Our everyday observation tells us that the primary function of hair follicles is to produce hair. That’s the function we care about because it has the most immediate and visible benefit to us. Scalp hair is an important cosmetic element in the image we present to others.
When hair follicles stop producing hair, we may seek ways to medically restimulate their hair-growing capacity (See on Nonsurgical Hair Loss Treatments , or to surgically restore hair to hair-loss areas. We seek the professional services of a hair specialist to accomplish the necessary cosmetic repair.
Why should that hair loss specialist be a physician?
That question can be answered under several headings:
- Medical education
- Surgical training
- Subspecialty training in hair restoration
- A unique combination of the science and esthetics of hair restoration
Medical Education
While hair loss is viewed primarily as a cosmetic problem, hair growth, hair loss and hair restoration are whole-body phenomena. The whole-body approach is what a physician learns in medical education and applies in everyday practice.
A good way to think about hair growth, hair loss and hair restoration from a whole-body perspective is to ask “What is hair?” From the cosmetic-only viewpoint, scalp hair is an adornment that is managed and styled for maximum cosmetic effect. From the whole-body viewpoint, hair is important esthetically, but it is also important biologically. It is an important part of the body’s outer covering and it participates in essential biological functions.
An old question is, “Why do we have hair?” At one time, it was believed that body and scalp hair is a useless evolutionary leftover from our primate past. At most, it was believed, hair may have some peripheral functions such as insulating our bodies from extremes of temperature.
As our understanding of the human body increased-especially by applications of molecular biology that sees body functions in fine detail-we learned that the hair follicle plays a role in many processes involving the skin. We learned that the hair follicle is a source of stem cells that can be active in wound repair as well as in hair growth and regrowth. We learned that hair follicles can be a source of some types of skin tumors, and may be implicated in diseases of uncertain cause such as alopecia areata (SeeAbout Hair Loss for more information about alopecia areata).
And, of course, we learned how hair follicle function is intimately associated with whole-body systems such as genetic control of androgenic hormone production, thyroid gland responses to internal and external environments, and nutritional status. Hair follicle function is highly integrated with molecular signals to and from these whole-body systems.
The whole-body viewpoint is how the hair loss specialist looks at hair growth, hair loss, and hair restoration. Before hair restoration is undertaken, the patient’s whole-body status must be considered and any underlying health problems addressed. Before hair restoration is undertaken, the reason for hair loss must be understood and the likelihood of successful hair restoration established.
Surgical Training
Surgical training of a hair specialist stands on a foundation of medical education. The surgeon must earn a degree in allopathic medicine (M.D.) or osteopathic medicine (D.O.) before entering full surgical training. The M.D. or D.O. surgeon is both physician and surgeon. The physician hair restoration specialist is a physician who approaches hair loss/hair restoration with the whole-body viewpoint of a physician and the technical skills of a surgeon with special training in surgical hair restoration.
Special Training in Hair Restoration Surgery
The physician hair restoration specialist has detailed knowledge of the physiology and anatomy of the scalp and the hair follicle. The scalp is not merely a layer of skin from which hair grows. Scalp skin a physiologically active and it has complex anatomy:
Scalp Anatomy
The five distinct layers of tissue:
- Superficial skin
- Subcutaneous fat and fibrous tissue, where most of the scalp blood vessels, lymph vessels and nerves are located
- The galea, a strong tendon-like structure
- Loose connective tissue that allows for free movement of the scalp
- The pericranium, the attachment of overlying layers to the bony skull.
The physician hair restoration specialist has detailed knowledge about the scalp’s blood supply. The scalp is one of the most vascular areas of the body, which accounts for the copious bleeding that follows any skin-breaking injury to the scalp. Knowledge of the arterial and venous blood supply helps to avoid unwanted blood loss during scalp surgery, and avoids compromise of blood supply to areas of hair restoration. Likewise, the physician hair restoration specialist has detailed knowledge of lymph drainage from the scalp; compromised lymph drainage can lead to forehead edema and “black eyes” after surgical hair restoration.
The physician hair restoration specialist also takes into consideration:
- Natural lines of cleavage in scalp skin, where incision or excision is least likely to result in scarring,
- Scalp biomechanics, including the ability of scalp skin to stretch and recover from stretch, and
- Principles of suturing to achieve wound closure with maximum ability to heal and minimal scarring.
The Science, Technique and Esthetics of Surgical Hair Restoration
Sound science and excellent surgical technique are two legs of the triad of surgical hair restoration. The third leg, just as essential, is esthetic judgment. Medical knowledge, surgical skill and esthetic judgment together comprise the science and art of surgical hair restoration. The hair specialist combines good science, excellent surgical skills and a “good eye” to achieve medically sound and esthetically satisfactory surgical hair restoration. (Source: ISHRS)