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Facial appearance plays a pivotal role in the formation of one's sense of self-esteem. We are recognized by our face more than any other single feature. Hence, the aging face can have a significant effect on personal interactions as well as quality of life. Aging has both intrinsic and extrinsic components. Hair loss is one intrinsic factor that dramatically affects appearance. Senescence, as it relates to hair, may involve recession or balding and also changes in hair texture, volume, and color. Patterned hair loss in both genders is genetically predetermined. Significant hair loss draws attention from the face to the forehead or crown. Furthermore, insufficient hair for facial framing makes one appear older than one's true chronologic age (Fig. 1). Androgenetic alopecia is the most common cause of hair loss in the aged patient. The recognition that androgens play a role in hair loss is a surprisingly modern concept, first suggested by Hamilton in 1942. 10 He subsequently devised a classification scheme for male pattern baldness. The newer and more widely accepted classification scheme for male pattern baldness was developed by Norwood and published in 1975 (Fig. 2). 18 In 1977, Ludwig described a similar classification scheme for androgenetic alopecia in women. 15 Female androgenetic alopecia, in contrast to that of men, occurs in a more diffuse pattern, especially after menopause when bitemporal hair loss can become significant. The incidence of male pattern baldness varies significantly with age. By the age of 60, over 50% of men will be a Norwood type III, IV, V, VI, or VII. 18 Increasingly, men and women are seeking treatments for hair loss and fortunately have an expanding list of options for treatment. An excellent review of medical options was recently published by Sawaya. 25 Perhaps what patients seek the most information about, and one of the most common procedures, is hair transplantation surgery. |
