Many previous theories regarding causes hair loss have been disproven, including poor scalp circulation, vitamin deficiency, dandruff, and frequently wearing hats. The idea that hair loss is passed genetically from the maternal grandfather is also untrue.
Successful treatment partly depends on the initial cause and severity of the hair loss. Some patients benefit from frequent washing, while others benefit from systemic steroids or hormones, application of ointments, tar preparations, and antibiotic ointments.
The two medications proven in clinical trials to stop hair loss and regrow new hair are Rogaine (minoxidil) and Propecia (finasteride). Rogaine is applied directly to the scalp and functions directly on the hair follicles. It can be used in male and female hair loss, and is available without a prescription. The most common side effects are itching, scaling, and irritation.
Propecia comes in pill form and acts by interfering with the production of dihydrotestosterone (DHT), which has been shown to be elevated in many men with male pattern hair loss. The medication comes as a pill, requires a prescription, and is not approved for use in women. Impotence, reduced sexual drive, and reduced sperm counts have each been seen in fewer than 2% of patients. Prostate specific antigen (PSA) levels, a marker for prostate cancer, can also be altered.
Hair replacement techniques use the patients' own hair, making healthy hair growth in "donor" areas such as the back and sides of the head necessary. Other factors such as hair color, texture, and shape can affect the cosmetic result. Several types of replacement techniques exist, and often multiple techniques are used in a single patient. These include transplant techniques, flaps, tissue-expansion, and scalp reduction.
Transplant techniques include punch grafts, minigrafts, micrografts, slit grafts, and strip grafts. These are helpful in patients desiring a more modest change in hair fullness, or in conjunction with other techniques. Traditional punch grafts are about the size of a pencil eraser. Mini- and micro-grafts are newer modifications that move as few as one or two hairs with the transplanted grafts (usually several hundred per session). These grafts are more tedious and time consuming, but can provide a more natural appearing hairline. With all of these techniques, several surgery sessions are normally required to reach the final result, with a healing period of several weeks to months between each session. The length of the sessions vary depending on the amount of grafts used, but often requires about 2 to 3 hours. It may take up to a few years to achieve the final result. Surgical touchups are common.
