Hair Treatment - Transplantation

Hair transplantation is a procedure in which hair is removed from permanent hair-bearing regions in the rim hair of balding individuals (the “donor” area) and transferred to bald or balding areas of the scalp (the “recipient” area). After initially falling out, the transplanted hair regrows, and will continue to grow in the new area for as long as it would have grown in the area from which it was taken. It also has the same color and other characteristics as the hair in the donor area from which it was taken.

Usually, only one of the following three areas can be treated during any session: the frontal area extending from the hairline to a line drawn more or less vertically from the ears, the mid-scalp area extending from that point to the point on the scalp where the head changes from being more or less horizontal to the ground to a more vertical orientation, and the vertex area or “crown” which is the balding area furthest back on the scalp.

HOW IS HAIR TRANSPLANTATION PERFORMED?
Most hairs emerge from the scalp in groups of 2 or 3 hairs. Approximately 15% of hairs emerge as single hairs and another approximately 15% in groups of 4 or 5 hairs. These small groupings of hairs are called Follicular Groups or Follicular Units (FU). FUs are the building blocks of most modern hair transplanting. They are typically obtained by sectioning, with the aid of a 6X-10X magnifying “stereomicroscope”, an 8 to 10 mm wide strip of skin that is excised from the donor area. The most important advantage of transplanting exclusively with Follicular Unit Transplanting (FUT) is that a single session in an area that is bald or destined to become bald will result in a perfectly natural appearance. The donor site is sutured closed leaving only a narrow scar when the wound is completely healed in 7 to 10 days. The donor scar is also usually excised within any subsequent transplant donor strip(s), so only a single scar is present in the donor area no matter how many transplants are carried out.

Small incisions are made in the recipient area using either small bore needles or blades. The angle and direction of the incisions mimic that of the hair that was originally present in the area. Once the grafts have been prepared they are carefully transferred into those sites. As noted earlier, usually all of the transplanted hairs will initially fall out within a period of 2 to 3 weeks. Approximately, 2 to 3 months later, they regrow in the recipient area.

Hair transplanting is most commonly performed for Male Pattern Baldness (MPB) and Female Pattern Hair Loss (FPHL). However, it can also be used to produce hair in scarring secondary to surgery, trauma or burns. A relatively new technique referred to as Follicular Unit Extraction (FUE) skips the removal of a strip from the donor area. A small, round punch similar to a small cookie cutter is used to excise each individual FU directly from the donor area. It has the advantage of avoiding the production of a linear scar in the donor area but is more time consuming, expensive, and more likely to result in injury of the FUs. Nevertheless, it is advantageous for some patients, for example those who have very tight scalps or who have a tendency to healing with bad scars. It may also prove to be an effective way of removing hair from the body and transferring it to the scalp. FUE is not recommended at this time for routine hair transplanting by most practitioners because of the drawbacks noted above.

Although most hair transplanting today is carried out using only individual FUs, there are some advantages in using grafts containing more than one FU in some individuals. Transplanting with grafts that are larger than a FU requires multiple sessions in the same area to produce adequate naturalness, however, one can achieve greater hair density than is possible with FUT.

WHAT TO EXPECT AFTER THE PROCEDURE
Initially, there are small crusts on the recipient sites. These fall off usually within 3 to 10 days. Post-operative pain is nearly always completely controllable with relatively mild “pain killers” such as Tylenol 3, Vicodin or Percocet. Such pain killers are usually necessary only for the first 1 or 2 nights after the procedure. Temporary mild-to-moderate swelling of the forehead usually occurs approximately 2 to 3 days after the operation and lasts for 3 to 7 days. Approximately 1 out of every 50 patients has no swelling and 1 out of every 50 patients has severe swelling that may cause “black eyes” that last for 7 to 10 days.

COMPLICATIONS THAT CAN OCCUR
As with any surgical procedure, there can be post-operative bleeding or infection, but both of these are extremely rare occurrences and are easily controlled. If the grafts are not handled properly, if too many are transferred in a single session or if the grafts are planted too densely, an unacceptable percentage of the transplanted hairs may not grow. If reasonable numbers of grafts and reasonable graft density is employed, hair survival should be between 90 and 100%. There are other complications that can occur but they are even less frequent than the preceding ones and virtually all of them are easily treated.

QUESTIONS TO ASK YOUR DERMASURGEON
Ask the physician how many procedures he/she has carried out and over how many years. What medical training has he/she had and to what medical educational organizations does he/she belong? Most serious hair restoration surgeons belong to the International Society of Hair Restoration Surgery, and the American Board of Hair Restoration Surgery certifies those who have passed oral and written exams designed to evaluate safety and (to a lesser extent) aesthetics. Ask whether the surgeon excises the donor strip and whether he/she makes all the recipient sites or whether other members of the surgical team carry out these aspects of the procedure. Ask who inserts the grafts. Ask to see “before” and “after” photographs of many patients. The photographs should always show the patient before and after treatment with their head in the same position, at the same distance and with the same lighting. Close-up photographs of the hairline after transplanting are also important to see.


Adapted from American Society for Dermatologic Surgery

Hair Treatment - Replacement

Hair loss is primarily caused by a combination of aging, a change in hormones, and a family history of baldness. As a rule, the earlier hair loss begins, the more severe the baldness will become. Hair loss can also be caused by burns or trauma, in which case hair replacement surgery is considered a reconstructive treatment, and may be covered by health insurance.
If you and your doctor have determined that hair transplants are the best option for you, you can feel comfortable knowing that board-certified plastic surgeons have been successfully performing this type of procedure for more than thirty years.

If you're considering hair replacement surgery, this brochure will give you a basic understanding of the variety of procedures involved. It can't answer all of your questions, since a lot depends on your individual circumstances. Ask your surgeon if there is anything you don't understand about the procedure you plan to have.

The Truth About Hair Loss
Baldness is often blamed on poor circulation to the scalp, vitamin deficiencies, dandruff, and even excessive hat-wearing. All of these theories have been disproved. It's also untrue that hair loss can be determined by looking at your maternal grandfather, or that 40-year-old men who haven't lost their hair will never lose it.

The Best Candidates for Hair Replacement
Hair replacement surgery can enhance your appearance and your self-confidence, but the results won't necessarily match your ideal. Before you decide to have surgery, think carefully about your expectations and discuss them with your surgeon.

It's important to understand that all hair replacement techniques use your existing hair. The goal of surgery is to find the most efficient uses for existing hair.

Hair replacement candidates must have healthy hair growth at the back and sides of the head to serve as donor areas. Donor areas are the places on the head from which grafts and flaps are taken. Other factors, such as hair color, texture and waviness or curliness may also affect the cosmetic result. There are a number of techniques used in hair replacement surgery.

Sometimes, two or more techniques are used to achieve the best results.
Transplant techniques, such as punch grafts, mini-grafts, micro-grafts, slit grafts, and strip grafts are generally performed on patients who desire a more modest change in hair fullness. Flaps, tissue-expansion and scalp-reduction are procedures that are usually more appropriate for patients who desire a more dramatic change.

Remember, there are limits to what can be accomplished. An individual with very little hair might not be advised to undergo hair replacement surgery.

Hair Loss in Women
Some doctors estimate that one in five women will experience some degree of hair loss usually caused by aging, illness, or hormonal changes after menopause. Women tend to experience a subtle thinning all over the scalp rather than losing hair in patches as is common in men. To correct the problem, some women choose to wear a wig or hair extensions. Others have had some success using a topical prescriptive drug. The effectiveness of such drugs varies in some patients and simply prevents further hair loss without stimulating any appreciable new growth. Hair replacement surgery may be the answer for those who feel uncomfortable with either of these options.

Because mini-grafts are usually the surgical treatment of choice for filling-in thinning areas, good candidates for this procedure should have dense hair growth at the back of the head. Mini-grafts are harvested from this dense area and replanted in thinning areas to create a fuller look. Occasionally flap and tissue expansion procedures may be used if the individual is judged to be a good candidate.

If you're considering a hair replacement procedure, it's important to understand that you will never have the coverage you had prior to your hair loss, but surgery may camouflage the thin areas and give you more fullness.

All Surgery Carries Some Uncertainty and Risk
Hair replacement surgery is normally safe when performed by a qualified, experienced physician. Still, individuals vary greatly in their physical reactions and healing abilities, and the outcome is never completely predictable.

As in any surgical procedure, infection may occur. Excessive bleeding and/or wide scars, sometimes called "stretch-back" scars caused by tension may result from some scalp-reduction procedures.

In transplant procedures, there is a risk that some of the grafts won't "take." Although it is normal for the hair contained within the plugs to fall out before establishing regrowth in its new location, sometimes the skin plug dies and surgery must be repeated. At times, patients with plug grafts will notice small bumps on the scalp that form at the transplant sites. These areas can usually be camouflaged with surrounding hair.

When hair loss progresses after surgery, an unnatural, "patchy" look may result-especially if the newly-placed hair lies next to patches of hair that continue to thin out. If this happens, additional surgery may be required.

Planning Your Surgery
Hair replacement surgery is an individualized treatment. To make sure that every surgical option is available to you, find a doctor who has experience performing all types of replacement techniques-flaps and tissue expansion as well as transplants. Look elsewhere if your doctor tells you that he or she has perfected one technique that can "do it all."

In your initial consultation, your surgeon will evaluate your hair growth and loss, review your family history of hair loss, and find out if you've had any previous hair replacement surgery. Your surgeon will also ask you about your lifestyle and discuss your expectations and goals for surgery.

Medical conditions that could cause problems during or after surgery, such as uncontrolled high blood pressure, blood-clotting problems, or the tendency to form excessive scars, should also be checked by your doctor. Be sure to tell your surgeon if you smoke or are taking any drugs or medications, especially aspirin or other drugs that affect clotting.

If you decide to have hair replacement surgery, your surgeon will explain anesthesia, the type of facility where the surgery will be performed, and the risks and cost involved. Don't hesitate to ask your doctor any questions.

Make sure you understand your surgeon's plan-which procedures will be used and how long each will take. Ask your doctor to give you an idea of what you will look like after the procedure or, in the case of grafts, after each stage of treatment.

Preparing For Your Surgery
Your surgeon will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking and avoiding certain vitamins and medications. Carefully following these instructions will help your surgery go more smoothly. If you smoke, it's especially important to stop at least a week or two before surgery; smoking inhibits blood flow to the skin, and can interfere with healing.

You should arrange for someone to drive you home after your surgery. Plan to take it easy for a day or two after the procedure and arrange for assistance if you think you'll need it.

Where Your Surgery Will Be Performed
Hair replacement surgery is usually performed in a physician's office-based facility or in an outpatient surgery center. Rarely does it require a hospital stay.

Types of Anesthesia
Hair replacement surgery, no matter what technique is used, is usually performed using a local anesthesia along with sedation to make you relaxed and comfortable. Your scalp will be insensitive to pain, but you may be aware of some tugging or pressure.

General anesthesia may be used for more complex cases involving tissue expansion or flaps. If general anesthesia is used, you'll sleep through the procedure.

The Surgery
Hair transplantation involves removing small pieces of hair-bearing scalp grafts from a donor site and relocating them to a bald or thinning area. Grafts differ by size and shape. Round-shaped punch grafts usually contain about 10-15 hairs. The much smaller mini-graft contains about two to four hairs; and the micro-graft, one to two hairs. Slit grafts, which are inserted into slits created in the scalp, contain about four to10 hairs each; strip grafts are long and thin and contain 30-40 hairs.

Generally, several surgical sessions may be needed to achieve satisfactory fullness-and a healing interval of several months is usually recommended between each session. It may take up to two years before you see the final result with a full transplant series. The amount of coverage you'll need is partly dependent upon the color and texture of your hair. Coarse, gray or light-colored hair affords better coverage than fine, dark-colored hair. The number of large plugs transplanted in the first session varies with each individual, but the average is about 50. For mini-grafts or micro-grafts, the number can be up to 700 per session.

Just before surgery, the "donor area" will be trimmed short so that the grafts can be easily accessed and removed. For punch grafts, your doctor may use a special tube-like instrument made of sharp carbon steel that punches the round graft out of the donor site so it can be replaced in the area to be covered-generally the frontal hairline. For other types of grafts, your doctor will use a scalpel to remove small sections of hair-bearing scalp, which will be divided into tiny sections and transplanted into tiny holes or slits within the scalp. When grafts are taken, your doctor may periodically inject small amounts of saline solution into the scalp to maintain proper skin strength. The donor site holes may be closed with stitches-for punch grafts, a single stitch may close each punch site; for other types of grafts, a small, straight-line scar will result. The stitches are usually concealed with the surrounding hair.

To maintain healthy circulation in the scalp, the grafts are placed about one-eighth of an inch apart. In later sessions, the spaces between the plugs will be filled in with additional grafts. Your doctor will take great care in removing and placement of grafts to ensure that the transplanted hair will grow in a natural direction and that hair growth at the donor site is not adversely affected.

After the grafting session is complete, the scalp will be cleansed and covered with gauze. You may have to wear a pressure bandage for a day or two. Some doctors allow their patients to recover bandage-free.

Plastic surgeons are the leaders in tissue expansion, a procedure commonly used in reconstructive surgery to repair burn wounds and injuries with significant skin loss. Its application in hair replacement surgery has yielded dramatic results-significant coverage in a relatively short amount of time.

In this technique, a balloon-like device called a tissue expander is inserted beneath hair-bearing scalp that lies next to a bald area. The device is gradually inflated with salt water over a period of weeks, causing the skin to expand and grow new skin cells. This causes a bulge beneath the hair-bearing scalp, especially after several weeks.

When the skin beneath the hair has stretched enough-usually about two months after the first operation-another procedure is performed to bring the expanded skin over to cover the adjacent bald area. For more information about tissue expansion, ask your plastic surgeon for the American Society of Plastic Surgeons, Inc. brochure entitled, Tissue Expansion: Creating New Skin from Old.

Flap surgery: Flap surgery on the scalp has been performed successfully for more than 20 years. This procedure is capable of quickly covering large areas of baldness and is customized for each individual patient. The size of the flap and its placement are largely dependent upon the patient's goals and needs. One flap can do the work of 350 or more punch grafts.
A section of bald scalp is cut out and a flap of hair-bearing skin is lifted off the surface while still attached at one end. The hair-bearing flap is brought into its new position and sewn into place, while remaining "tethered" to its original blood supply.

As you heal, you'll notice that the scar is camouflaged-or at least obscured-by relocated hair, which grows to the very edge of the incision.

In recent years, plastic surgeons have made significant advances in flap techniques, combining flap surgery and scalp reduction for better coverage of the crown; or with tissue expansion, to provide better frontal coverage and a more natural hairline.

Scalp reduction: This technique is sometimes referred to as advancement flap surgery because sections of hair-bearing scalp are pulled forward or "advanced" to fill in a bald crown.
Scalp reduction is for coverage of bald areas at the top and back of the head. It's not beneficial for coverage of the frontal hairline. After the scalp is injected with a local anesthetic, a segment of bald scalp is removed. The pattern of the section of removed scalp varies widely, depending on the patient's goals. If a large amount of coverage is needed, doctors commonly remove a segment of scalp in an inverted Y-shape. Excisions may also be shaped like a U, a pointed oval, or some other figure.

The skin surrounding the cut-out area is loosened and pulled, so that the sections of hair-bearing scalp can be brought together and closed with stitches. It's likely that you'll feel a strong tugging at this point, and occasional pain.

After Your Surgery
How you feel after surgery depends on the extent and complexity of the procedure. Any aching, excessive tightness, or throbbing can be controlled with pain medication prescribed by your physician.

If bandages are used, they will usually be removed one day later. You may gently wash your hair within two days following surgery. Any stitches will be removed in a week to 10 days. Be sure to discuss the possibility of swelling, bruising, and drainage with your surgeon.
Because strenuous activity increases blood flow to the scalp and may cause your transplants or incisions to bleed, you may be instructed to avoid vigorous exercise and contact sports for at least three weeks. Some doctors also advise that sexual activity be avoided for at least 10 days after surgery.

To make sure that your incisions are healing properly, your doctor will probably want to see you several times during the first month after surgery. It's important that you carefully follow any advice you receive at these follow-up visits.

Getting Back to Normal
How soon you resume your normal routine depends on the length, complexity and type of surgery you've had. You may feel well enough to go back to work and resume normal, light activity after several days.

Many patients who have had transplants (plugs or other grafts) are dismayed to find that their "new" hair falls out within six weeks after surgery. Remember, this condition is normal and almost always temporary. After hair falls out, it will take another five to six weeks before hair growth resumes. You can expect about a half-inch of growth per month.

Follow-Up Procedures
You may need a surgical "touch-up" procedure to create more natural-looking results after your incisions have healed. Sometimes, this involves blending, a filling-in of the hairline using a combination of mini-grafts, micro-grafts, or slit grafts. Or, if you've had a flap procedure, a small bump called a "dog ear" may remain visible on the scalp. Your doctor can surgically remove this after complete healing has occurred.

In general, it's best to anticipate that you will need a touch-up procedure. Your surgeon can usually predict how extensive your follow-up surgery is likely to be.


Adapted from American Society of Plastic Surgeons

Hair Loss in Men/Women

There are many kinds of hair loss, including what we call:
alopecia areata (patches of baldness that usually grow back);
telogen effluvium (rapid shedding after childbirth, fever, or sudden weight loss); and
traction alopecia (thinning from tight braids or ponytails).

All of these types of hair loss can be alarming but, fortunately, they are most often mild and temporary or reversible.
The majority of people who lose their hair, however, do it gradually and all through the scalp, with some emphasis on the frontal part. Doctors refer to this process as "androgenetic alopecia" which implies that a combination of hormones (andro-) and heredity (genetics) is needed to develop the condition.

Hair Loss in Men
What causes hair loss in men?Some men never go "bald" but everyone's hair thins out over the years. Despite much research, there's still only a little that men can do to slow down or reverse hair loss. I'm referring to garden-variety "male-pattern baldness." The medical term for that is "androgenetic alopecia," which means hair loss that you get when you have male hormones and a hereditary tendency to lose hair.

Sometimes, acute stress to the system (such as high fever, sudden weight loss, etc.) produces a sudden, rapid shedding of hair, where you find clumps of hair coming out all over the place. Although this syndrome (called telogen effluvium) is alarming, it actually is good news, because the body readjusts itself and most if not all the hair grows back. People whose loss of hair is inherited notice their hair is thinning but don't see very much hair actually coming out.
Once you think you're thinning, it's worth a check to be sure. Even men who never lose much hair develop some receding at both temples during adolescence. Boy's hairlines are straight across; adult men have more of an "M"-shape.

Clearing up the "Myths"
You inherit baldness through your mother's male relatives. Actually, baldness can come from either side of the family, or both. Looking at your family can give you at best, an educated guess about how you'll turn out.

Longer hair puts a strain on roots. Wrong. And hats choke off the circulation to the scalp causing hair loss. Nope, wrong again.

You lose up to 100 hairs per day normally - some days a lot more; others, a lot less. These hairs have finished their 3-year life span and are ready to be shed, then replaced. Finding hair on your comb or in the sink, therefore, does not necessarily mean you're going bald.

Shampooing does not accelerate balding; the hairs you find are just the ones ready to come out, and these will be replaced.

What treatments are there for hair loss in men? Many conditioners, shampoos, vitamins, and other products claim to help hair grow in some unspecified way. These are harmless but useless. To slow down hair loss, you have two options:

Minoxidil (brand name: Rogaine): This topical application is over-the-counter, no prescription is required. It works best on the crown, less on the frontal region. Available as a 2% solution, Rogaine may grow a little hair, but is better at holding onto what's still there. There are few side effects with Rogaine. The main problem with this treatment is the need to keep applying it twice a day, and most men get tired of it after awhile. In addition, Minoxidil mainly works on the crown (top of the head), not on the scalp on the front of the head, which is where baldness really bugs most men. This drug also comes in a higher strength, 5%, which may be a tad more effective, but is certainly much more expensive.

Finasteride (brand name: Propecia): This is a lower-dose version of a drug that shrinks prostates in middle-aged men. Propecia is by prescription and is taken once a day. Propecia seems to do a nice job of retaining hair, however, it may also grow or thicken hair a little. It's therefore the best treatment for men who still have enough hair to retain. One of the side effects is impotence, but it is uncommon and generally reversible. Taking Propecia once a day is easier that applying minoxidil, but the prospect of taking a pill daily for years doesn't sit well with some men. There's also the cost, about $50/month.

Stopping either Rogaine or Propecia puts you back where you would have been without them, but not worse off (except maybe financially).

What other options do I have for hair loss? Hairpieces, etc. You can always choose one of the time-honored ways to add hair temporarily; hairpieces or hair weaving, in which a mesh is attached to your remaining hair and artificial or human hair is woven to blend with your own. Either method can produce quite satisfactory results, but quality varies considerably and depends a great deal on how much you want to spend. Also, hairpieces and weaves stretch, oxidize, and loosen, which requires you to refresh or replace them (or in the case of hairpieces buy 2 or more at a time, to have on reserve.) Also, some stay on more securely than others during swimming and other activity. (How's that for a delicate euphemism?)

Surgery
Surgical approaches include various versions of hair transplantation (taking hair from the back and putting it near the front) or scalp reduction (cutting away bald areas and stitching the rest together.). Check credentials carefully when consulting about these approaches since the skill of surgeons varies widely. If the doctor has limited experience, a poor esthetic sense, or if he or she transplants hairs that are destined to fall out anyway, results can be unnatural and unfortunate.
Finally, there is fatalism. Some bald men console themselves with adages like, "Grass doesn't grow on a busy street." That's fine, if it works for you.

Hair Loss in Women

Is hair loss in women different than men?
Hair loss in women also has an inherited (genetic) basis too, only not as much as men, and the loss is not as fast. Also, women tend not to have big bald spots; in general women's frontal hairline sticks around even to the bitter end. Thinning in women tends to be distributed throughout the scalp. Like men, when women first notice that their hair is thinner than it used to be (which can be in their early 20's in some families), they assume the process will gallop along and leave them bald in no time. In fact, it usually takes many years for thinning to become obvious to others.

Women start losing their hair later in life and almost never lose the frontal hairline, no matter how thin their hair gets (this is called female-pattern baldness.)

All of us develop thinning of our hair as we age. How thin our hair gets all depends on how much hair we start out with and the overall appearance of hair within the family. Women who still have full heads of hair often exclaim: "This is nothing--you should have seen how thick it used to be!"
Notions about baldness being inherited through the mother's family, just like stories about hats choking off follicles or long hair pulling on the roots, are just folklore.

Clearing up the "Myths"
Longer hair does not put a strain on roots.

You lose up to 100 hairs per day normally - some days a lot more; others, a lot less. These hairs have finished their 3-year life span and are ready to be shed, then replaced. Finding hair in your brush or in the sink, therefore, does not necessarily mean you're loosing all of your hair.

Shampooing does not accelerate hairloss; the hairs you find are just the ones ready to come out, and these will be replaced.

Don't stop coloring, perming, or conditioning your hair if you like the results of these processes. Hair styles that pull tightly can cause some hair loss, but hair coloring and "chemicals" do not.

What treatments are there for hair loss in women?
Ask your doctor about minoxidil (the generic name for Rogaine.) This is over-the-counter and available in 2% and 5% concentrations. It's something of a nuisance to apply but it helps conserve hair and may even grow some.

Propecia is a drug that helps men retain their hair but unfortunately has no use for women. Propecia is not safe for women of childbearing age and it just doesn't work for older women. This is unfortunate but, for the moment, this is the situation.

Surgical procedures like hair transplants can be useful for some women as well as men to "fill in" thinned-out areas

Adapted from MedicineNet

Telogen Effluvium

It is normal to lose up to about 100 hairs a day on one's comb, brush, in the sink or on the pillow. This is the result of the normal hair growth cycle. Hairs will grow for a few years, then rest for a few months, shed, and regrow. Telogen is the name for the resting stage of the hair growth cycle. A telogen effluvium is when some stress causes hair roots to be pushed prematurely into the resting state. Telogen effluvium can be acute or chronic.

If there is some "shock to the system", as many as 70% of the scalp hairs are then shed in large numbers about 2 months after the "shock". This sudden increase in hair loss, usually described as the hair coming out in handfuls, is acute telogen effluvium. This is a different problem than gradual genetic hair thinning. However, this can be seen in the less common chronic telogen effluvium, only after a significant amount of hair has already been lost.

A considerable number of different causes for telogen effluvium exist. Among the common causes are high fevers, childbirth, severe infections, severe chronic illness, severe psychological stress, major surgery or illnesses, over or under active thyroid gland, crash diets with inadequate protein, and a variety of medications. Most hair loss from medications is this type and causes include retinoids, beta blockers, calcium channel blockers, antidepressants, and NSAIDS (including ibuprofen).

Typically, abrupt diffuse hair loss is noticed several weeks to several months after the incident has initiated the biologic program for hair loss. While the most often noticed hair loss occurs on the scalp, some individuals may also notice hair loss elsewhere on the body. Significant hair shedding usually occurs when shampooing, combing, or even when gently manipulating the hair. Shedding usually slowly decreases over 6 to 8 months once the cause for the hair loss is no longer present. As some of the causes represent ongoing problems, it is important to determine the likely cause when possible and take appropriate measures to prevent continued hair loss.

These shed or loose hairs all have club-shaped "roots" typical of resting, telogen hairs and may be easily identified under the microscope. After shampooing, the bulk of existing loose hair has often been shed and loose hair may not again appear until additional hairs enter this resting phase. When there is any doubt about the presence of this condition, a small piece of skin may be taken from the scalp as a biopsy to be examined under the microscope. In this way, the condition of the hair follicles, the tissues that produce the hair, may be determined.

No treatment is needed for most cases of telogen effluvium. Remember that the hairs fall out when a new hair growing beneath it pushes it out. Thus with this type of hair loss, hair falling out is a sign of hair regrowth. As the new hair first comes up through the scalp and pushes out the dead hair a fine fringe of new hair is often evident along the forehead hairline.

The most important issue in telogen effluvium is to determine if an underlying cause for the problem is present. Blood tests may need to be done if the cause is not obvious, such as mild iron deficiency. If the telogen effluvium is caused by a medication, the medication needs to be stopped. When the cause of the hair loss is something like giving birth, a transient illness, or other self-limited problem the induced telogen effluvium is also usually self-limited and requires no treatment.

Chronic telogen effluvium is recently recognized and not uncommon. It often occurs in women who previously had very thick hair in their teens and twenties and still have an apparently normal head of hair to a casual observer. It affects the entire scalp with no obvious cause apparent. It usually affects women of 30 to 60 years of age, starts suddenly and has a tendency to fluctuate for a period of years. The degree of shedding is usually severe in the early stages and the hair may come out in handfuls. It does not cause complete baldness and does appear to be self-limiting in the long run.

Adapted from American Osteopathic College of Dermatology

Hirsutism (Excess Hair)

Hirsutism is a condition in which too much hair grows on the face or body. Although hirsutism can occur in both men and women, usually only women consider it a problem.

Women who have hirsutism have dark, thick hair on their face, chest, abdomen and back. This thick, dark hair is different from the hair that some women have on their upper lip, chin, breasts or stomach, or the fine "baby" hair all over their body. Women from certain ethnic groups tend to have more body hair than others. This does not mean that they have hirsutism.

Causes

Hirsutism can be caused by abnormally high levels of male hormones (called androgens). Other symptoms associated with a high level of male hormones include acne, irregular menstrual periods, deepening of the voice and increased muscle mass. The following are some of the conditions that may increase a woman's normally low levels of male hormones:

Polycystic ovary syndrome
Cushing's disease
Tumors in the ovaries or adrenal gland, formed when abnormal cells grow out of control and clump together

Hirsutism can also be caused by hair follicles that are overly sensitive to male hormones. Doctors don't know why this occurs.
Some medicines can cause hirsutism. These medicines include birth control pills, hormones and anabolic steroids.
Hirsutism also seems to run in families. If you have hirsutism, your family doctor may want to do some tests to find out what is causing it.

When should I see my doctor about hirsutism?
See your doctor if you have a sudden increase in facial or body hair, if your periods have become irregular or if your voice has become deeper.

What can I do to get rid of the excess hair?
If you're overweight, lose weight. Losing weight reduces the amount of hormones in your body that cause increased hair growth. Other ways to eliminate or hide excess facial and body hair include the following:

Shaving is the safest and easiest method of removing hair. However, you will have stubble unless you shave every day. Your skin may become irritated with frequent shaving. If your skin becomes irritated, apply a small amount of 1% hydrocortisone cream.

Depilatories, or creams that remove hair, can be used. They leave no stubble. However, these creams may irritate your skin. To test how sensitive your skin is, apply a small amount of cream to the inside of your wrist. Wait for one day before applying the cream to other parts of your body. If you don't have a bad reaction to the cream on your wrist, it's probably okay to use it.
Bleaching paste may also be used. Use this product according to the directions on the label. Bleaching products may irritate your skin.

Plucking and waxing can cause skin irritation and make the hair grow faster by increasing the blood supply to the follicle. These methods aren't recommended for women who have hirsutism.
Electrolysis gets rid of hair permanently by delivering a small electrical current through a needle placed into the hair follicle. Electrolysis is expensive and time-consuming. If you choose to have electrolysis, make sure the operator is qualified and licensed. Home electrolysis products and electronic tweezers don't work well and are not recommended.

Laser hair removal uses a laser light to damage hair follicles so unwanted hair falls out. This also prevents the hair from growing back. You'll probably need multiple laser treatments over a number of weeks, and the results may not be permanent. Laser hair removal is very expensive and can only be done by a licensed practitioner. Side effects of the procedure may include redness, darkening or lightening of the skin, and scarring.

Are there medicines to treat hirsutism?
Yes, your doctor may prescribe a medicine called an anti-androgen to help control the male hormones that cause hirsutism. Anti-androgens usually take at least 3 to 6 months to work. They can decrease the amount of new hair growth, but they are less likely to change the amount of hair you already have.

There is also a medicine made specifically to slow down the growth of facial hair. It is a prescription cream that you apply to the affected skin on your face and chin. This medicine may start to work as soon as 4 to 8 weeks after you begin treatment.

Adapted from American Academy of Family Physicians

Folliculitis

Folliculitis is the infection of hair follicles. This can occur anywhere on the skin or scalp. Usually there is some itch, sometimes a little soreness. Folliculitis looks like acne pimples or non-healing, crusty sores.An acute eruption or one present for only a short time is usually due to Staph germs (impetigo of Bockhart). This is treated with oral Keflex, dicloxacillin or similar oral antibiotic for 10 days. Topical antibiotics creams or lotions can also be used. Bactroban ointment should be applied into the front of the nose for several days to prevent a carrier state.

While this may seem like it makes no sense, the inside front area of the nostrils is often a place where bacteria can survive a course of oral antibiotics. Later, they spread back to the skin to cause a relapse.Chronic or recurring folliculitis is less likely to clear with just antibiotics. Often this is on the legs of women, but it can occur in any areas of shaving, waxing, hair plucking or friction. These need to be stopped for at least 3 months to allow the hair to grow in healthy. If shaving is resumed, one should shave with the grain of the hair; it won't FEEL quite as smooth, but it will LOOK a whole lot better.A pill such as tetracycline or minocycline can be given for 4 to 6 weeks. Unless the skin is sensitive, drying, antiseptic lotions should be used on the affected areas such as Xerac-AC (aluminum chlorhydrate solution), Cleocin-T solution or Benzaclin gel.

In some cases, the infection with unusual bacteria may be picked up from a dirty hot tub or scrubbing brush.For those with sensitive skin, friction and rubbing must be avoided. Avoid Lycra workout clothes, and tight fitting rough fabrics like blue jeans in the affected area. Apply a non-greasy moisturizer such as Lac-hydrin cream (ammonium lactate 12%) plus mild prescription cortisone cream to the area if there is an associated atopic dermatitis (eczema).Resistant and recurrent cases, especially on the legs may clear with hair removal laser treatments. This may be expensive and require several treatments, but is helpful when other treatments fail.

Adapted from American Osteopathic College of Dermatology

Hair Problems - Alopecia

Our hair grows in cycles, and at any given time, a small percentage of our hairfollicles are at a point in the growth cycle where the hair is shed in preparation for newhair to begin growing.

Normal individuals lose some hair every single day. Whileprevious estimates on what constitutes 'normal' hair loss have been quoted as high as100 to 150 hairs a day, recent studies show that number to actually be closer to 35 to40 hairs a day. This means that you will see evidence of some shedding of hairs aspart of your normal grooming routine.

Yet what concerns us here isn't the normal shedding of the hair, but ratherabnormal hair loss, also known as alopecia Alopecia is commonlyfound in three forms: androgenic alopecia , alopeciaareata and postpartum alopecia. Each of these typesof alopecia is characterized as follows:

Androgenic Alopecia: Androgenic alopecia, also called Androgenetic alopecia, isthe most common form of alopecia and is the result of genetics, aging, and hormonalchanges that combine to cause changes in the hair follicle. These changes result inthe miniaturization of the terminal hair into vellus hair. The condition can found inindividuals from their teens and upward in age. It is frequently seen by the age offorty.

By the age of thirty-five, some forty percent of both men and women show somedegree of hair loss. With men, androgenic alopecia is often evidenced by the thinningof the hair in the front and at the crown of the head, progressing to the traditionalhorseshoe shaped fringe of hair around the sides of the head. When it occurs in men,androgenic alopecia is referred to as 'male-pattern baldness' and the condition affectsapproximately forty million men in America alone.

In women, androgenic alopecia progresses as a generalized thinning of the hairall over the crown and top areas of the head. Among American women, some twentymillion cases of androgenic alopecia are reported.

Alopecia Areata: Alopecia areata is a skin disorder wherein the body's autoimmune systemsuddenly begins to attack the hair follicles. The hair loss from alopecia areata istypically seen in patches on the head and or body, and can progress to the completeloss of hair from the head (called alopecia totalis) and can even spread to result inloss of all hair on the head and body (called alopecia universalis). Alopecia areata canoccur in both men and women of any race, and any age, although it usually begins inchildhood. In men, about ten percent of the cases of alopecia areata result in loss offacial hair (called alopecia barbae).

Alopecia areata is a fairly common disease affecting about 1.7 percent of theworld's population, with over 4.7 million cases reported in the United States. Itsprogression is often sporadic and can seem capricious. Patches of hair can be lost inone location, and then re-grow normally, and be lost again. It might also seem asthough the patches "move" over time, as an area of lost hair can re-grow while newpatches of loss form on other places. Other people may find that their alopecia areatabegins as a small spot of hair loss, and suddenly spreads, with or without re-growthin previously affected areas. Still others find that their alopecia only ever affects asingle, small area.

Although alopecia is a common disease, it is not widely known, and even thoughit is not life-threatening, its sporadic nature and tendency toward recurrence often hasprofound psychological effects on the sufferer. It can impact the person's life and abilityto function at school, work, and in social settings.

Postpartum Alopecia (& Telogen Effluvium): Another common form of hair loss, postpartum alopecia is caused by hormonalchanges during the course of a pregnancy. The changes cause an alteration in thegrowth pattern of the hair follicles. There is usually very little sign of these changesduring the pregnancy itself, but rather a sudden and very excessive loss of hair fromthree to nine months after the birth of the child. While this is often very traumatic forthe new mother suffering from the hair loss, the hair's growth cycle typically returns tonormal within a year after the end of the pregnancy.

There is a form of alopecia related to postpartum alopecia called telogeneffluvium, which refers to a condition in which the growthcycles of the hair follicles have shifted in such a way that abnormal numbers of folliclesmove into the telogen (or resting) phase of the growth cycle. The diffuse hair losscaused by telogen effluvium results in the loss of as many as 400 hairs a day - aroundten times the normal rate of hair loss. The resultant hair loss is often difficult to spotuntil about 25 percent of the hair has been lost. Telogen effluvium can be aggravatedby stress

Other Forms of Alopecia: While androgenic alopecia, alopecia areata, and postpartum alopecia are themost common causes of hair loss, there are others. These conditions include:

Endocrine conditions:
Hypo-andHyperthyroidism
Hypopituitarism
Hypoparathyroidism

Drug-induced conditions:
Oral contraceptives
Antibiotics
Vitamin A excess
Anticoagulants
Iron deficiency

Malnutrition:
Crash dieting
Severe chronic illnesses

The conditions listed above tend to result in diffuse hair loss (an even loss ofhair from all over the head) and are usually not identifiable as the cause of the hairloss. For this reason, any time you suspect that you are suffering from any abnormalhair loss, you should consult your physician for proper and thorough testing of possiblecauses and a clear diagnosis of the cause.

Through a wide range of medical testing - including blood-chemistry tests and skinbiopsies - your physician can determine what is causing your condition and offertreatment options and prognoses based on the findings. You should never attempt todiagnose the cause of abnormal hair loss on your own unless you are a qualifiedmedical professional. In some cases, abnormal hair loss can be symptomatic ofconditions that can have serious repercussions if not treated. In other words, rememberthat your goal is to cure the problem, not simply treat the symptom.

Adapted from Hairfinder