well-paid job. I did not complain about the lack of things to do, contrarily, my family more often accused me of having no time for them. I decided to slow down a little and take care more of my daughters. I also found some free time for myself. One day after having washed my hair I noticed with a worry that a lot of my hair left in the bath. It must be spring, I thought. My hair was always slightly weak at the beginning of spring so it simply fell out more than usually. The following warm months, proper diet enriched with huge amount of fresh vegetables and fruits slowed down this process and resulted in strengthening of the skin. This time, however, I decided not to wait and buy a set of vitamins. Our market is abundant in such medications. I comforted myself that as soon as I balanced the level of vitamins everything would come back to the original state. Soon, summer came. We spent summer vacation at the seaside and in the mountains. My girls also went to summer sports camps with their friends as both swam pretty good. We spent a few days at my parent’s-in-law forester,s lodge at the end of summer. Forest, fresh air, contact with nature resulted in forgetting about all my problems either professional or health ones. I even forgot about the problem of my hair.
When I came back to work, the amount of responsibilities and matters to deal with resulted in a huge level of stress I was exposed to and consequently the problem of balding came back. Unfortunately I had an impression that I had much less hair on my head than before the vacations. The hairline enlarged significantly as well as the skin started to show through in the region of the forehead and the top of my head. The only unchanged passages were the regions of the temple and occipital. What should I do?, I thought. I was then 35 years old. I felt young and I wanted to look young. One autumn evening I sat down at my computer and started browsing the websites in search of some information on balding and the ways of its treatment. I thought about new shampoos and conditioners as those that I used for many years seemed not to work any more. The vitamins also did not appear to be effective. I visited many websites and found some information on surgical treatment of baldness consisting in moving the hair from the occipital region so where the hair does not fall out in the bald regions of thin ones. I decided to read more about this problem. On the website of one of the clinics that dealt with such surgeries I had the opportunity to ask questions anonymously on line. I did it. Without giving my name I ask a few embarrassing questions. Next day I received the answer. I was informed that it was difficult to estimate whether I was right person to undergo the surgery and how many hair drafts I needed and what the price of the surgery would be. I was invited for a consultations with a surgeon. I decided to go there. Earlier I discussed everything with my wife who fully supported my idea. One afternoon I arrived at the clinic. Some people were already waiting in the waiting room. The lady at the reception desk gave me a leaflet and a brochure and she told me I was the third in the line. I waited patiently and 30 minutes later I was in the doctor,s office. The room did not resemble a traditional doctor,s office at all. It helped me to relax. The doctor examined my hair, ask my age and about the process of balding as well as similar cases in my family. The premises pointed genetic background of my balding. He also told me about the surgery, the number of grafts I needed to cover the whole thinning surface to obtain thick hair and how to schedule the appointments. He also prescribed me some medications that prevent hair follicles to fall out. They were some hormonal tablets which influenced male hormone metabolism and by the same token blocked hair receptors and prevented their falling out. He claimed that I was still a young man and the medications would not imbalance the level of hormones or change anything in my libido. Certainly, they would slow down the process of hair falling out especially in the central and top region. As I was going for the consultations with the intension of undergoing the surgery I decided on it at once.
After several weeks the deadline came and on the appointed day I arrived at the clinic in the morning. The service was extremely friendly so I did not feel as in an hospital. The surgery was to take place in the afternoon so I had some time to catch on reading papers. In the theater room my blood pressure was measured. It turned out to be slightly higher because of my excitement. In the first stage of the surgery I was lying on my stomach, then in some more comfortable reclining position. The injections were the worst part of the surgery but still I think that I was brave enough. To be honest I thought they would be more painful. The surgery was performed under a local anesthetic so I could listen to music and chat a little with the doctor during the surgery. I also had the feeling that I napped a while. After three hours I came back to my room. I ate dinner and I had the time only for relaxing. I had a dressing on my head that was taken off next day. After my breakfast during another meeting with the doctor, he explained me what I should do for the following days. I knew I could look horrible because of the swelling of the forehead and numerous scabs so I took two weeks off in advance. I came back home and all three girls looked interestingly at my cut skin head. Next day my forehead was swollen very much. I started using the cold compresses recommended by the doctor. Unfortunately, they did not help much. The swelling went lower to my eyes and I could hardly open my eyes. After three days everything was like before. Then I could wash my hair for the first time. It was the greatest relief for me. After one week I came back to the clinic for a control visit. The itches put in the taking place were taken off. After several days later all the scabs and little hair fell out. At that moment I looked exactly like before the surgery, quite normal. I needed to wait patiently until hair follicles appear on the surface of the skin.
These were the hardest three month in my life ever. How shall I wait patiently?, I thought. However my family and professional duties made the time pass quickly. One evening when I took a look into the mirror I noticed that something started to germinate, and I was not wrong. My hair started growing. After three more months they were 3 cm long and I could go to the hairdresser to have my luxuriant hair cut.
A non-balding person has about 100 up to 140 thousands growing hairs in the region of the hairy skin of the head. Their number depends on the thickness and color of the hair. Every hair usually grows about 1 cm a month and every day we lose about 50-100 hairs. Every hair undergoes three stages of its life: anagen, namely the period of growth, catagen, the transitional period and telogen, the time of rest. Properly when one hair falls out another one grows in its place and the whole cycle repeats. However, when more than 100 hairs fall out a day and, additionally, no new hair appears it is an alert state. The most frequent cause of balding is androgenic balding that concerns about 80% of men. It is genetically conditioned and passed down from one male generation to another. The beginning phase of balding consists in drawing back the forehead and temple line as well as gradual enlarging of hairlines. Next, the so called central balding appears on the top of the head. Usually these are male hormones, namely androgens whose main representative of is testosterone, which are responsible for this process. The hormone undergoes a transformation in blood under the influence of 5-alfa-reductase enzyme, and it changes into dihydrotestosterone (DHT), which consequently results in the disappearance of hair follicles with falling out of hair. Fortunately, not every hair follicle is susceptible to this substance, especially those situated around the head, namely in the occipital and temple region. In the population of white people balding concerns about 30% of men at the age of 30 and 50% of men at the age of 50. It is a long-lasting process and lasts from 15-25 years, in some extreme cases just 5 years. Within one year a balding man usually loses about 5% of his hair. The loss of hair is very often considered something negative by the man himself as well as other people. It results in deterioration of psychological condition, the feeling of low self-attractiveness, lowered self-esteem and sometimes even depression. It is commonly believed that balding man succeeds less in professional and private life.
There are many liquids and shampoos available on the market preventing hair falling out and influencing hair growth. Let us remember, however, that hair is a dead product of hair follicle and no substance applied externally is able to block the process of its falling out. Hence, all those medications are ineffective in baldness treatment.
Hair loss are most often corrected by means of various hairpieces and wigs. In numerous hair salons there is a tendency to promote the fashion of hair thickening and prolonging by adding artificial hair. Unfortunately, not only does it not give a positive result but also destroys, weakens and mechanically damages still growing hair. If one wants to take advantage of wigs or hairpieces, it is recommended to shave head to glue and adjust properly the wig to the head. Certainly, it is a solution but only in extreme cases when surgical treatment is impossible. Thanks to modern techniques, artificial hair can be adjusted to the rest of the hair very well by choosing proper color and thickness.
The only permanent and natural way of baldness correction is surgical treatment consisting in filling in non-hairy head regions by means of hair grafts.
The technique of moving some fragments of skin head containing hair follicles has been known for over 100 years. It was first mentioned in 1822 when Dieffenbach published experimental transplantation of animal fur and goose leathers. Te first surgery of hair graft was performed by a Japanese doctor Okuda in the year 1939. The inventor of today practised method was an American dermatologist Norman Orentreich whose papers were published in the 50s of 20thc. At the beginning the method called punch-technique was used, however, it left some skin irregularities and hair tufts that resulted in a very unnatural esthetic look. It was then replaced by micro and macro grafts proposed in the year 1981 by Rolf Nordtröm. In the year 1984 Headington as the first defined the technique and since 1990 many others (Limmer, Rassman, Shapiro, Bernstein) made the technique and the notion of follicular units popular.
The surgical treatment of balding consists in taking a sample of a hairy skin from the occiput region, proper preparation of micro and macro grafts containing single follicular units and next inserting those skin fragments into the regions where there is no hair or where hair is thin. All the operational stages are performed under a local anesthetic and only in exceptional cases especially in the case of children under a general unaesthetic. The skin fragment taken from the posterior part of the head can be a single strip 1-1,5cm long or consist of a few thin strips or little rollers obtained by means of punch-technique. During the recent years the FUE method (follicular unit extraction) has been gaining popularity. The technique consists in taking little fragments of hairy skin which contains single follicular units. The popularizers of this method are delighted with this technique, however, it has many limitations. It is usually applied in the case of young people at whom only the hairlines are thinning since the maximal number of grafts amounts to 500-600 during one surgery. The advantage is that instead of one horizontal few centimeters long scar in the posterior part of the head, there are several little scars. The method allows to have hair cut very shortly in the posterior region of the head which is quite popular among young men those days. The surgery based on this technique usually lasts 2-3 times longer than the traditional method and it is connected with higher costs.
Hair Clinic Poznań, which exists over 20 years has developed new technique of inserting grafts. It is widely recommended technique by Kolasiński M.D. called Four Hands Stick and Place. The method consists in inserting grafts in tiny skin cuts directly after they were created. Thanks to this technique it is possible to adjust more precisely the size of the cut to the diameter of the graft. Two surgeons work simultaneously using their two hands, which certainly shortens the time of surgery and a patient does not need a long-lasting unaesthetic. This perfect technique saves many hours spent on the operational table and is the fastest way of performing hair transplantation in the world.
In such a surgical treatment, it is extremely important that the patient,s expectations are adjusted to the technical possibilities and esthetic taste of the surgeon performing the surgery. During preliminary consultations the number of grafts should be estimated, their placement as well as plan carefully the front line of hair. While drawing up this line, individual features of face should be taken into consideration such as the height and width of the forehead, eyes distance, color and thickness of hair and the difference between the color of hair and skin. The grafts in the recipient region are inserted with a 1-1,5 mm space between them. It assures a proper healing but not always the needed thickness. So, usually the second surgery is needed in the same region so that the final thickness was satisfying. In the case of huge non-hairy areas, it is possible to perform several surgeries usually connected with scalp reduction. Nowadays the patients are offered to undergo huge sessions during which even 3000 grafts are taken. Such a surgery requires a huge ability on the part of the surgeons and right now not many clinics in the world are able to perform it. Hair Clinic Poznań is among those few and far between that perform the surgery.
For some time many surgeons dealing with hair surgeries recommend supplementing the therapy with some medications taken orally. In 1998 in the United States an oral medication called Propecia, i.e. Finasteride was introduced. Right now it is registered in 53 countries and the recommended dose is 1 mg daily. It is a hormonal medicine applied prescribed only men in the cases of treating androgenic balding. The aim of the medication is to block testosterone transformation to its metabolite, dihydrotestosterone (DHT). DHT prolongs the telogene phase and shortens anagenic one, i.e. the growth phase resulting in disappearance of hair follicle. The MSD Company producing Propecia recommends application of the pills in a constant way and the effect is visible after three months.
The future can belong to mother cells. During the recent years they have been mentioned more and more often in plastic and reconstructive surgery. If they are present in the skin, they stimulate the development of epidermis cells, sebaceous and sweat glands as well as hair follicles. Numerous growth factors present in the skin facilitate their growth and stimulate all elements of human hair to grow as well as its cyclic transformations. There seems to be a ray of hope in genetic and tissue engineering. It will allow in the future to find a suitable key to mother cells and stimulate them in such a way so that it would result not only in their unlimited development but also control of their growth in the regions with no hair.
In Poland the first hair transplantation surgery was performed by Jerzy Kolasiński in the year 1984. His first experiment was described during a symposium in Wroclaw in 1988. Dr Kolasiński belongs to the best surgeons in the world who deal with the problem of balding and its surgical treatment. He is invited to many countries to lecture, guide courses and train many doctors during workshops in various parts of the world. In the clinic he works in a team consisting of people together with Małgorzata Kolenda and Wojciech Zieliński.
Małgorzata Kolenda M.D., Ph.D.