The Importance of Hair

Why Hair Matters - to Everyone in the World

Unlike other tissues of the body, scalp hair and body hair are not essential to our physical well-being. The loss of scalp hair by the physiologic process of balding (androgenetic alopecia) does not make us ill. The graying of hair by the physiologic process of aging does not induce any metabolic changes in our bodies.

Why, then, do we care so much when we lose hair by balding or lose hair color by aging?

We care because scalp hair isn't just any tissue. It has special significance for us that is manifested in social, cultural and religious settings. Our hair-especially our scalp hair-is one of the principal presentations of "self" we make to the world.

In modern, Western cultures, this presentation of "self" is enhanced by a variety of products marketed by a multi-billion-dollar hair cosmetics industry, reflecting the importance we give to presenting a properly prepared image of "self" to ourselves and to the world.

Hair transplantation and other surgical and pharmacologic methods of hair restoration were developed and came to maturity along with other medical advances of the Twentieth and Twenty-first Centuries. Surgical and pharmacologic hair restoration were rapidly accepted by the public. Innovative physician hair restoration specialists used improved medical knowledge of hair physiology to develop surgical techniques specifically for the purpose of creating a wholly "natural" appearance of transplanted hair. Survey data indicate that annually more than 360,000 persons world-wide avail themselves of surgical and/or medical hair restoration procedures.

Great cultural and religious symbolism is attached to hair and its display in many societies. In some traditional cultures, there are social and/or religious rules governing how, when and to whom a woman may display her scalp hair. A religiously symbolic meaning is seen in the shaven, bald scalps of male monks who choose a life of chastity and poverty.

In the "Hippie" era of the 1960s in the U.S. and Europe, men grew long hair as an indication of their standing as "outsiders" who refused to participate is a society they claimed to abhor. The symbolism was powerful, and it still defines the 1960s as the era of long male hair and "protest".

Scalp hair fashions of movie, television and pop music celebrities have a significant impact on hair styles of everyday life. The shaven, bald scalp of actor Yul Brynner in the 1970s and '80s presented male baldness as a symbol of male power and sexuality. At about the same time, the wavy, thick locks of actor James Dean were a symbol of teen-age angst. The short, military style hair of actor Clint Eastwood mirrored a general acceptance of the "crew cut" as a symbol of male authority and discipline.

Carefully shaped and styled hair is essential to the well-groomed look that traditionally symbolizes trustworthiness and sincerity in the business world. Contrarily, hair worn in a tangled and matted style may symbolize a significant cultural position when worn by a magnate of the pop music industry.

The enforcement of short-hair style on women is a practice associated with punishment. Loss of her hair, and by implication her "self", symbolizes the infraction of rules for which she is punished. In liberated countries of post-World War Two Europe, women who were identified as collaborators with occupying troops were often shaven bald and forced to march down the street before jeering crowds.

In the U.S., a few minutes spent scanning covers of popular magazines speaks volumes about the importance of hair length, hair color and hair styling as a presentation of "self". Hair is as important as body weight, body height and body shape in the totality of "body image"-the "self" we see in the mirror and the "self" we want to present to the world.

While hair styling is often associated with women more than with men, a look at "men's magazines" makes clear that men also take their hair style seriously. The man who pumps iron to sculpt an attractive body shape does not neglect the effect of his hair style on overall body image. Styles may range from the shaven heads of professional wrestlers to the movie-actor hair of Arnold Schwarzenegger, but muscles and hair go together in the sculpting of a body image.

We don't often think about the symbolic importance of scalp hair in our daily lives. Hair is, for most of us, a "fact of life". We may suddenly find ourselves thinking about it when our hair begins to thin. Faced with the loss of an important part of our social and cultural "self", we find ourselves making a decision: should hair loss be accepted as a "fact of life", or is hair restoration an option we want to consider?

The loss of scalp hair will not make us physically ill. However, loss of scalp hair may have emotional and psychological consequences.

The Importance of Hair Throughout Human History

The earliest images we have of people depicting themselves show us the importance of hair in self-imaging. Most of the images we have from ancient times are of royal, rich and powerful people. Ordinary, non-aristocratic people generally did not get their images preserved; when they appear as background figures they usually have short hair. Enemies defeated in war are often shown with shorn hair, indicating loss of status and power.

In ancient Sumeria of about 4,000 years ago (often called a cradle of civilization), noble women wore thick, ornate hair styling-probably as a mark of social rank. Archeologists have found finely crafted gold ornaments used in hair dressing.

Sumerian, Babylonian and Assyrian nobles of 4,000 to 2,500 years ago were depicted with long, curled or braided hair and thick, curled beards. Figures believed to be of the hero-king Gilgamesh of Uruk had a curled, chest-length beard. Kings of the warrior kingdom of Assyria were inevitably depicted with long, curled or braided hair and long, curled beards. The relationship between "hair" and "power" was hard to dismiss.

Paintings in ancient Egyptian tombs show that noble men and women often had shaven heads in everyday life, but donned elaborate wigs and false beards for ceremonial occasions. It has been suggested that shaved heads made sense in daily life for people living in the hot climate of Egypt. Wigs and beards were reserved for occasions when a demonstration of status and power was necessary.

In more recent times, in Seventeenth and Eighteenth Century Europe, elaborate hair styles for both men and women were symbols of high status. In some instances the wigs of men were more elaborate than the hair styles of women. As always, the hair styles of ordinary people were simple and utilitarian for everyday life.

In our own era of mass communication and entertainment, hair as "social statement" is popularized by cinema and television personalities-the "royalty" of our time.-and emulation of popularized hair styles is available to everyone. No style of facial or scalp hair is reserved for aristocrats. A hair style seen on a cinema star at the Academy Awards ceremony is likely to be seen on the streets of American cities the following day. In cultures that subscribe to "traditional" social norms, women may follow popular trends of hair style but reveal their hair only to friends and family, not in public.

The Psychosocial Significance of Hair-and Hair Loss

Pictorial evidence from ancient times emphasizes the central importance of scalp and facial hair in presenting a "self" image to one's self and to others. Because we only see the hair styles of nobles and warriors, we believe that social status and power were symbolized by hair style.

As Western societies became more industrialized and democratic, hair style is more strongly associated with self-esteem and sexual attraction. The Nineteenth Century French novelist Gustave Flaubert shows us this in his novel "L'Education Sentimentale". His central "middle class" character makes a hair dresser one of his first stops when he moves from his provincial home town to Paris to improve himself in his own eyes and find a wealthy mistress.

In the industrial and post-industrial societies of the 21st Century-epitomized by the United States and Western Europe-facial and scalp hair are primarily sexual symbols and secondarily symbols of social status. As symbols of sexual attraction, they are necessarily symbols of self-esteem.

Facial and scalp hair-especially scalp hair-contribute to an overall body image, the image that one likes to see in the mirror and hopes to project to others. It is increasingly recognized by physicians and psychologists that hair loss can contribute to disturbance of body image, with resulting loss of self-esteem. The psychological and emotional effects associated with loss of self-esteem can, in some persons, become psychologically disabling anxiety and depression.

In psychologically predisposed persons, even the fear of hair loss may result in clinical symptoms of anxiety and depression. Physicians must carefully evaluate patients who display signs and symptoms of dysmorphophobia-a fear of loss of body image unsupported by any physical evidence of hair loss or other cosmetic deficiency.

Physicians are also more aware today of the necessity to take a patient's hair loss seriously. While some men may take hair loss in stride as a normal phenomenon to be expected in men, others may be less sanguine about their change in appearance. Women are less likely than men to take hair loss as a normal phenomenon-in part, at least, because hair loss is a "man thing" that is not acceptable in women. In either instance-for men or for women-physicians should be sensitive to the importance of hair in a patient's self-esteem, and be willing to counsel a patient on options for hair restoration.