Hair loss

 

 

 

Hair loss

 

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Hair loss

Hair is a very important structure cosmetically.  Ironically it does not serve much useful function for the body. However, it in a way serves as our passport to the society- how we look is largely decided by the appearance of the hair. - it contributes to the self-image of an individual, thus affecting the personality of a person. This explains the society’s obsession with hair. More money is spent on hair cosmetics and hair treatments than any other ailment!. Advertisements of all types abound in the lay press, often giving false and incomplete information. Hence it is very important to understand the causes of hairloss, and their treatments.
At the beginning, It is important to understand the importance of the hair cycle,  and the difference between natural daily shedding,  temporary hair loss and permanent pattern baldness.

 The normal hair growth cycle  and Natural shedding
At full maturity, the human scalp maintains an average of 100,000 hair follicles. Hair is made up of proteins called keratins. Human hair grows in a continuous cyclic pattern of growth and rest known as the "hair growth cycle." Normal hair  goes through 3 stages:

 

 

 Of the 100,000 hairs in the adult scalp, 90% are in growing stage (called anagen ) . The average duration of anagen is 1000 days. The   average daily loss of telogen hairs is 100, which is considered normal. After any illness or stress, delivery etc, this number of telogen hairs can go up leading to hair loss and is referred to as telogen effluium.This is the most common cause  for hair loss.

 

 

When does hair loss become abnormal?
Your hair loss may be abnormal if you are losing more than 100 hairs a day. This may result in a general thinning of hair or in a patchy loss of hair over the scalp and other areas-beard or eyebrows.
What are the different kinds of hair loss?

 

Temporary Hair loss

 

Emotional turmoil, medications, skin conditions, surgery, childbirth, poor nutrition and illnesses can cause hair follicles to enter the resting or telogen phase prematurely, resulting in increased shedding which presents itself as temporary diffuse thinning.Among the many medical conditions that can cause hair loss, the most common ones are:

• anemia
• thyroid disease
• other endocrine problems (especially those that produce excess androgens)
• gynecological conditions - such as ovarian tumors
• connective tissue disease (such as Lupus)
• surgical procedures and general anesthesia
• rapid weight loss or crash diets that are not nutritionally balanced
• severe emotional stress
• Drugs  such as oral contraceptives ,thyroid medication ,blood pressure medication (such as beta-blockers or water pills) ,"mood" medication such as lithium, Prozac, or tri-cyclic antidepressants , blood thinners such as heparin or coumadin ,cholesterol lowering medication

It is very important to note that all these varius causes listed above do not lead to permanent baldness and cause only temporary hairloss! The treatment of all these medical causes of hairloss( which never cause total baldness) is that of underlying cause. Proper nutrition containing protiens, vitamins and minerals, avoiding stress and treatment of the underlying disease, by a specialist, are advised.
In addition, certain skin and hair diseases may also lead to hair loss.These include:
a) Alopecia Areata - this usually results in a patchy loss of hair. .
b) Scalp Diseases - fungal and bacterial infection, and other local scalp diseases.
c) Excessive traction on the hair - for example tight curling and hair styles (corn-braiding, pony-tails).

What is dandruff? Does it lead to hair loss?
Dandruff is a condition causing scaling of scalp. It is due to a fungus in the hair called Pityrosporum ovale. This fungus which is normally present in the skin of most people , becomes more active under certain favourable conditions and results in inflammation , leading to dandruff. However, dandruff does not lead to hair loss, contrary to popular belief. Dandruff is treated by antifungal shampoos.It should be noted that treatment of dandruff is on a long term basis-patient needs to continue the use of shampoo at least once a week.

What should a patient do when he has abnormal hair loss ?
If you feel your hair loss is excessive you should consult your dermatologist. He will try to find the cause of your hair loss and may be able to treat any causative medical conditions.
Use a wide-tooth comb and avoid brushes. Avoid curlers and excessive traction with curlers. It is advisable to keep your hairstyle short .
Be wary of what others may offer you in terms of hair treatment and cure. Do not apply garlic, turmeric, oils etc. Contrary to popular belief, dandruff usually does not cause hairloss. Like wise, type of  water, frequent shampooing, helmet, oiling the scalp do not affect hair growth at all. Various shampoos which claim to make the hair grow have no basis.
 Also treat it as a manifestation of a disease and not simply as a cosmetic problem . When in doubt, consult doctor.
Permanent Baldness AND Hair Transplantation
Permanent Pattern Baldness –commonly referred to as Common baldness of men and women- (Androgenetic Alopecia) is an extremely common problem. Seventy percent of all men and fifty percent of women will experience some degree of pattern baldness in their lifetimes. It causes severe cosmetic deformity and emotional distress.

The Root of the Problem
The cause of baldness is no longer a mystery. Research has confirmed that hair loss is inherited like the color of the eyes. The gene can be inherited from the mother or father’s side .The hair follicles are genetically coded. If hair loss genes were present, the hair follicles on top of the head possess receptors, which are sensitive to the hormone dihydrotestosterone, or DHT. These hair follicles which are genetically "programmed", begin shrinking in adulthood. When this occurs, the hair follicles grow finer and smaller  hair that is lighter in color, shorter and less deeply rooted than their predecessors- hence they are called miniature hairs. In summary, pattern hair loss of men and women(Androgenetic Alopecia) is an inherited condition manifested when androgens are present in normal amounts. The onset, rate, and severity of hair loss are largely dictated by genetics, hormones and age. The severity increases with age and if the condition is present it will be progressive and relentless. In most cases, this "thinning hair" will progress to "baldness" when the shrinking follicles finally stop producing hair.
For men (Male pattern hair loss-MPHL), permanent baldness generally follows a specific pattern, which starts either in temporal areas (sides of head) or vortex (top of head). While it can also occur in women, total baldness is very rare.  It Men in their 20’s have a 20 percent incidence of MPHL, in their 30’s a 30 percent incidence of MPHL, in their 40’s a 40 percent incidence of MPHL, etc. Using these numbers one can see that a male in his 90’s has a 90 percent chance of having some degree of MPHL.
Androgens (testosterone, dihydrotestosterone) are necessary for the development of baldness(MPHL) .However, it should be emphasized that  the blood levels  of androgens present is  normal . It is the sensitivity of the hairs to the hormone which is  abnormal. It is important to note that even, in the most extensive cases, a horseshoe-shaped fringe of hair remains in the back of the scalp. This hair-bearing fringe is insensitive to hormones and usually will last a lifetime. These hairs, when transplanted into thinning or balding areas, will take root and grow, and continue to grow for the rest of a person's life-This is the principle of hair transplantation.

How can baldness be treated?
Firstly, it should be noted that treatment of  temporary hairloss discussed above and treatment of baldness are entirely different. Baldness can be treated with both medical and surgical treatments.
Presently, there are only two approved drugs for this purpose:
a) Minoxidil lotions 2% and 5%-it has to be applied daily twice over the affected area
b) Finasteride 1mg tablets (propecia)- one tablet daily for 3-4 years and is more effective over vortex
The disadvantages of these drugs are –they have to be taken for long duration, indefinitely. Also, they  may not be effective in established and extensive baldness.
Other modes of treatment such as hair weaving are temporary, need periodic maintenance and their long-term costs are significant . Thus hair transplantation is the only permanent method of hair transplantation.
Hair transplantation: The hair in the back of the scalp is genetically programmed and is insensitive to the balding process –hence is the basis for transplantation as they usually will last a lifetime. The transplanted hair is removed from back of the scalp (donor site) and transferred to another (recipient site). The transferred tissue is not "rejected" as it is not foreign tissue.
Originally, in 1970s, large circular grafts containing 15-20 hairs were transplanted resulting in noticeable and unnatural results. These were called punch grafts. They were replaced in early eighties by smaller punch grafts called minigrafts. Over years, instruments and techniques have been developed that allow us to achieve truly natural results by transplanting small grafts containing 1-2-3 hairs, very close together. It has been found that hair grows from the scalp in groups of one, two, and three hair follicles called follicular units. Transplantation of these units results in denser and more natural results. This, the so called ‘follicular unit transplantation ‘is the state of art technique for hair transplantation today. The other major advance in this field is the use of microscope to dissect hairs and avoid transaction of hairs.
Procedure
The procedure is performed under local anaesthesia, as follows:
1.  Donor area:  Strip 8-10 cm long and 1-1.5 cm wide is taken from occipital scalp.
2. The donor area is then sutured with continuous / intermittent suture. The sutures are removed after 7-10 day. The donor area heals with our any obvious scar.
3. The donor graft is then dissected into follicular units of 2 hair, 3 hairs and single hair
4. The follicular units are then implanted using special implanters over the recipient area.
The procedure is simple, though time consuming (lasting for 4-6 hours depending on the number of hairs to be implanted). Identification and dissection of follicular units may need magnification under microscope.
Very little pain is experienced during the procedure. Some discomfort is to be expected as the anesthetic is injected into the scalp. Once the skin is anesthetized, there is no pain.
Typically the grafted hair will shed in 2-4 weeks. New growth will begin in 4-5 months and length will increase approximately 1/2 inch per month. The advantages of this method are a large number of hairs are transplanted in one session, it is an outpatient procedure and patient can return to work the very next day with a very small bandage over back of scalp. And of course, with a very satisfying cosmetic result which is very permanent and for the rest of the patient’s life.
Often more than one session may be needed, depending on the 1) area of scalp treated 2) the number and size of grafts used and 3) the density which the patient desires 4) the individual characteristics of the patient, e.g. coarse hair will provide a more dense look than fine hair.

Great things are done by a series of small things brought together

-Vincent Von Gough

 

 Author:
Dr Venkataram Mysore MD. DipRCPath(Lond), dermatopathologist, 3437,Subbanna Garden, next to BTS garage,Vijay Nagar, Bangalore 40.ph:3392788

Branch:M104, Chicago avenue, Cunningham road, opp.standard chartered bank, Bangalore Ph:5114 8848
Visit website www.bangalorehairtransplant.com  www.bangaloreskin.com
The author is qualified from Royal College, UK in dermatopathology and is the first Indian dermatologist to obtain this qualification. He is also a member of international society for hair restoration surgery and a fellow of American academy of dermatology. With over 75 research papers, he is also the author of a textbook this subject , called “Fundamentals in dermatopathology”.

 

For details visit www.bangalorehairtransplant.com   www.bangaloreskin.com


Here are some answers to common questions asked about Permanent pattern baldness;
Hair Loss in Women
(This section focuses on diagnostic aspects of hair loss in women. To learn about treatment options please click on Treating Women).
Hair loss is relatively common in women, more common than one would imagine. The presentation, however, is much different than in men and the management of women with hair loss requires significant expertise in both diagnosis and treatment. For those women in whom surgical hair restoration is indicated, special surgical skills are required to achieve the best results. It is a mistake for a surgeon to assume that hair loss in women can be treated the same way as in men.
Women generally have a diffuse thinning (less hair all over), in contrast to men who more frequently have a "patterned" type (hair loss that spares the back and sides). Women often maintain their frontal hairline, whereas men characteristically lose a significant amount of hair in the front part of their scalp from the very beginning. Hair loss in women is most often very gradual, with the rate accelerating during pregnancy and at menopause. It is more often cyclical than in men, with seasonal changes that reverse themselves, and it is more easily affected by hormonal changes, medical conditions, and external factors.
There are two simple "bedside" tests that a doctor can use to help support a diagnosis of hair loss. The first is the "hair pull" in which a fingerling of hair is gently pulled and the hairs that easily pull out are counted. The second is "densitometry" in which a small area of the scalp is clipped short and examined under magnification (usually 30x). The hair density (number of hairs per cm) can then be measured and the approximate percentage of hairs that are in a miniaturized state (and subject to being lost) can be assessed.
To understand the different types of hair loss in women, and their management, it is helpful to divide the patterns into three broad categories.
Localized Hair Loss
Localized hair loss may be sub-divided into scarring and non-scarring types. Alopecia Areata is a genetic, autoimmune disease that typifies the non-scarring type. It manifests itself with the sudden onset of round patches of hair loss associated with normal skin and can be treated with local injections of Cortico-steroids. Scarring Alopecia can be caused by a variety of medical or dermatologic conditions such as Lupus and Lichen Planus, or local radiation therapy. Baldness from injuries, or from local medical problems that have been cured, are usually amenable to hair transplantation.
Localized hair loss that occurs around the hairline after face-lift surgery may be permanent as can Traction Alopecia, the hair loss that occurs with constant tugging on the hair. Both of these conditions can be treated with hair transplantation.

Patterned Hair Loss
Women with this type of hair loss have a pattern similar to what we observe in men. In other words, they have thinning in front or on top of their scalp with little hair loss in the permanent zone around the sides and in the back. Thus, the balding is in a characteristic "pattern" rather than generalized. Women with patterned hair loss may be excellent candidates for surgical restoration.

Diffuse Hair Loss
A third category of hair loss in women is a generalized thinning that affects all parts of the scalp. This is the most common type of hair loss seen in females. In this situation, much of the hair remains, but the thickness of the hair shaft is smaller than normal hair. The medical term for this type of thinning is "Diffuse Un-patterned Alopecia". These women have thinning that involves the donor area so that women with this type of hair loss are generally not good candidates for surgery. This condition may be identified with a Densitometer, an instrument developed by the New Hair Institute, which assesses the population of miniaturized hair in different parts of the scalp. (Miniaturization is the process by which hairs shrink in length and diameter from the effects of hormones.)
Because diffuse hair loss can be caused by a variety of conditions other than "hereditary balding" women who are losing their hair should be evaluated by a physician who is experienced with these problems. Most important, they should know when a medical evaluation is appropriate and whether medical or surgical treatments will offer the greatest benefit.
The physicians at the New Hair Institute have extensive experience treating women with hair loss problems. They have developed instrumentation that is used to determine which women may be helped by hair transplantation and those whose hair loss would be better managed by non-surgical means. NHI physicians are dedicated to seeing that women who are not candidates for transplantation receive the proper care and are not inappropriately treated with surgery.

What Causes Hair Loss in Women?
Common or "hereditary" baldness in women appears to be related to the same major factors that cause hair loss in men:

• Genes
• Hormones
• Time

As is men, the genes that cause hair loss can be inherited from either your mother or father. The expression of these genes is dependent on hormones called androgens, so common hair loss in women is called "Androgenetic Alopecia" (the same term is used for common balding in men).
There are a number of reasons to explain why hair loss in women presents differently than in men (although all of the factors are still not completely understood). Probably the most important reason is that men have a much higher level of the androgen testosterone. This is the hormone that is responsible for male sexual characteristics and, when the body converts it to DHT, it becomes the main culprit in causing baldness. Fortunately, the much lower levels of testosterone in women spare them from the extensive hair loss that is often seen in men.
Testosterone is converted to DHT by the enzyme 5-alpha reductase that is present in higher concentrations in the balding areas of the scalp. Women have only ½ the amount of this enzyme overall as men and have even less in the crown. In addition, women have higher levels of an enzyme called aromatase in all areas of the scalp that may block the formation of DHT. This enzyme is present in especially high concentration in the frontal hairline in women, possibly explaining why this area is fortunately resistant to balding in most females.
With age some normal degree of hair loss occurs in everyone so that total hair volume will decrease over time in both sexes. The hair loss associated with genetic balding is also dependent upon time to express itself. Hair loss tends to occur at different rates at different periods in one´s life with increased loss often occurring during periods of hormonal change, such as pregnancy and menopause.
Other Causes of Diffuse Hair Loss in Women
A number of "non-androgenetic" factors may be responsible for hair loss in women. Women´s hair seems to be particularly sensitive to underlying medical conditions. Since "systemic" problems often cause a diffuse type of hair loss pattern that can be confused with genetic balding, it is important that women with undiagnosed hair loss, especially of the diffuse or "un-patterned" type, be properly evaluated.
Among the many medical conditions that can cause hair loss, the most common ones are:

• anemia
• thyroid disease
• other endocrine problems (especially those that produce excess androgens)
• gynecological conditions - such as ovarian tumors
• connective tissue disease (such as Lupus)
• surgical procedures and general anesthesia
• rapid weight loss or crash diets that are not nutritionally balanced
• severe emotional stress

It is also important to review the use of medications that can cause hair loss. The more common ones are:

• oral contraceptives
• thyroid medication
• blood pressure medication (such as beta-blockers or water pills)
• "mood" medication such as lithium, Prozac, or tri-cyclic antidepressants
• blood thinners such as heparin or coumadin
• cholesterol lowering medication
• medication for gout, such as Zyloprim
• anti-inflammatory drugs such as cortisone
• vitamin A or tryptophan in high doses
• street drugs (such as cocaine)

Laboratory Evaluation in Women
The decision of when to perform a laboratory evaluation in women experiencing hair loss must be made on an individual basis by your physician. In this section we briefly describe some of the situations where your doctor may order lab tests and what they might be. It is important to stress that this is just an overview for your general information. When a physician orders laboratory tests he/she bases it upon specific clinical information and this can only be determined by the doctor who evaluates you.
The following signs and symptoms suggest that specific blood tests might be appropriate to rule out underlying sources of excess androgen:

• Irregular periods - for an extended period of time
• Cystic acne - severe acne which usually leaves scars
• Hirsuitism - increased body hair that doesn´t normally run in your family
• Virilization - appearance of secondary male sex characteristics such as a deepened voice
• Infertility - inability to become pregnant
• Galactorrahea - breast secretions when not pregnant (this is due to prolactin which is not actually an androgen)

Some of the tests that your doctor might order in these situations include the following:

• Total and Free Testosterone - the hormone that is mainly responsible for male secondary sex characteristics
• DHEA-Sulfate - a precursor to testosterone
• Prolactin - the hormone that enables the breast to secrete milk

Other test that are commonly ordered for underlying medical conditions include:

• CBC (complete blood count) - for Anemia
• Serum iron (and TIBC) - for Anemia
• T3, T4, TSH - for Thyroid disease
• ANA - for Lupus
• STS - for Syphilis

Localized Hair Loss
There are others causes of hair loss in women that are relatively common. Hairstyles that exert constant pull on the hair, such as "corn rows" or tightly woven braids produce a characteristic pattern called "Traction Alopecia" that can be identified by a rim of thinning or baldness along the frontal hairline and at the temples. This is easily prevented by changing your daily habits, but once the hair loss occurs it may be permanent. Fortunately this condition is easily amenable to surgery.
It is not often mentioned, but brow- and face-lift surgery can often result in local hair loss in the vicinity of the incision. This may present as hair loss along the frontal hairline, in the temples or adjacent to a surgical scar. Fortunately, these women have not experienced other types of hair loss and thus have a good donor supply and make excellent candidates for hair transplantation.
It is important to remember that there are also medical conditions that can cause localized hair loss such as Lupus, Alopecia Areata, fungal infections and a number of other problems that would require a knowledgeable physician for diagnosis and treatment. Some of the simple tests used to diagnosis these conditions include a scraping and culture for fungus and a skin biopsy that may identify Lupus or other causes of scarring hair loss.
The human body contains approximately five million hair follicles while the scalp (prior to any kind of hair loss) contains 100,000-150,000 hair follicles. Blondes have the greatest number of scalp follicles, followed by brunettes. Humans with red hair have the fewest number of scalp follicles. The normal growth rate of scalp hair is one-fourth to one-half inch per month.

 

MALE PATTERN HAIR LOSS (Androgenetic Alopecia)
It is estimated that 35 million men in the United States are affected by androgenetic alopecia. "Andro" refers to the androgens (testosterone, dihydrotestosterone) necessary to produce male-pattern hair loss (MPHL). "Genetic" refers to the inherited gene necessary for MPHL to occur. In men who develop MPHL the hair loss may begin any time after puberty when blood levels of androgens rise. The first change is usually recession in the temporal areas, which is seen in 96 percent of mature Caucasian males, including those men not destined to progress to further hair loss. Hamilton and later Norwood have classified the patterns of MPHL
Although the density of hair in a given pattern of loss tends to diminish with age, there is no way to predict what pattern of hair loss a young man with early MPHL will eventually assume. In general, those who begin losing hair in the second decade are those in whom the hair loss will be the most severe. In some men, initial male-pattern hair loss may be delayed until the late third to fourth decade. It is generally recognized that men in their 20’s have a 20 percent incidence of MPHL, in their 30’s a 30 percent incidence of MPHL, in their 40’s a 40 percent incidence of MPLH, etc. Using these numbers one can see that a male in his 90’s has a 90 percent chance of having some degree of MPHL.
Hamilton first noted that androgens (testosterone, dihydrotestosterone) are necessary for the development of MPHL. The amount of androgens present does not need to be greater than normal for MPHL to occur. If androgens are present in normal amounts and the gene for hair loss is present, male pattern hair loss will occur. Axillary (under arm) and pubic hair is dependent on testosterone for growth. Beard growth and male pattern hair loss are dependent on dihydrotestosterone (DHT). Testosterone is converted to DHT by the enzyme, 5¤ -reductase. Finasteride (Propecia®) acts by blocking this enzyme and decreasing the amount of DHT. Receptors exist on cells that bind androgens. These receptors have the greatest affinity for DHT followed by testosterone, estrogen, and progesterone. After binding to the receptor, DHT goes into the cell and interacts with the nucleus of the cell altering the production of protein by the DNA in the nucleus of the cell. Ultimately growth of the hair follicle ceases.
The hair growth cycle
is affected in that the percentage of hairs in the growth phase (anagen) and the duration of the growth phase diminish resulting in shorter hairs. More hairs are in the resting state (telogen) and these hairs are much more subject to loss with the daily trauma of combing and washing. The hair shafts in MPHL become progressively
miniaturized
smaller in diameter and length, with time. In men with MPHL all the hairs in an affected area may eventually (but not necessarily) become involved in the process and may with time cover the region with fine (vellus) hair. Pigment (color) production is also terminated with miniaturization so the fine hair becomes lighter in color. The lighter color, miniaturized hairs cause the area to first appear thin. Involved areas in men can completely lose all follicles over time. MPHL is an inherited condition and the gene can be inherited from either the mother or father’s side. There is a common myth that inheritance is only from the mother’s side. This is not true.
In summary, male pattern hair loss (Androgenetic Alopecia) is an inherited condition manifested when androgens are present in normal amounts. The gene can be inherited from the mother or father’s side. The onset, rate, and severity of hair loss are unpredictable. The severity increases with age and if the condition is present it will be progressive and relentless.

FEMALE PATTERN HAIR LOSS (Androgenetic Alopecia)
Female pattern hair loss (FPHL) differs from male pattern hair loss (MPHL) in the following ways. It is more likely to be noticed later than in men, in the late twenties through early forties. It is likely to be seen at times of hormonal change, i.e., use of birth control pills, after childbirth, around the time of menopause, and after menopause. Recession at the temples is less likely than in men and women tend to maintain the position of their hairlines. Like in men, the entire top of the scalp is the area of risk. In women there is generally a diffuse thinning throughout the area as opposed to thinning in the crown of men. Ludwig has classified hair loss in women into three classes.
The vast majority of women affected fall into the Ludwig I class.
In the United States it is estimated that 21 million women are affected by FPHL. The incidence in women has been reported to be as low as eight percent and as high as 87 percent. It does appear to be as common in women as in men. The hair loss in women becomes particularly notable in menopause.
Androgens are responsible for hair loss in women by the same mechanisms they cause hair loss in men. Women do produce small amounts of androgens by way of the ovaries and adrenal glands. Also prehormones are produced by the ovaries that are converted to androgens outside of the ovaries or adrenal glands. Women rarely experience total loss of hair in an area if the loss is due to FPHL. If they do they should be evaluated for an underlying pathological (disease) condition. In women, the process of miniaturization of the hair follicle is more random with some hair being unaffected. Normal thick hairs are mixed with finer, smaller diameter hairs. The end result is a visual decrease in density of hair rather than total loss of hair. The hair growth cycle is affected as in men. The growth phase (anagen) is shortened resulting in shorter hairs and the resting phase (telogen) is increased resulting in fewer hairs.
If the cause of hair loss is suspected to be abnormally elevated or decreased amounts of hormones the patient should undergo laboratory tests to measure hormone levels.

 

OTHER CAUSES OF HAIR LOSS
ALOPECIA AREATA
Alopecia areata (AA) is a recurrent disease, which can cause hairloss in any hair-bearing area. The most common type of AA presents as round or oval patches of hair loss most noticeably on the scalp or in the eyebrows. The hair usually grows back within 6 months to one year. Most patients will suffer episodes of hair loss in the same area in the future. Those who develop round or oval areas of hair loss can progress to loss of all scalp hair (alopecia totalis). The cause of AA is unknown but commonly thought to be an autoimmune disorder (the body does not recognize the hair follicles and attacks them). Patients frequently blame stress and anxiety as the cause of their hair loss. The most common treatment is with steroids (cortisone is one form) either topically or by injection. The outcome of treatment is good when the AA process is present less than one year and poor, especially in adults, if the disease has been present for longer periods of time. Minoxidil (Rogaine®) can help to regrow hair. Surgical treatment of this disorder is not recommended. If you have questions concerning Alopecia areata, please contact an ISHRS physician.

 

TRACTION ALOPECIA
Traction alopecia is caused by chronic traction (pulling) on the hair follicle and is seen most commonly in African-American females associated with tight braiding or cornrow hair styles. It is generally present along the hairline. Men who attach hairpieces to their existing hair can experience this type of permanent hairloss if the hairpiece is attached in the same location over a long period of time. Trichotillomania is a traction alopecia related to a compulsive disorder caused when patients pull on and pluck hairs, often creating bizarre patterns of hairloss. In long-term case of trichotillomania, permanent hairloss can occur.

 

What causes hair loss?
The most common cause of hair loss is inheritance. Men and women inherit the gene for hair loss from either or both parents. Men are most commonly affected by the inherited gene as the hormone, testosterone, activates the genetic program causing loss of hair follicles. Currently there is no known method of stopping this type of hair loss. The age of onset, extent, and rate of hair loss vary from person to person. Severe illness, malnutrition, or vitamin deficiency can accelerate this process. When applied incorrectly, permanent hair color and chemical relaxers damage the hair and follicle to the extent that hair loss can be permanent. Causes of hair loss do not include wearing a hat, excessive shampooing, lack of blood flow, or clogged pores.
 

Does it really work?
Yes. The transplanted hair is removed from one area of the body (donor site) and transferred to another (recipient site). The transferred tissue is not "rejected" as it is not foreign tissue. The transplanted hair maintains it's own characteristics; color, texture, growth rate, and curl, after transplantation and regrowth. The vitality of the grafted follicle is maintained by the rich blood supply to the scalp. Originally, large circular grafts containing 15-20 hairs were transplanted resulting in noticeable and unnatural results. Over years, instruments and techniques have been developed that allow us to achieve truly natural results by transplanting small grafts very close together. We have found that hair grows from the scalp in groups of one, two, and three hair follicles. We transfer these groups of follicles after eliminating the excess surrounding fatty tissue. This allows the grafts to be placed closer together resulting in a denser and more natural result.

What can be expected immediately after surgery?
The post-operative course will depend on adherence to the instructions given after surgery. Small scabs will form on the scalp at the graft sites. Generally speaking, these scabs disappear in 4-7days. Shampooing can be resumed 24 hours after surgery. The suture (stitch) used in the donor area is undetectable as it is completely covered by your existing hair. An appointment will be made for the suture to be removed one week after surgery. It is advisable to take at least two days off work after surgery. A baseball type cap can be worn at anytime after surgery. Patients should avoid strenuous physical activity for at least five days after surgery. Typically the grafted hair will shed in 2-4 weeks. New growth will begin in 3-4 months and length will increase approximately 1/2 inch per month.

Is Hair Transplantation painful?
Most people are surprised at how little pain there is during the procedure. Some discomfort is to be expected as the anesthetic is injected into the scalp. Once the skin is anesthetized, there is no pain. If the numbing medicine wears off during the course of the procedure, more is injected to re-anesthatize the area.

What will it look like after the procedure?
The grafts form small scabs in the days after the procedure. If one has enough surrounding hair, these scabs can be camouflaged with creative styling. If not, the small scabs may be visible but do not attract much attention. By keeping the scalp moist, the scabs usually come off in about a week or so.

When can I go back to work?
Depending on the type of procedure you have done and the type of work you do, it is often possible to go back to work the next day. Your surgeon will discuss this with you during the consultation.

Is hair transplantation expensive?
Hair transplantation is more expensive than a hairpiece or some alternative treatments. However considering that the results are permanent, most people consider it a good investment in their future happiness.

How many sessions will be required?
The number of the sessions will depend on the 1) area of scalp treated 2) the number and size of grafts used and 3) the density which the patient desires 4) the individual characteristics of the patient, e.g. coarse hair will provide a more dense look than fine hair. The estimate of the number of sessions can be discussed during the consultation with your surgeon.

 

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