Articles

1) International Society of Hair Restoration Surgery (ISHRS) 2009 Practice Census Facts and Figures

2) What is the impact of chemicals on our hair?

3) Hair loss in male pattern baldness

4) Eyebrow Restoration Surgery

5) Hair Restoration in Scarred Scalp

6) Eyebrows

7) Factors affecting Hair Restoration Surgery

International Society of Hair Restoration Surgery (ISHRS) 2009 Practice Census Facts and Figures

Extrapolated Number of Hair Restoration Procedures Worldwide

• An estimated 252,002 hair restoration procedures were performed worldwide in 2008 (a 12% increase from 2006)

o In the United States, 98,727 hair restoration procedures were performed
o In Canada, 5,268 hair restoration procedures were performed
o In Mexico/Central & South America, 13,102 hair restoration procedures were performed
o In Europe, 32,320 hair restoration procedures were performed
o In Asia, 78,822 hair restoration procedures were performed
o In Australia, 3,116 hair restoration procedures were performed
o In the Middle East, 20,647 hair restoration procedures were performed

Estimated Hair Restoration Worldwide Market Size

Based on the estimated number of 252,002 hair restoration procedures performed in 2008, multiplied by the average fee* charged to patients for a procedure, the estimated worldwide market for hair restoration was calculated as follows (expressed here in various currencies):

• $1,268,590,668 USD (U.S. Dollars)
• €971,501,957 (Euros)
• $1,536,263,299 CAD (Canadian Dollars)
• $1,760,994,136 AUD (Australian Dollars)

*The “average fee” charged for a procedure reported by survey participants and used in this calculation represents the overall average fee charged to all patients treated. Since the cost of procedures performed on individual patients may vary depending on the number of grafts and several other factors, the “average fee” as it related to this survey did not represent what all patients would expect to pay for a procedure, and should not be construed as a typical price for a hair restoration procedure.

Extrapolated Number of Hair Restoration Surgical & Non-Surgical Patients Worldwide

• The extrapolated worldwide number of hair restoration patients treated in 2008 was approximately 811,363 (236,468 surgical patients and 574,894 non-surgical patients) – a 26% increase from 2006

o In the United States, 227,216 hair restoration patients were treated
o In Canada, 10,695 hair restoration patients were treated
o In Mexico/Central & South America, 43,969 hair restoration patients were treated
o In Europe, 73,167 hair restoration patients were treated
o In Asia, 385,711 hair restoration patients were treated
o In Australia, 14,855 hair restoration patients were treated
o In the Middle East, 55,750 hair restoration patients were treated

By Age and Gender

• In 2008, 84.9% of all hair restoration surgical patients worldwide were male (down slightly from 86.2% in 2006)

o Men in their 30s represent the largest group of male patients (31.2%)

• In 2008, 15.1% of all hair restoration surgical patients worldwide were female (up slightly from 13.8% in 2006)

o Women in their 40s represent the largest group of female patients (31.1%)

• In 2008, 68.2% of all non-surgical hair restoration patients worldwide were male (down slightly from 71.8% in 2006)
• In 2008, 31.8% of all non-surgical hair restoration patients worldwide were female (up slightly from 28.2% in 2006)
• In 2008, more than half of both male and female patients worldwide fell between the ages of 30 to 49 years old (59.6% and 54.9%, respectively)

Trends by Country

Of the estimated 252,002 hair restoration procedures performed worldwide in 2008:

• The Middle East experienced the biggest increase in the number of procedures, with 20,647 procedures performed in 2008 (a 68% increase from 2006)
• While nearly all (92.9%) hair restoration procedures performed in 2008 targeted the scalp area, hair restoration procedures performed on the eyebrows increased in popularity worldwide by 43.1% (11,105 procedures in 2008 vs. 7,758 procedures in 2006)

o In Europe, eyebrow hair transplants increased by 297.9% (2,861 procedures in 2008 vs. 719 procedures in 2006)
o In Mexico/Central & South America, eyebrow hair transplants increased by 21.5% (745 procedures in 2008 vs. 613 procedures in 2006)

• In Asia, the demand for chest hair transplants rose by 184.4% (219 procedures in 2008 vs. 77 procedures in 2006)
• In the Middle East, the number of facial (moustache/beard) hair transplants increased by 110% (916 procedures in 2008 vs. 436 procedures in 2006)
• In the United States, the number of facial (moustache/beard) hair transplants increased by 15.1% (1,369 procedures in 2008 vs. 1,189 procedures in 2006)

Notice: Please refer to the full report of the 2009 ISHRS Practice Census, located at:
www.ishrs.org/mediacenter/media-statistics.htm.
The objective of the survey was to gather reliable statistics with regard to the volume of hair restoration procedures performed, patient demographics, surgical techniques, treatments used, and other practice dynamics. The margin of error for the sample is plus or minus 6.5 percent at the 95 percent confidence level.

The ISHRS commissioned RH Research of Chicago, IL, to help develop the survey instrument, collect the data, analyze the findings, and prepare the summary report. RH Research is an independent survey research company specializing in surveys and statistical programs for professional societies and trade
associations. All data collected from ISHRS members was kept completely confidential by RH Research.

The 2009 ISHRS Practice Census is published by the International Society of Hair Restoration Surgery (ISHRS) and is a compilation of information provided solely by participating physicians. The information published in this survey was developed from actual historical information and does not include any projected information. Neither RH Research nor ISHRS has verified the accuracy, completeness or suitability of any information provided here, and ISHRS does not recommend, encourage, or endorse any particular use of the information reported in this survey. ISHRS makes no warranty, guarantee or representation whatsoever and assumes no liability or responsibility in connection with the use or misuse of this survey.

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What is the impact of chemicals on our hair?

pH Scale

To understand about hair, we should first understand the pH scale. The pH scale ranges from 0 to 14. The scale can be divided into 2 parts at pH 7, where it is neutral. . ACIDS are from pH 0 – 7 and ALKALINES are from 7-14. Not many people know that the pH of our skin and hair is between 4.5 – 5.5, hence we can see our skin and hair is acidic.  We should search for good shampoos and conditioners between these pH ranges.        

And what about the chemicals? Where are they located on the scale? All chemicals are alkaline. They swell inside of the hair shaft and open the cuticle of the hair. For example when tint is applied, the colour molecules are still very small and undeveloped. In half an hour of the chemical procedure they are finally developed and become much larger. Because of their new size, the molecules cannot pass through the cuticle anymore and stay trapped inside of the cortex. That’s why after tinting, bleaching, perming or chemically straightening our hair usually results in fuzzy, dry and easily breakable hair! Most chemicals that colour our hair contain ammonia, which has the pH of 11. Bleach, which has a pH of 13, is used to highlight hair, that’s almost at the end of the scale! This is why after using chemicals, hair can suffer permanent damages.

             HEALTHY HAIR SHAFT                                       DAMAGED HAIR SHAFT

So does this mean we have to stop coloring, bleaching, perming or straightening our hair?? Not at all! We can still keep up with fashion and covering grey hair!! However it is important to look after our hair well! Always use professional shampoo and conditioner and acidic treatments which can reduce high level of alkaline in your hair. In the market, there are many professional brands offering hair serums, nutritive ampoules and other products to further assist in the pH balance of your hair.

Is it now easier to understand what impact chemicals can have on hair? And how we should look after our hair?

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Hair Loss in Male Pattern Baldness

Male pattern baldness or otherwise known as ‘androgenetic aloprecia’ affects millions of men around the world. ‘Andro’ refers to the androgens (testosterone, dihydrotestosterone) necessary to produce male pattern hair loss. ‘Genetic’ refers to the inherited gene necessary for male pattern baldness to occur. Hair loss may begin any time after puberty when blood levels of androgens rise; it usually begins receding in the temporal areas. In general, those who begin losing hair in their 20’s will have the most severe hair loss outcomes.

Hamilton and Norwood have classified male pattern baldness shown on the picture below. Hamilton found that androgens are necessary for the development of male pattern baldness. Androgens present do not need to be greater than normal for baldness to occur. In every male hair loss will occur to some degree, however, if the gene for hair loss is present, male pattern baldness will take place.

Testosterone is responsible for the growth of under arm and pubic hair, while Dihydrotestosterone (DHT) is responsible for beard growth and male pattern hair loss. DHT is the conversion of testosterone by the enzyme 5α - reductase. DHT works by binding, then entering into the cell to interact with the nucleus, changing the DNA and ultimately causing the hair follicle growth to cease. Finasteride (Propecia®) works by blocking the enzyme, decreasing the amount of DHT produced therefore slowing down or stopping the process of hair loss.

There are 3 phases in the hair growth cycle; Anagen - growth phase, Catagen – degradation phase, and Telogen – resting phase. Hair growth cycle is affected when there is a lower percentage of hair in anagen phase than the percentage of hair in telogen phase. Hairs in telogen phase are much more subject to loss with daily trauma such as combing and washing. In male pattern baldness, hair shafts become gradually miniaturized, meaning over time, the hair shaft slowly becomes smaller in diameter and length. Pigment (colour) production is also terminated with miniaturization causing the fine hair to become lighter in colour and affected area to appear thin. Over time, those hair follicles will be permanently terminated.

In short, male pattern hair loss is an inherited condition which can be passed down from either the father or mother. The rate and severity of hair loss is unpredictable, although the severity increases with age. If the condition is present it will be progressive and relentless. Hair loss is most likely to occur between late teen-age years and age 40-50 years.

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Eyebrow Restoration Surgery

Eyebrows make an important contribution to facial symmetry. A person with no eyebrows or eyebrow asymmetry may feel very self-conscious. Transplantation or reconstructive surgery can often restore or enhance eyebrows with postoperative complications usually limited to minor pain and swelling.

Eyebrows can be lost in a variety of ways, including:

• Physical trauma such as car accident, thermal, chemical or electrical burns
• Systemic or local disease causing loss of eyebrows
• Congenital inability to grow eyebrows
• Plucking (to reshape the eyebrow) that results in permanent loss of eyebrows

Before hair transplant restoration can occur, an evaluation and examination of prior medical history needs to be considered. Some points that will be examined are:

• Systemic or local disease that cause hair loss must be under control to assure success
• Trauma, burns or surgery scar tissues. Reconstructive surgery may be necessary before eyebrows restoration can be considered

Reconstructive surgery has been used for many years to restore missing eyebrows or to repair partially missing eyebrows. Technical considerations and the needs of the patient determine which procedure is used;

1. Transplants: a strip of hair-bearing skin and subcutaneous tissue is removed from a donor area on the scalp and grafted into the surgically –prepared eye brow site.

2. Scalp-to-eyebrow pedicle flaps: (not common) A strip of hair-bearing skin and subcutaneous tissue is taken from the temple area just in front of the ear. With its blood supply attached, this pedicle flap is then raised and pulled through a subcutaneous tunnel to the eyebrow site.

3. Hair Transplantation (more common): Traditionally, a strip of hair-bearing scalp skin is removed; hair follicles are then separated under microscope and grafted into the eyebrow site. This traditional method may not result in best match hairs for eyebrow restoration. However, using the latest technology, the follicular unit extraction (FUE) method can select and extract the best match hair from the scalp or the body, follicle by follicle. These hair follicles are then implanted with specialised implanters ensuring precise control of the angle and direction of each hair resulting in the most natural appearance of the eyebrow. As the transplanted hairs grow in their new position they may require occasional trimming as well as “training” with gel or wax.

With the development of the Minimally Invasive Hair Transplant surgery - FUE, now it is possible to have a permanent solution to a totally natural eyebrow.

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