Hair restoration is the general term for the numerous methods of restoring hair to areas that are balding. Some patients may benefit from medications designed to slow or stop hair loss (e.g., minoxidil, finasteride). However, surgical hair restoration is more effective for most patients. In some cases, a combination of medication and surgery is used to achieve the best results.

Hair restoration is performed to restore portions of hair to a person who has experienced hair loss, usually due to heredity. It may also be performed to restore hair lost because of injury (e.g., burns) or disease (e.g., alopecia areata).

Regardless of the success of the method used for hair restoration, it is important to note that a patient will never have the same degree of coverage prior to the beginning of hair loss. However, hair regrowth from medication or surgical techniques may give a fuller appearance and minimize the appearance of thin or bald areas.

Hair has long been recognized as an important characteristic of a person’s physical appearance. In addition to other physical features (e.g., size, body frame), hair may influence socioeconomic status and occupation, and it distinguishes facial features (“frame the face”). Men and women who experience abnormal hair loss (alopecia) often undergo hair restoration to restore hair to areas where it has been lost. Although treatment is not usually necessary, patients who are emotionally impacted by hair loss may benefit from seeking treatment.

Patients with mild-to-moderate pattern hair loss (androgenetic alopecia) are often good candidates for hair restoration using medication. Currently, minoxidil and finasteride are the only two medications approved for hair loss by the U.S. Food and Drug Administration (FDA), and finasteride is only approved for use in men. Each works to slow or reverse the shrinking of hair follicles (tiny, tubular structure in the skin through which hair grows) by interfering with the conversion of the hormone testosterone into dihydrotestosterone, the androgen (male sex hormone) that causes pattern hair loss. However, these medications do not work for everyone. Furthermore, any hair that grows as a result of their use usually occurs gradually over a period of several months or years.

Hair usually grows in pairs, though it may grow in groups of up to five or more. Understanding these hair growth patterns has helped lead to significant improvements in surgical hair restoration. Hair density following a transplant procedure often appears natural, and scarring is typically minimal and unnoticeable.

The most commonly utilized surgical hair restoration technique is hair transplantation. It involves transplanting healthy follicles from another site of the scalp (donor site) to a bald or thinning area. All surgical techniques use existing hair from the patient. The purpose of these techniques is to blend hair in the most efficient and natural way possible.

Criteria used to determine if a candidate is qualified for surgical hair restoration include:

• Degree of baldness. Perhaps the most important criteria for selecting a candidate. Individuals with baldness in the front portion of the scalp as opposed to the top of the head are preferable as candidates.
  
  
• Age. It is generally more difficult to gauge the amount of hair loss patients younger than age 25 will experience. As a result, the preferred candidate is usually age 25 or older.
  
  
• Hair shaft caliber. Individuals with thick hair shafts achieve greater coverage than those with thinner hair. Very small increases in the volume of hair diameter can make a tremendous difference in surface area coverage.
  
  
• Donor hair. Hair at the donor site must be dense enough for transplanting and sufficient in quantity to conceal the removed portions.
  
  
• Hair color. Individuals with hair that is red, blonde or “salt and pepper” colored tend to be preferred to those with black hair. People with black hair may still receive hair transplants, but require a grafting method that transplants only one or two hairs per follicle.

Lifestyle issues and patient expectations of hair restoration also factor heavily into the type of treatment chosen. For example, men with pattern hair loss that begins in the late teens or early 20s (premature male pattern baldness) may have unrealistic expectations of hair restoration surgery and do not typically make good candidates for surgical hair restoration. Because balding will likely continue to progress following surgery in the surrounding areas of the scalp, an unnatural or patchy appearance will probably develop. Furthermore, patients with this condition require an unusually large amount of donor follicles, making scarring at donor sites particularly difficult to conceal.

It is important to note that women with female pattern hair loss lose hair in different patterns than men. Mild forms of this condition are often only noticeable as a minor widening of the central hair part, whereas severe forms may appear as severe thinning across most of the scalp (diffuse unpatterned hair loss). In general, women in either category make poor candidates for transplantation. Female patients that are ideal candidates for hair restoration have high hair density in the donor site with thinning or hair loss largely confined to the front of the scalp.   

Hair transplant patients may also take medications to slow or stop further hair loss both before and after hair restoration surgery. This typically results in less donor site harvesting, less hair loss over time and a more natural overall appearance.

Not all forms of hair loss can be treated with hair restoration. Patients who are poor candidates for medical treatment may effectively disguise their hair loss with wigs, hairpieces and weaves. In some cases, hairstyle changes can also help disguise the condition. However, these methods do not slow or stop the progression of further hair loss.