Okuda, a Japanese dermatologist, in 1939 performed the first hair transplant on male pattern baldness. Unfortunately, he was killed in the war and his work, which was published in a Japanese journal, was overlooked and not discovered until 1970 by a German physician. In the meantime, Norman Orentreich, a New York dermatologist, independently and quite by accident, while studying the transfer of various skin diseases from one portion of the body to another, found that hair-bearing grafts could be used in the treatment of male pattern baldness. His work was published in 1958, and since that time hair transplantation has become the most common cosmetic surgical procedure performed on males.
Principle of Male Pattern Baldness
Male pattern baldness is caused by the interaction of three factors: (1) genetic predisposition (heredity), (2) male hormones (testosterone), and (3) time or age. All three factors must be present. Females do not develop male pattern baldness because they do not have enough testosterone. Eunuchs castrated prepubertally likewise lack testosterone, so they do not become bald. However, if a genetically predisposed female or genetically predisposed eunuch is given testosterone later on in life, the same degree of baldness that the person would have had if he or she been a normal male develops rapidly, within a few months.
Time or age is obviously a factor, because baldness increases with age in normal males. The genetic key is apparently contained within the hair follicle and has nothing to do with the blood or nerve supply. Consequently, the hair follicles on top of the scalp in a genetically predisposed male are going to fall out no matter where they are, as long as they are on the same person and have an adequate blood supply. The fact or principle is what makes the hair transplant procedure possible.
Hair transplantation is simply transplanting hair-bearing skin from the sides of the scalp to bald or balding areas on top. These grafts with their hair survive, grow, and maintain the same characteristics as they did in their old location.
Medical therapy of male pattern baldness has recently received a lot of attention because some high blood pressure medications have been found to contain some anti-male hormone or anti-testosterone effects. Current research is attempting to develop a medication that will block the action of testosterone on the hair follicles without affecting its other beneficial masculinizing properties.
Required Time for the Procedure
Hair transplantation is a multi-stage procedure. It usually requires four separate sessions to get enough hair in the area for good coverage. Some patients will require more sessions, some will require less. Critical areas, such as the hairline, may require as many as six or seven sessions to get a thick, natural-appearing hairline. On the other hand, areas that are easily concealed may only require one session of grafting.
The first two sessions in an area can be as close as one month apart, but subsequent sessions should be separated by at least three months. This allows the hair to grow between sessions so the grafts can be used more efficiently. In addition, having the hair growing reduces the risk of cutting out previously placed grafts.
In actual practice, because there are so many factors involved, it is difficult to give the patient a precise estimate of the time required for completion. Detailed explanations, just serve to confuse the patient. It is usually best to keep the discussion as simple as possible. Advise the patient only that it is a multi-stage procedure with certain requirements as to sequence and frequency, and that it usually takes about one year for completion.
Cost of the Procedure
The cost of the procedure should be discussed with the patient. Generally, the fee is based on cost per graft. Some Surgeons base their fee at the time required for each session and set their fees at the beginning based on the probable number of grafts required.
Since hair transplantation is a cosmetic procedure, most Surgeons expect payment in advance or at the time of surgery.
Because there are so many variables, it is impossible to predict the final result. Each patient should be given a realistic idea of what to expect. It is easy to oversell surgery to young balding males who are observed with hair loss. If they are overeager and examination reveals that they may have a marginal result, they should be repeatedly warned that the hair will be thin and possibly tufted will not appear natural, and will require careful styling.
If patient realizes this prior to surgery and does not expect miracles, they are more apt to be satisfied. If they are expecting too much, they will not be satisfied even with a good result.