Most adults lose 75 to 125 hairs a day as part of a natural process of hair growth. As long as the hair loss is balanced by new growth, there is no problem with hair density. The problem most often occurs in young men, which is due to hereditary factors. Hair gradually begins to thin and starts to shed. The process is most pronounced at the front and the top part of the scalp where, in contrast to the hair from the lateral and posterior part of scalp, hair follicles are much more susceptible to the action of a hormone dihydrotestosterone (DHT), which causes the so-called male type of baldness (androgenic alopecia). Much less frequently, and in conjunction with other hormones baldness also occurs in women. Excessive hair loss can be associated with thyroid disease, iron deficiency, excessive stress or taking certain medications. Permanent or temporary hair loss can also be caused by certain skin diseases that affect the scalp (alopecia areata, lichen planopilaris or lupus). Despite the many myths, hair loss is not caused by frequent shampooing, wearing hats or helmets and the presence of mites.

- The scalp can be restored by hair transplantation.

- With regular use, excessive hair loss can be slowed down with tablets (finasteride) or with the use of a liquid that is applied to the scalp (minoxidil).

- There are also so-called scalp enhancers, such as colored creams, sprays and powders to help conceal the balding areas of the scalp.

- Hairless parts of the scalp can also be hidden with a wig or a hair piece.

FUE - Follicular Unit Extraction is a new, minimally invasive method for harvesting hair follicles. It is used in modern surgical hair transplantation and can be used to restore scalp hair as well as hair on other body parts (eyebrows, beard, mustache, scars...) in both sexes. It is a very precise technique in which each hair follicle is taken separately with a special instrument and each hair follicle is implanted individually at the desired location. If hair is implanted with sufficient density and the pattern and direction of the implanted hair mimics the natural hair, it is almost impossible to tell the difference between the restored hair from the original hair on your scalp.

The main difference between FUE and the classic method is the technique of obtaining grafts. In the classical method, a strip of skin is surgically excised from the donor site in the back of the head and the resulting wound is sewn up. After the procedure, a 15-20 cm long scar remains at the donor site. Grafts are prepared under a magnifying glass by cutting the excised strip of skin into small follicular units containing different number of follicles. In FUE method we obtain follicular units using a micro-surgical technique. The grafts containing from one to three follicles are harvested using a circular blade with a diameter of 0.5 to 0.9 mm. After the procedure, aesthetically acceptable, virtually unnoticeable scars remain in the form of small dots.

The aim of each hair transplantation procedure is a natural look of transplanted hair. How natural the result really looks depends on many factors. The direction of growth of transplanted hair, graft size, density and pattern of the transplanted hair and natural shape of the hairline all influence the final look and the surgeon must be attentive to all of the above. Regardless of the technique (conventional or FUE) the experience, accuracy, patience, sense of aesthetics, as well as the choice of appropriate instruments are all crucial for the perfect end result. For this purpose, we use specially designed instruments called 'hair implanters '. These instruments allow us to implant hair under the specified angle in a selected pattern. The instrument also protects the hair bulb, which would otherwise be damaged by the forceps, and thus increases the percentage of successfully transplanted hair. When using implanters, scars on the recipient site are smaller, while bleeding during surgery is also reduced.

Research Report of the International Association for hair surgery from 2009 states that three out of five people are not able to distinguish natural hair from that which has been restored with the FUE technique at close inspection. However, if even a few years ago transplanted hair looked like the hair of plastic dolls, today, by using modern techniques, a completely natural look can be obtained.

For the restoration of the scalp hair, FUE method can be used to harvest the grafts by harvesting body hair. Hair that is transplanted to bald parts of the scalp can be removed from any part of the body. This is an important advantage for men with the advanced male pattern baldness. For these patients transplanting only the hair from the back of the head would not be enough for us to create acceptable density of the new scalp. If possible, it is necessary to harvest the hairs that are in color, structure and length similar to the patients scalp hair. All hair can also be transplanted in any other parts of body or face that, for whatever reason, became hairless. Thus, both men and women can have hair transplanted to the areas where they grow poorly or not at all. Hair can be transplanted to create mustache or beard, reconstruct the eyebrows or hide a scar that remains after surgery or an injury.

Hair transplantation is suitable for those patients who for whatever reason have lost their hair. The procedure can increase the density or completely restore the hairless parts. Some patients only need the transformation of the front hair line. Hair transplantation can cover scars after injury, previous surgery or bald areas caused by skin diseases.

The procedure is performed under local anesthesia. Except for a few seconds of  minor discomfort when injection of local anesthetic is administered, the procedure is completely painless. Restoration of the scalp with the use of FUE technique can be longer than the traditional method due to more meticulous method of extracting hair follicles. Depending on the number of transplanted follicles, the operation may last from a few hours (for transplantation of hundreds and up to thousand hair follicles), and up to nine or ten hours for transplantation of even larger number of hair follicles.

Donor site heals very quickly. In FUE method, there are no stitches and small wounds are usually healed after two days. The wounds at the recipient site heal even faster. Using cold compresses and aerosol with saline and sleeping in half upright position for 2-3 days after surgery helps reduce swelling and bruising.

Pain after the procedure is minimal. Analgesics, therefore, are usually not need. Similarly to other surgical procedures rest is recommended afterwards. The patient is not allowed to touch the scalp with fingers for a few days in order to prevent the bacteria entering the wounds and causing infections. Great physical exercise should be avoided up to two weeks after the procedure. In the meantime, you should avoid exposing the scalp to direct sunlight.

Everyone should decide individually when he or she will again normally include in social life. Unless you work in extreme working conditions, there is no medical reason not to go to work or outside, even one day after the procedure. Small crusts that are formed on the scalp after the procedure, fall off in the first days after the procedure and are usually completely gone within ten days.

The transplanted hair is shed in the first few weeks after surgery, but the roots remain dormant about 3-6 months, after which all new hair begins growing again. In the donor area, as well as in the recipient area slight numbness may be experienced temporarily after the procedure, but it usually disappears within a few months.

The outcome of treatment is influenced by many factors such as the density of hair on the donor site, the size of the wounds, hair texture, preceding interventions and others. A more detailed examination is required prior to the procedure, where we can discuss the expected results and design a treatment plan.

Finasteride (Propecia®) is a medicine in tablet form and is only available on prescription. It is used for the treatment of baldness in men. It inhibits the formation of DHT (dihydrotestosterone), which is responsible for the formation of androgenic alopecia. Finasteride does not reduce the level of testosterone, the hormone responsible for masculinity, so the influence on sexual function is mild and occurs in less than 2% of patients. Finasteride has been available on the market for more than 15 years and has been proven safe and effective. It works best for early or moderate hair loss, but it can also help patients with more advanced hair loss, because in some patients hair re-growth can be observed, in the majority however, the hair loss process is slowed down. Often it is used as a complementary treatment for hair transplant.

Hair lotion containing minoxidil (Rogaine®) has been in use for over 25 years and helps in inhibiting hair loss, but it is less effective in the promotion of re-growth. For successful treatment it needs to be used regularly.

Use of finasteride and minoxidil has a synergistic effect.