Understanding hair loss

1) What are the main causes of hair loss?

Hair loss occurs when the cycle of hair growth is disrupted, resulting in the hair shedding faster than usual, re-growing poorly or not growing back at all. The most common cause of hair loss is hereditary male and female pattern baldness. However, the following conditions can cause hair loss, or alopecia, in men and women:

  • Medical conditions, including thyroid problems and anaemia
  • Drugs and medication side-effects
  • Stress and trauma
  • Dietary disorders
  • Excessive tension on the hair scalp from wearing certain hairstyles, such as tight braiding (traction alopecia)
  • Hair-pulling disorder in which there is an irresistible urge to pull out hair (trichotillomania)
  • Immune system attacking hair follicles to cause patchy hair loss (alopecia areata)
  • Scarring alopecia or scalp infections, requiring careful dermatological management

2) How often is hair loss genetic?

The most common form of premature hair loss, androgenic alopecia, or male pattern baldness in men, is much more likely to affect men with a family history of hair loss.

The hair loss is caused by the production of a testosterone derivative called dihydrotestosterone (DHT). Some men are genetically predisposed to be abnormally sensitive to DHT.

3) Are there different forms of hair loss?

Yes but by far the most common form of premature hair loss is androgenic alopecia, which in men is known as male pattern baldness (MPB). MPB will affect up to 70% of men at some stage in their lifetimes. Androgenic alopecia is surprisingly common in women, female pattern baldness (FPB), affecting some 30% of the female population at some stage in their lives.

4) When do people start experiencing hair loss?

It varies hugely. For some men, male pattern baldness can take effect in the late teens or early twenties while others will remain unaffected well into their 50s. In woman hair loss can occur at any age but is most often associated with hormonal imbalances during the menopause.

Hair loss is different to sudden hair shedding, telogen effluvium, which can occur at any point during someone’s life if the body undergoes a trauma or stressful event but will later grow back.

5) Why is hair loss more common in men than women?

Hair loss is more common in men because the most common form of hair loss, androgenic alopecia, is associated with a testosterone derivative, called dihydrotestosterone (DHT). Since men product far more testosterone than women, they are much more likely to be affected by this.

6) How can hair loss affect someone psychologically?

Hair loss can really damage people’s confidence and feelings of self-worth. Recent research carried out by The Maitland Clinic a quarter of men and 14% of women worry about going bald. Nearly a fifth of men admitted they would feel less confident if they went bald. According to Men’s Health Forum 40% of men have noticeable hair loss by age 35 and 60% of hair loss sufferers would rather have more hair than money or friends.

7) How can someone minimise their chances of hair loss?

Hair loss can have many different causes but a healthy balanced diet can help slow the process. Skipping fried food for example may reduce oil-gland activity, slowing the switch from testosterone to DHT, according to some research. There are also a number of non-surgical hair loss treatments available such as the once-a-day pill Finasteride, which blocks the formation of DHT, and Minoxidil, a foam which boosts blood flow to the hair follicles stimulating growth.

8) What is the earliest age you can lose your hair?

Men can start losing their hair in their teens as their body starts producing more testosterone and therefore DHT. For women early hair loss can be triggers by medical conditions such as hormonal imbalances or lifestyle factors at any age but it is rare for women to suffer significant hair thinning before the menopause.

9) Why do men and women lose their hair as their get older?

As you age, the rate of your hair growth slows. More follicles go into the final resting phase, and the hairs that remain gradually become fewer, finer and shorter. This is a normal process and is known as involutional alopecia.

However, there are many other types of alopecia which can occur earlier in life, leading to premature loss of hair. There remains much scientific debate about why some hair follicles have a shorter growth cycle than others, but hair loss could be influenced by a whole range of factors including genetic predisposition, abnormal hormonal levels, underlying medical conditions, stress and even diet.

10) What are the common myths associated with hair loss?

There are a number of common myths associated with hair loss. Here are a few of the most common misconceptions:

Hair loss comes from the mother’s side – not true, it is often genetic but comes from both parents

Washing hair in cold water will prevent baldness – not true, it will boost circulation but not hair growth

Hair products cause hair loss – not true, gel, wax and spray have no effect on hair loss

Wearing a hat will cause baldness – not true, hair follicles don’t need to breathe, they get their oxygen from the blood

Regular brushing of the hair and scalp will prevent hair loss – not true, this will boost circulation but will not stop hair loss as circulation and hair loss are not related

Cutting your hair will not prevent hair loss – not true, cutting your hair just makes it appear thicker as hair is thicker nearer the roots

Shampoo and sun cause balding – not true, neither of these affect the hair follicles

Two claims that are true are that very tight hair styles and the chemicals in some hair dyes can cause hair loss.

Types of treatment

1) What non-surgical hair loss treatments are available?

Finasteride

Finasteride is a once-a-day pill that blocks the formation of DHT, which is the hormone that causes follicles to shrink and eventually stop growing hair. This can stabilise hair loss and even thicken hair when used early enough. We tend to see the best results in the crown and mid-scalp areas, but it can also help with frontal recession.

Finasteride is a prescription-only medicine (POM) and is not recommended for women. Our doctor will discuss the benefits and possible side effect and advise whether it is a suitable option for you.

Minoxidil

Minoxidil takes the form of a liquid or foam applied directly to the scalp. It works by helping blood flow to the hair follicles, stimulating and prolonging the hair growth phase. Both men and women can benefit from it and most products are available without prescription.

Laser treatment

Low-level laser therapy (LLLT) can be an effective option for men and women looking to prevent hair loss and to encourage new growth. When applied to the scalp, laser light is absorbed by the hair follicles in the form of energy, improving blood flow and stimulating cell metabolism.

This can slow or reverse the miniaturising process in weaker follicles, and result in faster, thicker hair growth in healthy follicles. For both men and women, it can mean a significant slowing of the hair loss process, and can result in increased hair volume.

The laser process is painless and non-invasive, with negligible side effects. It can be carried out in our practice or conveniently in your own home.

2) How effective are these non-surgical hair loss treatments?

Non-surgical hair loss treatments are often effective in the early stages of male and female pattern baldness. Minoxidil, which can be used by men and women, has been shown to prevent further hair loss in four out of five users.

Laser treatment can lead to a significant slowing of hair loss in both men and women, and can result in increased hair volume.

3) What are the risks associated with non-surgical hair loss treatments?

The risks associated with non-surgical hair loss treatments are low. Like all medical treatments there can be side effects associated with Finasteride and Minoxidil but these are rare and most are not serious.

Low level laser therapy is painless and non-invasive, with negligible side effects.

The Maitland Clinic’s team can talk you through the pros and cons of using hair loss medication, foam or laser treatment, and advise on the best products and routines to keep your scalp and follicles healthy.

4) Are there any side effects caused by non-surgical hair loss treatments?

There can be side effects associated with Finasteride and Minoxidil but these are rare and most are not serious.

Finasteride can in some cases lead to decreased libido. More serious side-affects include allergic reactions and depression.

Minoxidil can sometimes cause burning, stinging or redness when applied. Very rarely it has more serious side effects when absorbed through the skin or having triggered an allergic reaction.

Low level laser therapy is painless and non-invasive, with negligible side effects.

The Maitland Clinic’s team can talk you through the pros and cons of using hair loss medication, foam or laser treatment, and advise on the best products and routines to keep your scalp and follicles healthy.

5) What surgical hair loss treatments are available?

There are four types of surgical hair loss treatment carried out at The Maitland Clinic. These are:

Follicular unit transplant technique

Follicular unit extraction

ARTAS® Robotic FUE

FUE beards and eyebrow hair replacement

6) When should you consider a surgical treatment?

Non-surgical treatments can help patients in the early stages of hair loss but when hair loss is more advanced surgical treatment is a better option to restore a healthy head of hair.

The earliest stage of male pattern baldness that requires treatment is stage III on the Norwood Scale, when there is noticeable loss at the temples.

Dr Ball and his team will spend time getting to know each patient in order to advise them on the pros and cons of each treatment.

The hair transplant procedure

1) How does a hair transplant work?

There are different hair transplant methods but in its most basic form a hair transplant involves taking healthy hair follicles from a part of the scalp where hair is genetically programmed to keep growing for life and transplanting them to the areas affected by hair loss.

2) Where does the hair used in a hair transplant come from?

The hair comes from an area patient’s scalp where hair is genetically programmed to continue growing for life. This is typically at the back of the head.

3) What types of hair transplant are available?

There are four types of hair transplant carried out at The Maitland Clinic. These are:

Follicular unit transplant technique

Follicular unit extraction

ARTAS® Robotic FUE

4) What do each of the different hair transplant procedures involve?

Follicular unit transplant technique involves taking a thin strip of hair-bearing skin from an area of the scalp where hairs are genetically programmed to continue growing for life. The strip of skin is then divided into tiny follicular grafts, each containing about four healthy hair follicles, which are individually transplanted into an area of hair loss.

Follicular unit extraction involves transferring hair grafts from the area of the scalp where hairs are genetically programmed to continue growing for life to areas affected by hair loss. The difference is that rather than removing a strip of donor skin from which to dissect the follicular units, FUE extracts individual follicular units directly from the scalp, leaving only tiny dot scars.

The ARTAS® Robotic FUE system uses three-dimensional visualisation technology to digitally map the patient’s scalp, analysing the position of each natural grouping of hairs. Guided by the surgeon, it assists the harvest of the donor hairs, using a randomized pattern so that the donor area retains its natural appearance with a spread of hair across the scalp, leaving only dot scarring. This allows far greater flexibility with hair length after surgery compared with the FUT technique.

5) Which type of hair transplant is considered the best?

All the different types of hair transplant are extremely effective with natural looking results but different methods have different advantages.

Follicular unit transplant technique requires only a local anaesthetic and is virtually pain-free. The whole process can take between 4 and 12 hours depending on the size of the recipient area and the number of grafts that need to be transplanted.

Follicular unit extraction has the advantage of avoiding the linear scar left by FUT as individual follicular units are taken only leaving tiny dot scars which are covered by hair. Because it leaves minimal scarring FUE is ideal for people who like to keep their hair short, such as a number 1 or number 2 haircut.

It may also suit younger patients and those who only require a relatively small number of grafts in the hairline.

Again, FUE requires only a local anaesthetic and is almost completely pain-free, but it is significantly more time-consuming than FUT. A typical FUE treatment would require extracting up to 2,000 grafts and might take 10 hours, while larger cases may require more than one day in surgery.

ARTAS® Robotic FUE can be a very efficient method for harvesting large numbers of high quality FUE grafts for maximal density and coverage. It can enable the surgeon to place greater focus on the artistic process of creating recipient sites and the reimplanting of the grafts, creating the best possible aesthetic result.

6) Can someone have a hair transplant at any age or stage of hair loss?

The earliest stage of male pattern baldness that requires treatment is stage III on the Norwood Scale, when there is noticeable loss at the temples. However, modern techniques such as those practised at The Maitland Clinic mean that good results can be achieved even when the hair loss is much more advanced. For a hair transplant to work there does need to be hair still covering areas of the scalp in order to harvest the healthy follicles so someone who is completely bald cannot undergo a hair transplant.

7) How long does a hair transplant procedure take?

It varies depending upon the technique being used and how much of the scalp is affected by hair loss.

A follicular unit transplant can take between 4 and 12 hours depending on the size of the recipient area and the number of grafts that need to be transplanted.

Follicular unit extraction is significantly more time-consuming than FUT. A typical FUE treatment would require extracting up to 2,000 grafts and might take 10 hours, while larger cases may require more than one day in surgery.

8) How do hair transplant surgeons create a natural look?

The art of a skilled hair transplant surgeon is in studying the patients head to map out their natural hairline and the areas suffering hair loss. The surgeon must then carefully place each individual follicular unit to create a natural hair line and covering develops.

9) What preparation is needed before a hair transplant?

You need to ensure you are full informed of all the options and what they will involve before you decide on any one course of action. In an initial telephone and then face-to-face meetings at The Maitland Clinic, our patient advisor and doctor will listen to you and take the time to understand your particular situation and your goals.

We’ll give you clear guidance on all of the options available to you, the pros and cons of each and the costs involved. We’ll also give you full information about the kind of result you can realistically expect to achieve.

But we will never forget that if you decide to undertake a treatment with The Maitland Clinic, you are a medical patient under the care of our doctor, not merely a paying customer. Before recommending any particular course of treatment, we’ll take into account your age, your medical history and your general health and wellbeing. You can enter our surgery safe in the knowledge that you are receiving not just the best possible hair restoration treatment, but the best possible medical care.

10) What sort of aftercare is needed?

When you leave The Maitland Clinic after your treatment, we’ll provide you with everything you need to take care of your grafts in the first few weeks, including instructions for washing your hair and medication to manage any initial discomfort.

We provide state-of the-art Liposomal ATP aftercare sprays which optimise the healing and growth of your precious grafts.

The day after the procedure Maitland clinic staff will carry out a complimentary no contact hair wash. Patients are advised to wait at least six days after the procedure before undertaking a contact hair wash. By around day ten the patient’s head should be scab free.

But far beyond that, we see our patients as lifelong beneficiaries of our hair care service. You’ll be able to stay in contact with us for ongoing support and help on monitoring your hair growth progress, looking after your scalp, and preventing any potential problems.

You’ll be able to return to us for check-ups and maintenance procedures, giving you a lifetime of professional hair care.

11) Will the procedure hurt?

Both follicular unit transplant technique and follicular unit extraction can be undertaken using a local anaesthetic and are virtually pain free.

12) Does the procedure have any side effects?

There can be some minor side effects associated with hair transplants such as bleeding, itching, swelling and bruising but with the correct aftercare such effects will be short lived, lasting a couple of weeks at most.

Certain medical conditions such as bleeding disorders may preclude FUT, but there may be other factors that mean Dr Ball will advise an alternative treatment.

Your age, the quality of your donor hair and considerations about future hair loss will all affect whether FUT is the best option for you.

At the consultation stage, The Maitland team talk to each patient and get a full overview of their medical and hair loss history to ensure the most appropriate treatment is chosen.

The consulting process

1) What is the process for undergoing a hair transplant procedure?

In an initial telephone and then face-to-face meetings at our Harley Street and south coast clinics, our patient advisor and doctor will listen to you and take the time to understand your particular situation and your goals.

We’ll give you clear guidance on all of the options available to you, the pros and cons of each and the costs involved. We’ll also give you full information about the kind of result you can realistically expect to achieve.

Before recommending any particular course of treatment, we’ll take into account your age, your medical history and your general health and wellbeing. You can enter our surgery safe in the knowledge that you are receiving not just the best possible hair restoration treatment, but the best possible medical care.

If you are having a hair restoration procedure, your treatment day will take place at our state-of-the-art clinic discreetly located a short drive or train journey from London on the south coast. We can even arrange transport and accommodation for you to ensure maximum convenience and comfort.

Before surgery you’ll have a meeting with your doctor, who will talk you through the procedure and will assess you to make sure you are in the right condition to receive your procedure.

Although our treatments are medical operations conducted in a theatre, we have made every effort provide an environment that is comfortable and pleasant. All of our procedures are conducted using local anaesthetic, which is very like an injection at the dentist and is the only discomfort you will feel throughout the process.

You will be awake but relaxed throughout the day, and able to watch a movie or use an iPad while the procedure is taking place. We have made a treatment at The Maitland Clinic as much like a spa day as possible – and more than one patient has even said that their day with us was the most enjoyable ‘me time’ they’d had in years.

When the procedure is complete we will again assess you to ensure you are in full health and able to leave the clinic. We’ll provide you with everything you need to take care of your scalp, and full information on how to look after your new hair roots in the coming days and weeks.

2) How long will my first consultation be?

This can vary depending upon the patient and how many questions they have for Dr Ball and his team but a consultation would usually last for about an hour.

3) How many consultations are necessary before a hair transplant?

A patient would normally be expected to have at least one initial consultation so Dr Ball can assess their hair loss and get a detailed medical history. Patients then have a second meeting with Dr Ball on the day of their hair transplant procedure to assess them and ensure they are in the right condition for the transplant.

4) What sort of thing might the consulting staff ask?

Consulting staff will need to get a detailed medical history and an overview of a patient’s lifestyle and circumstances. They will also assess a patient’s hair loss.

Results of hair transplant procedure

1) What is the success rate of hair transplant procedures?

Hair transplants are very successful at replacing significant amounts of hair loss but the final results will be dependent upon many personal factors such as:

  • hair characteristics – coarse, curly hair will appear thicker than fine, straight hair
  • contrast between hair and skin colour – for patients with pale skin and dark hair the skin will be more visible through the hair, making it appear thinner
  • extent of hair loss – this will affect the ratio of donor area to recipient area
  • skin laxity – this will determine how much tissue can be taken in a FUT strip
  • size of head – in larger heads it is possible to harvest more grafts
  • donor area density – dense hair in the donor area will provide a greater supply of follicular units
  • donor follicular unit groupings – donor supply with lots of 3 and 4 hair follicular units will create more ‘thickness’ than one consisting mainly of 1 and 2 hair follicular units.

No treatment can guarantee a level of transplanted hair thickness that is inconsistent with the thickness and characteristics of your existing hair.

Before you opt for surgery, The Maitland Clinic team will give you a honest and realistic idea of the kind of result you can expect to achieve given your particular characteristics and circumstances – so you go into your procedure fully informed, safe in the knowledge that we can give you the best chance of achieving your goals.

2) How long will it take for the results of the procedure to show?

New hairs will begin to grow through in the treated areas of the scalp about four months after surgery, continuing to thicken over the first 10 to 15 months. These hairs will continue to grow in the same way as those in the donor area, creating a natural, fuller head of hair.

3) Will I be left with bruising or scarring from a hair transplant?

Follicular Unit Transplantation will leave a small linear scar where the donor strip is taken from the scalp. This is usually at the back of the head and is covered by the patient’s hair.

Follicular unit extraction only leaves tiny dotted scars where individual follicular units have been taken from the scalp so is preferable for people with very short hair. The same applies to the ARTAS® Robotic FUE system.

4) How long will it take to heal?

The scalp should be healed and scab free by day ten after surgery.

5) How long will the results last?

This will vary hugely according to the patient’s age, type of hair, lifestyle and more. In some patients a hair transplant can offer a lifetime of healthy hair but no treatment can guarantee a level of transplanted hair thickness that is inconsistent with the thickness, characteristics and lifespan of a patient’s existing hair.

6) Will I need another procedure?

It is not uncommon to undergo more than one hair transplant procedure during your hair restoration journey. This may be in order to add density to a previously transplanted area, address a new area or transplant hair to areas of ongoing hair loss. Taking hair loss medication (such as finasteride and/or minoxidil) can stabilise ongoing hair loss and help to reduce the need for further surgery.

Unfortunately, some of the patients we see at The Maitland Clinic have had a hair transplant procedure elsewhere but found the result unsatisfactory. This might be because they have undergone a procedure that is now out of date, or often they have been let down by what seemed a low-cost option, or by an advertisement, perhaps in a country where there is less regulation of the hair restoration industry.

If you wish to discuss having corrective surgery for a previous hair restoration procedure, Dr Ball will be able to examine you, identify how the current hair design can be improved or corrected, and provide a realistic idea of the kind of result you can expect.

7) What will the clinic do if the transplant does not work?

If our hair transplant procedures are not likely to help a patient, usually because they do not have enough healthy hair to harvest, we will advise against surgery during the consultation phase.

To ensure the best possible long term results, the Maitland Clinic provides comprehensive aftercare to all its patients. We see our patients as lifelong beneficiaries of our hair care service. You’ll be able to stay in contact with us for ongoing support and help on monitoring your hair growth progress, looking after your scalp, and preventing any potential problems.

You’ll be able to return to us for check-ups and maintenance procedures, giving you a lifetime of professional hair care.

8) Why do hair transplants not work for everyone?

No treatment can guarantee a level of transplanted hair thickness that is inconsistent with the thickness and characteristics of your existing hair. A patient whose donor hair is very fine, straight or sparse will not be able to achieve the same results as someone with course, curly, dense donor hair.

Treatment costs

1) How much does a hair transplant cost?

We offer a free initial consultation and hair assessment with David our Senior Patient Advisor and Dr Ball at our Hampshire clinic. This will be followed by a recommendation breakdown and cost by email.

For those requiring a more detailed assessment with diagnosis and onward treatment plan we offer a 1 hour consultation directly with Dr Ball. This includes global and high magnification scalp photography which aids diagnosis and allows us to accurately monitor response to future treatments. At the time of your enquiry David will be able to advise which is most suitable for your own situation. There is a charge of £125 for this initial appointment. This type of consultation is advisable for those that have a more complex nature to their hair loss and includes follow up support as required. Please note this is only available at our Hampshire clinic. The cost of this consultation is redeemable against any surgical procedure recommended.

For those wishing to consult in our Harley Street clinic we charge a small fee of £50 for an initial consultation and hair assessment with David and Dr Ball. There is also an opportunity for a free consultation directly with David who will be able to offer advice, recommendations and cost.

For hair restoration surgery, prices start from £4,000 including aftercare. The total cost will depend on the number of grafts and the type of procedure required.

Beards, eyebrow, sideburns and moustache transplant, prices start from £3,500 including aftercare. The total cost will depend on the number of grafts and the type of procedure required.

The Maitland Clinic

1) Who is behind the business?

Dr Edward Ball is the founder and medical director of The Maitland Clinic.

2) What is their experience?

Dr Edward Ball has been at the forefront of bringing world-class surgical hair replacement techniques to the UK.

A member of the Royal College of Surgeons, His background is in cosmetic medicine, general practice and plastic surgery. Trained in microsurgery and dermatology, he remains a valued member of the skin cancer surgery team at University Hospital Southampton. He was handpicked to undertake his Fellowship in Hair Restoration Surgery in Beverley Hills, California under the mentorship of Dr. Craig Ziering. He subsequently became Clinical Director of Ziering Medical UK, before founding The Maitland Clinic in 2015.

Dr Ball himself became one of the first patients to undergo an FUE hair restoration procedure using the revolutionary ARTAS® Robotic System. This gave him an invaluable insight into the experience of hair loss and hair loss treatment, and puts him in a unique position to understand and empathise with patients who are considering undergoing surgery

3) Why did they set up the business?

In 2015 Edward decided to launch his own specialist hair restoration business based in the UK, using his experience in surgery, dermatology, cosmetic medicine and hair restoration to offer a world class service.

4) Where is the business based?

The Maitland Clinic has one clinic on Harley Street in London and another near Portsmouth in Hampshire.

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