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| Social
Impact and Aesthetics of Hair |
What is it about hair? References to our "crowning
glory" abound in our historical and cultural experience,
a shared consciousness about what it means to have, or to
not have, this most outwardly evident portion of our human
anatomy. So why is hair so important to us, what is its
significance and why do we universally care so much about
it? Well, let’s examine some of these questions.
For one thing, it is so obvious. Rarely concealed by clothing,
it is one of the first characteristics that other people
notice about us. When someone asks for a description of
an individual, here’s what usually comes to mind:
"He’s a tall, blond guy, with long hair like
a Viking"… "she’s a beautiful brunette"…
"Medium build, dark, curly hair"… "an
impressive shock of thick, white hair"… "light-skinned,
with dreadlocks or cornrows"… "fat and balding"…
"she’s a real redhead!"… "he
was cute, with poofy hair like an ‘80’s rock
star".
Notice something common to all these descriptions of obviously
quite different people? Sure, it’s the hair. Before
eye color, nose shape, sometimes even before height and
weight, people comment on hair: length, color, style, or
the absence thereof. This is a large part of what we present
to the world, like it or not. It is also inevitably present
in our concepts of beauty.
The impact is powerful. We know that people with "outrageous"
hairstyles considered outside the mainstream may have difficulties
functioning in society at large. Our hair speaks to our
social, professional, cultural, and/or religious affiliations,
and is an important element of our self-expression. What
is less well known is that bald or balding men are often
regarded by society as older, weaker, more ineffectual,
and are more likely to be passed over for promotions or
raises than their peers. They are often seen as less desirable
as potential mates, lacking in virility, and less capable
of providing for a family. Even more significantly, balding
men have lower levels of self-esteem than their peers, suffer
more from depression, are less sociable, and are less likely
to succeed in life (British Journal of Psychology, 1995).
Hair is inextricably woven into the fabric of our culture.
Consider our common mythos: Samson and Delilah, Cleopatra,
Prince Valiant, Rapunzel, Goldilocks; hippies, skinheads,
mods and rockers, the Beatles (those ‘loveable "moptops"
from Liverpool!’) Hair and hairstyles define entire
eras (the 1960’s) and cultural movements. Likewise,
religion and spiritual disciplines often consider hair,
or its absence, of singular significance. Many sects of
monks or nuns require shaving of the hair as a demonstration
of withdrawal from "worldly" pursuits into the
spiritual world. Conversely, Sikhs and other religious groups
prohibit any cutting of the hair at all.
So in our society, and in most others, there is an enormous
symbolism attached to our hair. There are very few bald
members of the United States Congress, many fewer than would
be expected from a normal cross-section of our population.
Our only truly bald president in the past 50 years was Eisenhower,
who was enormously popular as a war hero. Imagine our cultural
icons, our celebrities, even our animated Disney heroes:
thick, luxuriant heads of hair are the desired norm. Why
the great emphasis?
Consider the birds of the field (and the snakes in the grass,
for that matter). Feathers, and scales, like hair, are appendages
of the skin, similar modifications in different species.
Brightly colored and obvious plumage and scales are important
in mating and courtship rituals in the animal kingdom, are
they not? They are expressions of gender and availability.
We all smile at the image of the "strutting cock of
the walk", but in the rooster’s world, he’s
the king! In our world, hair, an external form of living
clothing, expresses much about us to the world. Our choice
of styling, color, and length are, to some extent, outward
signals of our innermost desires and deepest feeling about
ourselves. The loss of this instrument of expression may,
for some men and women, be devastating.
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| Scientific
Basis of Hair Growth and Distribution |
In the following discussion, we will
mostly be concerned with scalp hair. Although scalp and
body hair share many of the same characteristics, it is
balding that we seek to understand and remedy, so this will
be the focus unless otherwise indicated.
Hair is a living entity, although the shafts we see are
largely the extension, outside the body, of a dead protein
called keratin. Beneath the level of the skin, however,
there sits a powerhouse of cellular activity. This cell
division and differentiation pushes the hair shaft outward;
thus we see hair growth that averages about one half inch
per month.
There are two types of hair: terminal and vellus. The terminal
hairs are the thick, strong, usually pigmented ones that
constitute the greatest volume of our hair. The vellus hairs
are the very fine, short, lightly pigmented hairs, sometimes
called "baby hairs", that can be often detected
around the hairline, and throughout the scalp, as well as
the light "fuzz" elsewhere on the body. This difference
is significant when discussing balding, for in balding,
the terminal hairs gradually undergo a metamorphosis called
"miniaturization". They become shorter, finer,
and less colored; in short, they become vellus hairs. If
you look closely at the heads of balding men, you will see
that, in many of the areas of balding, the strong terminal
hairs are replaced by these fine, vellus, "baby"
hairs; this is miniaturization, and we will discuss this
in greater detail in the next section on hair loss.
In addition to these two types of hairs, the individual
characteristics of the hair are very important in determining
appearance (including the appearance of balding) and styling
options. These characteristics include color, curl or kink,
caliber (cross-sectional area) and density (number of hairs
per unit area). For example, although African hair tends
to have a lower density (hairs per square inch) than Caucasian
hair, its extreme curliness lends it a great volume and
ability to achieve coverage after hair transplant surgery.
Asian hair, although it tends to be very coarse (high caliber),
may be more challenging to transplant due to the straight
nature of the hair, and the contrast between dark hair and
lighter skin. However, these are but a few examples, and
all of these characteristics are taken into account by the
hair restoration expert in designing a program for each
unique individual. This is where the art of hair restoration
meets the science.
In addition to the hair shafts themselves, there are other
structures involved in the growth and function of hair.
Each hair is associated with a sebaceous gland, which produces
the oily sebum that serves to lubricate the hair shafts.
Likewise, there is an erector pili muscle, which contracts
to raise the hair in situations of anger, fright or cold.
Although this function serves little purpose in humans,
we see it in other mammals when their "hackles"
rise.
Hair growth and rest occurs in three phases: anagen, catagen
and telogen. The anagen phase is the period of active growth.
At any time, about 85 to 91% of hairs are in this active,
anagen phase. Anagen may last from 2 to 7 years, but usually
about 3 years on average. The catagen phase is considered
transitional, and the telogen phase is the dormant, or resting
phase. When the hair enters the telogen stage, the hair
is either pulled out during normal grooming, or is pushed
out when the new hair shaft growth begins.
Last, but certainly not least, is the anatomical and physiological
unit we have come to call "follicular units".
If you have done any current reading on hair restoration
surgery, you have surely come across this term. Believe
it or not, it was only in the early 1980’s that it
was recognized that hairs grew not as strictly single shafts,
but as discrete groups of one, two, three, four, and rarely
five terminal hairs. These hairs are joined by one or two
vellus hairs, a sebaceous gland, an erector muscle, a neurovascular
bundle (meaning the nerve and blood vessels), and the perifolliculum,
or fine connective tissue sheath. These units are easy to
see emerging from the skin under slight magnification on
cross section through the skin (figure 1) or when the hair
is clipped short (figure 2).
Figure 1 (cross section)
Figure 2 (surface of scalp)
The significance of recognizing follicular units as the
fundamental grouping of scalp hair cannot be underestimated.
This understanding has led to a revolution in the techniques
of modern hair transplantation. The past decade has given
us a whole new perspective on the harvesting, movement and
implantation of permanent hair into areas of balding scalp.
This can now be done, at least by well-trained surgeons
and their operative teams, in a manner that is natural and
undetectable. We will discuss this more, in greater detail,
in later sections.
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