About Hair Transplant

Dr Sotirios Foutsizoglou offers the latest advances in hair restoration surgery for permanent and naturally looking hair. Results are guaranteed.

Dr Sotirios Foutsizoglou is a member of the International Society of Hair Restoration Surgery and performs hair transplant procedures (“Strip” and “FUE”) in Harley Street, London.

Book your appointment today to join the executive club of celebrities, professionals, models and people who have undergone hair transplant surgery to restore thinning or balding areas of their scalp, eyelashes and eyebrows.

Hair Loss

Hair loss can be a devastating problem for both men and women. Although genetically programmed hair loss or androgenetic alopecia cannot be classified as a “disease” or “illness” the negative impact it has on people’s psychological well-being should never be disregarded or overlooked.

Hair loss is not just a male problem. It is estimated that one in five women will experience some degree of hair thinning. The psychological toll of hair loss is often underestimated. Studies have shown that hair loss can significantly impair quality of life by causing increased anxiety, depression and low self esteem. Poor self image and confidence, not infrequently encountered in hair loss sufferers, can profoundly affect how a person relates to others in their social and professional environment.

In advanced alopecia hair restoration surgery is the only effective and long lasting answer to the problem. Nowadays with advancements in technology and better understanding of the anatomy of hair, new hair transplant techniques have evolved providing permanent and naturally looking results.

For further information about the causes of hair loss in both men and women along with explanation of medical and surgical treatments of the various degrees of alopecia please download Dr Sotirios Foutsizoglou's articles on Hair Transplant and Medical Treatments for Hair Loss.

Drug Treatments for hair loss

Dr Sotirios Foutsizoglou will keep you up to date with the latest developments in drug therapy for hair loss in both men and women. Non-surgical modalities and treatments can be used on their own or in conjunction with hair restoration procedures. Fortunately there are safe and effective medications available to treat male and female pattern hair loss. Most of the drugs used in the prevention or treatment of hair loss cannot be prescribed in the NHS and therefore finding an experienced private doctor or surgeon with an expertise in hair loss treatments can be quite challenging.

Most popular medical treatments used for male and female pattern hair loss

Minoxidil

Minoxidil was first implemented as an oral medication for high blood pressure acting specifically to open potassium channels. A reversal of androgenetic alopecia was noted in patients using oral minoxidil which led researchers to develop topical minoxidil formulations for hair loss.

The 5% concentration is superior to 2% in treating male pattern hair loss (MPHL) whereas 2% is probably a better option for women as it is associated with less side effects such as unwanted growth of facial hair. Topical minoxidil is very safe and any potential side effects associated with its daily use such as allergic or irritant dermatitis are less frequent with the foam version which does not contain propylene glycol.

There are several proposed mechanisms of action of minoxidil in the treatment of hair loss including enhanced cell proliferation and DNA synthesis, antiandrogen effects and shortening of the telogen (resting) phase.

Finasteride

The relationship between baldness and testosterone levels was first observed by Hippocrates, the father of Western Medicine. Finasteride belongs to a group of medications called 5-alpha reductase inhibitors which constitute the most efficacious medical treatment for hair loss.

5-alpha reductase is an enzyme produced in many tissues in both males and females, especially in the reproductive tract, testes and ovaries, skin, prostate, and many other organs. 5-alpha reductase converts testosterone to the more potent androgen Dihydrotestosterone (DHT). This enzymes exists as three isoenzymes (Type I, II and III) with the Types I and II being the most relevant to hair loss as they are found in hair follicles and skin including the scalp.

Finasteride works by inhibiting Type II 5-alpha reductase decreasing both serum and scalp levels of DHT leading to an increase in hair growth rate and count.

Dr Sotirios Foutsizoglou recommends the daily use of 1mg of Finasteride for prevention and treatment of hair loss and, in his experience, side effects such as decreased libido or erectile dysfunction are less than 3%.

Dutasteride

This is another 5-alpha reductase inhibitor which blocks both Type I and II 5-alpha reductase isoenzymes. There is evidence that Dutasteride is much more potent than Finasteride with a longer half-life of action.

5-alpha reductase inhibitors can also be used in post-menopausal women experiencing significant hair loss but the recommended dosage may be higher than that used in MPHL. Please note that 5-alpha reductase inhibitors should never be administered to women who plan to become pregnant.

Ketoconazole

2% ketoconazole shampoo which is usually used in the treatment of seborrheic dermatitis can also be used in hair loss sufferers as it is believed to have an androgen blocking mechanism.

For those who are not keen on medication or hair transplant surgery Dr Sotirios Foutsizoglou will give you information on a variety of other options such as low-level light therapy, various vitamins and supplements, hair products (e.g. shampoos and hair stimulating lotions), camouflage with keratin-based fibres, Mesotherapy, Platelet Rich Plasma therapy.

Please note that for female pattern hair loss Dr Sotirios Foutsizoglou may ask for some blood tests in order to exclude any pathological cause of alopecia.

Hair Transplantation

Hair transplant surgery is becoming increasingly popular in the UK. A number of celebrities including footballer Wayne Rooney, Dancing on Ice judge Jason Gardiner, Nicholas Cage, hair stylist James Brown, TV chef Gordon Ramsay, singer Elton John, Hollywood star Kevin Costner and many more have publicly admitted to having undergone hair restoration surgery.

Hair Transplantation depends primarily on the now well-established principle that transplanted hair follicles (roots moved from their original location to another area) will behave as they did in their original site. For example, even in the most advanced cases of common Male Pattern Baldness (MPB), a horseshoe-shaped fringe of hair persists (Fig.1). Hair follicles moved from appropriate areas of this hair-bearing fringe (the donor area) to a bald or balding area on the same patient's scalp (the recipient area), will take root and grow.

Fig.1. The Hamilton / Norwood classification of degrees of severity of Male Pattern Baldness with Type I the least severe and Type VII the most severe.

Hairs emerge from the scalp as single hairs or in small groupings of 2 to 5 hairs. These naturally-occurring "follicular groups" or "follicular units” (FU), can be harvested from the donor area and then placed into tiny incisions, in the balding or recipient area, at the same angle and direction as the original hair in that particular area - regardless of whether some of that hair may still be present or the area is completely bald.

Nowadays hair transplantation is considered safe and new techniques and equipment have been devised in order to give a naturally looking, permanent and aesthetically pleasing result. It is worth mentioning that with new transplanting techniques the hairline no longer appears "pluggy" or "Barbie doll hair" as much smaller grafts are used. In addition, experienced surgeons achieve more than 90% survival of transplanted hairs producing a substantial cosmetic improvement.

The goal of modern hair transplant is to re-establish the aesthetic balance lost in the hair thinning process. A successful surgical outcome restores the aesthetic function of scalp hair which is complimentary to the other facial features giving the appearance of a natural, pleasant and balanced whole.

There is no upper limit for hair transplant unless there is a medical condition that may compromise the safety of the patient. Dr Sotirios Foutsizoglou assesses every patient on an individual basis offering his professional and expert advice as to what the potential candidate for hair restoration surgery should expect out of their procedure and which technique would be recommended for the best possible results.

FUE versus FUT

The most commonly performed techniques in hair transplantation are the:

  • Strip Method or Follicular Unit Transplanting (FUT) where the surgeon applies local anaesthetic to the donor area he/she wants to take the hair from, usually the occipital “permanent” zone, and then a thin strip of hair bearing skin is removed which is subsequently slivered under the microscope into follicular grafts. These follicular unit grafts are then placed into pinprick incisions in the recipient area. The strip method of hair transplants is the “Gold Standard” as the most effective technique for transplanting hair and donor utilisation.
                                   A                                                                     B
    Fig.2. Strip Method: A) Before donor strip harvesting and B) immediately after a two-layer closure of the resulting scalp skin defect
  • FUE which stands for Follicular Unit Extraction. This technique uses a microscopic biopsy punch to remove individual hair grafts, in the same way as an apple corer removes the core of an apple. FUE is a relatively new technique, and only really established itself in the early years of this century.                                A                                                            B
    Fig.3. FUE: A) During graft extraction; B) Transplanting into thinning frontal area and hairlinet
A comparative table showing main advantages of FUT and FUE techniques
FUE FUT or strip method
No linear scar (Important for those who wear their hair very short) "Gold standard"; Yields high quality grafts from the permanent zone
Decreased healing time in the donor area Smaller donor region is required for sufficient number of grafts
Less post-op discomfort in the donor area Less follicular transection (damage to grafts) compared to FUE
Provides an alternative when the scalp is too tight for a strip excision Since the extraction process is quicker than FUE, smaller procedures are needed to get an equal amount of grafts when compared to FUE
Makes it possible to harvest non-scalp hair (e.g. beard or body hair) Less costly procedure for the patient

Less popular types of hair restoration surgery includes:

  • Frechet Scalp Reduction performed mainly on the crown area of the scalp, or ‘the monk’s bald spot’. In this procedure, the bald skin on the crown is removed and the hair bearing sides of the scalp above the ears are drawn together. This procedure usually requires three steps whereby some of the bald area is excised after skin has been stretched by using a Frechet extender (a thin sheet of silicone elastomer) affixed to galea for four weeks and finally a transpositional flap is used to relocate the final scar and hair direction into the classic crown swirl.
  • Scalp Expansion Surgery involves stretching the scalp with a silicone balloon under the skin over a period of weeks before the bald scalp tissue is surgically removed. This stretching results in increased elasticity of the scalp and the ability to remove more balding scalp. The scalp expansion procedure requires two procedures – one for inserting the expanding balloon and the second for its removal along with the excess loose bald skin.
  • Scalp flap surgery is a method of moving a hairy “flap” of scalp skin and underlying tissue to a bald area. This is a highly skilled surgical procedure which can be performed for both reconstructive and cosmetic reasons.

Hair Transplant Surgery for Women

Contrary to the common belief the majority of women with female pattern hair loss (FPHL) are good candidates for hair restoration surgery. However it should be noted that women have, generally speaking, smaller and thinner donor areas than those found in men’s “safe” donor zone and therefore lower graft densities should be used in order to produce satisfying results in women.

Even in high grades of FPHL, unlike men, women preserve their hairline. Hence it is well accepted that smaller operations for women confined to an area just behind the hairline, to reduce the "see-through" effect of thinning is more advantageous and cosmetically pleasing.


Fig.4. Ludwig pattern of hair loss in women.

Dr Sotirios Foutsizoglou also performs eyebrow and eyelash transplant surgery for those who would like to have thicker eyebrows and eyelashes.

As in scalp hair restoration surgery hair is removed from a suitable donor site and transplanted to create naturally looking eyebrows and eyelashes.

Other Treatments

Dr Sotirios Foutsizoglou can also offer a range of non-surgical treatments for hair loss such as Mesotherapy and Platelet Rich Plasma therapy. These treatments can also be combined with drug treatments and/or hair restoration surgery for better results.

Hair Mesotherapy is the practice of using a combination of hair follicle targeting specific microinjections of compounded homeopathic agents and plant extracts such as vitamins (e.g. Biotin), sulphur amino acids, essential minerals (e.g. Zinc), dexpanthenol (the biologically active form of panthenol), ginkgo biloba and organic silicon in order to cause an increase in blood circulation to the scalp and stimulate the follicles to produce better quality and thicker hair.

PRP therapy causes activated platelets to release growth factors. These growth factors promote bio cellular regeneration which in the case of hair loss is translated into prolongation of the anagen (growing) phase and follicular stimulation to produce better quality hairs.

Dr. Sotirios Foutsizoglou

As a qualified and regularly practicing Cosmetic Surgeon, Dr Sotirios Foutsizoglou has the training and experience to give you the results you desire. Dr Sotirios Foutsizoglou is a member of the International Society of Hair Restoration Surgery and performs hair transplant surgery in Harley Street, London. Moreover, with a plethora of treatments that he is well versed in, he is fully able to assess the facial proportions and the individual needs of the client to give them the most natural and complimentary results.

For further information about the causes of hair loss in both men and women along with explanation of medical and surgical treatments of the various degrees of alopecia please download Dr Sotirios Foutsizoglou’s articles on Hair Transplant and Medical Treatments for Hair Loss.

To book an appointment with Dr Sotirios Foutsizoglou or to get a quote for a hair surgical procedure please email us at contact@sfmedica.co.uk

 

Reference
Unger WP et al. Hair Transplantation. 5th Edition. Informa Healthcare 2011.