Transcript Hair Transplants and Hair Loss

Hair Transplants and Hair
Loss
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What is a Hair Transplant?
• Hair transplants are minor dermatologic surgical
procedure in which hair follicles are transferred
from the permanent and thick donor area around
the sides and back of the head to areas of
thinning or balding generally found on the front,
top, and crown of the head, as well as eyebrows,
beard areas, and sometimes even chest.
• In rare cases, even body hair can be used as
donor, if it is very thick and luxurious in areas
such as the chest.
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Proper Diagnosis of Hair Loss
• However, before one can decide if they might need a hair
transplant, a proper diagnosis of their hair loss condition
should be made by a dermatologist or hair loss specialist.
• Hair loss may be pattern hair loss (male or female) or nonpattern hair loss.
• In your consultation, your doctor must consider:
• Actual hair loss versus hair breakage
• Focal hair loss versus diffuse hair loss
• Hair thinning versus hair shedding
• Scarring hair loss versus non-scarring hair loss
• Hair shaft miniaturization versus reduced density
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Pattern Hair Loss
• Miniaturized or missing hairs in a distinct male
or female pattern occurs in the pattern
illustrated below.
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Non-Pattern Hair Loss
• Hair loss (or alopecia) that is not in a genetic
male or female pattern is divided into:
– Hair shedding.
– Scarring alopecia.
– Focal non-scarring alopecia.
– Telogen effluvium.
– Hair breakage problems.
– Diffuse thinning.
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Hair Shedding
• Sometimes generalized hair thinning is caused by hair
shedding. More than 100 hairs per day are significant – it
usually is a telogen effluvium (hairs which have entered the
resting or telogen phase of the growth cycle – and are thus
falling out).
• When hair follicles enter the telogen phase, the hairs held
firmly in those follicles become loose and fall out. Certain
severe toxins can cause anagen effluvium – where hairs are
shed during the anagen (growth) phase of the cycle – as the
follicles are destroyed by a toxin.
• A telogen effluvium usually occurs about three months
after the precipitating event, whereas anagen effluvium
occurs closer to the toxic event.
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Scarring Alopecia
• Generally, scarring alopecias present with a smooth, shiny scalp without
pores, because the hair follicles have been destroyed by the scarring
process.
• Usually a biopsy is required in these cases, as well as lab tests. There may
be redness and scaling at the active borders. They may usually be
transplanted after they have been “burned out” (inactive) for one year.
• Scarring Alopecia Entities
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Discoid lupus
Lichen planopilaris
Folliculitis decalvans
Morphea
Pseudopelade
Infection Pseudofolliculitis barbae
Sarcoidosis
Fibrosing alopecia in a pattern distribution
Follicular degeneration syndrome (hot-comb alopecia) (CCCA)
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Focal Non-Scarring Alopecia
Entity
Distinguishing features
Patchy alopecia areata
History, exclamation point hairs, hair
pull test, depigmented hairs
Secondary syphilis
Serology for syphilis (contagious)
Tinea capitis (ringworm)
Broken hairs, scaling, erythema,
positive smear and culture
(contagious)
Traction alopecia
Typical pattern from traction
Triangular alopecia
Pattern, configuration and history on
temple
Trichoterlomania
Shaved hairs
Trichotillomania
Broken hairs present from
manipulation, hairs of various lengths
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Causes of Hair Shedding (Telogen or
Anagen Effluvium)
Telogen Effluvium
Common Precipitating
Events
Common Drugs That Can
Cause Telogen Effluvium
Anagen Effluvium –
Common Precipitating
Events
Childbirth
Drug-induced
General anesthesia
High fever
Hormonal changes
Protein-deficient diet
Starting or stopping OCAs
Stress
Sudden weight loss
Systemic disease
ACE inhibitors
Androgens
Anticholesterol agents
Beta blockers
Cimetidine
Coumadin, Heparin
Lithium
Oral contraceptives (OCAs)
Vitamin A
Chemotherapy
Early alopecia areata
Loose anagen syndrome
Radiation
Toxins
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Hair Breakage Problems
1) Chemical or Physical Damage
2) Trichotillomonia
3) Anagen Effluvium
4) Hair Shaft Anomalies:
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Monilethrix (beaded hair)
Pili torti (twisted hair)
Trichorrhexis invaginata (bamboo hair)
Pili annulati (ringed hair)
Bubble hair (damage from heat of hair dryers, curling irons,
etc.)
Trichorrhexis nodosa (nodes on hair)
Trichonodosis (knotted hair) T
richoptilosis (split ends) Trichoschisis
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Pattern Baldness Versus Generalized
Diffuse Hair Loss
• Note that male and female pattern baldness are just that, hair loss
in a pattern area, generally on the top, sides, and back of the head,
but sparing a thick donor area.
• Other types of systemic problems such as low thyroid, iron
deficiency, collogen disorder, growth or sex hormone deficiency,
secondary syphillus all may cause diffuse hair thinning.
• If you have generalized hair thinning, you need a complete medical
workup for the various causes.
• Also note that some people have both a pattern hair loss as well as
a diffuse or generalized decrease in density.
• These people may well have both conditions simultaneously but
still require a complete medical workup, normally with lab tests and
biopsy
Comprehensive Medical Workup for
Diffuse Thinning and Hair Loss
A) LAB: CBC, Free T3 and T4 (thyroid), Ferritin,
Total and Free Testosterone, SHGB, and
Estradiol, DHEAS, Prolactin, RPR, TSH, IGF-1,
DHT, Progesterone, ANA
B) SCALP BIOPSIES: Vertical and horizontal
sections
C) OFFICE TESTS: Hair-pull test, hair window,
KOH prep, bacterial and fungal culture and
sensitivity
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Medical Treatment – Male Pattern
Hair Loss
• For optimal chemical therapy for male pattern hair loss, the
combination of Rogaine Foam and Propecia (1 mg per day) is the
place to start for men with early thinning and miniaturization of
their hair (in a pattern as described in the chart). When you see
your dermatologist or hair restoration specialist, he will prescribe
these items for you.
• These are generally tried for several months, following which a
second set of detailed photographs are compared with the ones
taken at your initial evaluation. If you have either stayed the same
or improved, that is a win for the medical therapy.
• You may very well need hair transplants in addition (to restore your
hair), but you may have stopped the progression of the balding
process with the medical therapy.
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Medical Treatment – Female Pattern
Hair Loss
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For female pattern baldness, the true causes have not been worked out well. We
believe most commonly that it is caused by the small amount of male hormone, or
testosterone, in women, but there probably are other causes.
After menopause, it is common for women to show generalized hair thinning due
to lower levels of female hormones, as well as the loss of the ability to convert T4
to T3 in the tissues, which results in a low thyroid-type of thinning hair, as well as
thinning of the outer third of the eyebrows.
T4 is the principal type of thyroid hormone produced in the thyroid gland. T3 is
the more active form, which is converted from T4 in the tissues. As we age, the
ability to convert T4 to T3 in the tissues diminishes so that many people that are in
excess of 50 years old have a normal T4 level in their blood, but have diminished
T3 in the tissues.
This is determined by measuring the free T3 hormone blood level. Even if you are
at the lower end of the normal range, your hair may well benefit from additional
thyroid supplement, which will bring you up to the high end of the normal range.
This also results in greater energy, higher metabolism, and usually some degree of
weight loss. Blood workup is required, as well as a thorough evaluation by your
physician. Other causes of diffuse thinning are iron deficiency, collagen disease,
infectious disease, and other hormone deficiencies.
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Contact Information
Address
Sai Shraddha Cosmetic Clinic (Pune)
Dr Amitabh Shrivastava
B-1 Friends Enclave,
In front of Sai Heera Building,
Mundwa, Pune – 411036
Mobile Number : 9822358559
E-mail Id : [email protected]
[email protected]
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