By: Cheah Ui-Hoon

HAIR loss is still primarily a man's problem, but stress and hormonal imbalances are causing women to narrow the gap between the sexes. But while men may be more likely to accept balding as a fact of their non-hirsute life, women are not standing by and letting their hair collect on the floor of their shower stall.

According to a recent survey conducted by the International Society of Hair Restoration Surgery (ISHRS), women are looking for practical solutions, and men are following suit.

So much so that in the period from 2006 to 2008, the number of people seeking out hair restoration treatments jumped by 26 per cent.

'Three out of 10 men have hair loss, whereas the ratio for women is one out of 10,' says Chih Chien May of NeuGlow Medical Hair clinic, which specialises in hair transplants and will open at the Mandarin Gallery in October.

What's driving this increasing demand? Obviously, better treatments and more options for the follicularly-challenged.

While treatment is the solution, it also helps to know if the problem can be avoided in the first place. Men can blame their hair loss on genes, but the causes of hair loss for women tend to be more complex. Some hair problems are temporary, caused by childbirth or thyroid imbalances, and see-sawing weight as well as nutritional deficiencies like the lack of iron or zinc.

'For women, hair loss tends to be more insidious. Hair gets finer, and the thinning usually starts at the crown of the head and increases in the degree of severity from type one to four,' explains Dr Chih, adding that the speed of hair loss depends on the cause.

The damage can be due to many factors, but simple actions like hair rebonding or tying the hair too tightly or too often also contribute to the problem.

Just as the causes of male and female hair problems are different, so are the solutions. Minoxidil, for example, seems to work better for women, notes Dr Damkerng Pathomvanich of DHT Hair Clinic in Bangkok, who attended the ISHRS meeting in Amsterdam recently.

Minoxidil is still the only FDA-approved solution, and Dr Chih agrees that it helps nourish the hair follicles.

But if men can take pills to regulate their hormone (DHT)-triggered hair loss, women can't. 'In fact, it's dangerous for them to do so,' stresses Dr Chih. The drug finasteride has been shown to be highly effective in stopping hair loss in men (at a rate of over 80 per cent) but this can't be used for women, even post-menopausal women.

For women, Dr Chih in fact recommends topical applications, unless they're really at a stage where they need hair transplants.

Most female patients who see Dr Damkerng present him with a thinning crown, called the Ludwig pattern of hair loss which sees hair loss starting from the centre line of the head.

'Unfortunately, a lot of them don't have good donor hair - meaning their hair loss is generalised to the temple and there is minimal good donor hair (from another part of the scalp) available for hair transplantation. For women with the Norwood pattern of hair loss, which is a receding hairline like men's, the result is usually excellent due to good donor hair and minimal area of baldness compared to men,' he says.

The good news is that technology has caught up with the hair industry, with new machines like the Omnigraft now making hair transplants faster and less 'invasive' as well. 'Hair transplants can now take half the time it used to,' explains Dr Chih.

NeuGlow Medical Hair clinic will be the only one here to carry the French-made Omnigraft technology which can automatically extract follicular units from the scalp in this process called Follicle Unit Extraction (FUE). Individual hair follicles are non-surgically 'harvested' with micro instruments and pushed into the bald sections of the head.

'About 500 follicle units can be transferred in three to four hours, while the patient is only under local anaesthetic,' says Dr Chih. It takes three to four months for the transplanted follicles to grow.

In the conventional strip method, doctors carve out a 10-15cm strip of hair - usually from the bottom of the back of the head where hair follicles there are genetically programmed to grow a lifetime. Doctors then pick out the follicles from that strip before they implant them onto the balding area.

Dr Damkerng says that the strip method is still the gold standard, as the technology for FUE is still relatively new so its extraction method may not be as accurate as desired.

'Doctors are still debating which is better. The problem with FUE is that it has to be done 'blind', as one just uses the machine to extract follicles and you can't 'see' what's underneath the skin,' he says.

About a fourth of the hair treatments worldwide are hair transplants, with the majority carried out by strip method, he adds.

Out of the total number of those undergoing hair transplants, about 15 per cent were women in 2008, up from 11.5 per cent in 2004.

New techniques like non-surgical FUE has been around for about five years, says Dr Chih, and the other advantage the patient has is that there is not so much visible scarring as unlike the strip method, a rectangular strip of hair is cut out.

With FUE, some patients are even getting their eyebrows filled in with transplanted hair, she adds.

Dr Damkerng, however, feels the scar produced by the strip method of harvesting is only minimal when closed by trichophytic donor closure.

'The scar produced by FUE seems bigger but not linear and is not attractive to the public eye. The only absolute indication for me to use FUE is a very tight scalp or a small session of transplantation, he adds.

Still, having a hair transplant doesn't mean that you don't have to take care of your new hair or scalp. Which is one reason perhaps why trichology centres like Glow and TrichoKare, and Beijing 101 are doing a flourishing business.

Beijing 101, for example, takes a holistic view of the person's health besides the hair. The Chinese haircare chain uses formulations based on traditional Chinese medicine to treat scalp problems while there are resident TCM practitioners there to give prescriptions to 'balance' out the body. A 'heaty' constitution will result in more secretion of oil in the scalp, for instance.

The TCM approach is to boost the body's immune system especially if stress or high anxiety is a root cause. While hair loss can be reversed, there's little to be done for white hair, says Serene Wong, Beijing 101's senior business manager.

What is true for both males and females is that they need to get a proper and correct diagnosis of the cause of their hair loss by dermatologists or hair loss specialists, says Dr Damkerng. 'Only then can you get the right treatment,' he adds.

But in his experience, most women will want to get a hair transplant done because their reaction to hair loss is often stronger than men.

'They might develop marital problems, or not go to work. But hair transplants will depend on the patients' donor density, laxity and area of baldness.'

This article was first published in The Business Times