Virtually all men (and many women) will experience some degree of hair loss with aging. The extent of the hair loss depends mainly upon the genetic predisposition of the individual, although stress and other factors definitely come into play. The most common form of hair loss is androgenetic alopecia, or male pattern baldness. Because of the genetic influence, the patient's family history is important, particularly in terms of the patient's father and grandfathers (particularly the maternal grandfather). A patient whose father became completely bald in middle age is not a good candidate for surgical hair correction of any type. Conversely, a patient whose father and both grandfathers maintained a wide strip of hair along the sides and the back of the scalp into old age generally represents a more acceptable candidate for hair replacement surgery.

A patient with androgenetic alopecia has hair follicles that are relatively sensitive to the effects of male sexual hormones (androgens). Usually, the hair most sensitive to the effects of these androgens is located on the crown of the head and in the frontal area. The hair on the back and the sides of the head is less sensitive to these effects. Because the hair follicles along the back and the sides of the scalp are less sensitive to the male sex hormone, these follicles can be transplanted much like a tree can be transplanted from one field to another and continue to live. The transplanted hair follicle will live as long as the surrounding follicles live in the donor site from which it was harvested. Therefore, surgery does not increase the number of hair follicles on the scalp, but only redistributes the follicles from an area of greater density to one of less density and abundance.

Since hair transplantation was introduced in the 1950s, the procedure has been refined, and many other alternative procedures to hair transplantation have been introduced. We presently can offer hair transplantation involving a variety graft sizes, from micro- to mini-sized plugs. In addition, adjunctive surgical procedures include hairline advancements (scalp reduction) and scalp flap procedures. It is important to understand that these procedures can be used alone or in combination to achieve the best effect. Again, no single technique is correct for all patients.