Tired of wearing that baseball cap to hide your receding hairline? Instead, tip your cap in recognition of the new surgical options in hair restoration.

Hair is no longer relied upon exclusively for protection, heat retention and camouflage. In today's world, the amount of hair—or lack of it—colors how we perceive another's personal appearance, which in turn can affect our social relationships.

Fortunately, modern man (as well as woman) has several new surgical options to choose in restoring the hair heredity has taken away. According to Dr. Paul Riggs of Clearwater, Florida, "The practice of treating hair loss is actually the 'art' of treating hair loss." He goes on to explain that whatever method for restoring lost hair is chosen, the procedures used should be tailored to the patient, with the results as natural as possible under the circumstances.

Hair Restoration Surgery

The most common surgical method of replacing lost hair is via hair restoration surgery (HRS). HRS is the only permanent hair replacement solution currently available, and is a surgical procedure performed in a doctor's office under local anesthesia. The procedure consists of taking strips of hairy scalp from the back of the head, converting the strips into grafts, and then transplanting these hair-containing skin grafts into the bald areas. Since the transplanted hair is the patient's own, chances of rejection are minimal.

The transplantation of this hair, referred to as "donor hair," doesn't change the hair's ability to grow or its color. The best candidates for HRS are men with sufficient donor hair to cover the bald area, or men who just want to look less bald.

A Major Improvement on Hair Plugs

The good news for today's man is that a hair transplant recipient need no longer look as if some compulsive gardener had planted clumps of hair in orderly hedgerows atop his head. Nor will the area from which the hair was taken resemble a cobblestone street.

Over the last few years, new instruments and techniques have allowed doctors to achieve natural results by transplanting very small grafts (micrografts) of hair into the bald area in groups of one, two and three hair follicles. Some men may require more than 1000 of these micrografts! The grafts are placed close together, and the result is denser hair growth that is more natural looking.

The procedures for obtaining these small grafts of hair vary. Richard S. Greene, M.D., of Plantation, Florida has done more than 7,000 hair transplants. He prefers to "harvest" donor hair using a multi-blade scalpel; other doctors, such as Dr. Riggs, use a single blade. Neither doctor uses a laser for harvesting hair. Instead, lasers are used to implant the grafts.

While the entire procedure is generally endured with minimal pain, Dr. Alan J. Bauman of Boca Raton, Florida, says that doing 1,500 to 3,000 hair grafts in one session can take up to five hours, and that most patients require two sessions before the entire procedure is complete.

Good Candidates

Dr. Green cautions that not all men are created equally when it comes to HRS. Obviously, the best candidates are men who are bald over a relatively small proportion of their scalp, and who have a large area of donor hairs. But the patient's hair color is a factor as well, and men with light colored or salt-and-pepper hair look most natural after HRS because these types of hair make for the best matches. Also, thin hair makes for a better blend than thick hair.

Restoration Without Grafts

Aside from grafting, there are two other surgical methods used in hair restoration.

  • Scalp reduction is a surgical method that can, in skilled hands, effectively reduce a man's bald appearance. According to the International Society of Hair Restoration Surgery (ISHRS), it is often done prior to HRS. In this procedure, patients with a good amount of dense hair on the sides and back of their scalp have their scalp stretched upward to cover as much of their bald area as possible, leaving less area in which grafts of hair follicles need be inserted.
  • However, the ISHRS cautions that there can be complications with this procedure, including scarring, stretching back of the bald area, and the creation of an unnatural appearance called a slot deformity .
  • Scalp flaps are a third type of surgical procedure which involves moving entire segments of hair bearing scalp into a bald area. Patients with frontal baldness exclusively, are ideal candidates since this procedure provides instantaneous hairline reconstruction. A different type of scalp flap, called a scalp lift , is used for treating hair loss in the crown of the scalp. This procedure involves moving the fringe hair on the sides and the back upward towards the center of the bald area in a U-shaped pattern. It is used in combination with hair transplantation and can achieve excellent results.
  • Done properly, the hair grafts as well as the donor sites will form small scabs after the procedure. If you have enough surrounding hair, the scabs can be camouflaged with careful hair combing, and the scabs will usually come off in about a week. Typically the grafted hair will shed in two to four weeks. New growth will begin in three to four months and length will increase approximately one-half inch per month.

Surgery, No Thanks

Maybe the very idea of surgery turns you off. For men not wishing to undergo HRS, there are several non-surgical options, including the use of oral and topical medications to halt the progression of baldness or renew actual hair growth. However, the ISHRS cautions that only finasteride (Propecia) and minoxidil (Rogaine) are approved by the U.S. Food and Drug Administration for the treatment of male pattern hair loss.

According to the ISHRS, many of the products being sold by infomercials and over the Internet are not miracle cures and have not been carefully analyzed in scientific studies to determine whether they are safe and effective.

A Careful Decision

For those men considering hair restoration surgery, Dr. Greene cautions that "doctor" does not mean "miracle worker." Doctors can only work with the amount of donor hair a patient has. He also says that the doctor should be chosen after careful study of the physician's certifications (usually in dermatology), number of years experience in this field, and references, preferably from satisfied patients or barbers/hair stylists. Sound strange? While a recommendation from another doctor is to be given great weight, Dr. Greene believes in the old adage about the wisdom of hairdressers. After all, they are the ones who see and work with the handiwork of hair replacement doctors. A recommendation from a barber or hair stylist comes from someone who has a first-hand look at the results...from the top, down.