Dr. Ken Williams of The Irvine Institute of Medicine & Cosmetic Surgery was honored to attend and speak at the 21st Annual State-of-the-Art in Facial Aesthetics 2013 conference sponsored by the Foundation for Facial Aesthetic Surgery. The conference was held on March 20-24, 2013 at the Intercontinental Hotel Buckhead in Atlanta, Georgia. Dr Williams presented video lectures on:
There is a growing demand for hair restoration surgery in recipient areas other than the scalp. According to the 2011 ISHRS practice census, 93% of the recipient regions where new hair was transplanted into were the scalp; and 7% of procedures had non-scalp recipient sites. The non-scalp recipient sites are:
- Eyebrows (4.4% in 2010 vs. 3% in 2004)
- Beard/Moustache (1.5% in 2010 vs. 1% in 2004)
- Eyelashes (0.6% in 2010 vs. 0.35% in 2004)
Slowly becoming more popular are procedures involving surgical hair restoration of the beard and mustache. Beard growth typically occurs dramatically during puberty and continues to increase in density until the mid-thirties. The common causes for decreased follicular density in the beard and mustache areas include:
- Surgical or trauma scars/burns
- Congenital absence of hair
- Cleft reparation
- Scarring alopecia
HOW IS THE PROCEDURE PERFORMED & WHAT ARE THE RESULTS?
Surgical facial hair restoration procedures are performed under local anesthesia with an oral sedative if desired by the patient. The procedure roughly takes 2 to 5 hours depending on the number of grafts harvested. For the first 5 days after the procedure, tiny crusts form around each transplanted hair, and careful attention the transplanted area must be given. By the second day, patients are able to travel home and resume non-strenuous activities. The transplanted hairs will begin to fall out at around 4 weeks, and then start to regrow at 3-4 months.
WHAT ARE THE RISKS WITH FACIAL HAIR TRANSPLANTATION?
There are few risks or adverse events associated with these procedures. Complications are few and excellent cosmetic outcomes are the usual results once the hair regrows. There are two surgical techniques used to remove the donor hair from the back of the scalp. The most common hair surgical procedure excises a linear strip from the back of the head. The second most common technique is Follicular Unit Extraction (FUE) where individual hair units are removed “one-follicle-at-a-time.” Both techniques are safe with excellent results, but a hair surgeon must be able to give you an opinion as to which technique may be better suited for you.
Many people believe female pattern hair loss is the same disease as male pattern hair loss, and the hair loss pattern just looks different in women. In the last decades, though, the discussion between hair restoration surgeons in the International Society of Hair Restoration Surgery (ISHRS) has focused on the reality these two separate diseases or problems exists. Today many ISHRS physicians hypothesize there are two different disease entities because their natural history (epidemiology) is so different.Many hair restoration surgery specialists think Female Androgenetic Alopecia is a misnomer and prefer the term Congenital Female Pattern Hair
PROMOTING PUBLIC AWARENESS-CARLOS PUIG
Promoting public awareness of female hair loss to the lay pubic and medical doctors is no easy matter. One particular physician, though, leading the effort is Carlos Puig , of Houston, Texas. His tireless efforts to bring public attention to this medical condition is applauded and deeply appreciated. He is the founding member and current President of the ISHRS. He is a world-renowned hair restoration surgeon and probably the most knowledgeable hair specialist on female hair loss.
On a regular basis he leads an international effort to teach physicians about female hair loss and surgical restoration. His hair restoration course, “Cowgirl Hair Loss Workshop,” is an excellent compilation of his knowledge as well as featured hair surgeons from around the globe. His below referenced chart comparison illustrates the differences between hair loss in men and women. We commend Dr. Puig for his efforts to bring hair surgical and medical restoration options to female hair loss suffers.
**Chart adopted from Dr. Puig’s web site: www.hairrestorationhouston.com
HORMONE, STRESS, GENETICS ?
In some women with a genetic predisposition to hair loss, a group of hormones called androgens interferes with the growth cycle of the hair. These androgen hormones-testosterone, Androsteinedione, and Dihydrotestosterone (DHT)- are dominant hormones in men, but are present in women to a much lesser degree. In some women, hair loss may be due to the action of androgens on the hair follicles.
Hair grows at one-half inch per month and the growth phase can lasts two to six years. With yet-to-be discovered physiologic signals, the hair goes into a resting phase for a period of time, then the hair follicle falls out and a new follicle starts the process all over again.
In women who are genetically susceptible, when the testosterone comes in contact with enzymes residing in the hair cell, it is converted into the more potent androgen DHT, which then binds with receptors deep within the hair follicle. Over time, DHT in the hair follicle alters the natural resting and growth phases of the hair. Some of the hair follicles eventually die, while others stop continuing healthy hair growth.
The term ‘androgenic alopecia’ in women is often referred to “female pattern hair loss.” It is a broader term that encompasses many possible causes of hair loss in women. Androgenic alopecia is caused by factors related to the actions of hormones, e.g., ovarian cysts, use of high androgen index birth control pills, pregnancy, and menopause. Just like in men, DHT and heredity plays a role in this disease.
In men, the pattern of hair loss is distinct whereas, women have a diffuse thinning of their hair. Female pattern balding affects circumferentially the whole top of the head with preservation of the frontal hairline. Men rarely have diffuse thinning and the frontal hair line is usually loss to balding.
The science of female balding remains not entirely understood. Genetic codes and other factors plays a role in hair loss in women and remains a challenge to doctors and patients alike.