Sometimes after you shave your head, the new hair seems to be thicker. That’s because the new hair is healthier and undamaged by chemicals in the air and shampoos. But that doesn’t mean shaving makes your hair thicker and healthier.

“When I started in 1973 … it was like the Stone Age,” the cosmetic surgeon says, referring to the equipment and techniques in use. Now, he says, surgeons have learned to create a much more natural-looking hair line, using scalpels to cut either small slits or holes in the scalp to receive transplanted hair.

While there are numerous types of surgery, they can be sifted into two main categories: transplantation and scalp reduction.

Transplantation involves moving hair from densely covered sites on the sides or back of the head to bald areas of the scalp.

The key to success, explains Anthony Santangelo, president of the American Hair Loss Council, is to have good sites on the sides or back of the head from which to move hairs. Otherwise, patients can’t expect ample coverage. Because their hair loss is diffuse, women generally lack good donor sites, making transplantation impractical for them.

The biggest improvement in transplants is with “micro” or “mini” grafts. “You’re looking at one to two hairs shot into the head with a needle,” Santangelo says. “It achieves a very, very fine, natural-looking hair line. The significant difference there is you need a lot of hair to do that.”

Surgeons also use larger round plugs of seven to 10 hairs. Line grafts, the shifting of strips of nine to 12 hairs, are common, too.

One thing to keep in mind is that prosthetic hair fibers for transplantation are banned by FDA. Implanting them, according to Stephen Rhodes, acting chief of FDA’s plastic and reconstructive surgery devices branch, caused a high incidence of adverse reactions, including infection.

If male-pattern baldness has left you with too much balding area to cover, you may benefit from scalp reduction: the surgical removal of large sections of a bald scalp. Extenders and expanders, elastic devices placed under the skin to stretch the hair-bearing scalp regions on the side of the head, have been used as a complement to reduction surgery.

Another surgical method is the flap technique, which rotates hair-bearing scalp areas from the sides or moves those areas from the back forward. The flap technique has the highest complication rate, though, Puig says. Bleeding, scarring and infection can occur from surgery. But advances, such as knowing what size flap to use and how to enhance blood supply to the region, have cut down on the visibility of scars.
Source: U.S. Food and Drug Administration

To be effective, minoxidil must be used twice a day. It works better on those who are younger and whose hair loss is recent, according to clinical studies by Pharmacia& Upjohn.

Those studies show that 26 percent of men between 18 and 49 reported moderate to dense hair regrowth after four months of Rogaine treatment. An additional 33 percent had minimal hair regrowth. Almost 20 percent of women between 18 and 45 had moderate regrowth, while an additional 40 percent showed minimal regrowth.

A company spokesman said the research accounted for the fully pigmented hair fibers normally seen on the scalp and not vellus hair, which is more like peach fuzz. Many doctors, however, say the number of their patients who have as much success is much lower, and some find that only vellus hair appears.

“I have not been that impressed that it helps regrow hair,” Kayne says. “I think that occurs in a very small minority.”

One plus that Denise Cook, M.D., medical officer in FDA’s division of dermatologic and dental drug products, points out is that patients report a decrease in shedding due to minoxidil use, though whether that perception is the result of fewer hairs being lost or more hairs being produced is unknown. Normally, you should lose only about 100 hairs a day.

One possible side effect of minoxidil is an itchy scalp. Another drawback is that it must be used for life or any regrown hair will fall out. Also, only those people losing hair on the crown, not in front, are candidates for regrowth.

Researchers are optimistic that more products to boost hair regrowth will be coming down the pike. For example, Proscar (finasteride), now used to treat enlarged prostate glands, has anti-androgen properties that may make it marketable as a hair-loss prescription, Washenik says. Theoretically, he says, if a drug can be targeted to halt the conversion of testosterone to DHT in the scalp region only, it could stop hair from falling out. He foresees combinations of medications as the wave of the future.
Source: U.S. Food and Drug Administration