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Hair Loss and Causes

There are many factors of hair loss. Genetic causes, environmental means to effectively etc. can be listed

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Aging encourages hair loss in approximately 50% of men and 20% of women. Hair loss occurs according to typical patterns. Hair loss is allocated according to the causes and type of hair loss. In the case of baldness due to genetic causes, the hair loss starts at the top of the head and progresses towards the lower parts. The most common genetic cause of baldness is the male hormone dihydrotestosterone (abbreviated as DHT). DHT is also known as the male sex hormone. However, it should not be assumed that this hormone is only secreted in men because it is also present in women. Testosterone found in the body as DHT (converted in the body as DHT by the enzyme 5 alpha-reductase). Although every person has DHT hormone, in some people, DHT causes to stop the growth of follicles. Eventually, hair loss occurs. Baldness may be genetically inherited from the mother, father or both two parents. DHT especially targets the crown and mid-scalp areas.
Genetic is primary the reason for hair loss observed in men. Due to genetic causes, dihydrotestosterone (abbreviated as DHT) stops hair growth and leads to hair loss. It cannot be concluded that people with hair loss have greater amounts of DHT while those without hair loss have less DHT. This hormone present in every person. The effect of DHT on the hair follicles is genetic and baldness is associated with this.
  • Hair loss in women may be observed due to genetic causes (due to the weakening of the hair follicles by the DHT hormone) also due to certain diseases, traumatic incidents, hormonal changes or pregnancy. Hair loss in women due to these causes may be temporary or permanent. If the hair growth has stopped or more than 125 hair strands are lost per day, the hair loss should be taken seriously. In female-type hair loss, baldness starts at the middle of the crown and expands. Usually, the hairline does not recede as severely as in men. Genetically, women possess high hairlines.

Hair loss in women usually occurs as presented in Figure 2 or Figure 4. The type of baldness presented in Figure 4 may be treated with hair transplantation.

  • Hair loss zones represent the transplant areas on the scalp.
  • This allows calculating the density distribution of hair. It also allows predicting the future work that may be required as hair loss progresses.
  • Zone 1: Defines the frontal hairline which represents the first 2 cm of the hair transplant area. This is the most important area as it must be performed with a number of different angles and definitely requires an artistic touch.
  •  Zone 1 includes the bald areas at the temples. Transplantation at the temple area is very important in framing the face and highlighting the facial features.
  •  Zone 1 is also important in terms of the appearance featuring the maximum density.
  •  In many ways, zone 1 is the key area due to various reasons.

Zone 2: Zone 2 is the midsection behind zone 1. This area is also important in terms of artistic design and supports the appearance of density.
Zone 3 and Zone 4: Zone 3 and 4 are located in the middle and the back of the head. In these areas, the hair strands should be transplanted in a circular pattern, because the hair should sit on the scalp instead of stand. In these zones, larger areas can be artistically covered using a smaller number of grafts.

In hair transplantation, we use a chart to determine the level of hair loss. Model 1: Hair loss from the front and back eventually meets in the middle. Model 2: Hair recedes from the front hairline progressing to the crown. Model 3: Hair loss starts at the crown and progresses towards the front. Model 4: Hair loss in the form of a crescent, beginning from the front and the sides of the crown, leaving only a wisp of hair at the front. This type of baldness is common among males in Asia, in the Middle East and the Mediterranean region. Model 5: This type of baldness is more frequently observed among women. It starts from the crown and progresses towards the sides. The hairline does not recede. This type of hair loss is also observed among men in the Middle East and the Mediterranean region.

Hair transplantation is being performed since the 1900s. In time, hair transplantation techniques have developed in order to provide a more natural and densitive look. The FUT method (also called strip surgery) still in use in certain clinics around the world causes deep scarring and is associated with a long healing period. The FUE method is currently the most advanced technique, which does not involve the disadvantages of FUT and leads to satisfactory results. No invasive surgical instruments are used in FUE. Instead, the microscopic hair extract technique which is allowing for the natural healing of the skin is applied. FUE is performed without invasive surgical instruments so that there is less pain, the healing is faster and no large scarring occurs at the back of the head. The method also does not harm the donor area, which may be beneficial in the case of secondary and tertiary hair transplantations in the future. All these benefits lead the majority of the patients to choose the FUE method. Istanbul Hair Institute performs hair transplantations with the FUE technique considering the maximum density, natural hairline, strategic placement and supportive methods.


  • Large scars
  • Low rate of hair growth
  • A Low number of extracted grafts (500/1000 grafts per session)\
  • Multiple sessions
  • Longer healing period
  • Insufficient hair density
  • Unnatural appearance of the hairline.

Past methods created negative perceptions of actual treatments available in the hair restoration industry. However, the newly developed techniques used by the Istanbul Hair Institute lead to the below-mentioned results and facilitate the decision of the patients for hair transplantation procedure.


  • Grafts (or follicular units) are extracted individually
  • Minimal scarring
  • Minimal invasive techniques
  • High growth rate
  • High number of grafts extract in one session (4000 or more grafts may be extracted in one session)
  • Satisfactory results in a single session
  • Rapid healing
  • An esthetic and natural-looking hairline
  • Maximum hair density
  • Natural cover of frontal angles
  • Ongoing research and innovation

The latest genetic research on new hair growth:

Cloning:  Cloning focuses on certain questions:

  • Which types of cells can be cloned?
  • Can different donors be used? What can be the reaction of the cells in this case?
  • Under which conditions do the new cells develop? (in vitro – in vivo)
  • Which conditions are required in order to keep the new cells viable?
  • Can the direction of growth be genetically manipulated?
  • Do the newly generated strains fall in the future?

Gene Therapy:

 Each of our cells contains genetic material, i.e. DNA. The structure of our body is determined based on this genetic plan (the proteins are formed according to the gene sequence). Like our eye color, hair loss also depends on the genes. Initially, the gene or group of genes leading to hair loss is researched. The second step involves the detection of the genes leading to hair loss and the research to determine the proteins forming the hair follicles resistant to the DHT hormone (hair strands sensitive to DHT are weakened and lost, leading to boldness). Finally, the genes are re-coded in order to produce new proteins in the target cells. The newly-produced stem cells proliferate to form the cells with the desired characteristics. Progressive research also describes the causes why these genes have mutated.

Dr. Shoji Okuda Japanese dermatologist Dr. Okuda has pioneered hair transplants until the year 1939. Dr. Okuda was using a method called the “punch technique”. He developed a breakthrough process to restore hair loss caused by scalp injuries and burn victims. Dr. Okuda used a punch technique, which involved extracting small sections of hair-bearing skin and implanting these into even smaller holes in the areas where the skin had been damaged. Once these grafts healed, they produced hair in areas that were previously bald.\
Dr. Hajime Tamura Dr. Tamura, improved upon Okuda’s method by minimizing the size of the grafts down to one to three hairs each in 1943. these innovative developments in hair restoration surgery occurred around the time of World War II they did not become accessible around the world.
Dr. Norman Orentreich Dermatologist Dr. Norman Orentreich performed the first hair transplantation against male baldness in North America. In 1959, Dr. Orentreich’s donor hair dominance theory was discussed for a long time in the archives of the New York Academy of Sciences in terms of hair loss treatment. The techniques by Dr. Okuda and Dr. Orentreich were used as standard methods for years. The concept of micro-grafting to achieve a more natural appearance in the front hairline developed during the 1980s and the esthetic quality became a prominent consideration. The use of follicular units in hair restoration started with Dr. Bob Limmer in 1988. Although hair transplantation is a procedure that should be performed by professionals only, various performers carried out operations without being aware of the difficulties involved in hair transplantations. Today, the most developed and advantageous method of hair transplantation is the FUE (follicular unit extraction) technique. There are various clinics applying this method. However, the success of the operation is directly associated with the medical skills and esthetic vision of the physician and the team performing the hair transplantation.

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