Causes of Hair Loss
Hair loss or baldness is a genetic trait—but unlike what you may have been told, it's not necessarily passed down from your maternal grandfather. Medical science has come to learn that baldness genes are actually passed down from both sides of the family—and they affect hair loss in women as well as men. Baldness genes may also skip generations and are utterly random in terms of which siblings (male or female) they will affect. They may even have very different effects on siblings in the same family.
Hair loss in men
Androgenetic Alopecia, or "male pattern baldness," occurs in men whose hair follicles are sensitive to the hormone dihydrotestosterone, or DHT. Over time, DHT-sensitive hair (usually found on the top and front of the head) becomes weaker, finer, and eventually stops growing. However, even men who experience advanced baldness have healthy hair follicles around the sides of the head that last a lifetime. Even though these healthy hairs are exposed to DHT, they are resistant to this hormone and survive for a lifetime.
Hair loss in women
In women, hair loss usually begins at menopause. Before this time, DHT is counteracted by estrogen, but when estrogen levels drop, women's hair follicles may also become prone to the effects of DHT. Unlike men, hair loss patterns in women are marked by thinning throughout the scalp; fully bald spots at the crown are rare.
Hair Loss Types
Thinning hair and balding are common occurrences, but they don't appear the same way for everyone. Recognizing the type of hair loss you have is a first step to determining the right treatment plan—Dr. Ashary can help you understand your hair loss. Study the illustrations and photos here to determine the classification of your hair loss. If you are experiencing hair thinning in the eyebrow area, Dr. Ashary also can help you.
Hair Regrowth for Men
Since you arrived at our website, chances are you’ve been looking for hair regrowth solutions for some time. You’ve probably changed your hairstyle to hide your Hair Loss condition, or tried various Hair Regrowth products and clinics that made promises they couldn’t deliver. Maybe you’ve even felt jealous of your friends who are not yet experiencing Hair Loss. When you look in the mirror, perhaps you barely recognize the person staring back at you. Hair has a lot to do with how we see ourselves. We grew up with hair, moved into our lives with hair. It not only framed our faces, for many of us, it defined our youth and virility. And despite the fact that 80% of men will eventually experience male pattern Hair Loss, that doesn’t lessen the blow when it finally happens to us. There are solutions to your Hair Loss condition. You can have your life back. When you look in the mirror you can see yourself again. There are hundreds of medical treatments on the market for genetic hair loss (male pattern baldness) which is behind 98% of hair loss in men. But the only scientifically valid ones are the Minoxidil and Fenestride. Our dermatologists can recommend the best form for you. The treatments must be maintained for life. They can also be delivered through tiny injections (mesotherapy). The ultimate and final solution is with hair transplantation.
Hair loss treatment for women
Dr. Ashary is providing women with stylish and undetectable non-surgical hair solutions to help restore their sense of well-being. Hair loss in women is a more common problem that people might think. Hair regrowth products for women and hair regrowth solutions are a multibillion Dollar industry that is full of unscrupulous operators. It is also a more complicated issue than it is for men. Not only do women generally lose their hair in different ways than men, the social implications of it are far more difficult. Women do not generally expect to ever lose their hair. So when she begins to lose that aspect of her character that makes her distinctively feminine, the emotional toll can be devastating. We understand what women are experiencing. We are proud of our industry-leading non-surgical hair solutions for women. We have helped women to regain their lives and restore their self-image along with their natural appearance. There are solutions to your hair loss condition. You can have your life back. When you look in the mirror you can see yourself again. In Cosmoderm Clinics we first start by investigation the reasons for hair loss. Thyroid problems, anemia, depression, protein deficiency due to unsupervised and unbalanced diets are just a few examples of reversible and easy to fix problems. There are hundreds of medical treatments on the market for genetic hair loss (male pattern baldness) which is behind 70% of hair loss in women. But the only scientifically valid ones are the ones using Minoxidil. Our dermatologists can recommend the best form for you. The treatments must be maintained for life. They can also be delivered through tiny injections (mesotherapy). The ultimate and final solution is with our natural-looking and undetectable hair transplantation.
Why Hair Transplantation?
Hair transplantation is widely considered to be the most effective option for restoring hair because it's a permanent, relatively simple procedure, and it achieves a natural look.
A permanent solution
Hair transplantation is permanent. Because the transplanted hairs are already resistant to the DHT hormone that causes hair loss, they will not thin or fall out in the future. Depending on your hair loss classification and stage of hair loss, our physician may recommend the use of the LaserComb®, Minoxidil-based treatments, or prescription Propecia® to help maintain non-DHT resistant hairs and prevent future thinning.
Your natural hair for a natural look
Unlike hairpieces which may not exactly match your hair color and type, hair transplantation looks completely natural because it is your own hair—just moved to a new spot. It is extremely important to find a physician qualified and skilled to transplant hair follicles in a natural-looking way. Our qualified physicians specialize in the Cosmoderm Clinics procedure that creates hairline zones that are nearly impossible to distinguish between native and transplanted hair. Permanent, lifetime hairs are found in good supply in most people—even the severely bald—usually on the back of the head. This is called the "donor area." The actual surgical process and transplantation is a simple outpatient procedure requiring less than a day. The complex part of hair transplantation is not the procedure itself, but in the artistry of designing a natural-looking hairline for your face shape, features, and age using the correct hair textures and placement.
Your procedure plan
Your physician will confirm your specific goals and plan for your procedure – including artistic considerations.
Anesthesia and donor hair removal
Once your plan is confirmed, you will receive local anesthetic and your physician will remove the donor strip. The donor area is then sutured; this will usually leave a thin scar that is easily concealed by the remaining hair.
Separation of follicular units
Our skilled surgical staff divides the donor strip into its follicular groupings, or units, each containing one, two, three or four hair follicles (a much more refined technique than plugs).
Preparing the recipient sites
You’ll receive local anesthesia in the recipient area of your scalp and your physician makes a tiny incision for each individual follicular unit. The detailed attention to location, depth and angle ensures a completely natural-looking hairline and graft area.
Placement of grafts
Under the direction of your physician, the surgical staff places the grafts into the donor sites. One- and two-hair follicular units are placed in front, while three- and four-hair follicular units are placed at the top and back for maximum coverage and density. See the natural results using our hairline magnifier.
The Artistic Difference
Dr. Ashary Clinics physicians are recognized for their ability to create extremely natural looking results for our patients. To achieve the most realistic results, Cosmoderm physicians evaluate several factors during your consultation to design a specific hair restoration plan for you, including: 1. Age 2. Facial structure 3. Existing hairline 4. Quality of hair 5. Long-term goals A restored hairline by Cosmoderm looks completely natural because it is not a line at all. It's actually a zone of hair that transitions from fine, thin, solitary hairs at the front to thicker, denser hair the further back you go on the head. Cosmoderm achieves this natural result using micrografts - fine, delicate hairs that are blended into the hairline zone. The Micrograft® process enables us to restore hairlines that look as soft and feathered as man's original, natural hairline Each restored hairline is done with this principle in mind, creating a hairline zone that makes it nearly impossible to distinguish between native and transplanted hairs. Look closely at a hairline yourself using our hairline magnifier. We also applies these skills to eyebrow restoration with tremendous results. Read more about the advantages of hair transplantation and what to look for when choosing a physician.
Follicular Unit Extraction (FUE) is the method of obtaining hair grafts directly and individually from the patient donor area. This process of collecting hair units was first introduced by Dr. Woods in Australia. It was further standardized by other hair transplant doctors such as Dr. Rassman and Dr. Bernstein in 2002. The advantage of FUE is that patients will not have a linear scar on the back of their head. The disadvantage of FUE is that a patient's hair in the small donor area needs to be clipped very short prior to the procedure. The spots where hair units are removed appear as small red dots for a few days, but generally heal fast within the first week after surgery. The other disadvantage of hair transplant surgery using FUE technique is that some patients may not be good candidates for this method. In FUE, we do not remove the strip of skin from the donor area. Patients will usually have fewer possible donor complications seen with the strip technique such as discomfort in donor area after surgery, the need for staple or suture removal and presence of linear scar.
Comparison between Strip Harvesting and Follicular Unit Extraction.
A great deal of discussion by physicians and the general public has occurred on the Internet and multiple media sources about the value of FUE versus strip harvesting and vice versa. Sadly, many of the claims of "superiority" of the newer technique seem more related to marketing and self-promotion rather than a clear scientific evaluation. The Cosmoderm team has been involved in hair transplantation since 1998. We do use both techniques based on individual anatomy and needs while keeping patients preferences in mind.
The Donor Area and Scar Formation
Strip harvesting produces a linear scar. The appearance of the donor strip scar can be a significant concern for patients who wish to wear their hair very short. The vast majority of patients who undergo strip harvesting have minimal scars that are easily concealed by the hair above the scar. And in many instances the scar may not be evident at all except on careful inspection. There are, however, some patients who have scars that have widened, and there are also patients who have several scars from multiple procedures. In some instances the apparent widened appearance of a scar may actually be due to damage to follicles along the incision line during harvesting rather than true scarring.
The use of the trichophytic method of closure for strip harvesting can also be extremely helpful in improving the appearance of the strip harvest scar. As noted above closing under minimal or no tension can help to avoid the widening of a scar. This allows hair to camouflage the scar and the hair growing through the scar can limit the stretching. Avoiding damage to the hair follicles along the incision lines is crucial in preventing the appearance of a prominent scar. The primary rationale for the use of FUE is that a linear scar is avoided. Several proponents of FUE market the procedure as a technique that does not involve cutting, is less invasive and does not result in scars (i.e., "scarless"). While a linear scar is not created with FUE, circular scars are created.
"Cutting" is clearly involved when using a punch. Although a linear scar is not produced with FUE, scars are created and evidenced by virtue of the fact that hypopigmented or hyperpigmented "dots" may be visible when the hair is cut very short. These "dots" may be a scar reaction or actual post inflammatory pigment changes, particularly in darker skinned individuals. Also the human eye may pick up "spaces" where follicular units are missing in the normal pattern. The depth of the incisions with FUE is usually shallower as compared to strip harvesting. The punch depth is to the level of the fat or at the fat-dermis junction. With strip harvesting the depth of incision is into the fat. Some physicians cut to the deeper fat or just above the fascia. When using FUE, it is important to recognize that as more and more grafts are harvested the area may appear moth eaten. If grafts are taken too close together there may be an appearance of a scar. In some patients as large numbers of grafts are removed there can be a clear demarcation between the areas that have been harvested and areas left alone. This is opposed to the strip technique where hair of similar density is brought back together at the suture line. Opponents of strip harvesting would note that if hair does not grow well in a strip scar and the scar widens, then the scar might be apparent if the hair above it is short or otherwise thin. Some promoters of FUE have stated that nerves and veins are not cut. This claim is untrue. By entering the skin with the punch arteries, veins and nerves are cut. It is important to point out that with FUE the patient's hair usually must be trimmed quite short for harvesting. This is the case especially when large numbers of grafts are required. A way to avoid trimming all of the donor hair is to set up rows of short hair between rows of long hair. The short hair grafts can be harvested within the existing long hair. But again, this is only suitable when relatively small numbers of grafts are needed.
Debate exists as to the rate of survival regarding FUE versus strip grafts. As of this time there are not adequate studies to compare survival rates. Clearly there are patients who have undergone the FUE procedure and have excellent results. Some physicians might argue that less successful results may be due to technical surgical skill rather than the nature of the more fragile graft created with FUE. With FUE there is a greater chance of transection of hairs as compared to strip harvesting and this could result in poor growth or lack of growth depending on the level of transection. The rates of transection seem to vary widely with FUE. Conversely, with strip harvesting, grafts may be damaged in making the initial skin incisions and subsequent dissection of the tissue, but this is considered minimal. We use of the microscope for dissection of the donor strip and this method limits transection rates to 1-2%. Grafts created with strip harvesting generally have a greater amount of surrounding tissue and fat. This may decrease the chance of dehydration and allow for greater leeway in manipulation of the grafts during placing and hence, better graft survival.
Placing of Grafts
When manual placement of grafts is utilized there is no difference in regard to the technique of placement of strip harvested or FUE harvested grafts. The surgeon must be able to create an aesthetic "blueprint" for graft placement, determining the distribution of 1, 2, and 3 hair grafts. Hairline design is obviously important, as is the grafting plan over the rest of the scalp. Our experienced hair surgeon will create gradients of density to achieve natural looking results with adequate density. In addition, the incisions must be made at the proper angle and direction. Even single hair grafts will look unnatural if placed at the wrong angle.
A somewhat different skill set is required for FUE harvesting. The surgeon must be able to align the small punch correctly, find the right depth and adjust the punch to account for changes in direction of the hair. The primary concern with FUE is the rate of transection. That is, if the hairs in a follicular unit are transected they are less likely to grow. This is in part dependent on the level of transection. The reports from physicians performing FUE indicate that the rate of transection is higher than with strip harvesting. FUE can be a tedious process and both patient, physician and his or her team of assistants may experience fatigue. This can limit the amount of grafts that can be harvested in a single session. Because of the time usually involved in harvesting and the possible strain on the surgeon performing the harvesting one has to wonder if less emphasis is placed on the recipient area.
Number of grafts per session
In general most physicians who perform FUE are not able to do as many grafts in a single session as can be done with strip harvesting. With strip harvesting, sessions of 2000-3000 grafts are very common. There are, however, exceptions as we routinely perform sessions in excess of 1500-2000 grafts. Unfortunately, the rates of graft transection in these larger FUE sessions has not been studied or reported.
The cost of FUE is usually significantly more than that for strip harvesting on a per graft basis. The costs may exceed double the price of strip harvesting. Body Hair FUE can be very useful for harvesting body hair. In such situations the majority of follicular units are single hairs. Evidence of the surgery is often visible as hypo or hyperpigmented "dots" in these non-scalp donor areas. Small number of grafts When small numbers of grafts are needed FUE may be an excellent choice of technique. Using the technique where narrow rows of trimmed hair are used it would be relatively easy to camouflage the work and avoid creating a linear scar. FUE into scars FUE can be used to try to camouflage linear donor scars. This is considered by many hair restoration surgeons to be another excellent use of the technique. Some surgeons have suggested that a combination of strip harvesting and FUE is the optimal use of the techniques.
Some of the surgeons who prefer FUE feel that patients experience less pain and there is a shorter recovery time. There is little data to support this view. One would need to compare the pain associated with comparable numbers of grafts harvested per session. For instance one would want to compare, for example, 1000 grafts harvested with strip vs. the same number harvested with the FUE technique. The fact that pain is very subjective complicates such studies. Patients may complain of altered sensation but this can occur with strip harvesting or FUE as small nerves are cut in both procedures. Years ago some strip-harvested patients may have experienced significant numbness of the scalp for 4-6 months as a result of damaging the occipital nerves. As dissection should be at the level of the fat or perhaps at the level of the fascia these nerves should not be damaged. Bleeding occurs with both techniques but more significant bleeding occurs with strip harvesting. That said, bleeding is not considered a problem with strip harvesting and in most cases bleeding is nominal.
Strip harvesting and FUE are both acceptable techniques for harvesting donor grafts. Each technique has advantages and disadvantages. On a cost-benefit ratio strip harvesting would seem to provide the most cost effective procedure. FUE is well suited for patients who insist on not having a linear scar. It may be an excellent choice for young patients seeking small procedures. FUE may be the ideal choice for harvesting trunk, leg and arm hair, and it is an excellent way to camouflage strip scars. The goal of hair restoration seems simple enough, namely to move hair from one part of the scalp to the other. However, any experienced physician will tell you how complex this seemingly simple task is. For example, one of the most important concepts the physician must appreciate is that hair loss is progressive and that any restoration plan must be made with this in mind. When a patient comes to the physician with a given stage of hair loss, the physician must be able to assess the donor area for hair density and quality, calculate the number of grafts needed, give the patient a reasonable expectation for what the result will be, and plan this result with the possibility of future hair loss in mind. The physician must be able to discuss the pros and cons of medical treatments designed to stop or slow future hair loss, such as oral finasteride and topical minoxidil. All of these elements require considerable training and expertise to implement for each patient. Successful graft harvesting is only one small component of surgical hair restoration. Without attention to all of the other aspects, there is a very real possibility of a bad outcome.
Hair Transplant Repair
Here at Cosmoderm, we practice modern procedures which produce undetectable and natural results. Older techniques of hair transplants such as plugs or mini-grafts which cause unnatural results can now have a repair procedure to revise the abnormal appearance to a perfectly natural and refined one. Our goal is to create the most natural appearance for your hair. Abnormalities can be easily repaired using the following hair transplantation techniques: Camouflage and repair of large hair grafts or plugs. Old plugs or large mini- and micro-grafts could be easily hidden by removing them and producing a natural hair appearance using follicular unit grafts. This method in selected patients can usually eliminate the pluggy look of hair in one session. The removed hair follicles are used to make follicular units that can be recycled and transplanted. To create a natural appearance of hair with refined follicular grafts, hair transplant surgeon often needs more hair follicles that are collected from the back of the scalp.
Repair of unnatural hair direction
Unnatural hair direction particularly in frontal and hairline areas can be very disturbing for patients and causes great difficulties with hairstyling. Using single hair follicular units enable hair transplant surgeons to control the direction and distribution of the hair. This is not the case in patients with old technique surgery using large grafts. The direction of hair in these patients can be corrected by removing individual hair follicles with unnatural direction and replacing them with follicular unit grafts in natural direction and orientation.
Repair of abnormal hairline
Abnormal hairline is either due to pluggy appearance of the hairline or designing problems. Normal hairline is generally irregular with a transitional appearance in front and a densely packed area behind it. Orientation of normal hairline is so irregular that one should never be able to connect the dots to make a straight line. Transitional irregular hairline could be easily created by implanting refined follicular unit grafts giving a natural and undetectable result.
Repair of scalp scars from scalp reduction, cranial surgeries and open donor
Scar of any scalp procedures such as scalp reduction, old plug surgery, trauma or neurosurgical procedures can be easily filled with transplanting follicular units into the scars. Patients may need more than one procedure in order to increase the hair density in the scar area and to minimize the sharp contrast between the scar and the hairy area of the scalp around the scar. Many patients who have had a bad experience with old hair transplant surgeries are unaware of modern hair transplant advantages and are reluctant to seek help because of their previous experience. However, those who are well informed on updated repair procedures can enjoy a normal and quite natural hair and hairline. Eyebrow hair transplant is a safe procedure and can create natural results for people who lost hair in the eyebrow or have scar in their eyebrows. This transplant is an effective treatment for both partial and full loss of eyebrow hair.
Causes of eyebrow hair loss
Main causes for eyebrow hair loss in men and women are: Congenital inability of growing eyebrow hair. This condition is seen in many members of a family and is easily treated by eyebrow hair transplantation. Physical trauma such as burn, accidental injuries. or over-plucking or reshaping of eyebrows. Hair transplant can effectively restore partial or total eyebrow hair loss in these conditions. Medical disorders such as thyroid diseases. Hair transplant need to be considered when the underlying medical condition is under control. Autoimmune disorders such as alopecia areata or lupus. Psychological obsessive disorders causing self-inflicted obsessive plucking of eyebrows and eyelashes. In this condition that falls under category of trichotillomania, hair transplant cannot be used unless the psychological condition is completely treated and is under control.
Eyebrow transplant procedure
Eyebrow transplant is done through harvesting scalp hair from the back of the scalp, known as the donor area. The removed skin is dissected with microscopic magnification to follicular units. Hair can be harvested with conventional strip techniques or FUE. US Hair Restoration offers both techniques for harvesting donor hair for eyebrow hair transplant in its Los Angeles, California hair restoration clinics. The area is prepared and very small incisions are made in the eyebrow area. Tiny incisions produce a tight grip for the single hair grafts that are already harvested. In order to create the best natural results, making the normal looking direction and distribution is very important. The growth of transplanted hair in eyebrow follows the pattern of scalp hair growth. Transplanted eyebrow hairs are permanent and grow constantly needing to be trimmed more often than normal eyebrow hair. Patients may need 40 to 300 follicular hair grafts for each eyebrow. The number of hair grafts may vary based on patient's sex and ethnic background and eventually individual facial features. The procedure is performed using local anesthesia. Complications after this procedure are minimal. Redness, swelling and scabbing can be seen during the first few days after eyebrow surgery, but usually go away in 3 to 5 days. Daily washings will minimize scabbing and facilitate healing of implanted hair grafts. Newly transplanted hair to the eyebrow area usually falls out in the first 2 weeks, but new hair grow from those follicles in about 3 to 6 months. Full results are expected in about 6 months.