Hair
Cosmetic Surgery - Plastic Surgery - Aesthetic Medicine - Reconstructive Surgery
The hair is an organ specific to humans. Its role as organ of body
decoration and social belonging is very important both in men and in
women. Hair is produced by highly specialized epithelial cells.
Everything begins at the embryonic stage, from the third month, under
the epidermis; mesenchymal cells (embryonic tissue at the origin of
connective tissue, cartilage, bone, muscle, etc.) will form the hair
bud from the basal layers of the epidermis. At the scalp, the bud will
initiate production of a down that will progressively become hair.
The hair follicle is the hair root; it is situated deep in the dermis.
The great metabolic activity leads, at the base of the hair follicle
(the bulb), to the formation of the hair shaft.
Deep down, a dermal papilla is located in the hair bulb. It consists
of hyper-specialised fibroblasts that will regulate the growth of the
hair. Nearer the surface, the hair bulb is composed of keratinocytes
and melanocytes (pigment producers, causing hair colour). In the hair
bulb, a piloerector muscle is responsible for straightening up the
hair. The hair shaft that grows from the bulb will be sandwiched
between two epithelial sheaths (external and internal) as soon as it
comes out of the bulb. Each hair follicle is associated with a
sebaceous gland. The hair shaft is released from its sheath when it
reaches the orifice of the sebaceous gland. The hair has then finished
maturing.
The protein constituting hair is keratin, a fibrous protein, insoluble
and highly resistant to degradation that can absorb various metals and
drugs.
Hair is a part of the human body, derived from living cells containing DNA fragments.
Hair growth is 0.3 to 0.5 millimetres per day. So a hair grows by
around 1 to 1.5 centimetres per month. Hair grows in successive cycles
during life. This is known as the hair cycle:
- a growth or anagen phase, lasting an average of three years but which can vary from a few months to ten years.
- a regression or catagen phase, lasting an average of three weeks.
The hair follicle stops making hair, the bulb cells die, while the hair follicle shrinks to the surface of the scalp.
- a phase of hair loss or telogen phase, lasting about two to five
months; the hair falls out, the follicle goes into complete rest.
A stimulus, which has not been identified, will cause the hair
follicle to wake up and begin the cycle again with a growth phase and
the production of new hair. This cycle will continue throughout the
life of a human being.
Not all hair is at the same stage at any one time; approximately
80-90% of hairs are in growth phase and 10 to 15% in phase regression.
Losing 10 to 50 hairs per day is perfectly normal.
The activity of the hair follicle is complex and intense. It is
managed by hormonal activity (especially androgens) and many nutrient
factors. Hair is very sensitive to various health problems which can
arise during life but also to the seasons. The summer season stops the
growth of hair and about three months later, in autumn, significant
hair loss occurs...
The melanocytes that manage hair colour dos not age the same way as
those that are responsible for aging of the skin. At the end of life
you can have white hair as a result of hair melanocytes but continue to
tan.
Hair follicles, depending on their location on the scalp, will not
have the same sensitivity to androgens. The top of the skull is very
sensitive. There we see an accelerated hair cycle thus early exhaustion
and the onset of baldness. For the same individuals, these androgens
have no adverse effect on hair follicles at the edge of the scalp or in
the beard.
Baldness is less common in women because oestrogens have a protective effect.
It is part of the field of aesthetic surgery to treat baldness.
Baldness, hair loss or absence, is observed both in men and women.
Baldness, with permanent hair loss, is more prevalent in men. This is
called male pattern baldness. In this type of baldness it is the
destruction of hair follicles that causes hair loss. This type of
baldness is hereditary to varying degree. Its origin is a problem of
hormonal imbalance (male hormones, testosterone and androgens) in the
blood. Tis type of baldness is more or less significant in about 40% of
the male population. Hair loss is gradual and begins with the hair at
the front of the forehead or with the formation of temporal gaps with
crown thinning. Here we are talking about male pattern baldness with
tonsure when there is only hair on the sides and back of the head.
There is another type of baldness with a temporary hair loss due to
transient damage to the hair follicles. This is called alopecia. This
phenomenon is found after irradiation with X- rays, ingestion of
metals such as thallium, tin and arsenic, and ingestion of anticancer
drugs. Alopecia is also a result of diseases accompanied by high fever,
some inflammatory skin diseases, endocrine disorders, etc. It is also
possible to find circumscribed alopecia or alopecia areata,
characterized by the appearance of temporary patches of baldness.
Baldness whether in man or woman is badly regarded. Aesthetic surgery,
with the advent of micro-grafts, has changed the treatment of
baldness. This involves transplanting hair follicles from regions of
the scalp which still have hair (usually in the region of the crown
that will not thin out) and implanting them in those areas that are
already bald (forehead and tonsure).
Treatment for baldness requires the use of multiple surgical
techniques, currently there are four, which can be used separately or
together in the same patient:
micro grafts; flaps; tonsure reduction and lifting of the scalp.
- Micro grafts allow a reduction in the size of the operation and
residual scarring. A small strip of scalp is removed and then cut into
fragments of one to three hairs (micro graft) or four to eight hairs
(minigraft) to be implanted in the area to be treated. It takes two
micro graft procedures at least to achieve a good density of hair.
- Flaps are longer, still attached to the scalp through the vascular
system; the surgeon rotates them towards the frontal region.
- Tonsure reduction is the complete removal of a portion of the bald
area; closure is then undertaken immediately using the elasticity of
the skin.
- The lifting of the scalp is an important technique involving significant scalp reduction with one or two flaps.
Surgery for baldness is performed by a specialist plastic surgeon. It
is like any surgical procedure with preoperative assessment and
consultation with an anaesthesiologist. Surgery for baldness can be
carried out under local anesthesia, local anesthesia in combination
with sedatives or classic general anesthesia (as in the lifting of the
scalp).
The period of hospitalization after surgery for baldness varies
depending on the type of surgery and anaesthesia. The procedure can be
carried out on an outpatient basis but sometimes a short period of
hospitalization may be recommended. Surgery for baldness is a procedure
the duration of which depends on the surgical work to be done by the
plastic surgeon. Each surgeon uses his/her own technique that he/she
adjusts to the patient to get the best result.
Following surgery, the scalp must rest for a period of 4 to 8 days.
The postoperative consequences of surgery to the scalp are variable in
duration and magnitude depending on the patient: headache, swelling
(oedema) and bruises (ecchymoses).
It takes a period of 3 to 6 months for the result to be fully
appreciated by the patient. This is the time needed for healing and
recovery of flexibility in the tissues.
Do not forget that surgery for baldness, although performed in many
cases for purely aesthetic reasons, is a surgical procedure with all
the risks associated with any medical procedure (anaesthesia and
surgery) even when done under the best circumstances, that is to say by a
qualified plastic surgeon .. Without overstating the risk, a
proportion of risks remain. Recourse to a qualified plastic surgeon can
help prevent complications or treat them effectively.