Using hair transplants for male baldness

JAKARTA (JP): What a shock to look in the mirror and see the area of thin hair on the top of your head is widening and getting thinner! What can you do to stop the process?

Surveys show that 1.5 percent of men experience male pattern baldness (MPB). They are men who inherit the trait from their parents and the hair loss occurs when they have reached the age of 40 years or older.

"It is proven that the male sex hormone, in this case androgen, plays a role in male baldness," said a dermatologist and veneorologist at Persahabatan Hospital, Adityawarman, during a discussion held by the study group of the Indonesian Skin Surgery and the Jakarta Skin Center last week.

However, he pointed out that androgen-related baldness was not strictly a male problem, and could also occur in women with high levels of male sex hormones, a condition called adrenal virilism.

Adityawarman explained that this type of baldness only caused hair loss in specific areas on the scalp, which include the frontal area (forehead), occipital (the back part of the head), temporal (the sides of the skull) and the vertex (top of the head).

"Doctors still cannot explain why baldness occurs only in those particular areas of the scalp," he said.

To remedy the condition, Adityawarman said a hair transplant, a procedure that requires taking hair grafts from other parts of the scalp to be transplanted to the affected areas, could be performed to cover the bald spots.

"With this procedure, the hair will grow the way it did in its original areas (donor areas); its growth is not determined by the location where it is implanted," Adityawarman said.

Patients suitable for this procedure are those between the ages of 20 and 40 who are in good health.

People with diabetes mellitus, hypertension, diatesis bleeding, drug allergies, cardiovascular problems or scalp problems such as dermatitis seboroic and recurrent foliculitic are not eligible for the procedure.

Adityawarman underlined the importance of giving patients adequate information about the procedure, including the techniques employed, duration and possible complications during and after the procedure.

Patients should be informed in advance about possible complications like bleeding, infection, edema (accumulation of fluid in cavity or connective tissue) and pigment irregularity.

There are also standard esthetics that should be followed by doctors to make sure that the results of the procedure look natural.

"Patients may be unaware that the human face is naturally divided into three parts, each accounting for one-third of the total face. The first third is the span between the hairline and the glabella area, the second is between the glabella and subnasale and the remaining is between the subnasale and menton.

"We will explain this to the patients so they will not ask for the transplant to cover wider areas than the proportional standard. That would look unnatural," he said.

Doctors will likely turn away patients who have mental problems, are depressed and those with unrealistic demands, he said.

As for the procedure itself, Adityawarman mentioned five considerations before the doctor performs the transplant. These considerations include hair color, because gray hair is hardly visible; type of hair, as curly hair is more difficult to transplant; and hair thickness, because thick hair is preferred for transplanting.

The procedure begins with the administering of anesthetics to both the donor and recipient areas of the scalp. The doctor will then perform either a standard graft, which requires four- millimeter-deep punches to the donor area; a minigraft, using a multiple blade knife to take three to eight hairs; or a micrograft to take one to two hairs. The graft is then stored on a hygienic plate soaked with saline solution. The punched gaps on the donor areas are closed with a glycolate absorbable thread or polydiaxone subcuticular and prolene.

The grafted hairs are then cleansed, with foreign particles carefully removed without damaging the delicate layer of natural oil.

The doctor will then make slits or holes where these hairs are to be implanted. The hair fragments are then inserted according to the direction of hair growth.

"A combination of punch graft and minigraft/micrograft will give a natural look," he said.

After the hair implant, the scalp will be covered with a kling bandage for the next 12 to 18 hours to secure the grafted hairs in place.

"After day three or four, the graft locations will start to heal and on day 10 to 14, the stitches in the donor areas can be removed," he said.

Transplanted hairs will shed within several months but will regrow in the third month at a pace of three to five millimeters a month.

"The end result will show 12 to 18 months after the procedure," he said.

There are cases where the grafted areas end up with a perforated finish after recovery. "This can be overcome by dermabrasion or electrodesiccation to smoothen the perforated areas," he explained. (lup)