What causes hair loss? In men and women, the most common cause is generally genetic. Other causes are hormonal, such as thyroid imbalances, or excess testosterone causing an increase in DHT (dihydrotestosterone).

Many men taking steroids have increases in DHT, causing permanent hair loss. In men, genetic hair loss is called Male Pattern Baldness (MPB), and in women, Female Pattern Baldness (FPB).

For non-surgical treatments there is Spectral DNC Spray or minoxidil 5% (Rogaine) form or solution; both are topical solutions.  For men, Finasteride, a prescription medication that prevents conversion of testosterone to DHT, can be prescribed. There are also various vitamins and shampoos available.

PRP (platelet-rich plasma) scalp injections can also be very successful. Blood is drawn from the patient and processed to isolate the platelets, which contain multiple growth factors, and then injected into the scalp.

Generally, a series of three-monthly injections are scheduled and then annually. Often PRP injections are used with hair transplants to prevent further hair loss in the balding areas.

For hair transplants, hair grafts are removed from the back of the scalp, where they are not destined to fall out, and micro-grafted to the front, top or wherever hair is needed. In the new location, these grafts will grow like normal hair.

Two current hair transplant techniques are follicular unit extraction, or FUE, and follicular unit transplant, or FUT.

FUE involves removing 1-millimeter micro-grafts containing from one to four hair follicles (and thus hairs). FUE grafts require no sutures and leave no visible scars in the back of the scalp.

FUT removes the grafts by removing a strip of scalp, closing the donor site defect with sutures, and dissecting the strip into the same 1-millimeter grafts as with FUE. FUT is faster, and only a strip of the scalp needs to be shaved, but it does leave a scar hidden by hair.

NeoGraft is another option. It is an automated FUE technique allowing a greater number of grafts to be taken than manual FUE, with no scar.

The most important factors to consider are the skill and experience of those performing the procedure. The hairline must be designed naturally, the grafts must be placed in the proper direction, and the grafts must be single hair follicle grafts for a totally natural hairline.

Behind the hairline, grafts with two to four follicles should be used for more density.

Grafted hair starts growing at 3 months. Full density is at 1 1/2 years. Generally, hair growth is permanent.

For more information visit hairrestorationsavannah.com.

E. Ronald Finger, MD, FACS is a board certified plastic surgeon with offices in Savannah and Bluffton. fingerandassociates.com