Hair replacement/ transplantation

A hair transplant involves taking hair from one area of the head, where hair is growing, and placing it where there is a a bald or areas of hair that are becoming thin. It requires surgery. Hair restoration surgery usually takes a full day. Before beginning the transplant the doctor will administer a local anesthetic injection and sedation to numb the area at the back of the head. There are two common methods for the transplant: follicular unit extraction (FUE) or follicular unit strip surgery (FUSS).

The following step takes place with FUE:

  1. The surgeon will remove hair follicles one by one from the back of the head.

The following steps take place with FUSS:

  1. the surgeon removes a strip of skin from the back of the head.
  2. The surgeon sews the scalp closed
  3. The removed scalp is divided into tiny grafts.

In both hair transplantation techniques the surgeon then  creates holes or slits with a scalpel or needle in the areas where the hair will be placed. People often need follow up procedures. Regrowth should take place about 3 months after surgery. Some patients need to wait 6-9 months before they see any regrowth. 

The recovery time is dependent on the extent of the surgery. After surgery the patients report pain, numbness and soreness. Patients often need to take pain medication and antibiotics or anti-inflammatory drugs for several days. Patients may have to wear bandages over their scalp and may not be able to return to work immediately.

Possible side effects:

  • bleeding
  • infections
  • scarring
  • folliculitis: inflammation or an infection of the hair follicles
  • sudden loss of original hair

Possible limitations:

  • Expensive treatment and expensive repeat sessions
  • Repeat hair transplants are needed because of continued hair loss
  • Hairs in the donor area may not be genetically resistant to hair loss
  • Large bald areas cannot be fully covered
  • The transplanted hair lacks density
  • Unnatural-looking hair growth

Cosmetics for baldness

  • People can change their part so that it covers up the place where their hair is thinnest.
  • Getting more frequent haircuts, may help to increase fullness.
  • Applying scalp makeup. The makeup should be the same color as the hair. This may help to camouflage bald parts and thinning areas of hair.

Micropigmentation (tattoo) to resemble shaven scalp

Micropigmentation (tattoo) involves tattooing little dots in place of hair follicles. This gives men the appearance of having a shaved head instead of a bald, or partially bald, head. Some people become dissatisfied with their tattoo after a while. This can be a problem as it is hard to remove a tattoo. People also often complain that their tattoo fades over time. Sometimes the tattooist may inject the pigment too deeply into the skin. The pigment may then look blurred.

Risks involved in tattooing:

  • Infection

Unsterile tattoo equipment and needles can transmit certain infectious diseases. These disease include: HIV, hepatitis, bacteria, and staphylococcus (a skin infection).

  • Removal problems

Removing a tattoo is a time consuming process that can involve several treatments. It can also be an very expensive process. Scars are often left behind.

  • Allergic reactions

If allergic reactions occur it can be a problem as pigments can be difficult to remove.

  • Granulomas

Granulomas are nodules. Granulomas can form around substances that the body thinks are foreign. Tattoo pigment when detected by the body may be deemed foreign. This may cause the development of nodules around the tattooed area.

  • Keloid formation

Keloids are scars that grow beyond normal boundaries. Some people are more likely to develop keloids than others. Keloids can form as a result of a tattoo.

In 2004 the FDA recalled a brand of ink that was connected with many adverse reactions that people were having when they underwent permanent makeup procedures. The New England Journal of Medicine declares: “Our findings show that application of permanent makeup can result in serious, long-term disfiguring reactions.” [1]



A hairpiece may go by different names but essentially all hairpiece work in the same way. They are all hair prosthesis and are made from similar materials. Some examples of hair piece systems are: toupees, strand-by-strand insertion system, wig, hairpieces etc.

Side effects:

  • Hair loss

Hairpieces can also cause damage to existing hair on the scalp.

  • Prevents hair growth

Wearing a hair piece can stop natural oils getting to the scalp. This can make the scalp dry which can minimize the chances of new hair growth. A dry scalp can also be very sore.

  • Headaches

A hairpiece can cause headaches. Sometimes hairpieces are not properly worn or don’t fit properly. The result can be frequent headaches.

  • Glue and gum damage

Some hair pieces are attached using bonding glue or a gum. These glues and gums can thin out the hair on the scalp. They can also create patches at the hairline.

  • Allergies

People may at times be allergic to the material the hair piece is made from. This can cause itchiness. It can also damage the hair on the scalp.

Minoxidil topical solution

Minoxidil solution and foam are used to promote hair growth. Minoxidil is available as a lotion that is rubbed into the scalp on a daily basis. The medication contains either 5% or 2% minoxidil. It is not used for receding hairlines in men. It is commonly used for sudden, patchy hair loss. Women with thinning hair can also used minoxidil. It is not known exactly how minoxidil works, but evidence suggests it can cause hair regrowth in some people.

See a doctor if, when using minoxidil solution, you have signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.

Other side effects include:

  • itching or skin rash (on going)
  • acne at site of application
  • burning of scalp and/or reddened skin
  • facial hair growth
  • increased hair loss
  • inflammation or soreness at root of hair

Sometimes too much medicine enters the body. This can cause the following side effects:

  • chest pain
  • fast or irregular heartbeat
  • blurred vision or other changes in vision
  • dizziness and/or fainting
  • headache and/or light-headedness
  • flushing
  • numbness or tingling of hands, feet, or face
  • swelling of face, hands, feet, or lower legs
  • weight gain (rapid)

Finasteride tablets

Finasteride (Propecia) is used for the treatment of male pattern hair loss.  It works by stopping the testosterone to dihydrotestosterone (DHT) in the body. Some studies have suggested that finasteride can increase the number of hairs people have. It generally takes around 6-12 months before any effect is seen.

Finasteride is for use in men only. Finasteride should never be taken by a woman or a child.

Finasteride can cause birth defects if a woman is exposed to it during pregnancy. Finasteride tablets should not be handled by a woman who is pregnant or may become pregnant.

Finasteride can be absorbed through the skin, so women or children should not be allowed to handle finasteride tablets. If a woman or child accidentally comes into contact with a broken or crushed tablet, wash the area with soap immediately.

Side effects for finasteride can include a loss of sex drive (libido) or erectile dysfunction (the inability to get or maintain an erection). Using finasteride may increase a man’s risk of developing prostate cancer. You should not use finasteride if you are allergic to it.

Tell your doctor if you have the following (before using finasteride):

  • prostate cancers
  • liver disease, or abnormal liver enzyme tests
  • a bladder muscle disorder
  • if you are unable to urinate
  • stricture of your urethra or
  • if you have ever had an allergic reaction to a similar medicine called dutasteride.


Dutasteride has proved to be very effective in treating genetic male pattern hair loss on the top of the head and the mid-scalp area. Dutasteride works by blocking the formation of DHT.

Side effects for Dutasteride can include a loss of sex drive (libido) or erectile dysfunction (the inability to get or maintain an erection). It can also cause ejaculation problems and enlarged or painful breasts. Dutasteride can also affect sperm by: lowering sperm count and semen volume and affecting sperm movement.

Serious side effects:

  • Allergic reactions including:
    • swelling of your face, tongue, or throat
    • peeling skin
  • prostate cancer.