Do hair transplants improve physical and mental health and are they thus a medical necessity and not merely a cosmetic procedure?
Keywords | Summary | Correspondence | References
androgenetic alopecia, hair loss, hair transplants, medical procedure, quality of life, symptoms of depressions
Introduction. Hair is perceived as an essential part of our appearance, reflective our personalities. Hence, it is not surprising that numerous studies have shown a negative impact of hair loss on the well-being and quality of life of patients. Furthermore, a correlation with mental health issues such as low self-worth and depression have been observed. Whether these symptoms improve after hair restoration procedures, is currently poorly researched.
Objective. This study was performed to investigate the impact of hair restoration on mental health issues (such as low self- worth and symptoms of depression), and on the overall quality of life in hair loss patients.
Materials and Methods. This retrospective cohort-two-center study investigated 150 patients who suffered from androgenetic alopecia and who underwent hair transplantation surgery between 9 and 36 months before inclusion. 200 age- and gender-matched patients who had not yet undergone hair restoration surgery served as control. All patients were asked to complete three questionnaires: (1) a questionnaire designed by the author, which collected demographic data as well as hair-specific perceptions; (2) AQoL-8D, a standardized quality of life questionnaire in 8 dimensions; (3) BDI-II (Beck Depression Inventory-II, another standardized questionnaire for the assessment of symptoms of depression and their severity.
Results and Discussion. (1) There was no significant difference in age- and gender distribution between pre- and postoperative group: mean age 37.0 ± 12.1 years and 88.7% male versus 36.9 ± 11.8 years and 88,5 % male. (2) 96.6% of patients indicated that hair transplantation had positively affected their life, and 97.7% would undergo surgery again (n = 213). (3) The AQOL-8D values for all eight dimensions were significantly higher (p < 0,001) for the pre-surgery group (n = 188) as compared to the post-surgery group (n = 129). (4) The BDI-II results also showed statistically significant differences between pre- and postoperative patients with a mean score of 9.58 ± 9.45 in the former and an average score of 3.31 ± 5.33 in the latter group. Clinically relevant depression as defined as a BDI-II score of > 20 was present in 18.2% of the preoperative and 2.4% of the postoperative patients.
Conclusion. Successful hair transplantation has a significant positive impact on mental health parameters and can improve the well-being and overall quality of life of hair loss patients. It should therefore be deemed a medically necessary treatment of relevance to health as opposed to a merely cosmetic procedure.
Address of Correspondence
Dr. Bruce Reith, MD, PhD
Medical Director Medical Hair & Esthetics Munich
and Haarzentrum der Bodenseeklink, (Lindau, Germany)
Conflict of Interests
1. Faust V. Haar und seelische Störungen Psychiatrie heute, Seelische Störungen erkennen, verstehen, verhindern, behandeln. . 2005; Available from: http://www.psychosoziale-gesundheit.net/psychiatrie/haar.htm.
2. Trübe RM. Systematisches Vorgehen bei Frauen mit Haarausfall. JDDG, 2010. 8: p. 284-298.
3. Han SH, et al. Quality of life assessment in male patients with androgenetic alopecia: result of a prospective, multicenter study. Ann Dermatol, 2012. 24(3): p. 311-8.
4. Henns, R. Psycho-soziale Bedeutung des Haarausfalls Haarausfall Glatze androgenetische Alopezie. 2000. 1.
5.Henns R. Zur Wirkung des erblich bedingten Haarausfalls beim Mann (Androgenetische Alopezie) auf den Betrachter - Eine empirische Studie. 2000; Available from: http://www.haar-und-psychologie.de/haarausfall/glatze-studie-01.html.
6.Reid EE, et al. Clinical severity does not reliably predict quality of life in women with alopecia areata, telogen effluvium, or androgenic alopecia. J Am Acad Dermatol, 2012. 66(3): p. e97-102.
7. Alfonso M, et al. The psychosocial impact of hair loss among men: a multinational European study. Curr Med Res Opin, 2005. 21(11): p. 1829-36.
8. Mohebi P and Rassman WR. Psychology of hair transplants. Hair Trans Forum Int. Vol. 47. 2008. 47-48.
9. Richardson J, Khan M. The AQoL-8D (PsyQoL) MAU Instrument: Overview September 2009. Monash Univ. Cent. Heal. Econ. p. 1-19.
10. Richardson J, Iezzi A, Khan MA, Maxwell A. Validity and reliability of the Assessment of Quality of Life (AQoL)-8D multi-attribute utility instrument. Patient, 2014. 7: p. 85-96.
11. Beck AT, Steer RA, Brown GK. Depression Inventory®-II, 2nd Edition. Manual, T.T.P.C. San Antonio, Editor.
12.Mayring P. Qualitative Content Analysis. 2014.
13. Sawant N, et al. Androgenetic Alopecia: Quality-of-life and Associated Lifestyle Patterns. Int J Trichology, 2010. 2(2): p. 81-5.
14. Hesketh PJ, et al. Chemotherapy-induced alopecia: psychosocial impact and therapeutic approaches. Support Care Cancer, 2004. 12(8): p. 543-9.
15. Rencz F, et al. Alopecia areata and health-related quality of life: a systematic review and meta-analysis. Br J Dermatol, 2016. 175(3): p. 561-71.
16. Gulec, A.T., et al., The role of psychological factors in alopecia areata and the impact of the disease on the quality of life. Int J Dermatol, 2004. 43(5): p. 352-6.
17. Hirsso P, et al. Health-related quality of life and physical well-being among a 63-year-old cohort of women with androgenetic alopecia; a Finnish population-based study. Health Qual Life Outcomes, 2005. 3: p. 49.
18. Wells PA, Willmoth T and Russell RJ. Does fortune favour the bald? Psychological correlates of hair loss in males. Br J Psychol, 1995. 86 ( Pt 3): p. 337-44.
19. Lemieux J, Mansell E and Provencher L. Chemotherapy-induced alopecia and effects on quality of life among women with breast cancer: a literature review. Psychooncology, 2008. 17(4): p. 317-28.